1. Impact of long chain polyunsaturated fatty acids during pregnancy and lactation on infant body composition up to 5 years of life – Results of the INFAT-study
Christina Brei*, Stefanie Brunner, Karina Pusch, Daniela Much, Lynne Stecher, Ulrike Amann-Gassner and Hans Hauner
Else Kröner-Fresenius-Center for Nutritional Medicine, Chair of Nutritional Medicine, Technische Universität München, Georg-Brauchle Ring 60/62, Munich
Background & Aim
There is a strong need for the prevention of childhood overweight and obesity starting early in life. The ratio of long-chain polyunsaturated fatty acids (LCPUFAs) in the maternal diet may have an impact on offspring body composition. We investigated the effect of reducing the n-6/n-3 LCPUFA ratio in maternal diet during pregnancy and lactation on offspring growth and body composition from birth up to 5 years of life.
Study Design & Methods
208 healthy pregnant women (pre-pregnancy BMI: kg/m2) were randomly assigned to either a dietary intervention [supplementation with 1.2 g n-3 LCPUFAs as 3 fish oil capsules/day and dietary counseling to reduce arachidonic acid (AA) intake] from the 15th week of gestation until 4 months postpartum or to a control group, receiving general recommendations on a healthy diet. Skinfold thickness (SFT) measurements as primary outcome, abdominal ultrasonography (US) and other anthropometric measurements were determined at study visits (1). To investigate long-term effects, a follow-up program up to 5 years was initiated (Figure 1).
2006: Study start
2014: End of follow-up
Randomization
Intervention: Supplementation with n-3 LCPUFAs and dietary counseling to reduce AA in the diet
Abbreviations
Maternal blood
A = anthropometry SFT = skinfold thickness measurement US = ultrasonography
wk gest. = weeks of gestation
wk = week
pp = postpartum
Control: Recommendations for a healthy diet
Blood infant
15th wk gest.
32nd wk gest.
Delivery
6 wks pp
4 months pp
1 year pp
2 years pp
3 years pp
4 years pp
5 years pp
Umbilical cord blood Placental tissue
A+SFT
A+SFT+US
A+SFT+US
A+SFT+US
A+SFT+US
A+SFT+US
A+SFT+US
A+SFT+US
N=208
N=189
N=188
N=180
N=174
N=170
N=118
N=120
N=107
N=114
Figure 1: Study design and follow-up
Results & Interpretation
A total of 208 women of Caucasian origin, relatively well-educated, nonsmoking, with an average age of 32 years, and a mean prepregnancy BMI of 22 kg/m2 were enrolled in the study. Maternal clinical characteristics, diet, lifestyle factors, and sociodemographic variables of the 2 groups were comparable at baseline (data not shown). Compliance was confirmed by blood fatty acid composition/dietary records before and after intervention (data not shown) (2).
Newborns in the intervention group showed a higher weight and growth indices at birth (weight-for length, BMI and ponderal index), which were caused by prolonged gestation (2). Differences disappeared and were not detectable at 6 weeks postpartum or at any other timepoint. Only BMI showed a significant difference between the groups in the adjusted model at 4 years of life with higher values in the intervention group [mean difference: 0.4 kg/m2 (95% CI: 0.0; 0.8 kg/m2); p=0.05] (data not shown), which was no longer present at 5 years of age.
Longitudinal SFT measurements as primary outcome variable did not differ between groups at any of the 8 time points investigated, neither the 4 individual SFTs nor their calculated sum. Data for growth indices and body composition at 5 years of age are given in Table 1. a b
Table 1 Growth indices and body composition at 5 years of age by study group
Parameter
Group N
Mean ± SD
Adjusted mean
difference (95% CI) p
Weight [kg]
Intervention 58
19.2 ± 3.0
0. (-0.5; 1.5)1
0.338
Control 56
18.7 ± 2.1
Height [cm]
111.2 ± 4.8
0.5 (-1.1; 2.2)1
0.522
110.7 ± 4.0
BMI [kg/m2]
15.5 ± 1.4
0.2 (-0.3; 0.7)1
0.434
15.2 ± 1.1
Waist circ. [cm]
53.4 ± 5.2
0.5 (-1.1; 2.1)1
0.556
52.8 ± 2.9
Head circ. [cm]
51.2 ± 1.3
0.0 (-0.5; 0.5)1
0.990
Sum 4 SFT 57
23.9 ± 4.7
-0.7 (-2.5; 1.1)1
0.453 55
24.5 ± 5.0
Body fat [%]
17.9 ± 3.4
-0.0 (-1.3; 1.3)2
0.976
18.1 ± 3.6
Fat mass [g] ±
113.1 (-275.6; 501.9)2
0.565
± 847.2
Lean body mass [g] ±
305.6 (-409.6; )2
0.399 ±
Figure 2 Development of abdominal subcutaneous (a) and preperitoneal (b) fat distribution by study groups assessed by ultrasonography
Area sag sc = Area of subcutaneous fat in sagittal plane
Area sag pp = Area of preperitoneal fat in sagittal plane
Multiple regression analysis controlling for sex, pregnancy duration, PI at birth and breastfeeding status at 4 months, current weight, current height; * p < 0.05; ** p < 0.02; *** p < 0.001
Conclusion
1 Multiple regression analysis controlling for sex, pregnancy duration, PI at birth, breastfeeding status at 4 months
2 Multiple regression analysis controlling for pregnancy duration, PI at birth, breastfeeding status at 4 months
Results from the present study and the current scientific view (3) indicate that a modification of dietary fatty acid intake during pregnancy and lactation seems not to be a reasonable strategy to limit adipose tissue growth and thereby prevent obesity in early life.
Thickness of abdominal subcutaneous fat layers assessed by US differed significantly at 2, 4 and 5 years of age in the adjusted model, but not at 3 years of age, showing slightly more subcutaneous fat in the control group (Figure 2a). Preperitoneal fat was not significantly different in the two groups at any time point of investigation (Figure 2b).
Literature
1) Hauner et al. (2009) Ann Nutr Metab. 54:97-103; 2) Hauner et al. (2012) AJCN. 95: ; 3) Hauner and Brunner (2015) Curr Opin Clin Nutr Metab Care. 18:
Funding
* Contact person: Christina Brei, M. Sc.,
The INFAT-study was funded by the Else Kröner-Fresenius-Foundation, Bad Homburg, the International Unilever Foundation, Hamburg, Danone Baby Nutrition Research, Friedrichsdorf, German Ministry of Education and Research, Competence Network Obesity, and the EU-Consortium EARNEST
*Contact person: Christina Brei, M. Sc.,