BACKGROUND:To examine associations of B-vitamin intake, B-vitamin-rich dietary patterns, and the B-Vitamin Deficiency Index (BVDI) with bone mineral density (BMD) in children. DESIGN/METHODS:This cross-sectional study included 1026 Chinese children aged 9-12 years. Dietary intake was assessed using a semi-quantitative food-frequency questionnaire. B-vitamin-rich dietary patterns were derived using reduced-rank regression, and cumulative B-vitamin inadequacy was assessed using BVDI based on Chinese Dietary Reference Intakes. Forearm BMD was measured by dual-energy X-ray absorptiometry. Multivariable logistic regression and restricted cubic splines were used. RESULTS:Higher quartiles of vitamin B2, B9, and B12 (Q4 vs Q1: OR = 0.43, 95% CI: 0.25-0.74, OR = 0.50, 95% CI: 0.30-0.85, OR = 0.46, 95% CI: 0.27-0.81, respectively) were associated with lower odds of low BMD. The B-vitamin-rich dietary pattern showed an inverse but borderline association with low BMD (OR = 0.61, 95% CI: 0.36-1.02; P = 0.060). Participants in the highest BVDI quartile had 72% higher odds of low BMD than those in the lowest BVDI quartile (OR = 1.72, 95% CI:1.02-2.92). CONCLUSIONS:Higher intakes of vitamins B2, B9, and B12 were associated with lower odds of low BMD, whereas higher BVDI was associated with higher odds of low BMD. These observational findings suggest that B-vitamin nutritional status may be related to pediatric bone health indicators. IMPACT:Reduced-rank regression identified a B-vitamin-rich dietary pattern characterized by higher intakes of beans, dairy products, meats, grains, eggs, vegetables, and aquatic products; greater adherence to this pattern showed an inverse but borderline association with low bone mineral density (BMD). Higher intakes of vitamins B2, B9, and B12 were associated with lower odds of low BMD. The B-Vitamin Deficiency Index (BVDI), reflecting cumulative inadequacy across eight B vitamins, was associated with higher odds of low BMD. These observational findings suggest that B-vitamin nutritional status may be related to skeletal health indicators in childhood.

Purpose:To evaluate the sleep quality of pregnant women in mid-pregnancy in Wuhan study and analyze its association with birth outcomes in a cross-sectional study. Patients and Methods:The sleep quality of 2210 pregnant women in the second trimester from Wuhan were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Dietary quality and prenatal depression were assessed by the dietary variety score (DVS) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Birth outcomes were retrieved from the Maternal and Child Health Information System. Principal component analysis, stratified analysis, and binary Logistic regression were used for statistical analysis. Results:Among the 2210 pregnant women, the prevalence of sleep disturbance during the second trimester was 18.14%. After adjusting for confounding factors, a EPDS score ≥ 11, pre-pregnancy alcohol consumption, and moderate to severe vomiting during pregnancy were risk factors for sleep disturbance; while a DVS score ≥ 28 points and exercise during pregnancy were protective factors for sleep disturbance. Sleep disturbance were significantly associated with a reduced risk of large for gestational age (LGA) (OR = 0.65, 95% CI: 0.45-0.94, P = 0.023), macrosomia (OR = 0.34, 95% CI: 0.13-0.86, P = 0.023), and a marginal association with an increased risk of preterm birth (PTB) (OR = 1.51, 95% CI: 0.97-2.35, P = 0.065), but stratified interaction analysis showed that sleep disturbance increased the risk of PTB, low birth weight, small for gestational age and small vulnerable neonates in mothers with pre-pregnancy BMI ≥ 24 kg/m2 or delivering a male fetus. Conclusion:Clinically, it is crucial to enhance sleep quality screening during the second trimester and provide targeted interventions for high-risk groups to improve maternal and infant outcomes.

Vitamin D metabolites beyond total 25(OH)D may influence fetal development, yet their trimester-specific associations with small vulnerable newborns (SVN) remain underexplored. This study examined longitudinal associations of multiple vitamin D metabolic markers with SVN-related outcomes and identified key determinants during pregnancy. In this prospective cohort of 2,505 mother-infant pairs from China, serum levels of five vitamin D metabolites 25(OH)D2, 25(OH)D3, total 25(OH)D, 3-epi-25(OH)D3, and 24,25(OH)2D3] were quantified using HPLC-MS/MS. Two vitamin D metabolite ratios (VMR), VMR1 [24,25(OH)2D3/25(OH)D3] and VMR2 [3-epi-25(OH)D3/25(OH)D3], were derived. Outcomes included low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and composite SVN. Associations were evaluated using multivariable logistic regression and restricted cubic spline models. Determinants, including dietary intake, supplementation, season of sample collection, and sociodemographic factors, were evaluated via multivariable linear regression. Vitamin D deficiency decreased from 42.0

Background: The Nutrition Improvement Program has been implemented in China for over a decade; however, its assessment in Hubei Province has not yet been systematically reported. This study evaluated the implementation outcomes of the Rural Compulsory Education Students' Nutrition Improvement Program in Hubei Province. Methods: A multi-stage cluster sampling design with stratification by school type was used. Standardized questionnaires were administered to schools, districts, and students to assess the food environment, nutrition policies, and dietary behaviors. Anthropometric and biochemical measurements were collected from all participants in 2014 and 2023. Results: A total of 24 schools across six counties in Hubei Province were surveyed at two time points, comprising 8619 students (4388 in 2014 and 4231 in 2023). Between 2014 and 2023, the proportion of students in the Nutrition Improvement Program reporting satisfaction with school meals increased significantly, and average nutritional knowledge scores improved. Nevertheless, several deficiencies persisted: menus remained poorly aligned with dietary guidelines, food variety was limited, full-time nutrition or health teachers were scarce, and absolute levels of nutritional knowledge remained low. In 2023, the prevalence of undernutrition, overweight/obesity, and anemia among program participants was 9.5%, 15.9%, and 12.2%, respectively. Compared with girls, boys had higher rates of undernutrition and overweight/obesity and a lower anemia rate; the same pattern was observed in primary school students relative to junior high school students. Compared with 2014, the nutritional profile shifted markedly (p < 0.001). Undernutrition and anemia declined by 7.4 and 4.9 percentage points, respectively, whereas overweight/obesity increased by 6.9 percentage points. Conclusions: From 2014 to 2023, students in the Nutrition Improvement Program of Hubei Province experienced observable changes in nutritional status: the primary nutritional concern had shifted from undernutrition to overnutrition, and the prevalence of anemia has generally decreased, while it has increased in some areas. However, given the observational nature of the repeated cross-sectional design, causal inference regarding the program's impact was not supported.

Abstract This study aimed to explore association of maternal dietary cholesterol and polymorphisms of genes coding for cholesterol metabolism pathway proteins with birth weight. A total of 1941 mother-infant pairs were included based on Tongji Birth Cohort. Dietary cholesterol was assessed by a validated food frequency questionnaire. Genotyping was performed using time-of-flight mass spectrometry. The genetic risk score (GRS) was calculated using genetic variants from 21 cholesterol metabolism-related single-nucleotide polymorphisms (SNPs). The results showed that the dietary cholesterol intake was linearly associated with the odd ratio (OR) of large-for-gestational-age (LGA) (P = 0.012), but nonlinearly associated with small-for-gestational-age (SGA) (P = 0.014). Compared to pregnant women with an egg intake of <7.0 eggs/week, participants who consumed ≥ 7 egg/week had an increased risk of LGA (OR = 1.62, 95%CI 1.00, 2.62). LDL-C mediated the association between dietary cholesterol and LGA. The variants of the ABCA1 rs1883025 C → T showed a significant association with birth weight and LGA, and CYP7A1 rs7833904 A → T presented a significant association with SGA. The GRS of these 21 variant SNPs was also linked to SGA and LGA, respectively. The OR was 2.13 (1.12, 4.07) in the highest categories of both dietary cholesterol and GRS compared with individuals with the lowest strata. Both dietary cholesterol intake and genetic variants of cholesterol metabolism genes are associated with risk of SGA and LGA.

Yogurt is commonly recommended during pregnancy, but its association with infantile diarrhoea remains unclear. This prospective study was embedded in the Tongji Maternal and Child Health Cohort. Yogurt intake was assessed using a food frequency questionnaire and categorised based on frequency, amount and their combination. Infantile diarrhoea was diagnosed by doctors. Poisson regression models were used to estimate the adjusted relative risks (aRRs). Among 2161 mother-infant pairs, 72.9% mothers consumed yogurt, and 24.2% infants experienced diarrhoea. Each 100 g/week increase or each 1 time/week increase in yogurt intake were associated with reduced risks of infantile diarrhoea, with aRRs (95% CI) of 0.98 (0.96, 0.99) and 0.96 (0.94, 0.99), respectively. Compared with non-consumers, regular high consumers (≥3 times/week and ≥600 g/week had a significantly lower risk of infantile diarrhoea (aRR: 0.79, 95% CI: 0.65, 0.96). Regular high yogurt intake during late pregnancy may help protect infants from diarrhoea.

Objective:The study aims to prospectively examine the association between the minimum dietary diversity for women (MDD-W) score and risk of gestational diabetes mellitus (GDM). Methods:All participants were pregnant women enrolled in the Tongji Maternal and Child Health Cohort. Dietary intake was assessed using a food frequency questionnaire (FFQ) or 24-h dietary recall. The MDD-W score was constructed by categorizing all food items into 10 food groups, following the Food and Agriculture Organization guidelines. Oral glucose tolerance tests (OGTT) were conducted during 24-28 weeks of gestation to screen for GDM. Poisson regression models were used to assess the association between MDD-W scores and GDM risk. Results:In total, 357 (11.8%) of the 3,026 women were diagnosed with GDM. Compared with participants whose MDD-W score was ≥ 8, those with a score of 5-7 had an increased risk of GDM (relative risk ( RR): 1.32; 95% confidence interval ( CI): 1.03, 1.69), and those with a score ≤ 4 had a significantly higher GDM risk ( RR: 1.58; 95% CI: 1.12, 2.26). Furthermore, these findings indicate that pregnant women with MDD-W scores < 8, in conjunction with being overweight or obese before pregnancy and excessive gestational weight gain, have the highest risk of developing GDM. Conclusions:These data suggest that a higher MDD-W score during pregnancy is independently associated with a lower GDM risk. Therefore, promoting dietary diversity and weight management is recommended to protect pregnant women from developing gestational diabetes.

Cholesterol has increasingly been recognized for its pivotal role in the regulation of glucose metabolism. It influences the pathophysiological processes of type 2 diabetes mellitus (T2DM) by affecting pancreatic β-cell function and promoting insulin resistance. Potential mechanisms include alterations in Ca2⁺ homeostasis, activation of the PERK-eIF2α signaling pathway, Golgi stress, as well as modulation of inflammation, oxidative stress, bile acids metabolism, and gut microbiota composition. While observational studies consistently demonstrate significant associations between cholesterol and its metabolic markers with T2DM, the findings from randomized controlled trials and Mendelian randomization studies remain inconsistent. This review provides an overview of cholesterol metabolism, examines the biological mechanisms linking cholesterol dysmetabolism to T2DM, and summaries the current evidence from population-based studies regarding the relationship between cholesterol metabolism and risk of T2DM.

BACKGROUND:A varied diet during pregnancy benefits development of the fetus, but its impact on the infant respiratory health is less well-known. This study prospectively examines the association between the maternal Minimum Dietary Diversity for Women (MDD-W) score and the risk of lower respiratory tract infections (LRTIs) in infants. METHODS:This study included 2588 women in Wuhan, China. Dietary intake was assessed using validated food frequency questionnaires. All food items were categorized into 10 groups based on guidance from the Food and Agriculture Organization to construct the MDD-W score. Infant LRTIs were recorded at 3-, 6-, and 12-months postpartum follow-ups. RESULTS:In the study, 347 (13.4%) infants with LRTIs during the first year. Maternal MDD-W score ≤5 was associated with the higher risk of infant LRTIs (RR: 1.51; 95% CI: 1.11, 2.06) and hospitalization due to LRTIs (RR: 1.93; 95% CI: 1.23, 3.05) compared score ≥9. When the outcome was further subdivided into LRTIs at 0-6 months and 6-12 months of age, this association was only present at 0-6 months of age (RR: 2.02; 95% CI: 1.31, 3.10). CONCLUSIONS:Our results suggest that low maternal dietary diversity is associated with a higher risk of infant LRTIs. IMPACT:Diversified diet during pregnancy benefits the fetus's development, but few studies have demonstrated the effect of dietary diversity during pregnancy on the infant respiratory health. In this longitudinal cohort in China, we found that a varied diet during pregnancy was associated with a lower risk of infant lower respiratory tract infections, the association remained regardless of whether infants breastfed. An intervention to increase maternal dietary diversity should be carefully considered.

BACKGROUND:Diabetes mellitus promotes atherosclerosis (AS), a major cause of cardiovascular disease. Statins, clinical drugs for AS treatment, may increase the risk of diabetes and induce hepatotoxicity. Polyphenols can alleviate AS by exerting anti-inflammatory and antioxidant effects, and play a role in liver protection. However, the effects of polyphenol extract (PE) on diabetic AS and whether PE can assist atorvastatin in managing diabetic AS with additional benefits remain poorly understood. PURPOSE:This study aims to investigate the synergistic effects of a type of PE with atorvastatin on diabetic AS, as well as explore the anti-atherogenic mechanisms of PE. METHODS:Polyphenol constituents in PE were identified using UPLC-MS/MS. Streptozocin -induced diabetic ApoE-/- mice were orally administered 350 and 700 mg/kg of PE, 10 mg/kg of atorvastatin, or 5 mg/kg of atorvastatin+700 mg/kg of PE for 10 weeks. Atherosclerotic lesions and plaque stability were evaluated using Oil Red O staining, Sirius red staining, and immunofluorescence. Inflammation and oxidative stress were determined using the corresponding markers. Hepatic pathological changes were assessed using hematoxylin and eosin staining. Network pharmacology prediction, molecular docking, microscale thermophoresis (MST) and western blotting were used to explore the anti-atherosclerotic mechanisms of PE. RESULTS:The polyphenolic constituents of PE mainly consist of flavonoids and phenolic acids. PE treatment effectively mitigated atherosclerotic lesions in diabetic mice, particularly at high dose. Co-treatment with a half-dose of atorvastatin and PE did not restrain the anti-atherosclerotic effects of atorvastatin treatment, whereas the combination better relieved hyperglycemia, inflammation, oxidative stress, and liver damage in diabetic AS compared to that with atorvastatin alone. In addition, network pharmacology, molecular docking, MST and western blotting results indicated that PE ameliorated diabetic AS, possibly by targeting the AKT/mTOR/HIF-1 signaling pathway. CONCLUSION:The PE demonstrated efficacy against diabetic AS and cooperated with atorvastatin for some additional benefits, especially in liver protection, indicating that PE has the potential to be developed as a supplement for the management of diabetes-related AS.

Studies in rats indicate that oscillatory signatures of memory processing during sleep, specifically hippocampal sharp wave-ripples, also regulate peripheral glucose concentration. Here, we examined whether there is a similar link between such signatures of memory processing and glucose regulation during sleep in healthy humans. We obtained polysomnographic recordings and continuous recordings of peripheral interstitial glucose levels (1 sample/minute) from 10 participants (5 females) during two consecutive nights. Temporal relationships between electroencephalography (EEG) events of interest and glucose levels were examined using cross-correlation functions and peri-event time histograms. Confirming the findings in rats, we found that sleep spindles, a core signature of sleep-dependent memory processing, were followed within 1-6 minutes by a robust decrease in glucose concentrations. By contrast, slow oscillation events hallmarking slow wave sleep were followed, with a lag of 5-11 minutes, by an increase in glucose levels. Transitions into rapid eye movement sleep were followed by a glucose decrease after 10-14 minutes, whereas awakenings and microarousals were linked to immediate glucose increases. These temporal relationships indicate a sleep-specific regulation of peripheral glucose concentrations that is linked to both signatures of sleep-dependent memory processing as well as the macro-architecture of sleep. They possibly reflect noradrenergic regulation of sympathetic activity via the brainstem locus coeruleus and may be of relevance in clinical conditions with concurrent disturbances of sleep and glucose regulation.

BackgroundBreastfeeding and human milk are the normative standards for infant feeding and nutrition.ObjectivesWe aimed to examine the association of breastfeeding practices during the first year of life with subsequent infant respiratory tract infections (RTIs).MethodsThe study was a secondary analysis embedded in the Tongji Maternal and Child Health Cohort study. Information on infant breastfeeding was collected at 3, 6, and 12 months of age. Pediatrician-diagnosed infant RTIs and hospitalization for RTIs during 12-24 months were obtained at 24 months postpartum. Robust log-Poisson regression models were applied to explore the association of breastfeeding practices with RTIs risk and hospitalization due to RTIs.ResultsAmong the 5242 infants studied, 13.1% (n = 435) of infants received full breastfeeding for six months and continued breastfeeding for at least one year (F6-L). When compared with infants in the F6-L group, those who were formula fed (FF) had a higher risk of RTIs, including upper RTIS and lower RTIS, the adjusted RRs (95%CIs) were 1.34 (1.17, 1.53), 1.31 (1.12, 1.52), 1.59 (1.10, 2.31), respectively. When compared with infants in the F6-L group, the adjusted RRs (95%CIs) for hospitalization from RTIs was 1.88 (1.20, 2.95) for the FF group.ConclusionFull breastfeeding for six months and continued breastfeeding for at least one year was associated with a lower risk of subsequent infant RTIs and hospitalization from RTIs.

Maternal vitamin D deficiency is common worldwide and has a significant impact on newborns. However, whether vitamin D intake during pregnancy is related to small vulnerable newborns (SVN) has not been confirmed. Thus, we sought to examine the relationship between maternal vitamin D intake, including vitamin D supplementation and dietary intake, and the risk of SVN. A total of 2980 Chinese mother-infant pairs were included in this study. Information on vitamin D supplementation and dietary intake was prospectively collected through face-to-face interviews. The outcomes assessed included low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and SVN (having LBW, PTB, or SGA). Logistic regression models were used to evaluate the association of vitamin D intake with different types of SVN, and a restricted cubic spline function was modeled to explore their dose-response associations. Compared to the lowest total vitamin D intake in the first trimester, the highest total vitamin D intake was associated with a 50.0% decrease in the SGA risk (OR: 0.50, 95% CI: 0.26, 0.96) and a 41.0% decrease in the SVN risk (OR: 0.59, 95% CI: 0.36, 0.95). Similar protective results were observed between vitamin D supplementation in the first trimester and SGA and SVN risks. Moreover, a significant L-shaped relationship was identified for total vitamin D intake, vitamin D supplementation, and dietary intake with the risk of different types of SVN. In conclusion, higher total vitamin D intake and supplementation in the first trimester were associated with a reduced risk of SGA and SVN.

A high-fat diet (HFD) induces obesity and insulin resistance, which may exacerbate amyloid-β peptide (Aβ) pathology during Alzheimer’s disease (AD) progression. Branched-chain amino acids (BCAAs) accumulate in obese or insulin-resistant patients and animal models. However, roles of accumulated BCAAs and their metabolites, branched-chain keto acids (BCKAs), in the HFD-induced deterioration of AD and the underlying mechanisms remains largely unclear. In this study, APPswe/PSEN1dE9 (APP/PS1) transgenic mice were fed a HFD for 6 months, and the BCAAs content of the HFD was adjusted to 200

Scope To assess the associations of dietary protein intake from different sources during pregnancy with maternal and umbilical cord plasma amino acid levels. Methods and results The study includes 216 pregnant women and 39 newborns from the Tongji Birth Cohort in Wuhan, China. The study examines the levels of 21 amino acids in maternal and cord plasma samples using ultra‐performance liquid chromatography with tandem mass spectrometry. A significant positive relationship is observed between dietary protein intake from refined grains and maternal plasma cysteine levels. Dietary protein intake from dairy products is positively associated with maternal plasma levels of sulfur amino acid (mainly cystine), but negatively associated with maternal plasma levels of glutamic acid. In addition, the study observes that pre‐pregnancy body mass index and parity may be potential determinants of maternal plasma amino acid levels, whereas a history of passive smoking during pregnancy is an important factor influencing cord plasma amino acid levels. Conclusions These findings suggest that dietary protein intakes from specific sources during pregnancy may affect maternal plasma levels of amino acids.

Diet is an essential modifiable determinant of bone health, yet the associations between dietary patterns (DPs) and bone mineral density (BMD) in Chinese children remain limited. This study aimed to investigate the relationship between overall diet and low BMD risk among school-aged children in China. A total of 1,099 children aged 9–12 in China were recruited for this cross-sectional study. A semi-quantified food frequency questionnaire (FFQ) was used to assess dietary intake. A priori numerical index, the Chinese Dietary Guidelines Index for Children and Adolescents [CDGI (2021)-C] was utilized to assess dietary quality. Specific DPs were identified by using principal components analysis (PCA). The BMD of the left forearm was assessed using dual-energy X-ray absorptiometry (DXA). Spearman correlation test was conducted to investigate the associations between DPs. Multivariate logistic regression analysis and restricted cubic spline models (RCS) were applied to explore the associations between DPs and BMD. Three distinct DPs were identified: the plant-animal balanced pattern, the grain-tuber-meat pattern, and the bean-dairy pattern. We found a weak but significant positive correlation of the CDGI (2021)-C with the plant-animal balanced pattern (R = 0.318, P < 0.001), and with the bean-dairy pattern (R = 0.266, P < 0.001), respectively. After adjusting for covariates, adherence to the CDGI (2021)-C (Q4 vs. Q1, OR = 0.45, 95

With the increasing trend of global aging, sarcopenia has become a significant public health issue. Goji berry, also known as "Gou qi zi" in China, is a traditional Chinese herb that can enhance the structure and function of muscles and bones. Otherwise, previous excellent publications illustrated that plant-derived exosome-like nanoparticles can exert good bioactive functions in different aging or disease models. Thus, we issued the hypothesis that Gouqi-derived nanovesicles (GqDNVs) may also have the ability to improve skeletal muscle health, though the effect and its mechanism need to be explored. Hence, we have extracted GqDNVs from fresh berries of Lycium barbarum L. (goji) and found that the contents of GqDNVs are rich in saccharides and lipids. Based on the pathway annotations and predictions in non-targeted metabolome analysis, GqDNVs are tightly associated with the pathways in metabolism. In muscle atrophy model mice, intramuscular injection of GqDNVs improves the cross-sectional area of the quadriceps muscle, grip strength and the AMPK/SIRT1/PGC1 alpha pathway expression. After separately inhibiting AMPK or PGC1 alpha in C2C12 cells with dexamethasone administration, we have found that the activated AMPK plays the chief role in improving cell proliferation induced by GqDNVs. Furthermore, the energy-targeted metabolome analysis in the quadriceps muscle demonstrates that the GqDNVs up-regulate the metabolism of amino sugar and nucleotide sugar, autophagy and oxidative phosphorylation process, which indicates the activation of muscle regeneration. Besides, the Spearman rank analysis shows close associations between the quality and function of skeletal muscle, metabolites and expression levels of AMPK and SIRT1. In this study, we provide a new founding that GqDNVs can improve the quality and function of skeletal muscle accompanying the activated AMPK/SIRT1/PGC1 alpha signaling pathway. Therefore, GqDNVs have the effect of anti-aging skeletal muscle as a potential adjuvant or complementary method or idea in future therapy and research.

Context Evidence on the associations of low-carbohydrate diet (LCD) during pregnancy with gestational diabetes mellitus (GDM) has been limited and inconsistent. Objective We aimed to prospectively evaluate the risk of GDM associated with the LCD considering the quality of macronutrients. Methods All participants were from a prospective cohort in Wuhan, China. The overall, healthy LCD (emphasizing low-quality carbohydrates, plant protein, and unsaturated fat), and unhealthy LCD (emphasizing high-quality carbohydrates, animal protein, and saturated fat) scores were calculated according to the percentage of energy intake from carbohydrates, protein, and fat. GDM was screened by a 75-g oral glucose tolerance test between 24 and 28 weeks. Poisson regression models were used to calculate relative risks (RRs) and 95% CIs. Results Of 2337 pregnant women, 257 (11.0%) were diagnosed with GDM. Overall LCD score was not associated with risk of GDM, but the healthy and unhealthy LCD scores were associated with the risk of GDM. The multivariable-adjusted RRs (95% CI) were 0.68 (0.49-0.94) and 1.52 (1.11-2.08) for healthy and unhealthy LCD scores comparing the highest with the lowest quartile. Substituting high-quality carbohydrates for low-quality carbohydrates and animal protein, and substituting unsaturated fat for saturated fat, were associated with a 13% to 29% lower risk of GDM. Conclusion A healthy LCD during pregnancy characterized by high-quality carbohydrates, plant protein, and unsaturated fat was associated with a lower risk of GDM, whereas an unhealthy LCD consisting of low-quality carbohydrates, animal protein, and saturated fat was associated with a higher risk of GDM.

Objective: To evaluate the association between patterns of gestational weight gain (GWG) and allergic diseases in offspring.Design: Prospective cohort study.Setting: Prenatal clinics in Wuhan, China. Population: A cohort of 2546 mother and offspring pairs were enrolled before 16 weeks of gestation and followed up to 24 months postpartum.Methods: Maternal body weights were measured regularly during pregnancy, and their GWG patterns were estimated using the growth mixture model. Robust Poisson models were used to evaluate relative risk (RR) and 95% CI after multivari-able adjustment.Main outcome measures: Offspring atopic allergy and allergic contact dermatitis were defined according to a physician's diagnosis reported by the mother, and food allergy was reported by the mother.Results: Three GWG patterns were identified: 18.1% (461) of the women were de-scribed as pattern 1, characterised by rapid GWG earlier in pregnancy; 56.6% (1442) of the women were described as pattern 2, with steady GWG throughout pregnancy; and 25.3% (643) of the women was described as pattern 3, with rapid GWG later in pregnancy. By the age of 24 months, 360 (14.1%), 109 (4.3%) and 757 (29.7%) offspring had atopic allergy, allergic contact dermatitis or food allergy, respectively. Compared with women in GWG pattern 2, the RRs (95% CIs) among women in pattern 1 were 0.74 (0.55- 0.99) for atopic allergy, 0.64 (0.36- 1.15) for allergic contact dermatitis and 0.95 (0.81- 1.12) for food allergy.Conclusions: Maternal GWG pattern characterised by rapid GWG earlier in pregnancy was associated with a lower risk of atopic allergy in offspring.