Body composition and cardiometabolic risk markers in children of women who took part in a randomized controlled trial of a pre-conceptional nutritional intervention in Mumbai, India

BackgroundMaternal nutrition influences fetal development and may permanently alter (?program?) offspring body composition and metabolism, thereby influencing later risk of diabetes and cardiovascular (cardiometabolic) disease. The prevalence of cardiometabolic disease is rising rapidly in India.ObjectivesTo test the hypothesis that supplementing low-income Indian women with micronutrient-rich foods pre-conceptionally and during pregnancy has a beneficial impact on the children's body composition and cardiometabolic risk marker profiles.DesignFollow-up of 1,255 children aged 5?10 years whose mothers took part in the Mumbai Maternal Nutrition Project (Project ?SARAS?; ISRCTN62811278). Mothers were randomized to receive a daily micronutrient-rich snack or a control snack of lower micronutrient content, both made from local foods, in addition to normal diet, from before pregnancy until delivery. Children's body composition was assessed using anthropometry and dual X-ray absorptiometry (DXA). Their blood pressure, plasma glucose, insulin and lipid concentrations were measured. Outcomes were compared between allocation groups with and without adjustment for confounding factors.ResultsOverall, 15 34 there were no differences in body composition or risk markers between children in the intervention and control groups. Among children whose mothers started supplementation ? 3 months before conception (the ?per protocol? sample) the intervention increased adiposity among girls, but not boys. BMI in girls was increased relative to controls by 295, 4; P = 0.01); fat mass index by 1095, 18; P = 0.004); and fat95, 13; P = 0.01) unadjusted, with similar results in adjusted models.ConclusionsOverall, supplementing women with micronutrient-rich foods from before pregnancy until delivery did not alter the body composition or cardiometabolic risk markers in the children. Sub-group analyses showed that, if started at least 3 months before conception, supplementation may increase adiposity among female children