Oral Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

Maternal protein intake during pregnancy and obesity risk in mothers and offspring: a prospective cohort study (125725)

Hanyue Zhang 1 , Alistar M Senior 2 , Christopher Saner 3 , Nicholas A Koemel 4 , Stephen J Simpson 5 , David Raubenheimer 5 , Berit Lilienthal Heitmann 1
  1. Research Unit for Diet and Health, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Danmark
  2. The Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
  3. Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, VIC, 3052 Australia; Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  4. The Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  5. The Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia

Aims: To understand the relationship between maternal dietary macronutrient composition and obesity outcomes in mothers and offspring.

Methods: We analyzed 66,360 singleton pregnancies from the Danish National Birth Cohort, with dietary intake assessed at gestational week 25. Outcomes included maternal postpartum weight retention (PPWR) at 6 and 18 months and offspring's birth weight, risks of small for gestational age (SGA) and large for gestational age (LGA), body mass index (BMI) z-scores, and overweight/obesity (OWOB) risk at ages 7, 11, and 14 y. Mixture models with response surface visualization examined interactive macronutrient associations, and mixed restricted cubic splines assessed potential nonlinear relationships between maternal protein intake and obesity outcomes.

Results: Mean maternal macronutrient intakes were 15.2% protein-energy, 30.2% fat-energy, and 54.1% carbohydrate-energy. Response surfaces revealed that maternal lower protein intake (%), diluted by higher fat and/or carbohydrate, was associated with higher maternal PPWR at 6 and 18 months, and lower birth weight and BMI z-scores in offspring at ages 7, 11, and 14 y. Mixed restricted cubic splines indicated nonlinear associations between maternal %protein intake  and SGA risk (nonlinear P=0.003) and LGA (nonlinear P=0.04), with a threshold around 15% protein; below this, SGA risk increased whereas LGA risk decreased. Linear associations were observed for risks of substantial PPWR (PPWR >5 kg) and childhood OWOB risk (nonlinear P>0.05). Each 5% higher protein intake during pregnancy was related to a lower risk of substantial PPWR at 6 months (OR: 0.90; 95%-CI:0.85-0.95) and 18 months (OR:0.88; 0.82, 0.94) but higher risks of OWOB at ages 7 y (1.07; 1.01, 1.15) and 11 y (1.11; 95%-CI:1.03-1.18), with no association at 14 y (OR:1.02; 95%-CI:0.95-1.10).

Conclusions: Higher maternal protein intake during pregnancy was associated with lower PPWR and SGA risk but higher LGA and childhood OWOB risks, suggesting divergent effects on maternal and offspring obesity outcomes.