Objective:

To determine the importance of dietary habits and appetite in the relationships between in utero malaria exposure and the cardio-metabolic profile of adolescents. To determine whether appetite and dietary patterns contribute to the association between in utero malaria exposure and fasting plasma glucose in adolescence.

Approach:

• : The study used data from 155 mother-child pairs from a birth cohort in rural Ghana. In utero malaria exposure was assessed from maternal blood collected at delivery. At approximately age 15 years, adolescents underwent assessment of appetite, dietary intake, fasting plasma glucose, body mass index, and blood pressure. Mediation analysis evaluated whether appetite or dietary patterns contributed to the association between in utero malaria exposure and cardiometabolic traits.

Key Findings:

• Forty-five percent of participants had in utero malaria exposure, and 72% had increased appetite.
• Four dietary patterns were identified: processed food-based, vegetable-based, roots and tubers-based, and soup and fufu-based.
• In utero malaria exposure was associated with increased appetite and greater adherence to the roots and tubers-based dietary pattern.
• Exposed adolescents had fasting plasma glucose levels 0.20 mmol/L higher than unexposed adolescents in adjusted analysis.
• The roots and tubers-based dietary pattern tended to be associated with higher fasting plasma glucose and accounted for 60% of the observed exposure-glucose association.

Interpretation:

The findings suggest that in utero malaria exposure may influence dietary habits and appetite, potentially affecting metabolic health in adolescence. The findings suggest that in utero malaria exposure may influence later appetite and dietary patterns, with a roots and tubers-based diet potentially contributing to altered glucose metabolism in adolescence.

Limitations:

• The study had substantial loss to follow-up, a relatively small final sample, possible residual confounding, and limited statistical power. Dietary intake was assessed with a nonvalidated food frequency questionnaire. Fasting plasma glucose also cannot substitute for a diagnosis of diabetes.

Conclusion:

The study highlights the potential long-term effects of in utero malaria exposure on dietary habits and metabolic health in adolescents. 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 dietary pattern could potentially mediate part of this association, but the finding requires confirmation in larger, independent cohorts.