Maternal Obesity and Diet Quality Modulate the Villous Placental Metabolome

Abstract Objectives Maternal diet and body composition are important determinants of offspring obesity risk, which may be mediated via changes in placental function. Here we examined the influence of maternal obesity and diet quality on the placental metabolome using untargeted metabolomics. Methods Placenta were collected from a longitudinal observational study in which maternal anthropometrics, body composition, dietary intake (3 d food records) and other variables were collected every trimester. Untargeted metabolomics of villous placental tissues from normal weight (NW, n = 72), overweight (OW, n = 49), and obese women (OB, n = 29) based on BMI at first trimester, were performed using GC-TOF MS. Differential metabolite features were identified using univariate comparisons (ANOVA/Mann Whitney U tests) and partial least squares discriminant analysis (PLS-DA). Results Principal component analysis did not reveal global shifts in the metabolome with maternal OW or OB. While no differences survived multiple testing corrections (P < 0.05), univariate analysis indicated that OW/OB subjects showed increased abundance of 2-deoxypentitol and decreases in maltotriose and 3-hydroxybutanoic acid relative to NW subjects (un-adjusted P < 0.05). Alterations in a number of non-annotated metabolites were also observed between NW, OW and OB groups. PLS-DA models predicted maternal OB status with ∼80% accuracy in held out samples. Predictive metabolites were enriched for aspartate metabolism and ammonia recycling. The global placental metabolome was significantly associated with maternal diet quality (Healthy Eating Index 2010 score averaged over pregnancy; PC1 ANOVA P < 0.01) which was characterized by differences in 138 metabolites (ANOVA, un-adjusted P < 0.05). Abundance of heptadecanoic acid and glycerol-3-galactoside increased with HEI score. Conclusions Maternal obesity appears to alter amino acid or protein metabolism, whereas diet quality seemed to affect metabolism of fatty acids and BCAA. These results suggest a potential shift in nutrient delivery to the offspring. Funding Sources Supported by USDA-ARS Project 6026–51,000-010–05S.

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Associations between Diet Quality and Body Composition in Young Children Born with Very Low Body Weight

Journal of Nutrition ◽

10.1093/jn/nxaa281 ◽

2020 ◽

Vol 150 (11) ◽

pp. 2961-2968

Author(s):

Meghan McGee ◽

Sharon Unger ◽

Jill Hamilton ◽

Catherine S Birken ◽

Zdenka Pausova ◽

...

Keyword(s):

Body Composition ◽

Birth Weight ◽

Diet Quality ◽

Healthy Eating Index ◽

Neurodevelopmental Outcomes ◽

Donor Milk ◽

Added Sugars ◽

Air Displacement Plethysmography ◽

Z Scores

ABSTRACT Background Very low birth weight (VLBW; <1500 g) infants have increased adiposity and metabolic disease risk in adulthood. Limited evidence suggests low-quality childhood diets are a predisposing risk factor. Despite this, to our knowledge no study has yet examined associations between diet quality and body composition in VLBW individuals. Objective The objective of this study was to determine associations between Healthy Eating Index-2010 (HEI-2010) scores and consumption of fruits/vegetables, added sugars, and macronutrients with body composition in 5.5-y-old children born VLBW. We hypothesized HEI-2010 scores were inversely associated with adiposity. Methods This cohort study leveraged the 5.5-y follow-up to the Donor Milk for Improved Neurodevelopmental Outcomes randomized controlled trial. From June 2016 to July 2018, participants attended a follow-up visit at The Hospital for Sick Children, Canada, or were visited in their home. All 316 surviving infants from the trial were eligible, and the caregivers of 158 children (50%; 53% male) consented to follow-up. Diet quality (HEI-2010) and usual intake of fruits/vegetables, added sugars, and macronutrients were determined from two 24-h dietary recalls (ASA24). Linear regressions evaluated associations of diet with BMI (kg/m2) and waist circumference z-scores, total fat, fat-free mass (air displacement plethysmography), and skinfolds. Results Mean ± SD age at follow-up was 5.7 ± 0.2 y, birth weight was 1013 ± 264 g, and gestational age was 27.9 ± 2.5 wk. Dietary data and BMI z-scores were available for all children; 123 completed air displacement plethysmography. HEI-2010 score was 58.2 ± 12.4 out of 100, and 27% of children had poor quality diets (scores ≤50). HEI-2010 scores were inversely associated with BMI z-score, but only in children with obese mothers. A 10-point increase in HEI-2010 score was associated with reduced BMI (β: −0.5 SD; 95% CI: −0.7, −0.2) and subscapular (−0.3 SD; 95% CI: −0.6, −0.06) z-scores. Conclusions Improving diet quality in children born VLBW with obese mothers may be an important strategy to prevent excess adiposity. This trial was registered at clinicaltrials.gov as Optimizing Mothers' Milk for Preterm Infants (OptiMoM) Program of Research: Study 1-Impact of Donor Milk at Kindergarten, NCT02759809.

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A Prospective Study of Prenatal Maternal Dietary Patterns and Offspring Adipokine Levels During Adolescence

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_042 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 745-745

Author(s):

Erica Fossee ◽

Astrid Zamora ◽

Karen Peterson ◽

Alejandra Cantoral ◽

Wei Perng ◽

...

Keyword(s):

Mexico City ◽

Maternal Diet ◽

Principal Component ◽

Positive Association ◽

First Trimester ◽

Significant Positive Association ◽

Diet Patterns ◽

Funding Sources ◽

Diet Pattern ◽

A Prospective Study

Abstract Objectives Maternal diet during pregnancy has been associated with offspring adipokine levels related to insulin resistance and hyperlipidemia during infancy. However, whether this relationship persists into adolescence is unknown. We examined the association between maternal prenatal diet patterns with adolescent leptin and adiponectin levels a Mexico City cohort. Methods Data from 379 mother-adolescent dyads from the Mexico City ELEMENT cohort were analyzed. Diet patterns were derived from principal component analysis of food frequency questionnaire data collected during pregnancy trimesters. Adolescent serum leptin and adiponectin were measured at ages 10–17. Information on maternal covariates was measured during pregnancy. Multiple linear regression was used to examine overall and sex-stratified associations between quartiles of diet patterns with leptin and adiponectin, adjusting for maternal marital status, education, and parity. Results Three maternal diet patterns were identified: Prudent Diet (PD), high in fish and vegetables, the High Meat & Fat Diet (HMFD), high in pork and processed meats, and the Transitioning Diet (TD), high in corn tortillas and sugar beverages. At follow-up, the mean (SD) of leptin and adiponectin were 24.3 (18.2) ng/ml and 11.7 (3.9) ng/ml. A significant positive association was demonstrated between first trimester TD scores and adipokines in girls. In a multivariate-adjusted model, compared to girls in the lowest quartile (Q1) of the TD pattern, the highest quartile of the TD pattern (Q4) had 10.39 ng/mL higher leptin (95% CI: 3.1, 17.6; p for trend = 0.0024). In addition, compared to girls in the lowest quartile (Q1) of the TD pattern, those in the third quartile (Q3) of the TD pattern had 1.86 ng/mL lower adiponectin (95% CI: −3.5, −0.2; p for trend = 0.168). Associations were mostly consistent across all trimesters. Conclusions During pregnancy, a Transitioning Diet pattern was positively associated with leptin and non-monotonically inversely associated with adiponectin in females. Findings suggest maternal diet patterns during pregnancy may influence offspring leptin and adiponectin levels in adolescent girls. Funding Sources Funded by grant P01ES022844.

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Pre-pregnancy Diet Quality Is Associated With Lowering the Risk of Offspring Obesity and Underweight: Finding From a Prospective Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzab038_020 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 408-408

Author(s):

Dereje Gete ◽

Michael Waller ◽

Gita Mishra

Keyword(s):

Medical Research ◽

Diet Quality ◽

Research Council ◽

Medical Research Council ◽

Research Training ◽

Multinomial Logistic Regression ◽

Maternal Diet ◽

Healthy Eating Index ◽

Health Study ◽

Research Fellowship

Abstract Objectives To examine the association between maternal diet quality before pregnancy and childhood BMI in offspring. Methods We included 1936 mothers with 3391 children from the Australian Longitudinal Study on Women's Health (ALSWH) and the Mothers and their Children's Health study (MatCH). Maternal diet was assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). We used the healthy eating index (HEI-2015) score to explore maternal diet quality before pregnancy. Children over 2 years of age were categorized as underweight, normal, overweight, and obese based on age and sex-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses. Results Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring underweight after adjustment for potential confounders, highest vs lowest quartile (RRR = 0.68, 95% CI: 0.49, 0.96). Higher adherence to pre-pregnancy diet quality was also inversely associated with the risk of offspring obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, slightly attenuated by pre-pregnancy body mass index (BMI) in the full adjusted model. No significant association was observed between pre-pregnancy diet quality and offspring overweight. Conclusions This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity. Funding Sources The ALSWH is funded by the Australian Government Department of Health. MatCH is funded by the National Health and Medical Research Council (NHMRC) project grant. Dereje Gete is supported by the University of Queensland Research Training Scholarship. Gita Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship.

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Longitudinal dietary trajectories from preconception to mid-childhood in women and children in the Southampton Women’s Survey and their relation to offspring adiposity: a group-based trajectory modelling approach

International Journal of Obesity ◽

10.1038/s41366-021-01047-2 ◽

2021 ◽

Author(s):

Kathryn V. Dalrymple ◽

Christina Vogel ◽

Keith M. Godfrey ◽

Janis Baird ◽

Nicholas C. Harvey ◽

...

Keyword(s):

Diet Quality ◽

Early Life ◽

Maternal Diet ◽

Principal Component ◽

Dietary Quality ◽

Contributory Factor ◽

Group Model ◽

Percentage Body Fat ◽

Childhood Adiposity ◽

Trajectory Modelling

Abstract Background Rates of childhood obesity are increasing globally, with poor dietary quality an important contributory factor. Evaluation of longitudinal diet quality across early life could identify timepoints and subgroups for nutritional interventions as part of effective public health strategies. Objective This research aimed to: (1) define latent classes of mother-offspring diet quality trajectories from pre-pregnancy to child age 8–9 years, (2) identify early life factors associated with these trajectories, and (3) describe the association between the trajectories and childhood adiposity outcomes. Design Dietary data from 2963 UK Southampton Women’s Survey mother-offspring dyads were analysed using group-based trajectory modelling of a diet quality index (DQI). Maternal diet was assessed pre-pregnancy and at 11- and 34-weeks’ gestation, and offspring diet at ages 6 and 12 months, 3, 6-7- and 8–9-years using interviewer-administered food frequency questionnaires. At each timepoint, a standardised DQI was derived using principal component analysis. Adiposity age 8–9 years was assessed using dual-energy X-ray absorptiometry (DXA) and BMI z-scores. Results A five-trajectory group model was identified as optimal. The diet quality trajectories were characterised as stable, horizontal lines and were categorised as poor (n = 142), poor-medium (n = 667), medium (n = 1146), medium-better (n = 818) and best (n = 163). A poorer dietary trajectory was associated with higher maternal pre-pregnancy BMI, smoking, multiparity, lower maternal age and lower educational attainment. Using linear regression adjusted for confounders, a 1-category decrease in the dietary trajectory was associated with higher DXA percentage body fat (0.08 SD (95% confidence interval 0.01, 0.15) and BMI z-score (0.08 SD (0.00, 0.16) in the 1216 children followed up at age 8–9 years. Conclusion Mother-offspring dietary trajectories are stable across early life, with poorer diet quality associated with maternal socio-demographic and other factors and childhood adiposity. The preconception period may be an important window to promote positive maternal dietary changes in order to improve childhood outcomes.

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The impact of high maternal body mass index on obstetric and perinatal outcomes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210729 ◽

2021 ◽

Vol 10 (3) ◽

pp. 1031

Author(s):

Natasha Sharma ◽

Manasi Patnaik

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Pregnancy Outcomes ◽

Maternal Obesity ◽

Gestational Hypertension ◽

First Trimester ◽

Maternal Body Mass Index ◽

Obese Women ◽

Adverse Pregnancy ◽

The Impact

Background: The incidence of obesity has increased to pandemic proportions over the last 20 years. Maternal obesity is associated with a wide array of adverse maternal pregnancy outcomes and increased risks in the offspring. The aim of the study was to find the effect of obesity on maternal and perinatal outcome in obese women in comparison to those of normal weight women.Methods: The study was designed as a case-control study. Antenatal women with first trimester body mass index (BMI) of more than 30 kg/m2 constituted the cases and those with BMI between 18 and 24.9 kg/m2 formed the controls.Results: There was increased incidence of antepartum complications in obese women. Obese women had a significant history of prior treatment for infertility (p<0.00001). The incidence of gestational diabetes (OR 4.76, 95%CI 1.267-17.72 p=0.014), gestational hypertension (OR 3.05, 95%CI 1.01-9.20 p=0.04), induction of labor (OR 2.5, 95%CI 1.0-6.28 p=0.04), preeclampsia (OR 2.38, 95%CI 1.0-5.64 p=0.04, Caesarean section (OR 1.98, 95%CI 1.24-3.14 p=0.003), postpartum haemorrhage (OR 8.57, 95%CI 1.07-76.15 p=0.04) and wound infection (OR 8.57, 95%CI 1.07-76.15 p=0.04) and adverse neonatal outcomes such as higher mean birth weight (p<0.0001) and requirement of NICU (OR 2.79, 95%CI 1.33 -5.84 p=0.006) was higher in obese women.Conclusions: Obesity is an independent risk factor for adverse pregnancy outcomes and hence, interventions directed towards weight loss and prevention of excessive weight gain must begin in the preconception period.

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A lipid-related metabolomic pattern of diet quality

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa242 ◽

2020 ◽

Vol 112 (6) ◽

pp. 1613-1630

Author(s):

Minoo Bagheri ◽

Walter Willett ◽

Mary K Townsend ◽

Peter Kraft ◽

Kerry L Ivey ◽

...

Keyword(s):

Diet Quality ◽

Eating Behaviors ◽

Principal Component ◽

Cross Sectional Study ◽

Healthy Eating Index ◽

Health Study ◽

Linear Regression Models ◽

Cross Sectional ◽

Unhealthy Eating ◽

Complementary Approach

ABSTRACT Background Adherence to a healthy diet has been associated with reduced risk of chronic diseases. Identifying nutritional biomarkers of diet quality may be complementary to traditional questionnaire-based methods and may provide insights concerning disease mechanisms and prevention. Objective To identify metabolites associated with diet quality assessed via the Alternate Healthy Eating Index (AHEI) and its components. Methods This cross-sectional study used FFQ data and plasma metabolomic profiles, mostly lipid related, from the Nurses’ Health Study (NHS, n = 1460) and Health Professionals Follow-up Study (HPFS, n = 1051). Linear regression models assessed associations of the AHEI and its components with individual metabolites. Canonical correspondence analyses (CCAs) investigated overlapping patterns between AHEI components and metabolites. Principal component analysis (PCA) and explanatory factor analysis were used to consolidate correlated metabolites into uncorrelated factors. We used stepwise multivariable regression to create a metabolomic score that is an indicator of diet quality. Results The AHEI was associated with 83 metabolites in the NHS and 96 metabolites in the HPFS after false discovery rate adjustment. Sixty-three of these significant metabolites overlapped between the 2 cohorts. CCA identified “healthy” AHEI components (e.g., nuts, whole grains) and metabolites (n = 27 in the NHS and 33 in the HPFS) and “unhealthy” AHEI components (e.g., red meat, trans fat) and metabolites (n = 56 in the NHS and 63 in the HPFS). PCA-derived factors composed of highly saturated triglycerides, plasmalogens, and acylcarnitines were associated with unhealthy AHEI components while factors composed of highly unsaturated triglycerides were linked to healthy AHEI components. The stepwise regression analysis contributed to a metabolomics score as a predictor of diet quality. Conclusion We identified metabolites associated with healthy and unhealthy eating behaviors. The observed associations were largely similar between men and women, suggesting that metabolomics can be a complementary approach to self-reported diet in studies of diet and chronic disease.

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Pre-Pregnancy BMI Influences the Association of Dietary Quality and Gestational Weight Gain: The SECOST Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193735 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3735 ◽

Cited By ~ 4

Author(s):

Heng Yaw Yong ◽

Zalilah Mohd Shariff ◽

Barakatun Nisak Mohd Yusof ◽

Zulida Rejali ◽

Yvonne Yee Siang Tee ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Diet Quality ◽

Healthy Eating Index ◽

Dietary Quality ◽

Obese Women ◽

Third Trimester ◽

Gestational Weight ◽

Measured Weight ◽

The Difference

Poor diet quality in pregnancy could impact gestational weight gain (GWG) and consequently fetal growth and development. But today there is limited data available on gestational diet quality. This study investigated the association between diet quality in each pregnancy trimester and GWG in Malaysian women. Diet quality was assessed using the modified Healthy Eating Index for Malaysians (HEI). Total GWG was defined as the difference between measured weight at last prenatal visit and pre-pregnancy weight. About one-fourth of women (23.3%) had excessive total GWG. There were significant differences in the HEI component score across trimesters, except for fruits. Overall, overweight/obese women had lower total HEI score (51.49–55.40) during pregnancy compared to non-overweight/obese women (53.38–56.50). For non-overweight/obese women, higher total HEI scores in the second and third trimesters were significantly associated with lower risk of inadequate GWG (aOR = 0.97, 95% CI = 0.95–0.99, p = 0.01) and higher risk of excessive GWG (aOR = 1.04, 95% CI = 1.01–1.07, p = 0.03), respectively. Overweight/obese women with higher total HEI scores in the second (aOR = 1.04, 95% CI = 1.01–1.07, p = 0.02) and third trimester (aOR = 1.04, 95% CI = 1.01–1.08, p = 0.02) were significantly at higher risk for excessive GWG. Pregnant women had relatively low diet quality throughout pregnancy. Diet quality and GWG association differed according to pre-pregnancy BMI with excessive GWG more likely to be associated with higher total HEI scores in the third trimester.

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Impact of maternal obesity and prebiotic supplementation on select maternal milk miRNA levels and correlation to offspring outcomes

British Journal Of Nutrition ◽

10.1017/s0007114521001197 ◽

2021 ◽

pp. 1-22

Author(s):

Dana E. Lowry ◽

Heather A. Paul ◽

Raylene A. Reimer

Keyword(s):

Body Composition ◽

Gut Microbiota ◽

Body Fat ◽

Milk Protein ◽

Maternal Obesity ◽

Maternal Diet ◽

Female Offspring ◽

Milk Composition ◽

Sprague Dawley ◽

Maternal Body

Abstract Breastmilk composition varies with maternal factors including diet, and confers health benefits to the neonate; however, the mechanisms mediating this protection remain incompletely understood. Our aim was to investigate the effects of supplementing a maternal high fat/sucrose (HFS) diet with prebiotic oligofructose (OFS) on milk composition in rats and associations with offspring body composition and gut microbiota. Obese Sprague-Dawley dams consumed a control, HFS, HFS+OFS (10% wt/wt) or HFS diet weight-matched to the HFS+OFS group (HFS-WM) during pregnancy and lactation. Pups were weaned onto a HFS diet on day 21. Milk was collected at weaning and analysed for protein, leptin, and microRNA (miRNA) levels. Milk produced by HFS dams contained less protein than milk from lean controls which was normalized by OFS. Six miRNAs (miR-222, miR-203a, miR-200a, miR-26a, miR-27a, and miR-103) were differentially expressed in milk according to maternal diet. Milk leptin content was positively correlated with maternal body fat and fecal Enterobacteriaceae in male offspring at 24 weeks of age. Milk protein content was inversely associated with maternal body fat and body weight. miR-200a was positively associated with maternal body fat and Enterobacteriaceae in female offspring at 24 weeks of age. Correlations between milk protein and multiple milk miRNAs and offspring body composition and gut microbiota differed by sex. Overall, our results suggest that obesogenic diets and prebiotic supplementation can alter the protein and miRNA levels in breastmilk in rats and these milk components may explain, in part, the influence of these maternal diets on offspring body composition.

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Diet Quality in Overweight/Obese Women: Higher Protein Intake During Weight Loss (P08-014-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p08-014-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Anna Ogilvie ◽

Sue Shapses ◽

Yvette Schlussel

Keyword(s):

Weight Loss ◽

Diet Quality ◽

Protein Intake ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Secondary Outcome ◽

Obese Women ◽

Food Diary ◽

Poor Diet ◽

Increased Risk

Abstract Objectives Accumulating evidence suggests that assessing diet quality rather than nutrients in isolation provides a more accurate representation of the interactions between foods and diseases. The Healthy Eating Index (HEI) is a validated scoring system of diet quality focused on sufficiency of nutritional intake regarding the Dietary Guidelines for Americans wherein lower scores are associated with increased risk of several chronic diseases. The objective of the dietary intervention was to increase protein intake during weight loss in overweight/obese women, and examine dietary quality, as measured by the HEI. Methods Women (body mass index, BMI, 25–40 kg/m2) were randomly assigned to either high or normal protein groups during a one-year weight loss trial. Food diaries were collected at baseline and multiple times during the intervention. In this secondary outcome, HEI scores were assessed by entering food diary information into the National Cancer Institute's (NCI) Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool that configures data into 13 food components and calculates HEI in SAS v. 9.4. Results Forty-one women (58 ± 4.6 years of age with BMI, 32 ±4.5 kg/m2) had a baseline energy intake of 1831 ± 642 kilocalories; 47% of the energy consumed was from carbohydrates, 17% was from protein, and 36% was from fat. Also, HEI was 58.4 ± 15.3. Using standard HEI categories, 29% were in the poor diet quality range (<51), 64% had fair diet quality (51–80), and 7% were in the good diet quality category (>80). Conclusions Approximately 14% of American adults have poor diet quality (HEI < 51) (cnpp.usda.gov) compared to a larger percentage of women in this study who were consuming a poor diet. Ongoing analysis will determine if HEI changes over time due to weight loss with higher protein intake. Funding Sources International Life Sciences Institute and NIH-AG-12161 to S.A.S.

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Associations of Early Parental Concerns and Feeding Behaviors with Child’s Diet Quality through Mid-Childhood

Nutrients ◽

10.3390/nu12113231 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3231

Author(s):

Véronique Gingras ◽

Karen M. Switkowski ◽

Sheryl L. Rifas-Shiman ◽

Sabrina Faleschini ◽

Emily Oken ◽

...

Keyword(s):

Early Childhood ◽

Diet Quality ◽

Maternal Diet ◽

Healthy Eating Index ◽

Dietary Intakes ◽

Z Score ◽

Linear Regression Models ◽

Feeding Behaviors ◽

Parental Concerns ◽

Parental Feeding

Parental feeding practices have been associated with children’s dietary intakes, yet the directionality of these associations remains unclear. Among 1172 mother-child pairs from Project Viva, we aimed to examine associations of parental concerns and feeding behaviors at 2 years (behaviors dichotomized as yes vs. no), with diet quality (Youth Healthy Eating Index; YHEI) in early (mean 3.2, SD 0.3 years; n = 1076) and mid-childhood (mean 7.8, SD 0.7 years; n = 993). We used multivariable linear regression models adjusted for sociodemographic characteristics, parental body mass index (BMI), maternal diet quality in pregnancy, and child’s BMI z-score and diet quality at 2 years. Early parental concerns about their child becoming overweight (15%) was associated with lower YHEI (β −1.54 points; 95%CI −2.75, −0.33; fully adjusted model) in early childhood. Early parental concerns about their child becoming underweight (7%) was associated with lower YHEI (−2.19 points; −4.31, −0.07) in early childhood, but the association was attenuated after adjustment for child’s BMI z-score and diet quality at 2 years. We did not find associations of parental restrictive feeding (8%) and parental pressure to eat (47%) with child’s YHEI through mid-childhood. In conclusion, we found no evidence that early parental concerns and feeding behaviors independently contribute to child’s diet quality through childhood.

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