Letter to the Editor: Influence of maternal NAFLD on infant weight—the real precursor to NAFLD in offspring?
Bibliographic record
Abstract
To the editor, We read with enthusiasm the publication by Amadou et al.1 demonstrating that within a large French cohort, extremes of birthweight increased the risk for NAFLD in adulthood. On mediation analysis, findings for low birthweight were explained by prematurity. As the authors’ highlight, an important limitation was unavailable maternal data, including maternal weight. Beyond maternal obesity, there remains a knowledge gap regarding the in-utero influence of maternal NAFLD on infant outcomes. NAFLD rates in pregnancy have nearly tripled over the past decade, and NAFLD cirrhosis is also rising in pregnant women.2,3 In pediatric populations, NAFLD can develop even in utero, and by school-age 10% of all children, and 30%–40% of those with obesity have NAFLD.4 Thus, there is an urgent need to identify early and modifiable risk factors in pregnant women with NAFLD and their offspring. Though prior data link maternal obesity to childhood NAFLD, the influence of maternal NAFLD on long-term metabolic outcomes has not been elucidated. In a large US study we evaluated NAFLD in pregnancy and maternal and perinatal outcomes at delivery.2 Importantly, maternal NAFLD increased risk for both large-for-gestational age infants (adjusted OR of 1.8, 95% CI: 1.4–2.5) and preterm birth (adjusted OR: 1.60, 95% CI: 1.3–2.0), independent of maternal metabolic comorbidities. Likewise, in our Canadian study of cirrhosis in pregnancy, maternal NAFLD independently increased arge-for-gestational age risk as compared with other etiologies of cirrhosis (RR: 1.6, 95% CI: 1.3–2.1).3 These data suggest a direct influence of in utero NAFLD exposure as a contributor to prematurity and arge-for-gestational age infants, key risk factors for long-term NAFLD risk in offspring as demonstrated by Amoudou and colleagues. Although the underlying mechanisms have not been elucidated, independent of diabetes and obesity the liver plays a critical role in the regulation of glucose and lipid metabolism. NAFLD-specific effects beyond the liver include peripheral insulin resistance, systemic inflammation, and dysregulated lipid metabolism, which may help to explain our findings of increased arge-for-gestational age risk in infants of mothers with NAFLD. In summary, we applaud the work by Amadou and colleagues and emerging literature evaluating early influencers of NAFLD. An even earlier focus on preconception through postpartum periods may further define contributors to NAFLD in offspring, and support interventions among expectant mothers to help mitigate rising NAFLD rates in young populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.040 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.014 | 0.020 |
| Insufficient payload (model declined to judge) | 0.005 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".