Clinical Report: Dietary Habits and Appetite in In Utero Malaria Exposure

Overview

This study examines whether appetite and dietary patterns contribute to the association between in utero malaria exposure and fasting plasma glucose in adolescents from rural Ghana. Adolescents exposed to malaria in utero had higher fasting plasma glucose levels than unexposed adolescents, and a roots and tubers-based dietary pattern may partly mediate this association.

Background

Sub-Saharan Africa faces a double burden of infectious diseases and noncommunicable diseases. Malaria during pregnancy can impair placental function and reduce maternal-fetal nutrient transfer, contributing to fetal undernutrition. The authors investigated whether later appetite and dietary behavior may help explain the association between in utero malaria exposure and cardiometabolic health.

Data Highlights

• The main analysis included 155 adolescents from a rural Ghanaian birth cohort.

• Forty-five percent had been exposed to malaria in utero, and 72% had increased appetite.

• Adolescents exposed to malaria in utero had adjusted fasting plasma glucose levels 0.20 mmol/L higher than unexposed adolescents.

• In utero malaria exposure was associated with increased appetite (OR, 2.38; 95% CI, 1.05-5.60).

• Exposure was also associated with greater adherence to a roots and tubers-based dietary pattern (β, 2.23; 95% CI, 0.94-3.54).

• The roots and tubers-based dietary pattern was estimated to mediate 60% of the observed association between in utero malaria exposure and fasting plasma glucose.

Key Findings

• In utero malaria exposure was associated with higher fasting plasma glucose in adolescence.

• Exposed adolescents had greater odds of increased appetite and stronger adherence to a roots and tubers-based dietary pattern.

• The roots and tubers-based dietary pattern tended to be associated with higher fasting plasma glucose.

• The dietary pattern may partly mediate the association between in utero malaria exposure and altered glucose metabolism.

• The authors discuss fetal undernutrition, epigenetic changes, alterations in organs involved in appetite control, and changes in the intestinal microbiota as possible underlying mechanisms.

Clinical Implications

The study does not establish formal clinical recommendations. The authors identify malaria control during pregnancy as a potential prevention entry point. They also identify adolescence as another potential period for prevention by shaping dietary practices for healthy living, including approaches such as health-related school subjects, food fortification, regular health checkups, and nutrition, sports, and health-promotion campaigns. The proposed association between in utero malaria exposure, dietary behavior, and glucose metabolism requires confirmation in larger, independent birth cohorts.

Conclusion

In utero malaria exposure was associated with increased appetite, greater adherence to a roots and tubers-based dietary pattern, and higher fasting plasma glucose in adolescence. The roots and tubers-based dietary pattern could potentially contribute to this association, but further verification is needed.

Related Resources & Content

1. Bedu-Addo G, Alicke M, Boakye-Appiah JK, et al. In utero exposure to malaria is associated with metabolic traits in adolescence: The Agogo 2000 birth cohort study. J Infect. 2017;75(5):455-463.

2. Utomo DAM, Andriolo V, Barnighausen T, Danquah I. Linking malaria in pregnancy with dietary behavior of the next generation. Brain Behav Immun. 2019;8(1):1-3.

3. Brabin BJ, Romagosa C, Abdelgalil S, et al. The sick placenta-the role of malaria. Placenta. 2004;25(5):359-378.

4. World malaria report 2025: addressing the threat of antimalarial drug resistance. World Health Organization. 2025.