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Context: Sex-specific effects of pregnancy calcium carbonate supplementation have been reported in 8-12 year old Gambian children, indicating faster growth in boys but slower growth in girls born to calcium-supplemented mothers., Objective: To determine whether the pregnancy supplement resulted in sex-specific effects on offspring IGF1 and other growth-related indices in mid-childhood., Design: Analysis of archived data obtained in mid-childhood from the children of rural Gambian mothers who had been randomised to 1500 mgCa/d (Ca) or placebo (P) from 20 weeks pregnancy to delivery (ISRCTN96502494)., Participants and Methods: Of the 526 children born and followed in infancy, 290 had early-morning, fasting plasma assayed for IGF1, IGFBP3, leptin, insulin and calcium-related indices and had anthropometry performed at age 7.5 (SD1.2) years (N/group: Males(M)-Ca = 64, Females(F)-Ca = 77; M-P = 76, F-P = 73). Sex-specific effects of maternal supplementation were considered using regression with sexes separated and together to test for sex ∗ supplement interactions., Results: Boys had lower IGF1, IGFBP3, leptin and insulin than girls (P ≤ 0.004). IGF1 was higher in M-Ca than M-P (+14.2 (SE7.7)%, P = 0.05) but lower in F-Ca than F-P (-17.8 (SE7.4)%, P = 0.01); sex ∗ supplement interaction P = 0.001. IGF1 concentrations (ng/ml, geometric mean [-1SE,+1SE]) were M-Ca = 78.1[4.3,4.5], M-P = 67.8[3.4,3.6]; F-Ca = 99.5[4.8,5.1], F-P = 118.9[6.4,6.8]. Similar sex ∗ supplement interactions were seen for IGFBP3 and IGF1-adjusted-for-IGFBP3 but group differences were smaller. There were no significant supplement effects on the other biochemical indices., Conclusions: Calcium carbonate supplementation of pregnant Gambian mothers resulted in higher IGF1 in boys and lower IGF1 in girls during mid-childhood, consistent with the reported maternal supplement effects on growth of the offspring in later childhood., (Copyright © 2018. Published by Elsevier Inc.)

Background: The long-term impact of early malnutrition on human capital outcomes remains unclear, and existing evidence has come largely from observational studies., Objective: We compared the impact of a nutritional supplement given during pregnancy or lactation in rural Gambia on educational performance and cognitive ability in offspring at their maturity., Design: This study was a follow-up of a randomized trial of prenatal high protein and energy supplementation conducted between 1989 and 1994. Subjects were 16-22 y of age at follow-up, and information was collected on schooling achievement and cognitive ability by using the Raven's progressive matrices test, Mill Hill vocabulary test, and forward and backward digit-span tests., Results: A total of 1459 individuals were traced and interviewed and represented 71% of the original cohort and 81% of the surviving cohort. There was no difference in cognitive ability or educational attainment between treatment groups by using any of the methods of assessment., Conclusion: We have shown little evidence to support a long-term effect of prenatal protein-energy supplementation compared with supplementation during lactation on cognitive development in rural Gambians. This trial was registered at http://www.controlled-trials.com as ISRCTN72582014.

Background: Maternal nutritional intake during pregnancy may have important consequences for long-term health in offspring., Objective: The objective was to follow up the offspring in 2 randomized trials of nutrient supplementation during pregnancy to investigate the effect on cardiovascular disease (CVD) risk in offspring., Design: We recruited offspring born during 2 trials in The Gambia, West Africa. One trial provided protein-energy-dense food supplements (1015 kcal and 22 g protein/d) to pregnant (intervention, from 20 wk gestation until delivery) or lactating (control, for 20 wk from birth) women and was randomized at the village level. The second was a double-blind, individually randomized, placebo-controlled trial of calcium supplementation (1.5 g/d), which was also provided from 20 wk gestation until delivery., Results: Sixty-two percent (n = 1267) of children (aged 11-17 y) born during the protein-energy trial were recruited and included in the analysis, and 64% (n = 350) of children (aged 5-10 y) born during the calcium trial were recruited and included in the analysis. Fasted plasma glucose was marginally lower in children born to mothers receiving protein-energy supplements during pregnancy than in those children of the lactating group (adjusted mean difference: -0.05 mmol/L; 95% CI: -0.10, -0.001 mmol/L). There were no other differences in CVD risk factors, including blood pressure, body composition, and cholesterol, between children born to intervention and control women from the protein-energy trial. Maternal calcium supplementation during pregnancy was unrelated to offspring blood pressure., Conclusion: These data suggest that providing supplements to pregnant women in the second half of pregnancy may have little effect on the CVD risk of their offspring, at least in this setting and at the ages studied here. This trial was registered at www.controlled-trials.com as ISRCTN96502494.

Background: Evidence suggests that increased maternal calcium intake during pregnancy may result in lower offspring blood pressure, prompting calls for more robust data in this field, particularly in settings of habitually low calcium intake., Objective: The objective was to investigate the effect of maternal calcium supplementation on blood pressure in offspring by recruiting children born after a randomized, double-blind, placebo-controlled trial of calcium supplementation during pregnancy., Design: Children (n = 389) from a rural area of The Gambia (mean age: 7.4 ± 1.2 y; range: 5-10 y), whose mothers received a calcium supplement (1500 mg Ca/d from 20 wk of gestation until delivery) or placebo, were followed up in West Africa. Blood pressure was assessed under standardized conditions with use of the Omron 705IT automated oscillometric device (Morton Medical Ltd, London, United Kingdom), and anthropometric and body composition (bioelectrical impedance) measurements were also made., Results: The analysis was restricted to 350 children born at term, which represented 64% of original trial births. There was no difference in systolic (adjusted mean difference: -0.04 mm Hg; 95% CI: -1.78, 1.69 mm Hg) or diastolic (adjusted mean difference: 0.25 mm Hg; 95% CI: -1.27, 1.77 mm Hg) blood pressure between children whose mothers had received calcium and those who received placebo. No interaction between childhood body mass index (in kg/m(2); mean: 14.0) and maternal calcium supplementation was observed in this study., Conclusion: Calcium supplementation in the second half of pregnancy in Gambian women with very low habitual calcium intakes may not result in lower offspring blood pressure at 5-10 y of age.

Animal studies have demonstrated that altering the maternal diet during pregnancy affects offspring disease risk. Data from human subjects on the early-life determinants of disease have been derived primarily from birth-weight associations; studies of the impact of the maternal diet are scarce and inconsistent. Investigating CVD risk factors in the offspring of women who have participated in maternal supplementation trials provides a useful resource in this research field, by virtue of employing an experimental design (as compared with observational studies). To date, follow-up studies have been published only for a small number of trials; these trials include the impact of maternal protein-energy, multiple-micronutrient and Ca supplementation on offspring disease risk. In Nepal maternal micronutrient supplementation has been shown to be associated with lower offspring systolic blood pressure at 2 years of age. Data from Guatemala on a pre- and postnatal protein-energy community intervention have suggested long-term improvements in fasting glucose and body composition but not in blood pressure. In The Gambia no association has been found between prenatal protein-energy supplementation and markers of CVD risk including body composition, blood pressure and fasting glucose and insulin in childhood and adolescence. Little evidence of an effect of maternal Ca supplementation on offspring blood pressure has been demonstrated in four trials, although the risk of high systolic blood pressure was found to be reduced in one trial. The present paper reviews the current evidence relating maternal nutritional supplementation during pregnancy to offspring CVD risk and explores the potential explanations for the lack of association.

Background: Birthweight, and by inference maternal nutrition during pregnancy, is thought to be an important determinant of offspring blood pressure but the evidence base for this in humans is lacking data from randomized controlled trials., Methods: The offspring from a maternal prenatal protein-energy supplementation trial were enrolled into a follow-up study of chronic disease risk factors including blood pressure. Subjects were 11-17 years of age and blood pressure was measured in triplicate using an automated monitor (Omron 705IT). One-thousand two-hundred sixty seven individuals (71% of potential participants) were included in the analysis., Results: There was no difference in blood pressure between those whose mothers had consumed protein-energy biscuits during pregnancy and those whose mothers had consumed the same supplement post-partum. For systolic blood pressure the intention-to-treat regression coefficient was 0.46 (95% CI: -1.12, 2.04). Mean systolic blood pressure for control children was 110.2 (SD +/- 9.3) mmHg and for intervention children was 110.8 (SD +/- 8.8) mmHg. Mean diastolic blood pressure for control children was 64.7 (SD +/- 7.7) mmHg and for intervention children was 64.6 (SD +/- 7.6) mmHg., Conclusions: We have found no association between maternal prenatal protein-energy supplementation and offspring blood pressure in adolescence amongst rural Gambians. We found some evidence to suggest that offspring body composition may interact with the effect of maternal supplementation on blood pressure.

Fetal nutrition is thought to be an important determinant of later disease risk, although evidence from randomized-controlled trials in humans is lacking. We followed children born during a protein-energy supplementation trial to investigate to what extent this maternal supplement, which improved birth weight, influenced offspring body composition in adolescence. Subjects were 1270 Gambian children (659 boys, 611 girls) aged 11-17 y whose mothers had participated in the original cluster-randomized trial and had received the supplement during pregnancy (intervention) or postpartum (control). Basic anthropometry was measured using standard techniques and fatness was assessed by bioelectrical impedance analysis and population-specific prediction equations. For boys, mean body fat was 12.6% for both intervention and control groups. Mean trunk fat was 11.9% in the intervention group and 12.0% in the control. Intervention girls had a mean body fat of 19.5% and trunk fat of 15.2%; for control girls, it was 19.3 and 14.8%, respectively. BMI, body fat, trunk fat, fat mass index, and fat-free mass index did not differ for either sex when analyzed with generalized estimating equations adjusted for age, maternal height, maternal parity, location, season of birth, and menarche in females. Neither infant-attained size nor the onset of menarche were affected by maternal supplementation. These findings suggest that protein-energy supplements to pregnant women, compared with lactating women, do not affect offspring body composition during adolescence.

Objective: To validate the Tanita BC-418MA Segmental Body Composition Analyser and four-site skinfold measurements for the prediction of total body water (TBW), percentage fat-free mass (%FFM) and percentage body fat (%BF) in a population of rural Gambian children., Subjects/methods: One hundred and thirty-three healthy Gambian children (65 males and 68 females). FFM estimated by the inbuilt equations supplied with the Tanita system was assessed by comparison with deuterium oxide dilution and novel prediction equations were produced. Deuterium oxide dilution was also used to develop equations for %BF based on four-site skinfolds (biceps, triceps, subscapular and suprailiac)., Results: The inbuilt equations underestimated FFM compared to deuterium oxide dilution in all the sex and age categories (P<0.003), with greater accuracy in younger children and in males. The best prediction of %FFM was obtained from the variables height, weight, sex, impedance, age and four skinfold thickness measurements (adjusted R(2)=0.84, root mean square error (MSE)=2.07%)., Conclusions: These data suggest that the Tanita instrument may be a reliable field assessment technique in African children, when using population and gender-specific equations to convert impedance measurements into estimates of FFM.