Mediterranean diet counselling may help counter overweight/obesity in the offspring

A personalized nutritional counselling targeting adherence to the Mediterranean diet (MD) during pregnancy may be an effective strategy against childhood overweight/obesity, findings from the PREMEDI study have shown.

“Paediatric obesity prevalence is growing at an alarming rate, affecting >300 million children worldwide. This imposes the need for new effective preventive strategies to limit the disease burden and to reduce the socioeconomic costs for healthcare systems,” said Serena Coppola, a registered dietitian and nutritionist from the University of Naples Federico II, Naples, Italy, during her presentation at ESPGHAN 2023.

“Maternal diet during pregnancy could influence the development of paediatric obesity through epigenetic mechanisms,” Coppola continued.

“The first 1,000 days of life, from conception to 24 months, are crucial to achieve long-term health outcomes and represent a strategic period to intervene under prevention and public health perspective. Nutritional exposures during this critical period of life can influence future disease susceptibility. Until now, randomized controlled trials aimed at evaluating the effects of MD during pregnancy on paediatric obesity occurrence are lacking,” noted Coppola in a press release.

Coppola and her team sought to evaluate the effects of MD during pregnancy on the onset of overweight/obesity in the offspring at 24 months. A total of 104 women (mean age 34 years) who were at the first trimester of pregnancy were randomized 1:1 to receive a standard obstetric-gynaecological follow-up with or without nutritional counselling aimed at promoting MD adherence. [ESPGHAN 2023, abstract N-O033]

The standard follow-up consisted of recommendations on energy and nutrient intake and on weight gain during pregnancy based on pre-pregnancy BMI, as well as lifestyle advice and those geared at preventing major foodborne illnesses. The MD counselling encouraged participants to consume foods included in the MD.

In the per-protocol analysis, the MD group had a substantially lower rate of overweight/obesity in the offspring than the control group (n=3 vs 15).

At 24 months, the absolute risk reduction for overweight/obesity occurrence was significantly greater in the MD vs the control group, both in the intention-to-treat (0.27; p<001) and per-protocol analyses (0.24; p=0.003).

At baseline (first trimester), MD adherence was poor overall, as reflected by the MEDIET score (~7). But after going through their respective regimens, the MD group trumped the control group, demonstrating a significant improvement in MD adherence from the second trimester towards the end of pregnancy – the MEDIET scores in the MD group ranged between 9 and 10 at trimesters 2 and 3, whereas in the control group, the scores dropped to about 6.

With regard to maternal weight gain during pregnancy, MD was able to protect against pre-pregnancy obesity, noted Coppola. In the pregravidic normal weight group, median body weight gain was lower in the MD than the control group during the third trimester (10.5 vs 12.0 kg).

A better trajectory was observed in the pregravidic overweight/obesity group, as median body weight gain was consistently lower in the MD vs the control group, right from the first (1 vs 2 kg) towards the second (5 vs 7 kg) and third trimesters (9 vs 11 kg).

“Overall, our study has demonstrated that optimal MD adherence is poor, but this could be significantly improved by nutritional counselling aimed at promoting MD adherence. Nutritional counselling could be protective against the occurrence of paediatric obesity/overweight,” said Coppola.

“The beneficial effects of MD are due to the synergistic and interactive combinations of nutrients, deriving from foods rich in fibre, polyphenols, vitamins, and essential fatty acids,” Coppola noted. “MD is an ancient lifestyle with an innovative nutrigenomic power … We have chosen this dietary model for our study, a preventive strategy at no cost, without side effects and with high applicability and feasibility.”