The importance of dietary patterns and appetite for the association between in utero exposure to malaria and fasting plasma glucose among adolescents in rural Ghana.

OBJECTIVE

In rural Ghana, in utero exposure to malaria is associated with 0.20 mmol/L higher fasting plasma glucose (FPG) in adolescence. We aimed to determine whether appetite and food intake mediate this association.

METHODS

We used data of 155 mother-child pairs who were recruited at delivery in 2000 with data on in utero exposure to malaria. In 2015, we assessed appetite, food intake, and cardio-metabolic traits of the teenaged children. Mediation analysis was used to determine the contributions of increased appetite and dietary patterns to the observed infection-FPG-association.

RESULTS

45% of participants had in utero exposure to malaria, and 72% presented with increased appetite. Four dietary patterns were identified: i) manufactured foods, ii) vegetables, iii) roots and tubers, iv) soup and fufu-based. In utero exposure to malaria was positively associated with increased appetite (odds ratio: 2.38, 95% confidence interval (CI): 1.05, 5.60) and the roots & tubers pattern (beta: 2.23, 95% CI: 0.94, 3.54). This pattern tended to increase FPG (beta: 0.02, 95% CI: -0.01, 0.04 mmol/L), and mediated 60% of the infection-FPG-association.

CONCLUSION

In utero exposure to malaria appears to increase appetite and promote adherence to carbohydrate-dense diets in adolescence. This pattern may contribute to altered glucose metabolism in adolescence.