Effect of supplemental nutrition in pregnancy on offspring’s risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India

Autoři: Sanjay Kinra aff001;  John Gregson aff001;  Poornima Prabhakaran aff002;  Vipin Gupta aff003;  Gagandeep Kaur Walia aff002;  Santhi Bhogadi aff004;  Ruby Gupta aff002;  Aastha Aggarwal aff002;  Poppy Alice Carson Mallinson aff001;  Bharati Kulkarni aff004;  Dorairaj Prabhakaran aff002;  George Davey Smith aff005;  K. V. Radha Krishna aff004;  Shah Ebrahim aff001;  Hannah Kuper aff001;  Yoav Ben-Shlomo aff006
Působiště autorů: Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom aff001;  Public Health Foundation of India, Delhi, India aff002;  Department of Anthropology, University of Delhi, Delhi, India aff003;  National Institute of Nutrition, Hyderabad, India aff004;  MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom aff005;  Population Health Sciences, University of Bristol, Bristol, United Kingdom aff006
Vyšlo v časopise: Effect of supplemental nutrition in pregnancy on offspring’s risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003183
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003183



Undernutrition during intrauterine life and early childhood is hypothesised to increase the risk of cardiovascular disease (Developmental Origins of Health and Disease Hypothesis), but experimental evidence from humans is limited. This hypothesis has major implications for control of the cardiovascular disease epidemic in South Asia (home to a quarter of world’s population), where a quarter of newborns have low birth weight. We investigated whether, in an area with prevalent undernutrition, supplemental nutrition offered to pregnant women and their offspring below the age of 6 years was associated with a lower risk of cardiovascular disease in the offspring when they were young adults.

Methods and findings

The Hyderabad Nutrition Trial was a community-based nonrandomised controlled intervention trial conducted in 29 villages near Hyderabad, India (1987–1990). Protein-calorie food supplement was offered daily to pregnant and lactating women (2.09 MJ energy and 20–25 g protein) and their offspring (1.25 MJ energy and 8–10 g protein) until the age of six years in the 15 intervention villages, but not in the 14 control villages. A total of 1,826 participants (949 from the intervention villages and 877 from the control villages, representing 70% of the cohort) at a mean age of 21.6 years (62% males) were examined between 2009 and 2012. The mean body mass index (BMI) of the participants was 20 kg/m2 and the mean systolic blood pressure was 115 mm Hg. The age, sex, socioeconomic position, and urbanisation-adjusted effects of intervention (beta coefficients and 95% confidence intervals) on outcomes were as follows: carotid intima-media thickness, 0.01 mm (−0.01 to 0.03), p = 0.36; arterial stiffness (augmentation index), −1.1% (−2.5 to 0.3), p = 0.097; systolic blood pressure, 0.5 mm Hg (−0.6 to 1.6), p = 0.36; BMI, −0.13 kg/m2 (−0.75 to 0.09), p = 0.093; low-density lipoprotein (LDL) cholesterol, 0.06 mmol/L (−0.07 to 0.2), p = 0.37; and fasting insulin (log), −0.06 mU/L (−0.19 to 0.07), p = 0.43. The limitations of this study include nonrandomised allocation of intervention and lack of data on compliance, and potential for selection bias due to incomplete follow-up.


Our results showed that in an area with prevalent undernutrition, protein-calorie food supplements offered to pregnant women and their offspring below the age of 6 years were not associated with lower levels of cardiovascular risk factors among offspring when they were young adults. Our findings, coupled with evidence from other intervention studies to date, suggest that policy makers should attach limited value to cardiovascular health benefits of maternal and child protein-calorie food supplementation programmes.

Klíčová slova:

Birth weight – Blood pressure – Cardiovascular diseases – Cholesterol – Insulin – Malnutrition – Nutrition – Pregnancy


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