Association of maternal pre-pregnancy BMI and breastfeeding with NAFLD in young adults: a parental negative control study

Kushala Wm Abeysekera; James G Orr; Paul Madley-Dowd; Gwen S Fernandes; Luisa Zuccolo; Fiona H Gordon; Deborah A Lawlor; Jon Heron; Matthew Hickman

doi:10.1016/j.lanepe.2021.100206

Association of maternal pre-pregnancy BMI and breastfeeding with NAFLD in young adults: a parental negative control study

Lancet Reg Health Eur. 2021 Sep 5:10:100206. doi: 10.1016/j.lanepe.2021.100206. eCollection 2021 Nov.

Authors

Kushala Wm Abeysekera^{1

2}, James G Orr², Paul Madley-Dowd¹, Gwen S Fernandes¹, Luisa Zuccolo^{1

3}, Fiona H Gordon², Deborah A Lawlor^{1

3

4}, Jon Heron¹, Matthew Hickman^{1

3}

Affiliations

¹ Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
² Department of Liver Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, UK.
³ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
⁴ Bristol NIHR Biomedical Research Centre.

Abstract

Background: The importance of the maternal-infant dyad in the genesis of nonalcoholic fatty liver disease (NAFLD) is of increasing interest. The Avon Longitudinal Study of Parents and Children (ALSPAC) showed that at age 24, 1 in 5 had NAFLD measured by transient elastography and controlled attenuation parameter (CAP). Our aim was to investigate the association between breastfeeding duration and maternal pre-pregnancy BMI on offspring NAFLD in young adulthood.

Methods: 4021 participants attended clinic for FibroScan and CAP measurement using Echosens 502 Touch®. 440 participants with Alcohol Use Disorders were excluded. Offspring of 100 non-singleton pregnancies were excluded. 2961 valid CAP measurements for NAFLD were analysed. Exposures of interest were breastfeeding of any duration, ≥6months exclusive breastfeeding, and maternal pre-pregnancy BMI. Multivariable regression models estimated the odds of NAFLD at 24 years. We performed a paternal negative control test to explore residual confounding in the analyses of pre-pregnancy BMI.

Findings: There was a modest inverse association of exclusive and non-exclusive breastfeeding ≥6 months having a protective effect on NAFLD in offspring (OR 0·92 [95%CI 0·66-1·27] and OR 0·90 [0·67-1·21] respectively).The odds of offspring NAFLD in overweight pre-pregnancy maternal BMI and paternal BMI was OR 2·09 [1·62-2·68] and OR 1·33 [95%CI 1·07-1·65] respectively, with the ratio of effect sizes OR 1·57 [1·11-2·22]. Similarly, odds of offspring NAFLD with obese pre-pregnancy maternal BMI and paternal BMI was OR 2·66 [1·71-4·14] and OR 1·35 [0·91-2·00] respectively, with the ratio of effect sizes OR 1·98 [1·05-3·74].

Interpretation: Higher maternal pre-pregnancy BMI was associated with offspring NAFLD, having accounted for shared parental confounding. We did not replicate previous work that found a strong association between breastfeeding and NAFLD.

Funding: Medical Research Council UK, Alcohol Research UK, David Telling Charitable Trust.

Keywords: ALSPAC; Breastfeeding; Controlled attenuation parameter; Maternal pre-pregnancy BMI; Non-alcoholic fatty liver disease; Transient elastography; Young adults.

Abstract

Grants and funding