Maternal diet during early childhood, but not pregnancy, predicts diet quality and fruit and vegetable acceptance in offspring

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  • Maternal diet during early childhood, but notpregnancy, predicts diet quality and fruit and vegetableacceptance in offspring

    Amy M. Ashman*, Clare E. Collins, Alexis J. Hure, Megan Jensen andChristopher Oldmeadow**,*School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, 2308, Australia, Gomeroi gaaynggal centre, The University ofNewcastle, Tamworth, New South Wales 2340, Australia, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle,Callaghan, New South Wales 2308, Australia, School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales 2308,Australia, CHU Sainte-Justine, Montral, Quebec H3T 1C5, Canada, **Clinical Research Design, IT and Statistical Services, Hunter Medical ResearchInstitute, Rankin Park, New South Wales 2305, Australia, and School of Medicine and Public Health, Faculty of Health and Medicine, The University ofNewcastle, Callaghan, New South Wales 2308, Australia


    Studies have identified prenatal flavour exposure as a determinant of taste preferences in infants; however, thesestudies have focused on relatively small samples and limited flavours. As many parents struggle with gettingchildren to accept a variety of nutritious foods, a study of the factors influencing food acceptance is warranted.The objective of this study was to determine whether exposure to a wider variety of fruit and vegetables andoverall higher diet quality in utero results in acceptance of a greater variety of these foods and better diet qualityfor offspring during childhood. This study is a secondary data analysis of pregnant women (n = 52) and theirresulting offspring recruited for the Women and Their Childrens Health study in NSW, Australia. Dietaryintake of mothers and children was measured using food frequency questionnaires. Diet quality and vegetableand fruit variety were calculated using the Australian Recommended Food Score and the Australian Child andAdolescent Recommended Food Score. Associations between maternal and child diet quality and variety wereassessed using Pearsons correlations and the total effect of in utero maternal pregnancy diet on childhood dietwas decomposed into direct and indirect effect using mediation analysis. Maternal pregnancy and post-natal dietwere both correlated with child diet for overall diet quality and fruit and vegetable variety (P < 0.001). Mediationanalyses showed that the indirect effect of maternal pregnancy diet on child diet was mediated through maternalpost-natal diet, particularly for fruit (P = 0.045) and vegetables (P = 0.055). Nutrition intervention should there-fore be aimed at improving diet quality and variety in mothers with young children, in order to subsequentlyimprove eating habits of offspring.

    Keywords: pregnancy, child, diet quality, variety, fruit, vegetable.

    Correspondence: Professor Clare E. Collins, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle,Callaghan, NSW 2308, Australia. E-mail:


    Vegetables and fruit are cornerstones of a healthfuldiet, and their consumption has long been linked withchronic disease prevention and positive health out-comes (National Health and Medical ResearchCouncil, Department of Health and Ageing 2013).However, the 2007 Childrens Nutrition and PhysicalActivity Survey showed that three quarters of Aus-

    tralian children aged 2 to 8 years did not meet veg-etable recommendations for a healthy, nutrient-densevaried diet, with inadequate fruit and vegetableintake, and high saturated fat and sugar intakehighlighted (Department of Health and Ageing,Department of Agriculture, Fisheries and Forestry2008). Poor eating habits in childhood have beenshown to track into adulthood and can contribute tothe development of chronic disease later in life


    DOI: 10.1111/mcn.12151

    Original Article

    1 2014 John Wiley & Sons Ltd Maternal and Child Nutrition (2014), , pp.

  • (Berenson et al. 1992; Mikkil et al. 2005; Northstone& Emmett 2008). It is therefore imperative to estab-lish healthy eating habits in early childhood.

    In westernized countries, most of the diseaseburden from poor nutrition is due to excess intake ofenergy-dense, nutrient-poor foods, which are foodshigh in energy, saturated fat and added or refinedsugars and/or salt (National Health and MedicalResearch Council, Department of Health and Ageing2013). These energy-dense, nutrient-poor foods arereadily available and affordable (Beauchamp &Mennella 2009). Many parents report difficulties withfeeding children a wide variety of nutrient-densefoods from the core food groups (vegetables andlegumes, fruit, whole grains, lean meat and vegetarianalternatives and dairy foods), particularly for vegeta-bles (National Health and Medical Research Council,Department of Health and Ageing 2013). Encourag-ing vegetable intake from an early age remains achallenging area for both parents and dietetic profes-sionals (Carruth et al. 2004; Maier et al. 2007).If children enjoy the flavour of a food, they are morelikely to consume it (Benton 2004; Beauchamp &Mennella 2009). Young children are also more likelyto accept a food if its flavour is familiar to them(Beauchamp & Mennella 2009). An exploration intofood acceptance in young children can therefore leadto valuable insight upon which to base nutritionintervention.

    The majority of observational studies of fruit andvegetable intake in children have focused on post-natal influences on food choices (Benton 2004; Savageet al. 2007; Fisk et al. 2011). Experimental studiesaiming to increase fruit and vegetable intake in youngchildren have also focused primarily on post-natalexposure (Birch et al. 1998; Forestell & Mennella2007; Maier et al. 2007; Mennella et al. 2008). Thesestudies have shown that exposure to a food throughbreast milk or formula or exposure to a solid food

    during infancy promotes long-lasting effects, namelyfamiliarity of and preference for this food (Schaalet al. 2000; Forestell & Mennella 2007; Mennella et al.2008).

    While extensive studies examining post-natal influ-ences on child taste preferences are available, limiteddata are available on the prenatal influence on tastedevelopment. It has been suggested that infants areborn with innate preferences for sweet, salty andumami foods over bitter or sour foods (Beauchamp &Mennella 2009). However, humans can override theseinnate preferences and develop preferences for bitteror sour foods, including certain vegetables and fruit(Maier et al. 2007; Mennella et al. 2008; Beauchamp &Mennella 2009). Classic studies by Mennella and col-leagues have increased our understanding of theinfluence of maternal diet and in utero flavour expo-sure on the future taste preferences of offspring(Mennella et al. 2001). By 1315 weeks gestation, thefetus can perceive tastes and smells while still in thewomb via amniotic fluid (Mennella et al. 1995, 2001),suggesting the earliest taste and smell experiencesbegin during gestation (Mennella et al. 2001). Indeed,Mennella has shown that prenatal exposure to certainflavours is associated with a greater acceptance ofthese foods in infancy (Mennella et al. 2001). In arandomised controlled trial, mothers in the experi-mental group drank 300 mL carrot juice 4 days perweek for three consecutive weeks during the last tri-mester of pregnancy. At 56 months old, the infantswho had been exposed to the carrot flavour prenatallyexhibited less negative facial responses while beingfed carrot-flavoured cereal, relative to plain cereal(P = 0.01). The control group exhibited the oppositetendency, although this was not significant. (Mennellaet al. 2001). Multiple animal studies on rat, pig, sheepand rabbit young support the finding that prenatalflavour learning influences feeding preferences(Bilk et al. 1994; Bayol et al. 2007; Simitzis et al. 2008;

    Key messages

    Maternal post-natal diet, not pregnancy diet, is associated with child diet. Maternal post-natal diet, not maternal pregnancy diet, predicted child diet quality, and vegetable and fruit

    variety. Nutrition interventions should aim to improve diet quality and variety in mothers with young children.

    A.M. Ashman et al.2

    2014 John Wiley & Sons Ltd Maternal and Child Nutrition (2014), , pp.

  • Oostindjer et al. 2009). Although studies in humanshave been of relatively small sample sizes and usedonly one or two foods, these early studies and animalmodels support the hypothesis for in utero flavourlearning (Schaal et al. 2000; Mennella et al. 2001).

    Whole foods contain not only macro- andmicronutrients but a range of other non-nutrientcomponents, including phytochemicals that offerprotective effects against disease (National Healthand Medical Research Council, Department ofHealth and Ageing 2013). Therefore, exposure to abroader variety of flavours is associated with greatervariety of food and therefore a broader range ofmacronutrients, micronutrients and non-nutrientcompounds consumed (National Health and MedicalResearch Council, Department of Health and Ageing2013). Diet quality refers to both diet variety andnutritional adequacy, and high-quality diet is associ-ated with improved health outcomes and reducedrisk of chronic disease (National Health and MedicalResearch Council, Department of Health and Ageing2013). Therefore, willingness to accept a wide rangeof flavours will likely increase both diet variety anddiet quality (Mennella et al. 2008). While food prefer-ence refers to foods that are found to be enjoyableand pleasant, food acceptance is also used in thisstudy to refer to those foods which are willinglyconsumed.

    There is a need to explore the relationship betweenmaternal diet qual


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