Our team has previously utilized ALSPAC data and published findings suggesting that a) maternal nutritional status during pregnancy and b) free sugar intake at age 3 years are both positively associated with hepatic steatosis in young adulthood.1,2 We would like to extend our research to examine associations between early life free sugar and sugar-containing beverage consumption at 18 months and obesity and cardiometabolic risk throughout childhood and adolescence. Building off our earlier findings related to maternal nutritional status, we will also examine effect modification of the free sugar and later obesity association by maternal metabolic dysfunction and diet during pregnancy.

Increasingly, research has implicated early childhood as a critical window for the establishment and maintenance of obesity, necessitating a focus on preventing obesity early in life. Consequently, it is critically important to develop a better understanding of early life dietary factors that increase obesity risk. Current infant and toddler dietary recommendations include a focus on minimizing free sugar consumption as excessive intake may predispose children to obesity, but the evidence underpinning these guidelines is limited. It is unclear what amount of free sugar intake during early life conveys increased risk of obesity and compromised cardiometabolic health, and what factors modify this risk. Further, maternal metabolic dysfunction during pregnancy is associated with increased risk of offspring chronic disease via in-utero metabolic programming, and recent research has suggested that an interplay may exist between the prenatal environment, early nutrition, and later cardiometabolic health. However, to date, no researchers have examined how the early free sugar-childhood obesity relationship may be modified by maternal conditions such as pre-pregnancy obesity, excessive gestational weight gain, and gestational diabetes. A better understanding of the potential effect modification by maternal health during pregnancy could help provide insights into which, if any, groups may benefit from increased, targeted early life nutrition guidance. We will utilize longitudinal data from a British birth cohort study (Avon Longitudinal Study of Parents and Children) to assess the association between free sugar and sugar-containing beverage consumption at 18 months and obesity at ages 5, 7, 13, 15 and 17 years and cardiometabolic risk at ages 15 and 17 and examine effect modification of the associations by maternal metabolic dysfunction and diet during pregnancy. Our findings will inform existing infant and toddler nutrition guidelines and help guide the development and targeting of early childhood obesity prevention interventions.

Publications from original proposal:
1. Sekkarie A, Welsh JA, Northstone K, Stein AD, Ramakrishnan U, Vos MB. Associations between Free Sugar and Sugary Beverage Intake in Early Childhood and Adult NAFLD in a Population-Based UK Cohort. Children. 2021; 8(4):290. doi: 10.3390/children8040290
2. Sekkarie A, Welsh JA, Northstone K, Stein AD, Ramakrishnan U, Vos MB. Associations of maternal diet and nutritional status with offspring hepatic steatosis in the Avon longitudinal study of parents and children. BMC Nutr. 2021;7(1):28. Published 2021 Jul 8. doi:10.1186/s40795-021-00433-3