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DESIGN
Cohort study of mother–infant dyads.
STUDY QUESTION
Setting: Canadian Healthy Infant Longitudinal Development Study. A population-based study with four contributing sites.
Patients: Mothers of singleton pregnancies and their 1-year-old infants.
Exposure: Maternal artificial and sugar-sweetened beverage intake from questionnaire, classified according to the number of servings per day/week/month.
Outcomes: Primary outcome was infant body mass index (BMI) z-score at 1 year of age. Secondary outcome was the risk of being overweight (BMI z-score >97th centile) at 1 year of age.
Follow-up period: Women recruited over 5 years (2009–2013). Infant BMI was calculated at 1 year of age.
Patient follow-up: 3033 mother–infant dyads were recruited. 2682 completed follow-up of BMI and 2413 completed BMI and essential covariate follow-up.
MAIN RESULTS
Covariates were infant sex, total energy intake, Healthy Eating Index score, maternal smoking, diabetes in pregnancy, maternal education, breast feeding and introduction of solids. After adjusting for covariates, daily consumption of artificially sweetened beverages (ASBs) (n=122) was associated with a 0.2 increase in infant BMI z-score and a twofold increase in overweight risk (see table 1), when compared with the no ASB consumption group (n=1702). No association noted with sugar-sweetened beverages.
Primary and secondary outcomes
CONCLUSION
Maternal consumption of artificial sweeteners in pregnancy was associated with increased BMI z-score and overweight risk in infants at 1 year of age.
Abstracted bySarveshni Naidoo, Department of Paediatrics, Wishaw General Hospital, Wishaw, Scotland, UK
Abstracted from: Azad MB, Sharma A, de Souza RJ, et al. Association between artificially sweetened beverage consumption during pregnancy and infant body mass index. JAMA Pediatr 2016;170:662–70.
Commentary
Obesity is at epidemic proportions within the developed world with estimates of up to one-third of children and adolescents being overweight.1 This has significant implications for the health of the population with increased risks of cardiovascular disease, diabetes and cancer within the obese population.2
The reasons behind the increased obesity rates in childhood are multifactorial, including birth weight, parental obesity, sleep duration and television viewing. Increased BMI in early life has been implicated in contributing to childhood obesity.3 It is well documented that sweetened drinks cause obesity; however, there is a growing body of counterintuitive evidence showing that artificially sweetened drinks also contribute to obesity.3
This cohort study demonstrates for the first time, evidence in humans that ASB consumption during pregnancy is associated with an increase in infant BMI and childhood obesity risk. This was not explained within the study by other obesity risk factors, maternal BMI, energy intake nor diet quality. The study, however, did not examine the effects of ongoing maternal ASB consumption during infancy.
Limitations of this study include the potential for measurement error in self-reported dietary outcomes, as the food questionnaire used was not validated for beverages. The study could not distinguish between non-nutritive sweeteners in food versus drinks. There is also uncertainty whether BMI is the best anthropometric measure of body fat in infants.
Further studies are essential to evaluate the findings of this study and its underlying biological mechanisms. If confirmed, simple interventions, such as, advising against consumption of ASBs during pregnancy may provide a potential further strategy in tackling childhood obesity and its associated health and economic implications within our population.
Footnotes
Provenance and peer review Not commissioned; internally peer reviewed.