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Parental pre-pregnancy obesity and the risk of offspring weight and body mass index change from childhood to adulthood

Zalbahar N, Najman J, McIntyre HD, Mamun A

Clin Obes, 2017 Aug;7(4):206-215.
PMID: 28557382 DOI: 10.1111/cob.12200

The purpose of this study was to examine the association of parental pre-pregnancy weight and body mass index (BMI) on offspring weight and BMI change from childhood to adulthood. We analysed BMI data from a subsample of parents (n = 1494) from the Mater-University of Queensland Study of Pregnancy cohort that started in the early 1980s in Brisbane, Australia: data were collected at pre-pregnancy and then also for offspring at 5, 14 and 21-year follow-ups. Multiple regression for continuous outcomes and multinomial regression for categorical outcomes were performed. A total of 14.7% of offspring experienced BMI change from normal at 5 years to overweight or obese (OW/OB) at 14 years, 15.3% of normal at 14 years to OW/OB at 21 years and 22.8% from normal at 5 years to OW/OB at 21 years. Overall, the strength of the association of parental BMI with offspring BMI was stronger as offspring become older. Pre-pregnancy parental BMI differentially impacts offspring OW/OB across the life course. For every unit increase in paternal and maternal BMI z-score, offspring BMI z-score increased, on average, by between 0.15% (kg m-2) and 0.24% (kg m-2) throughout all three stages of life when both parents were OW/OB; these associations were stronger than with one parent. Parental pre-pregnancy BMI and OW/OB is a strong predictor of offspring weight and BMI change from early life to adulthood.
Parental pre-pregnancy BMI influences on offspring BMI and waist circumference at 21 years

Zalbahar N, Najman J, McIntrye HD, Mamun A

Aust N Z J Public Health, 2016 Dec;40(6):572-578.
PMID: 27624991 DOI: 10.1111/1753-6405.12574

OBJECTIVES: To investigate the prospective association between parental pre-pregnancy BMI and adult male and female offspring BMI and waist circumference (WC).
METHODS: Sub-sample of 2,229 parent-offspring pairs with parental pre-pregnancy BMI and offspring BMI and WC at 21 years were used from the MUSP (Mater-University of Queensland Study of Pregnancy cohort). Multivariable results were adjusted for maternal factors around pregnancy (e.g. gestational weight and smoking during pregnancy) and offspring factors in early life (e.g. birth weight) and at 14 years (e.g. sports participation and mealtime with family).
RESULTS: After adjustments for confounders, each unit increase in paternal and maternal BMI, the BMI of young adult offspring increased by 0.33kg/m(2) and 0.35kg/m(2) , and the WC increased by 0.76 cm and 0.62 cm, respectively. In the combination of parents' weight status, offspring at 21 years were six times the risk being overweight/obese (OW/OB) when both parents were OW/OB, compared to offspring of healthy weight parents.
CONCLUSIONS: Prenatal parental BMI are independently related to adult offspring BMI and WC.
IMPLICATIONS: Both prenatal paternal-maternal weight status are important determinants of offspring weight status in long-term. Further studies are warranted to investigate the underlying mechanisms.
Association of parental body mass index before pregnancy on infant growth and body composition: Evidence from a pregnancy cohort study in Malaysia

Zalbahar N, Jan Mohamed HJ, Loy SL, Najman J, McIntyre HD, Mamun A

Obes Res Clin Pract, 2016 09;10 Suppl 1:S35-S47.
PMID: 26321098 DOI: 10.1016/j.orcp.2015.08.002

BACKGROUND AND OBJECTIVES: Parental body mass index (BMI) is strongly linked with the development of offspring overweight and obesity. However, there are a limited number of studies focusing on the association of parental body mass index before pregnancy on offspring growth and body composition in early life, particularly in developing countries.
METHODS: Data from the University Sains Malaysia (USM) Pregnancy Cohort which consists of 153 mother-offspring pairs were used. Data were collected using interview-administered questionnaires and anthropometric measurements were also obtained. Multiple linear regression and generalised equation estimation (GEE) were used to examine the direction and impact of the association between parental BMI and child growth and body composition (weight for age, height for age, body mass index for age, weight for height and fat mass at age 2m, 6m, and 12m). Potential confounders, including validated measures of maternal diets and physical activity during pregnancy, were considered.
RESULTS: Of 153 parents, one-quarter of the mothers and 42.2% of the fathers, respectively, were overweight or obese before pregnancy. A significant association was found between maternal BMI and child's weight for height z-score (WHZ) and body mass index for age z-score (BAZ).
CONCLUSIONS: Having high pre-pregnancy BMI may increase BMI and WAZ of offspring in early life. Findings from this study emphasise the importance of monitoring maternal weight status, particularly before and during pregnancy and early life of offspring among Malaysians.
Fulltext Exploration of Food-Seeking Behaviour, Food Preparation, and Restrictions to Sufficient Food among the Jahai Sub-Tribe (Indigenous People) in Gerik, Malaysia

Gan WY, Sulaiman N, Law LS, Zalbahar N, Ahmad Fuzi SF, Wilkes MA

Int J Environ Res Public Health, 2020 01 04;17(1).
PMID: 31947907 DOI: 10.3390/ijerph17010348

Access to food has been determined to be a factor that strongly influences the dietary intake and eating habit of indigenous people (Orang Asli, OA). This study explored food acquisition and the barriers in obtaining traditional and market foods among the Jahai subtribe (within the Negrito ethnic group) via a qualitative approach. Twenty-eight OA (14 males and 14 females) from Gerik, Perak, Malaysia participated in four focus group discussions (FGDs; two male-only and two female-only groups; seven informants in each FGD). Thematic analysis was adopted to analyse the gathered data. The results found that the Jahai applied both modern (buying and receiving food assistance) and traditional (gathering, farming, fishing, and hunting) methods in obtaining food. The barriers they faced in gathering sufficient food supply included low purchasing power, high demand for food, high transport costs, depletion of food supplies in their surroundings, threats from wild animals on the farm and during food searching activities, and food sharing. Food preparation methods practiced by the OA include roasting and grilling, frying, simmering (gulai), and boiling. In conclusion, this study enhances our understanding of the dietary behaviour of the Jahai subtribe and highlights restricted food access among the OA, which demands urgent attention.
COVID-19 Restrictions and Maternal Experience and Infant Feeding

Shukri NHM, Ying GW, Zalbahar N, Tusimin M, Nasri NM

Nurs Res, 2021 Nov 23.
PMID: 34818264 DOI: 10.1097/NNR.0000000000000568

BACKGROUND: The Movement Control Order (MCO), also known as the partial lockdown, was introduced in Malaysia in March 2020 to combat the COVID-19 pandemic, changing many public-sector protocols and regulations. This may have implications for neonatal and maternity care and services, especially among new mothers.
OBJECTIVE: To compare the postnatal experiences and feeding practices between mothers who gave birth before MCO (B-MCO) and during MCO (D-MCO).
METHOD: 1,051 mothers with an infant under 18 months in Malaysia completed an online survey between July 2020 and October 2020. The survey advertisement was disseminated online via various social media platforms.
RESULTS: More D-MCO mothers faced a significant effect on the ability to pay rent/mortgage, with their spouses facing a higher impact on employment. D-MCO mothers were more likely to have changed their birth plans, perceived insufficient breastfeeding support, and experienced changes in postnatal services since MCO. In contrast, more B-MCO mothers had stopped breastfeeding during the MCO and started complementary feeding earlier than planned. Many mothers reported feeling down, lonely, and having sleeping trouble and a poor appetite. D-MCO mothers had more time to focus on their health, whereas B-MCO mothers spent more time outdoors.
DISCUSSION: MCO affected mothers' livelihood and postnatal experiences, potentially causing emotional distress. Hence, improved breastfeeding support, particularly at birth, is recommended, as is routine mental health screening during the postnatal check-up. Furthermore, since online contact was readily accessible during the pandemic, the efficacy of online breastfeeding support should be evaluated.
Fulltext Effect of vitamin D3-fortified fruit juice supplementation of 4000 IU daily on the recovery of iron status in childbearing-aged women with marginally low iron stores: Protocol for an 8-week, parallel group, double-blind randomized controlled trial

Ahmad Fuzi SF, Su Peng L, Zabaha Zalbahar N, Ab Manan N, Mohamad Alwi MN

PLoS One, 2022;17(3):e0265772.
PMID: 35333885 DOI: 10.1371/journal.pone.0265772

BACKGROUND: In recent years, emerging evidence has highlighted the role of vitamin D as an iron absorption enhancer by suppressing hepcidin concentration, albeit with an unclear underlying mechanism. Dietary-based approach in improving iron status has been widely practised, however, there is a scarcity in randomized controlled trials (RCT) to elucidate the effect of vitamin D-fortified juice on iron status recovery. Therefore, this study aims to investigate the effect of an 8-week vitamin D3-fortified fruit juice supplementation on iron status indicators in childbearing-aged women with marginally low iron stores.
METHODS: In a placebo-controlled, double-blind, RCT, a total of 120 women aged between 19-40 with serum ferritin < 20 μg/l and fulfilled the eligibility criteria will be randomized into consuming either vitamin D3-fortified fruit juices containing 4000 IU (100 mcg) (vitamin D) or placebo-fruit juices (placebo) daily for eight weeks. At every 4-week interval, 10 ml fasting blood sample, information on dietary habit and anthropometric measurement will be collected. A mixed model repeated-measures analysis of variance will be performed to determine the effect of the intervention and the interaction with time points for all iron and vitamin D status blood biomarkers.
DISCUSSION: Vitamin D supplementation in food fortification as a novel iron absorption enhancer might be a future and relevant alternative management of iron deficiency as opposed to the oral iron therapy that has poor adherence.
TRIAL REGISTRATION: Clinicaltrials.gov: registration number NCT04618289, registration date October 28, 2020, protocol ID JKEUPM-2020-033.
An 8-Week Vitamin D3-Fortified Fruit Drink Supplementation Increases Serum Ferritin Concentration: A Randomized Controlled Trial in Malaysian Women With Low Iron Stores

Suhaimi NA, Loh SP, Ab Manan N, Zalbahar N, Mohamad Alwi MN, Ahmad Fuzi SF

J Acad Nutr Diet, 2024 Nov;124(11):1440-1450.e1.
PMID: 38408566 DOI: 10.1016/j.jand.2024.02.013

BACKGROUND: There is limited randomized controlled trial evidence to support the association between vitamin D deficiency and anemia risk, highlighting the necessity for further investigations into the role of vitamin D in influencing iron status.
OBJECTIVE: The aim of this study was to determine the effect of vitamin D3-fortified fruit drink consumption (4,000 IU) on vitamin D and iron status biomarkers among iron-deficient women (serum ferritin of <20 μg/L [to convert μg/L ferritin to ng/mL, multiply by 1]).
DESIGN: An 8-week double-blind randomized controlled trial was conducted.
SUBJECTS/SETTING: A total of 45 healthy, nonpregnant, nonlactating subjects aged 18 through 40 years (mean [SD] 25.3 [4.6] years) were included in the study, excluding those who donated blood 6 months prior, regularly consumed nutritional supplements, or had gastrointestinal or iron metabolic disorders.
INTERVENTION: Subjects were randomly assigned to receive either vitamin D3-fortified fruit drink or a placebo.
MAIN OUTCOME MEASURES: Measurements of 25-hydroxyvitamin D (25[OH]D), serum ferritin, high-sensitivity C-reactive protein, and full blood count concentrations were obtained at baseline, interim, and post intervention.
STATISTICAL ANALYSES: A mixed model, repeated measures analysis of variance was used to analyze the intervention effect.
RESULTS: Attrition rate for the study was 13%, with 6 dropouts, and 39 subjects completed the study. Daily consumption of vitamin D3-fortified fruit drink in the intervention group resulted in significant increases in 25(OH)D and serum ferritin concentrations compared with the placebo group. The intervention group showed significantly higher mean (SD) changes (Δ) in both 25(OH)D (Δ 76.4 [30.2] nmol/L [to convert nmol/L 25(OH)D to ng/mL, multiply by .4] vs Δ -1.3 [10.7] nmol/L; P = .001) and serum ferritin concentrations (Δ 2.2 [4.2] μg/L vs Δ -0.3 [3.4] μg/L; P = .048) between baseline and post intervention. The other iron status biomarkers were not affected by the intervention.
CONCLUSIONS: Our study found that daily vitamin D3-fortified fruit drink supplementation for 8 weeks effectively improved 25(OH)D and iron stores, indicated by increased serum ferritin concentrations, in iron-deficient women. Further research is needed to evaluate its safety, efficacy, feasibility, and optimal food fortification in diverse populations.