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Mediators of lifestyle intervention effects on neonatal adiposity: are we missing a piece of the puzzle?


We evaluated possible mediators underlying lifestyle intervention effects on neonatal adiposity, assessed with sum of skinfolds and cord blood leptin. This is a secondary analysis of the DALI study, a randomised controlled trial in nine European countries. Pregnant women with a pre-pregnancy body mass index of ≥29 kg/m2 were randomly assigned to counselling for healthy eating (HE), physical activity (PA), HE&PA combined, or to usual care. We considered five maternal metabolic factors at 24–28 and 35–37 weeks of gestation, and four cord blood factors as possible mediators of the effect of combined HE&PA counselling on neonatal adiposity. From all potential mediators, the intervention only affected cord blood non-esterified fatty acids (NEFA), which was higher in the HE&PA group compared to UC (0.068 (mmol/L), 95% CI: 0.004 to 0.133). Cord blood NEFA did not mediate the HE&PA intervention effects on neonatal sum of skinfolds or cord blood leptin, based on an indirect effect on skinfolds of 0.018 (mm), 95% CI: −0.217 to 0.253 and an indirect effect on leptin of −0.143 (μg/l), 95% CI: −0.560 to 0.273. The Dali study observed reductions in neonatal adiposity in pregnant women with obesity, but we were not able to identify the underlying metabolic pathway.

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Fig. 1: Direct and Indirect path coefficients between HE&PA intervention condition, cord blood NEFA, and sum of skinfolds or cord blood leptin.

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Deidentified data might be made available upon reasonable request to M.N.M.v.P. (


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This work was supported by European Union 7th framework (FP7/ 2007–2013) under Grant Agreement no. 242187. In the Netherlands, additional funding was provided by the Netherlands Organisation for Health Research and Development (ZonMw) (grant 200310013). In Poland, additional funding was obtained from Polish Ministry of Science (grants 2203/7, PR/2011/2). In Denmark, additional funding was provided by Odense University Free Research Fund. In Spain, additional funding was provided by CAIBER (1527-B-226). The funders had no role in any aspect of the study beyond funding.

The DALI core investigator group

Rodrigo Antunes Lima1, Gernot Desoye2, David Simmons3,4, Roland Devlieger5, Sander Galjaard5,6, Rosa Corcoy7,8, Juan M. Adelantado7,8, Fidelma Dunne9, Jürgen Harreiter10, Alexandra Kautzky-Willer10, Peter Damm11,12, Elisabeth R. Mathiesen11,12, Dorte M. Jensen13,14,15, Lise-Lotte Andersen13,14,15, Mette Tanvig13,14,15, Annunziata Lapolla16, Maria Grazia Dalfra16, Alessandra Bertolotto17, Ewa Wender-Ozegowska18, Agnieszka Zawiejska18, David J. Hill19, Frank J. Snoek20,21 and Judith G. M. Jelsma22

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Authors and Affiliations




R.A.L. designed this study, conducted the statistical analysis, contributed to the interpretation of the results, and drafted the manuscript. G.D. and M.N.M.v.P. designed this study, contributed to the interpretation of the results, and drafted the manuscript. All authors, except R.A.L., made substantial contribution to the conception of the DALI Study and acquisition of data. All authors revised the manuscript, contributed to the content, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

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Correspondence to Rodrigo Antunes Lima.

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The authors declare no competing interests.

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Written informed consent were obtained before enrolment of participants.

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Lima, R.A., Desoye, G., Simmons, D. et al. Mediators of lifestyle intervention effects on neonatal adiposity: are we missing a piece of the puzzle?. Pediatr Res 91, 522–525 (2022).

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