Obesity and Pregnancy

Maternal obesity directly impacts male offspring’s lifelong health

Recent findings reveal that sons born to mothers with obesity are more likely to face a host of health challenges from birth into adulthood, including a predisposition to obesity, liver conditions, and diabetes.

This increased risk is attributed to the unique way male hormones, or androgens, interact with the developmental processes of the liver in male offspring.

A groundbreaking study spearheaded by the University of South Australia (UniSA) delves into the complex effects maternal obesity has on the foetal liver’s response to androgen signalling.

The research highlights a concerning trend: male foetuses carried by women with obesity exhibit altered liver responses to androgens, pushing them towards accelerated growth, often at the cost of their long-term health.

According to UniSA’s Dr Ashley Meakin, androgens play a pivotal role in bestowing male traits and are integral to male development. However, an excess of these hormones can lead to oversized male foetuses. This not only complicates the birthing process but can also lead to lifelong liver function issues.

In contrast, female foetuses seem to have a protective mechanism against the excess testosterone stemming from maternal obesity, effectively dampening the androgen pathway in the liver. This curbs their growth and reduces the likelihood of facing metabolic disorders in later life.

Dr Meakin notes significant gender disparities in the prevalence of metabolic disorders in adulthood, attributing a higher susceptibility to non-alcoholic fatty liver diseases and diabetes in men to maternal obesity during pregnancy, especially if the birth weight exceeds 4 kilograms.

The research team, including study lead Professor Janna Morrison, head of the Early Origins of Adult Health Research Group at UniSA, underscores the critical importance of balanced nutrition during pregnancy. They argue that achieving a “Goldilocks pregnancy” – not too little, not too much, just right – is essential for fostering the best health outcomes for offspring.

Professor Morrison warns of the long-term challenges posed by societal attitudes towards nutrition, emphasising the urgent need to combat obesity and its ripple effects from gestation through to adulthood. She advocates for early education on healthy eating habits, which can have a lasting impact, particularly during pregnancy when optimal nutrition is crucial.

In the meantime, Dr Meakin suggests that dietary supplements might offer a temporary solution to correct nutritional imbalances during pregnancy, ensuring the foetus has the best possible conditions for healthy development.

The study, published in the journal Life Sciences, forms part of a broader investigation by Professor Morrison and her colleagues into the effects of maternal nutrition – both excessive and insufficient – on the developing placenta, heart, lungs, and liver.

Study shows early breastfeeding mitigates child obesity, regardless of maternal weight

A recent study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health has revealed a significant correlation between early breastfeeding and reduced childhood obesity risks. This relationship holds true irrespective of the mother’s pre-pregnancy body mass index (BMI).

The ECHO Cohort study delved into the impact of breastfeeding practices in women who had overweight or obesity before pregnancy and its influence on their children’s BMIz scores. BMIz scores are used to compare a child’s height and weight against their peers, whereas BMI assesses body weight relative to height.

The research discovered that any consistent breastfeeding during the first three months of an infant’s life was linked with lower BMIz scores at ages 2 to 6, regardless of the mother’s pre-pregnancy BMI. This association was particularly pronounced in children whose mothers had obesity before pregnancy, compared to those whose mothers were merely overweight.

Dr. Gayle Shipp from Michigan State University, who led the study, emphasised the importance of each additional month of breastfeeding, whether exclusive or combined with other foods, in contributing to lower childhood weights. This effect was notably significant for mothers who had overweight or obesity before pregnancy.

The study analysed data from 8,134 mother-child pairs across 21 sites in 16 states and Puerto Rico. It examined BMI and BMIz scores obtained from study visits, medical records, or self-reported information. The research particularly focused on two aspects of breastfeeding: whether the mother ever breastfed and if she was exclusively breastfeeding at three months. The definition of continuous breastfeeding included any breastfeeding duration with the allowance of formula or other food, and the duration of exclusive breastfeeding without formula feeding or other food.

The study found that exclusive breastfeeding at three months was linked to a lower child BMIz score primarily among women with a normal pre-pregnancy BMI. Each additional month of either any or exclusive breastfeeding correlated with a significantly lower child BMIz score, especially for mothers who had overweight or obesity before pregnancy.
Dr. Shipp highlighted the significance of this research for health professionals, suggesting it as an opportunity to promote breastfeeding among all women, particularly those with obesity. The study’s findings have been published in the journal Pediatrics.

New study finds obesity in pregnancy raises risk of future heart disease

The link between maternal obesity and the long-term risk of cardiovascular disease has been further solidified by new research findings. A study led by Northwestern University in the United States has shone a light on the significant health risks faced by women who enter pregnancy with obesity.

The research team discovered that women with obesity before conception are more susceptible to complications during pregnancy than their counterparts with healthier pre-pregnancy weights. These complications include conditions like pre-eclampsia and gestational diabetes, which have previously been associated with an increased risk of heart disease later in life.

The study’s principal investigator, Dr. Sadiya Khan, emphasised that while these pregnancy-related issues can indeed signal future cardiovascular problems, they are not the underlying cause of heart disease. Instead, they merely highlight pre-existing risk factors that become apparent during the metabolic and physical demands of pregnancy.

To reach these conclusions, the researchers analysed health data from 4,216 women who were giving birth for the first time. They observed that those with higher body mass indices (BMIs) in the first trimester had an elevated risk of developing hypertensive disorders during pregnancy than those with BMIs within the normal range.

Dr. Khan explained that the study approached pregnancy as a ‘natural stress test’ for the heart, which could expose pre-existing health concerns. The implications of these findings underscore the importance of addressing pre-pregnancy obesity with proactive health interventions rather than waiting for cardiovascular events to occur.

The research team is advocating for healthcare providers to emphasise the importance of a nutritious diet and regular physical activity during prenatal visits. While weight loss is not recommended during pregnancy, guidance and support for maintaining an appropriate weight gain during this period are crucial.

The study also presented quantitative insights, revealing that among the participants, 4% had gestational diabetes and 15% encountered complications due to high blood pressure.

These findings, which align with prior research advocating for weight management during pregnancy through diet and exercise, have been published in the journal Circulation Research, providing valuable insights for expectant mothers and healthcare professionals alike.

Rising obesity levels may intensify menopause symptoms and reduce hormone therapy efficiency, preliminary study indicates

The global surge in obesity, with an estimated 13% of adults now grappling with the condition, is a growing concern. A recent report suggests that obesity prevalence is higher among women than men (15% vs. 11%), with a more pronounced incidence in developed nations. Particularly in the United States, data from the Centers for Disease Control and Prevention (CDC) reveals that in 2020, 41.9% of individuals aged 20 and over were categorised as having obesity.

The far-reaching health implications of obesity are well-documented, encompassing a higher propensity for heart attacks, strokes, type 2 diabetes, respiratory ailments, and musculoskeletal issues.

A nascent study unveils a potential additional concern: obesity might amplify the severity of menopausal symptoms and compromise the effectiveness of hormone therapy aimed at alleviating these symptoms. The study’s lead author, Dr. Anita Pershad from the Eastern Virginia Medical School, shared her insights stating, “The core inference from our study is that obesity might exacerbate a woman’s menopausal symptoms while concurrently diminishing the relief provided by hormone therapy (HT).”

However, Dr. Kara McElligot, a NAMS-certified menopause practitioner and medical advisor at Mira, underscored the preliminary nature of this investigation, which encompassed a mere 119 participants and was executed retrospectively via chart review, thus inheriting a higher risk of bias.

The research, though yet to be peer-reviewed, was showcased at the 2023 Annual Meeting of The Menopause Society in Philadelphia, held between September 27 and 30. The study, spanning five years, meticulously reviewed the medical records of 119 women visiting a menopause clinic. These women were segregated into two cohorts based on their Body Mass Index (BMI)—those with a BMI above 30 were categorised as having obesity, while those below this threshold formed the other group.

The evaluation revealed no substantial disparity between the groups concerning age, the extent of menopause, hormone therapy utilisation, and acceptance. However, a significant finding emerged: women with obesity exhibited a higher propensity to report symptoms such as vasomotor symptoms (hot flashes), genitourinary/vulvovaginal symptoms, mood fluctuations, and diminished libido.

Dr. Sherry Ross, a seasoned OB/GYN at Providence Saint John’s Health Center in Santa Monica, elucidated a plausible cause, positing that women with obesity might experience intensified hot flashes and night sweats as fatty tissues could act as insulators, retaining heat within the body. Another theory proposes that obesity might trigger hormonal imbalances, thus engendering elevated oestrogen levels which, in turn, could exacerbate menopausal symptoms.

Dr. Ashley Parr, D.O., OB/GYN at The Women’s Hospital at MemorialCare Saddleback Medical Center, concurred with this notion, adding that the oestrogen-producing capability of fat cells could potentially alter the hormonal equilibrium of women with obesity during menopause, even post the cessation of ovarian function.

Moreover, the research identified a diminished likelihood of symptomatic relief post systemic and/or localised hormone therapy among women with obesity, compared to their counterparts without obesity. Dr. Pershad disclosed ongoing inquiries into the ambiguous efficacy of hormone therapy among women with obesity.

She further discussed exploring alternative designs and administration routes to potentially enhance hormone therapy effectiveness. Concurrently, Dr. Parr highlighted that obesity-associated risks for other health conditions like heart disease and breast cancer could deter the choice of hormone replacement, prompting considerations for non-hormonal treatment alternatives such as SSRIs, SNRIs, and vaginal oestrogen based on the specific symptoms sought to be addressed.

Dr. McElligot delineated the conceivable reasons behind the diminished effectiveness of hormone therapy in women with obesity, referring to various factors influencing the severity and experience of oestrogen deficiency, with obesity being a prime contender. She also brought attention to liver drug metabolism studies that reveal variations in circulating drug quantities based on BMI among adults, shedding light on the possible need for revising hormone therapy dosing recommendations to cater to the distinct metabolic dynamics presented by obesity.

Pioneering digital health startups target U.S. maternal health challenges

The escalating maternal health crisis in the U.S., highlighted by a disconcerting 40% surge in maternal deaths during or shortly after pregnancy to 1,205 in 2021, is instigating an urgent response from the digital health sector. Startups like Pomelo Care, Maven Clinic, and Babyscripts are harnessing virtual services to bridge the maternal care gaps and mitigate pregnancy-related complications, according to the National Center for Health Statistics.

This alarmingly high mortality rate was a significant topic at The Wall Street Journal Health Forum in March. Here, Chelsea Clinton, through her venture-capital firm Metrodora Ventures, stressed the imperative need for intensified support towards women’s health. Clinton is an investor in Oula Health, a startup that’s diving into the sphere of maternal care.

Reports from the Centers for Disease Control and Prevention suggest that 80% of pregnancy-related deaths in the U.S. could have been prevented. Major underlying causes of these fatalities include mental health disorders, heart conditions, and hypertensive disorders during pregnancy.

Digital health startups aim to leverage telehealth and app technologies to identify and manage these health conditions proactively, thereby preventing potentially fatal complications. While technology isn’t the panacea, it undeniably enhances access to medical services and compensates for the scarcity of healthcare professionals, thereby promoting equitable care delivery.

Dr. Kathaleen Barker, an Assistant Professor of Obstetrics and Gynecology at UMass Chan Medical School-Baystate, emphasised the role of technology in equalising access to prenatal care. Baystate Health, a healthcare system in Western Massachusetts, utilises Babyscripts technology.

Investor-backed Babyscripts, headquartered in Washington D.C., collaborates with over 70 U.S. health systems. Co-founder and Chief Executive Anish Sebastian stated that Babyscripts, also known as 1EQ, offers patients a blood-pressure monitor that pairs with an app via Bluetooth. This technological intervention aims to preempt conditions such as preeclampsia, a condition characterised by high blood pressure and signs of liver or kidney damage that can arise after the 20th week of pregnancy.

Pomelo Care, a New York-based virtual clinic, aims to supplement in-person care by providing services between doctors’ appointments. Having secured $33 million in seed and Series A funding led by Andreessen Horowitz, Pomelo Care assigns a nurse to each patient to oversee their care. After assessing the patient’s needs and health claims data, the nurse assembles a personalised care team.

Pomelo Care operates on a value-based business model that encourages improving patient access to care, enhancing outcomes, and reducing costs. The company plans to validate its effectiveness through studies conducted in collaboration with insurers and academic medical centres, with the findings set to be published.

Another player in the field, Maven Clinic, grants virtual access to an array of services, such as doulas, midwives, physical therapists, and mental health care. Maven has devised a tool to screen for social needs like access to housing, food, and essentials for the family and baby.

The stark truth is that women’s health has been neglected in the U.S., resulting in many women living in maternal-care deserts where access to services is challenging. The conversation about this issue is just starting at the national level, noted Kate Ryder, founder, and CEO of Maven Clinic. However, these innovative digital health startups are undoubtedly setting the stage for a more promising, tech-driven future in maternal healthcare.

Prenatal exposure to durable ‘forever chemicals’ may contribute to childhood obesity, study finds

A recent study backed by federal funding suggests that exposure to per- and polyfluoroalkyl substances (PFAS), also known as ‘forever chemicals,’ during pregnancy is associated with higher body mass indices (BMIs) and increased risks of obesity in children.

The study, spearheaded by Brown University researchers, adds to the growing body of evidence that the consequences of exposure to PFAS begin even before birth, potentially predisposing children to health challenges later in life.

PFAS are a group of chemicals used in a variety of products such as water-repellent textiles, personal care items, firefighting foams, food packaging, and medical products, due to their oil and water-resistant properties. Their extremely stable structure means they can persist in the environment for thousands of years, earning them the nickname ‘forever chemicals’.

The research was carried out under the Environmental Influences on Child Health Outcomes (ECHO) program at the National Institutes of Health, employing a more extensive dataset compared to previous studies. Lead author Yun “Jamie” Liu, a postdoctoral research associate in epidemiology at the Brown University School of Public Health, stated that the study analysed eight research cohorts with varying demographics across the United States, making the findings more representative of the general population.

Using data collected over two decades involving 1,391 children aged between 2 and 5 years and their mothers, who were part of ECHO research sites in California, Illinois, Massachusetts, Colorado, New Hampshire, Georgia, and New York, the study examined blood samples taken from mothers during pregnancy. The levels of seven different PFAS were analysed, and children’s body mass indices were calculated.

The study revealed a correlation between higher levels of PFAS in the mothers’ blood during pregnancy and slightly elevated BMIs in children. This increased risk of obesity was consistent among both male and female children. Notably, these associations were evident even at relatively low levels of PFAS exposure.

Joseph Braun, the study’s senior author and a professor of epidemiology at Brown’s School of Public Health, highlighted the significance of these findings in contemporary contexts. He noted that despite the reduction in PFAS usage as manufacturers have phased them out due to health concerns, exposure during pregnancy could still pose risks. “This implies that children may continue to face risks of PFAS-related health issues,” Braun added.

Braun has been engaged in several studies examining the effects of PFAS on children’s health for over a decade. He believes that this kind of research can inform environmental policies and safety guidelines.

The research team aims to continue their investigations by exploring the relationships between maternal PFAS exposure and obesity-linked health outcomes in older children, eventually expanding to adolescents and adults.

The study received support from the ECHO program, the National Institute of Environmental Health Sciences, and the National Institute of General Medicine Sciences.

Elevated risk of stillbirth among pregnant women with obesity

Obesity before pregnancy appears to considerably increase the likelihood of perinatal mortality, suggests a mediation analysis study.

The study, involving 392,820 women, revealed that women with obesity before pregnancy had a 55% increased risk of perinatal mortality – defined as stillbirth or neonatal death prior to hospital discharge, as informed by Jeffrey Bone, a PhD candidate at the University of British Columbia, Vancouver, along with his team.

The study, published in PLoS One, also showed that even women who had overweight before pregnancy exhibited a 22% increased risk of perinatal mortality compared to women who had a normal BMI.

The largest mediator between obesity and perinatal death was the gestational age at delivery, which accounted for 63.1% of the association, according to the researchers. Adjustments were made for factors such as chronic hypertension, smoking, alcohol and substance use, previous stillbirths or preterm births, parity, maternal age, year of birth, chronic diseases, and asthma during the study.

Bone commented that women with obesity often face higher neonatal death rates and stillbirths, and the exact reasons for this remain to be fully deciphered. He said, “Our aim was to determine whether this could be partially attributed to their pregnancies ending earlier than those of women with normal weight.”

Even though these findings were anticipated, Bone believes there are still numerous questions that warrant further investigation. The team has recommended future studies to identify the specific factors contributing to higher pre-pregnancy BMI and their impact on perinatal mortality, such as inactive lifestyle, high calorie diet, and medical or genetic conditions.

The study emphasises the necessity for healthcare professionals to pay extra attention to pregnant women with obesity to prevent stillbirth and neonatal death, especially in the second trimester. Bone emphasised the complexity of the reasons for increased risks, which include maternal complications leading to preterm birth more frequently in obese women, as well as foetal and placental reasons. He stressed that more research is needed to better devise interventions for women with high pre-pregnancy BMI.

The research team evaluated data from 547,401 single live births and stillbirths in British Columbia between 2004 and 2017. The study excluded data from late terminations and women with births before 20 weeks of gestation.

Of the 392,820 women included in the study, 12.8% (50,352) were classified as having obesity, 20.6% (81,065) as having overweight, 60.6% (237,726) as normal weight, and 6.0% (23,677) as underweight. These pre-pregnancy weight categories were self-reported based on the following BMI ranges: underweight (<18.5), normal (18.5 to <25), overweight (25 to <30), and obese (BMI 30+).

The study found that, compared to women with normal BMI, those with obesity were more likely to have multiple births, smoke during pregnancy, suffer from chronic and gestational hypertension or diabetes, and have a history of caesarean delivery.

In terms of preterm birth rates, a pattern emerged correlating higher rates with an increased BMI: 7.3% among women with a normal BMI, 8.1% among overweight women, and 9.7% among women with obesity, according to the researchers.

Increased risk of obesity and high blood sugar in children linked to prenatal cannabis exposure

A newly conducted study suggests that the use of cannabis during pregnancy may heighten the likelihood of children developing obesity or experiencing elevated blood sugar levels by the age of five.

Products containing non-psychoactive cannabidiol (CBD) or the psychoactive compound tetrahydrocannabinol (THC) are often employed by pregnant women to mitigate symptoms such as morning sickness, anxiety, post-traumatic stress disorder (PTSD), insomnia, and pain.

However, the study establishes a correlation between the exposure to such compounds during pregnancy and breastfeeding, and “increased percentages of fat mass and fasting glucose levels” in children upon their entry into school.

Brianna Moore, an assistant professor of epidemiology at the University of Colorado, who focuses her research on how early-life exposure to tobacco and cannabis impacts children’s growth and brain development, is the author of the study. Moore advises women to “avoid all forms of cannabis while pregnant or breastfeeding in order to minimise potential adverse health outcomes in their children.”

The research team analysed urine samples from 103 pregnant women, revealing that 15% of the women had detectable cannabinoid compounds in their bodies.

The findings show that the five-year-old children of these mothers had greater fat mass and fasting glucose levels compared to children whose mothers did not use cannabis during pregnancy.

Cannabis is known to contain over 100 cannabinoids, with CBD and THC being the most widely recognized. According to Dr. Moore, further studies are required to explore the effects of the other compounds on babies exposed to them during gestation and through breastfeeding.

In a separate 2016 study conducted in Colorado, it was discovered that up to 22% of pregnant women exhibited detectable cannabinoid levels in their bodies.

Earlier studies have also indicated that women who use CBD and THC during pregnancy not only increase the risk of their children having low birth weights and behavioural issues but are also doubling the likelihood of premature birth. Additionally, cannabis use during pregnancy has been associated with a higher prevalence of “psychotic-like” behaviours in nine-year-old children, as per other studies conducted in 2019 and 2020.

The research, titled ‘Fetal Exposure to Cannabis and Childhood Metabolic Outcomes: The Healthy Start Study’, is available in the Journal of Clinical Endocrinology and Metabolism published by the Endocrine Society.

Caesarean births linked to higher childhood obesity risk, Japanese study finds

A recent scientific study published in the journal Scientific Reports explores the potential impact of Caesarean section (CS) delivery on the incidence of obesity among three-year-old Japanese children.

Childhood obesity is a growing global health issue, as it can often persist into adulthood and raise the risk of various cardiometabolic disorders. Prior research has suggested that children born via CS may have a higher likelihood of obesity, potentially due to disturbances in their gut microbiomes. These children have been found to exhibit lower adiponectin levels and greater insulin resistance.

While ethnicity and race are also factors in the prevalence of paediatric obesity, with Asian children reportedly at a higher risk than their White and European counterparts, the correlation between CS birth and childhood obesity in the Japanese population remains relatively unexplored.

The objective of this study was to investigate this correlation, which could aid in the early identification of children at risk of adult obesity, thereby enabling early intervention through weight management programs.

For the study, the research team analysed data from 60,769 Japanese mother-child pairs participating in the national Japan Environment and Children’s Study (JECS). The mode of delivery was determined from health records, while anthropometric data was gathered through online questionnaires completed by the participants themselves.

The researchers identified obesity in children using the body mass index (BMI) cut-off values defined by the International Obesity Task Force guidelines, and only included children from singleton births in the analysis. The study excluded any multiple participations, multiple births, stillbirths or miscarriages, or any data with missing information related to height and/or weight, mode of delivery, and other covariates.

The researchers used logistic regression analysis and estimated adjusted risk ratios (aRR), taking into account various maternal and paediatric factors. They also conducted a sensitivity analysis using the obesity thresholds provided by the Japanese Association for Human Auxology guidelines.

The study found that 19% of the children were born via CS, with 8% classified as having obesity. The aRR for obesity in three-year-old Japanese children born through CS was 1.2 compared to those born via vaginal delivery. When the data was stratified by sex, the aRR values were 1.1 for boys and 1.2 for girls.

The sensitivity analysis corroborated these findings, with the risk of childhood obesity remaining statistically significant for Japanese girls. This aligns with previous studies that have reported an increased risk of certain cancers in females born through CS.

The data also revealed that children born via CS had lower birth weights and heights and were more likely to be born before 37 weeks of gestation. Mothers who had a CS were generally older, had higher pre-pregnancy BMIs, were less educated, and had a higher rate of pregnancy-related and obstetric complications. They were also more likely to smoke, suffer from physical illnesses, and use assisted reproductive technology.

In conclusion, the study suggests that CS births slightly heighten the risk of obesity at age three for both boys and girls in the Japanese population. This indicates that the mode of delivery may influence metabolic health, even among ethnic groups that are typically less prone to obesity. Factors such as maternal pre-pregnancy BMI, education level, and the child’s birth weight appeared to confound this relationship.

The study emphasises the need for further research to understand the mechanisms underlying the increased risk of paediatric obesity associated with CS delivery, including the possible association with gut microbiota. Moreover, the long-term cardiometabolic impacts of CS delivery should be further investigated.

Obesity in pregnancy increases the risk of cardiovascular disease in offspring, animal study shows

New research reveals that maternal obesity during pregnancy can have a negative impact on the lifelong health and function of a foetus’s heart. 

Researchers from the University of Colorado, US, have found a connection between maternal obesity and a higher risk of cardiac problems in offspring later in life due to the nutrients received while in the womb. The study involved feeding female mice a high-fat diet equivalent to a human eating a burger, chips, and a fizzy drink daily until they had obesity. Researchers then studied the foetuses of the mice while in the womb and up to 24 months after birth. They analysed their genes, proteins, and mitochondria and found that the heart is affected by the nutrients it receives while growing in the uterus. This leads to alterations in how the organ metabolises carbohydrates and fats. Due to the nutrients found in the high-fat diet, the hearts developed a preference for fats and moved away from sugar.

The study found that the hearts of both female and male offspring grew larger than average, impairing the organ’s ability to function normally due to an increase in weight. Male offspring showed signs of cardiovascular impairment from the start, while females’ health became worse over time. This may be due to increased oestrogen levels present in female mice that offer initial protection against cardiovascular dysfunction. However, this resistance weakens as oestrogen levels decline with age.

Having obesity during pregnancy can lead to the development of cardiovascular and metabolic conditions in humans, such as type 2 diabetes, heart disease, and cancer. The study’s lead author, Dr. Owen Vaughan, suggests that by improving our understanding of the mechanisms involved, this research can pave the way for treatments that could be used in early life to prevent later-life cardiometabolic illnesses. This could include offering more tailored advice on nutrition to mothers or children based on their body mass index or sex or developing new drugs that target metabolism in the heart of the foetus. Therefore, keeping active through regular exercise and maintaining a healthy diet during pregnancy are essential for reducing the risk of developing health complications.

How does birth weight affect adult obesity in a low resource context?

South Africa is experiencing rapid increases in weight gain across the entirety of its population. Obesity is rising in both males and females, across all ages and socioeconomic groups. Like many other low-middle-income countries, it is experiencing a double burden of malnutrition alongside these high obesity rates. Malnutrition is present in one quarter of children under the age of three, resulting in stunting.

This stunting has been reported to be associated with adulthood disease risk, including obesity. Researchers thus far have not been able to look at this relationship in a low-middle-income country in the same participants by following them from birth into early adulthood. The authors of this study were able to do this for the first time using the Birth to Twenty Cohort which is a longitudinal study of children born in 1990 in South Africa.

Authors found that relative weight gain from birth into adulthood was positively related to fat mass, including both visceral and subcutaneous fat in adulthood. Being stunted at age two was inversely associated with fat-free soft tissue mass (i.e. lean body mass) in adulthood. This finding is analogous to trends that have been shown across Brazil, Guatemala and India.