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Maternal pregnancy diet quality, night eating, and offspring metabolic health: the GUSTO study

Pediatric Research (2024)Cite this article

Abstract

Background

We investigated the understudied influence of maternal diet quality, food timing, and their interactions during pregnancy on offspring metabolic health.

Methods

Maternal diet at 26–28 weeks’ gestation was assessed using a 24-h recall and adherence to the modified-healthy-eating-index (HEI-SGP) reflects diet quality. Predominant night-eating (PNE) was defined as consuming >50% of total daily energy intake from 19:00 to 06:59. Outcomes were offspring composite metabolic syndrome score and its components measured at age 6 years. Multivariable linear regressions adjusted for relevant maternal and child covariates assessed associations of diet quality and PNE with these outcomes.

Results

Up to 758 mother-child pairs were included. The mean(SD) maternal HEI-SGP score was 52.3(13.7) points (theoretical range: 0-100) and 15% of the mothers demonstrated PNE. Maternal diet quality showed inverse relationship with offspring Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) [β(95% CI): –0.08(–0.15, –0.02) per-10-point HEI-SGP increment; P = 0.012]. Maternal PNE was associated with a higher offspring HOMA-IR [0.28(0.06, 0.50); P = 0.012], with similar estimates after adjustment for children’s BMI and diet quality; the association was stronger for boys (P-interaction<0.001) and among mothers with lower diet quality (<median HEI-SGP) (P-interaction = 0.062).

Conclusions

Maternal PNE and low dietary quality were associated with a higher level of insulin resistance in early childhood, especially among boys.

Impact

  • We demonstrated that maternal predominant night-eating behavior and low-quality diet are associated with higher offspring insulin resistance.

  • Maternal low-quality diet and predominant night-eating behavior synergistically interact to influence offspring insulin resistance, particularly among boys.

  • While maternal diet quality and food timing impact the mother’s health, their influence on offspring long-term health outcomes through developmental programming is not well understood.

  • Our findings highlight the significance of maternal food timing and calls for further studies on its influence on child health through developmental programming. Targeting both dietary quality and food timing during pregnancy could be a promising intervention strategy.

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Fig. 1: Joint analysis of diet quality and night-eating in association with HOMA-IR.

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Data availability

Data are available upon request to the GUSTO team for researchers who meet the criteria for access to confidential data.

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Acknowledgements

We would like to thank the GUSTO study group, which includes Allan Sheppard, Amutha Chinnadurai, Anne Eng Neo Goh, Anne Rifkin-Graboi, Anqi Qiu, Arijit Biswas, Bee Wah Lee, Birit F.P. Broekman, Boon Long Quah, Borys Shuter, Chai Kiat Chng, Cheryl Ngo, Choon Looi Bong, Christiani Jeyakumar Henry, Claudia Chi, Cornelia Yin Ing Chee, Yam Thiam Daniel Goh, Doris Fok, E Shyong Tai, Elaine Tham, Elaine Quah Phaik Ling, Evelyn Chung Ning Law, Evelyn Xiu Ling Loo, Fabian Yap, Falk Mueller-Riemenschneider, George Seow Heong Yeo, Helen Chen, Heng Hao Tan, Hugo P S van Bever, Iliana Magiati, Inez Bik Yun Wong, Ivy Yee-Man Lau, Izzuddin Bin Mohd Aris, Jeevesh Kapur, Jenny L. Richmond, Jerry Kok Yen Chan, Joanna D. Holbrook, Joanne Yoong, Joao N. Ferreira., Jonathan Tze Liang Choo, Jonathan Y. Bernard, Joshua J. Gooley, Keith M. Godfrey, Kenneth Kwek, Kok Hian Tan, Krishnamoorthy Niduvaje, Kuan Jin Lee, Leher Singh, Lieng Hsi Ling, Lin Lin Su, Ling-Wei Chen, Lourdes Mary Daniel, Lynette P Shek, Marielle V. Fortier, Mark Hanson, Mary Foong-Fong Chong, Mary Rauff, Mei Chien Chua, Melvin Khee-Shing Leow, Michael Meaney, Mya Thway Tint, Neerja Karnani, Ngee Lek, Oon Hoe Teoh, P. C. Wong, Paulin Tay Straughan, Peter D. Gluckman, Pratibha Agarwal, Queenie Ling Jun Li, Rob M. van Dam, Salome A. Rebello, Seang-Mei Saw, See Ling Loy, S. Sendhil Velan, Seng Bin Ang, Shang Chee Chong, Sharon Ng, Shiao-Yng Chan, Shirong Cai, Shu-E Soh, Sok Bee Lim, Stella Tsotsi, Chin-Ying Stephen Hsu, Sue Anne Toh, Swee Chye Quek, Victor Samuel Rajadurai, Walter Stunkel, Wayne Cutfield, Wee Meng Han, Wei Wei Pang, Yap-Seng Chong, Yin Bun Cheung, Yiong Huak Chan and Yung Seng Lee. The study is supported by the National Research Foundation (NRF) under the Open Fund-Large Collaborative Grant (OF-LCG; MOH-000504; MOH-000504-05 THEME 4) administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC) and the Agency for Science, Technology and Research (A*STAR). In RIE2025, GUSTO is supported by funding from the NRF’s Human Health and Potential (HHP) Domain, under the Human Potential Program. KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042) and NIHR Southampton Biomedical Research Center (NIHR203319)) and the European Union (Erasmus+ Program ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP). L-WC is supported by grants (MOST110-2314-B-002-290-MY2; NSTC112-2314-B-002-322-MY3) from the Ministry of Science and Technology (now the National Science and Technology Council) and receives further financial support from the National Taiwan University Higher Education Sprout Project (111L7304, 111L7306, 110L7418, 110L881002) within the framework of the Higher Education Sprout Project by the Ministry of Education. For the purpose of Open Access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.

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Author notes

  1. These authors contributed equally: Yung Seng Lee, Mary F. F. Chong.

Authors and Affiliations

  1. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan

    Ling-Wei Chen

  2. Master of Public Health Program, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan

    Ling-Wei Chen

  3. A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore

    Ling-Wei Chen, Mya Thway Tint, Navin Michael, Jia Ying Toh, Yap-Seng Chong, Johan G. Eriksson, Yung Seng Lee & Mary F. F. Chong

  4. Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore

    See Ling Loy

  5. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore

    See Ling Loy, Kok Hian Tan & Fabian Yap

  6. Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Mya Thway Tint, Yap-Seng Chong & Johan G. Eriksson

  7. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Yi Ying Ong & Yung Seng Lee

  8. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Yi Ying Ong

  9. Liggins Institute, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand

    Peter D. Gluckman

  10. Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Kok Hian Tan

  11. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Yap-Seng Chong & Johan G. Eriksson

  12. MRC Lifecourse Epidemiology Centre & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 6YD, Southampton, UK

    Keith M. Godfrey

  13. Department of General Practice and Primary Health Care, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland

    Johan G. Eriksson

  14. Folkhälsan Research Center, Topeliusgatan 20, 00250, Helsinki, Finland

    Johan G. Eriksson

  15. Department of Pediatric Endocrinology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Fabian Yap

  16. Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Yung Seng Lee

  17. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore

    Mary F. F. Chong

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  1. Ling-Wei Chen
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Contributions

L.W.C. conceptualized the current study, conducted formal statistical analysis, and wrote the first draft of the manuscript. S.L.L., M.T.T., N.M., Y.Y.O., J.Y.T. contributed to data acquisition and curation. P.D.G., K.H.T., Y.S.C, K.M.G., J.G.E., F.Y., Y.S.L., and M.F.F.C. designed and led the GUSTO cohort study. All authors interpreted the findings and revised drafts of the manuscript. All authors read and approved the final version of the manuscript submitted for publication.

Corresponding author

Correspondence to Ling-Wei Chen.

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Competing interests

K.M.G. and Y.S.C. are part of an academic consortium that has received research funding from Société Des Produits Nestlé S.A., Abbott Nutrition, Danone and BenevolentAI Bio Ltd, and are co-inventors on patents filed on nutritional factors and metabolic risk outside the submitted work. K.M.G. has received reimbursement for speaking at a Nestle Nutrition Institute conference. All other authors have no competing interests to declare that are relevant to the content of this article.

Consent to publish

This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants provided informed consent upon recruitment, and the study was approved by the Domain Specific Review Board of Singapore National Healthcare Group (D/2009/021) and the Centralised Institutional Review Board of SingHealth (2018/2767).

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Chen, LW., Loy, S.L., Tint, M.T. et al. Maternal pregnancy diet quality, night eating, and offspring metabolic health: the GUSTO study. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03574-w

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