Diet and exercise for obese mothers-to-be found to lower cardiovascular risk in offspring

17th July 2024

Diet and exercise interventions before and during pregnancy could lower cardiovascular risk in children, researchers have suggested.

Scientists at King’s College London (KCL) reviewed previous studies to examine the effectiveness of health interventions in obese women such as antenatal and postnatal exercise programmes and healthy diets for unborn children and the development of cardiovascular health.

Over half of women attending antenatal clinics in England and Wales are either obese or overweight, putting their unborn children at risk of heart issues in both childhood and later life.

The findings, published in the International Journal of Obesity, could help inform public health strategies and improve the heart health of future generations, the authors said.

The researchers reviewed existing data from sources such as PubMed, Embase, and previous reviews, to determine whether lifestyle interventions in pregnant women with obesity could reduce the chance of abnormal cardiac development in their offspring. In particular, they examined how the intervention could impact changes in the shape, size, structure and function of the heart, known as cardiac remodelling, and related cardiovascular parameters.

After screening over 3,000 articles, eight studies from five randomised controlled trials were included in the review. Diet and exercise interventions introduced during these trials included antenatal exercise (n = 2), diet and physical activity (n = 2), and preconception diet and physical activity (n = 1). The children in the studies were under two months old or between the ages of three and seven.

The researchers found that lifestyle interventions in obese women could benefit the heart health of children. Interventions led to lower rates of heart wall thickening, normal heart weight and a reduced risk of high heart rates.

In all the reviewed studies, reduced cardiac remodelling and reduced interventricular septal wall thickness were reported as a result of diet and exercise interventions. In some of the studies, the interventions in diet and exercise led to improved systolic and diastolic function and a reduced resting heart rate.

Dr Samuel Burden, research associate in the Department of Women and Children’s Health at KCL, said: ‘Maternal obesity is linked with markers of unhealthy heart development in children. We reviewed the existing literature on whether diet and exercise interventions in women with obesity either before or during pregnancy can reduce the impact of this and found evidence that these interventions indeed protect against the degree of unhealthy heart development in their children.’

The researchers suggested that longitudinal studies with larger sample sizes and in older children are required to confirm these observations and to determine whether these changes persist to adulthood.

Dr Burden added: ‘If these findings persist until adulthood, then these interventions could incur protection against the adverse cardiovascular outcomes experienced by adult offspring of women with obesity and inform public health strategies to improve the cardiovascular health of the next generation.’

Evidence from The Academy of Medical Sciences earlier this year highlighted that early years health, which starts in pre-conception and goes through pregnancy and the first five years of life, is often overlooked in current policy but is crucial for laying the foundations for lifelong mental and physical health.

A version of this article was originally published by our sister publication Nursing in Practice.

Trial shows that resistant hypertension is helped by diet and exercise

4th October 2021

In resistant hypertension, a 4-month supervised diet and exercise programme resulted in a significant reduction in systolic blood pressure.

According to the American Heart Association, resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of three anti-hypertensive drug classes. The prevalence of RH has been estimated at 10.3% in the general population of anti-hypertensive treated patients, but rises among those with cardiovascular risk factors such as chronic kidney disease (22.9%) and the elderly (12.5%). Management of RH is important, especially given how one study identified how the condition was associated with a 47% increased risk of adverse cardiovascular events compared to controlled patients.

Both exercise and diet appear to play an important role in RH, although the evidence is limited. For example, an aerobic exercise programme in patients with RH reduced both systolic and diastolic pressure but the study included only 50 patients. Similarly, adoption of a low salt diet also reduced overall blood pressure in those with RH, but again, the study included only 12 patients.

This led a team from the Department of Psychiatry and Behavioural Sciences, Duke University, North Carolina, US, to set up the Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial to examine the effect of diet and exercise on blood pressure control in those with resistant hypertension. The TRIUMPH study randomised patients to one of two arms: a Center-Based Lifestyle intervention (C-LIFE) or Standardised Education and Physician Advice (SEPA) for a 4-month period. The C-LIFE intervention included advice from a nutritionist, weekly group counselling together with behavioural weight management and a three-times weekly exercise session. Participants in the SEPA arm received a 1-hour educational session and blood pressure management diet programme and the same exercise prescription. In other words, both arms were the same except for the higher intensity of the intervention in the C-LIFE arm. Included participants had RH for at least 6 weeks with a clinic systolic blood pressure (SBP) > 130mmHg or diastolic blood pressure (DBP) > 80mmHg, or the need for four or more drugs with a SBP > 120mmHg. The primary outcome measure was the clinic SBP with secondary outcomes including ambulatory SBP and DBP. Other measures included baroreflex sensitivity (which is a measurement to quantify how much control the baroreflex has on the heart rate), high-frequency heart rate variability and flow-mediated dilation.

Findings

A total of 140 RH patients with a mean age of 63 years (48% female) were randomised to C-LIFE (90) or SEPA (50). The mean baseline SBP was 139mmHg and the diastolic 79mmHg. C-LIFE participants experienced a lower clinic SBP compared with those assigned to SEPA (126mmHg vs 132.8mmHg, p = 0.005). Similarly, mean DBP levels were significantly lower (73.2mmHg vs 75.6mmHg, p = 0.034). Ambulatory blood pressure measurements were also significantly reduced for C-LIFE but did not change among SEPA patients. In addition, C-LIFE participants had greater improvements in resting baroreflex sensitivity, high-frequency heart rate variability and flow-mediated dilation.

In their conclusion, the authors suggested that the results provided support for the value of an intensive, structured intervention to improve blood pressure in those with treatment resistant hypertension. They added that policymakers should consider RH as a new indication for cardiac rehabilitation that should be covered by government and private insurers.

Citation

Blumenthal JA et al. Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial. Circulation 2021