TY - JOUR T1 - Maternal diet in pregnancy and child's respiratory outcomes: an individual participant data meta-analysis of 18 000 children JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01315-2021 SP - 2101315 AU - Sara M. Mensink-Bout AU - Evelien R. van Meel AU - Johan C. de Jongste AU - Isabella Annesi-Maesano AU - Adrien M. Aubert AU - Jonathan Y. Bernard AU - Ling-Wei Chen AU - Cyrus Cooper AU - Sarah R. Crozier AU - Wojciech Hanke AU - Nicholas C. Harvey AU - James R. Hébert AU - Barbara Heude AU - Joanna Jerzynska AU - Cecily C. Kelleher AU - John Mehegan AU - Fionnuala M. McAuliffe AU - Catherine M. Phillips AU - Kinga Polanska AU - Caroline L. Relton AU - Nitin Shivappa AU - Matthew Suderman AU - Vincent W.V. Jaddoe AU - Liesbeth Duijts Y1 - 2021/01/01 UR - http://erj.ersjournals.com/content/early/2021/08/26/13993003.01315-2021.abstract N2 - Rationale Severe fetal malnutrition has been related to an increased risk of respiratory diseases later in life, but evidence for the association of a suboptimal diet during pregnancy with respiratory outcomes in childhood is conflicting. We aimed to examine whether a pro-inflammatory or low-quality maternal diet during pregnancy was associated with child's respiratory health.Methods We performed an individual participant meta-analysis among 18 326 mother-child pairs from seven European birth cohorts. Maternal pro-inflammatory and low-quality diet were estimated by energy-adjusted Dietary Inflammatory Index (E-DIITM) and Dietary Approaches to Stop Hypertension (DASH) scores. Preschool wheezing and school-age asthma were measured by questionnaires and lung function by spirometry.Results After adjustment for lifestyle and sociodemographic factors, we observed that a higher maternal E-DII score (a more pro-inflammatory diet) during pregnancy was associated only with a lower FVC in children (Z-score difference (95% confidence interval (CI)): −0.05 (−0.08, −0.02), per IQR increase). No linear associations of the maternal E-DII or DASH score with child's wheezing or asthma were observed. When exploratively examining the extremes, a very low DASH score (<10th percentile) (a very low dietary quality) was associated with an increased risk of preschool wheezing and a low FEV1/FVC (z-score <−1.64) (OR (95% CI) 1.20 (1.06, 1.36), 1.40 (1.06, 1.85), compared to ≥10th percentile), with corresponding population attributable risk fractions of 1.7% and 3.3%.Conclusion Main results from this individual participant data meta-analysis do not support the hypothesis that maternal pro-inflammatory or low-quality diet in pregnancy are related to respiratory diseases in childhood.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Mensink-Bout has nothing to disclose.Conflict of interest: Dr. van Meel has nothing to disclose.Conflict of interest: Dr. de Jongste has nothing to disclose.Conflict of interest: Dr. Annesi-Maesano has nothing to disclose.Conflict of interest: Dr. Aubert has nothing to disclose.Conflict of interest: Dr. Bernard has nothing to disclose.Conflict of interest: Dr. Chen has nothing to disclose.Conflict of interest: Professor Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda and UCB.Conflict of interest: Dr. Crozier has nothing to disclose.Conflict of interest: Dr. Hanke has nothing to disclose.Conflict of interest: Professor Harvey has nothing to disclose.Conflict of interest: Dr. Hebert reports grants and other from Connecting Health Innovations LLC (CHI), outside the submitted work; In addition, Dr. Hebert has IP protection via Federally registered trademark for the DII with royalties paid to Connecting Health Innovations LLC (CHI).Conflict of interest: Dr. Heude has nothing to disclose.Conflict of interest: Dr. Jerzynska has nothing to disclose.Conflict of interest: Dr. Kelleher has nothing to disclose.Conflict of interest: Dr. Mehegan has nothing to disclose.Conflict of interest: Dr. McAuliffe has nothing to disclose.Conflict of interest: Dr. Phillips has nothing to disclose.Conflict of interest: Dr. Polanska has nothing to disclose.Conflict of interest: Prof. Relton has nothing to disclose.Conflict of interest: Dr James R. Hebert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the rights to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smartphone applications for patient counseling and dietary intervention in clinical settings. Dr Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this projectConflict of interest: Dr. Suderman has nothing to disclose.Conflict of interest: Dr. Jaddoe has nothing to disclose.Conflict of interest: Dr. Duijts reports grants from European Union's Horizon 2020 research and innovation programme, grants from European Union's Horizon 2020 co-funded programme ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL) and ZonMW, during the conduct of the study; . ER -