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BMC Nutrition
Published in: BMC Nutrition 1/2017

Open Access 01-12-2017 | Study protocol

Protocol for the EMPHASIS study; epigenetic mechanisms linking maternal pre-conceptional nutrition and children’s health in India and Sub-Saharan Africa

Authors: Giriraj R. Chandak, Matt J. Silver, Ayden Saffari, Karen A. Lillycrop, Smeeta Shrestha, Sirazul Ameen Sahariah, Chiara Di Gravio, Gail Goldberg, Ashutosh Singh Tomar, Modupeh Betts, Sara Sajjadi, Lena Acolatse, Philip James, Prachand Issarapu, Kalyanaraman Kumaran, Ramesh D. Potdar, Andrew M. Prentice, Caroline H. D. Fall, Lena Acolatse, Meraj Ahmed, Modupeh Betts, Giriraj R. Chandak, Harsha Chopra, Cyrus Cooper, Momodou K. Darboe, Chiara Di Gravio, Caroline H. D. Fall, Meera Gandhi, Gail R. Goldberg, Prachand Issarapu, Philip James, Ramatoulie Janha, Landing M. A. Jarjou, Lovejeet Kaur, Sarah H. Kehoe, Kalyanaraman Kumaran, Karen A. Lillycrop, Mohammed Ngum, Suraj S. Nongmaithem, Stephen Owens, Ramesh D. Potdar, Andrew M. Prentice, Ann Prentice, Tallapragada Divya Sri Priyanka, Ayden Saffari, Sirazul Ameen Sahariah, Sara Sajjadi, Harshad Sane, Smeeta Shrestha, Matt J. Silver, Ashutosh Singh Tomar, Kate A. Ward, Dilip Kumar Yadav, Chittaranjan S. Yajnik, the EMPHASIS study group

Published in: BMC Nutrition | Issue 1/2017

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Abstract

Background

Animal studies have shown that nutritional exposures during pregnancy can modify epigenetic marks regulating fetal development and susceptibility to later disease, providing a plausible mechanism to explain the developmental origins of health and disease. Human observational studies have shown that maternal peri-conceptional diet predicts DNA methylation in offspring. However, a causal pathway from maternal diet, through changes in DNA methylation, to later health outcomes has yet to be established. The EMPHASIS study (Epigenetic Mechanisms linking Pre-conceptional nutrition and Health Assessed in India and Sub-Saharan Africa, ISRCTN14266771) will investigate epigenetically mediated links between peri-conceptional nutrition and health-related outcomes in children whose mothers participated in two randomized controlled trials of micronutrient supplementation before and during pregnancy.

Methods

The original trials were the Mumbai Maternal Nutrition Project (MMNP, ISRCTN62811278) in which Indian women were offered a daily snack made from micronutrient-rich foods or low-micronutrient foods (controls), and the Peri-conceptional Multiple Micronutrient Supplementation Trial (PMMST, ISRCTN13687662) in rural Gambia, in which women were offered a daily multiple micronutrient (UNIMMAP) tablet or placebo. In the EMPHASIS study, DNA methylation will be analysed in the children of these women (~1100 children aged 5–7 y in MMNP and 298 children aged 7–9 y in PMMST). Cohort-specific and cross-cohort effects will be explored. Differences in DNA methylation between allocation groups will be identified using the Illumina Infinium MethylationEPIC array, and by pyrosequencing top hits and selected candidate loci. Associations will be analysed between DNA methylation and health-related phenotypic outcomes, including size at birth, and children’s post-natal growth, body composition, skeletal development, cardio-metabolic risk markers (blood pressure, serum lipids, plasma glucose and insulin) and cognitive function. Pathways analysis will be used to test for enrichment of nutrition-sensitive loci in biological pathways. Causal mechanisms for nutrition-methylation-phenotype associations will be explored using Mendelian Randomization. Associations between methylation unrelated to supplementation and phenotypes will also be analysed.

Conclusion

The study will increase understanding of the epigenetic mechanisms underpinning the long-term impact of maternal nutrition on offspring health. It will potentially lead to better nutritional interventions for mothers preparing for pregnancy, and to identification of early life biomarkers of later disease risk.
Literature
1.
Potdar RD, Sahariah SA, Gandhi M, Kehoe SH, Brown N, Sane H, Dayama M, Jha S, Lawande A, Coakley PJ, Marley-Zagar E, Chopra H, Shivshankaran D, Chheda-Gala P, Muley-Lotankar P, Subbulakshmi G, Wills AK, Cox VA, Taskar V, DJP B, Jackson AA, Margetts BM, CHD F. Improving women’s diet quality pre-conceptionally and during gestation: effects on birth weight and prevalence of low birth weight; a randomized controlled efficacy trial in India (Mumbai maternal nutrition project). Am J Clin Nutr. 2014;100:1257–68.CrossRefPubMedPubMedCentral
2.
Owens S, Gulati R, Fulford AJ, Sosseh F, Denison FC, Brabin BJ, Prentice AM. Periconceptional multiple-micronutrient supplementation and placental function in rural Gambian women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2015;102:1450–9.CrossRefPubMedPubMedCentral
3.
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE, and the Lancet Nutrition Interventions Review Group, and the Maternal and Child Nutrition Study Group. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382:452–77.CrossRefPubMed
4.
Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, Perez-Escamilla R, Rao N, Ip P, LCH F, MacMillan H, Hanson M, Wachs TD, Yao H, Yoshikawa H, Cerezo A, Leckman JF, Bhutta ZA, and the Early Childhood Development Interventions Review Group, for the Lancet Early Childhood Development Series Steering Committee. Nurturing care: promoting early childhood development. Lancet. 2017;389:91–102.CrossRefPubMed
5.
Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993;341:938–41.CrossRefPubMed
6.
Sutton EF, Gilmore LA, Dunger DB, Heijmans BT, Hivert MF, Ling C, Martinez JA, Ozanne SE, Simmons RA, Szyf M, Waterland RA, Redman LM, Ravussin E. Developmental programming: state-of-the-science and future directions. Obesity (Silver Spring). 2016;24:1018–26.CrossRef
7.
Ganpule A, Yajnik CS, Fall CH, Rao S, Fisher DJ, Kanade A, Cooper C, Naik S, Joshi N, Lubree H, Deshpande V, Joglekar C. Bone mass in Indian children--relationships to maternal nutritional status and diet during pregnancy: the Pune maternal nutrition study. J Clin Endocrinol Metab. 2006;91:2994–3001.CrossRefPubMed
8.
Waterland RA, Michels KB. Epigenetic epidemiology of the developmental origins hypothesis. Ann Rev Nutr. 2007;27:363–88.CrossRef
9.
Burdge GC, Lillycrop KA. Nutrition, epigenetics, and developmental plasticity: implications for understanding human disease. Ann Rev Nutr. 2010;30:315–39.CrossRef
10.
Lillycrop KA, Phillips ES, Jackson AA, Hanson MA, Burdge GC. Dietary protein restriction of pregnant rats induces and folic acid supplementation prevents epigenetic modification of hepatic gene expression in the offspring. J Nutr. 2005;135:1382–6.PubMed
11.
Perkins E, Murphy SK, Murtha AP, Schildkraut J, Jirtle RL, Demark-Wahnefried W, Forman MR, Kurtzberg J, Overcash F, Huang Z, Hoyo C. Insulin-like growth factor 2/H19 methylation at birth and risk of overweight and obesity in children. J Pediatrics. 2012;161:31–9.CrossRef
12.
Godfrey KM, Sheppard A, Gluckman PD, Lillycrop KA, Burdge GC, McLean C, Rodford J, Slater-Jefferies JL, Garratt E, Crozier SR, Emerald BS, Gale CR, Inskip HM, Cooper C, Hanson MA. Epigenetic gene promoter methylation at birth is associated with child's later adiposity. Diabetes. 2011;60:1528–34.CrossRefPubMedPubMedCentral
13.
Clarke-Harris R, Wilkin TJ, Hosking J, Pinkney J, Jeffery AN, Metcalf BS, Godfrey KM, Voss LD, Lillycrop KA, Burdge GC. Peroxisomal proliferator activated receptor-gamma-co-activator-1alpha promoter methylation in blood at 5-7 years predicts adiposity from 9 to 14 years (EarlyBird 50). Diabetes. 2014;63:2528–37.CrossRefPubMed
14.
Lillycrop K, Murray R, Cheong C, Teh AL, Clarke-Harris R, Barton S, Costello P, Garratt E, Cook E, Titcombe P, Shunmuganathan B, Liew SJ, Chua Y-C, Lin X, Wu Y, Burdge GC, Cooper C, Inskip HM, Karnani N, Hopkins JC, Childs CE, Chavez CP, Calder PC, Yap F, Lee YS, Chong YS, Melton PE, Beilin L, Huang R-C, Gluckman PD, Harvey N, Hanson MA, Holbrook JD, the EpiGen Consortium, Godfrey KM. ANRIL promoter DNA methylation: a perinatal marker for later adiposity. EBiomed. 2017;19:60–72.CrossRef
15.
16.
Dominguez-Salas P, Moore SE, Baker MS, Bergen AW, Cox SE, Dyer RA, Fulford AJ, Guan Y, Laritsky E, Silver MJ, Swan GE, Zeisel SH, Innis SM, Waterland RA, Prentice AM, Hennig BJ. Maternal nutrition at conception modulates DNA methylation of human metastable epialleles. Nat Commun. 2014;29(5):3746. doi: 10.​1038/​ncomms4746.
17.
Silver MJ, Kessler NJ, Hennig BJ, Dominguez-Salas P, Laritsky E, Baker MS, Coarfa C, Hernandez-Vargas H, Castelino JM, Routledge MN, Gong YY, Herceg Z, Lee YS, Lee K, Moore SE, Fulford AJ, Prentice AM, Waterland RA. Independent genomewide screens identify the tumor suppressor VTRNA2-1 as a human epiallele responsive to periconceptional environment. Genome Biol. 2015;16:118. doi: 10.​1186/​s13059-015-0660-y.CrossRefPubMedPubMedCentral
18.
Moore SE, Cole TJ, Poskitt EM, Sonko BJ, Whitehead RG, McGregor IA, Prentice AM. Season of birth predicts mortality in rural Gambia. Nature. 1997;388:434.CrossRefPubMed
19.
Kühnen P, Handke D, Waterland RA, Hennig BJ, Silver M, Fulford AJ, Dominguez-Salas P, Moore SE, Prentice AM, Spranger J, Hinney A, Hebebrand J, Heppner FL, Walzer L, Grötzinger C, Gromoll J, Wiegand S, Grüters A, Krude H. Interindividual variation in DNA methylation at a putative POMC metastable epiallele is associated with obesity. Cell Metab. 2016;24:502–9.CrossRefPubMed
20.
International Institute for Population sciences (IIPS) and Operations Research Centre (ORC) Macro. National Family Health survey (NFHS-2), India, 1998–99: Maharashtra. Mumbai: IIPS; 2001.
21.
Lawande A, Di Gravio C, Potdar RD, Sahariah SA, Gandhi M, Chopra H, Sane H, Kehoe SH, Marley-Zagar E, Margetts BM, Jackson AA, Fall CHD. Effect of a micronutrient-rich snack taken pre-conceptionally and throughout pregnancy on ultrasound measures of fetal growth: the Mumbai maternal nutrition project (MMNP). Mat Child Nutr. 2017 (e-pub; doi: 10.​1111/​mcn.​12441.
22.
Sahariah SA, Potdar RD, Gandhi M, Kehoe SH, Brown N, Sane H, Coakley PJ, Marley-Zagar E, Chopra H, Shivshankaran D, Cox VA, Jackson AA, Margetts BM, Fall CHD. A daily snack containing green leafy vegetables, fruit and milk before and during pregnancy prevented gestational diabetes in a randomized controlled trial in Mumbai. India J Nutr. 2016;146(Suppl):1453S–60S.CrossRefPubMed
23.
World Health Organization and Food and Agriculture Organization of the United Nations. Vitamin and mineral requirements in human nutrition (2nd edition). Report of a joint FAO/WHO expert consultation. Rome: Food and Agriculture Organization; 2004.
24.
Cooper WN, Khulan B, Owens S, Elks CE, Seidel V, Prentice AM, Belteki G, Ong KK, Affara NA, Constância M, Dunger DB. DNA methylation profiling at imprinted loci after periconceptional micronutrient supplementation in humans: results of a pilot randomized controlled trial. FASEB J. 2012;26:1782–90.CrossRefPubMed
25.
Khulan B, Cooper WN, Skinner BM, Bauer J, Owens S, Prentice AM, Belteki G, Constancia M, Dunger D, Affara NA. Periconceptional maternal micronutrient supplementation is associated with widespread gender related changes in the epigenome: a study of a unique resource in the Gambia. Hum Mol Genet. 2012;21:2086–101.CrossRefPubMed
26.
Hennig BJ, Unger SA, Dondeh BL, Hassan J, Hawkesworth S, Jarjou L, Jones KS, Mooe SE, Nabwera HM, Ngum M, Prentice A, Sonko B, Prentice AM, Fulford AJ. Cohort profile: the KiangWest longitudinal population study (KWLPS)—a platform for integrated research and health care provision in rural Gambia. Int J Epidemiol. 2015; doi: 10.​1093/​ije/​dyv206.
27.
Relton CL, Davey SG. Two-step epigenetic Mendelian randomization: a strategy for establishing the causal role of epigenetic processes in pathways to disease. Int J Epidemiol. 2012;41:161–76.CrossRefPubMedPubMedCentral
28.
29.
30.
Teh AL, Pan H, Chen L, Ong ML, Dogra S, Wong J, MacIsaac JL, Mah SM, McEwen LM, Saw SM, Godfrey KM, Chong YS, Kwek K, Kwoh CK, Soh SE, Chong MF, Barton S, Karnani N, Cheong CY, Buschdorf JP, Stünkel W, Kobor MS, Meaney MJ, Gluckman PD, Holbrook JD. The effect of genotype and in utero environment on interindividual variation in neonate DNA methylomes. Genome Res. 2014;24:1064–74.CrossRefPubMedPubMedCentral
31.
Gaunt TR, Shihab HA, Hemani G, Min JL, Woodward G, Lyttleton O, Zheng J, Duggirala A, McArdle WL, Ho K, Ring SM, Evans DM, Davey Smith G, Relton CL. Systematic identification of genetic influences on methylation across the human life course. Genome Biol. 2016;17:61. doi: 10.​1186/​s13059-016-0926-z.CrossRefPubMedPubMedCentral
32.
Hoffmann A, Ziller M, Spengler D. The future is the past: Methylation QTLs in schizophrenia. Genes. 2016;7:E104.CrossRefPubMed
33.
Banovich NE, Lan X, McVicker G, van de Geijn B, Degner JF, Blischak JD, Roux J, Pritchard JK, Gilad Y. Methylation QTLs are associated with coordinated changes in transcription factor binding, histone modifications, and gene expression levels. PLoS Genet. 2014;10:e1004663.CrossRefPubMedPubMedCentral
34.
Gibbs JR, van der Brug MP, Hernandez DG, Traynor BJ, Nalls MA, Lai SL, Arepalli S, Dillman A, Rafferty IP, Troncoso J, Johnson R, Zielke HR, Ferrucci L, Longo DL, Cookson MR, Singleton AB. Abundant quantitative trait loci exist for DNA methylation and gene expression in human brain. PLoS Genet. 2010;6:e1000952.CrossRefPubMedPubMedCentral
35.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R. Maternal and child nutrition study group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51.CrossRefPubMed
36.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: pooled analysis of 751 population-based measurement studies with over 4.4 million participants. Lancet. 2016;387:1513–30.CrossRef
37.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1,479 population-based measurement studies with 19.1 million participants. Lancet. 2017;7(389):37–55.
38.
Kaufman AS, Kaufman LN. Kaufman assessment battery for children, second edition: manual. Circle Pines: AGS Publishing; 2004.
39.
Korkman M, Kemp SL, Kirk U. Effects of age on neurocognitive measures of children ages 5 to 12: a cross-sectional study on 800 children from the United States. Dev Neuropsychol. 2001;20:331–54.CrossRefPubMed
40.
Kohs SC. Intelligence measurement: a psychological and statistical study based upon the block-design test. New York: Macmillan; 1923.CrossRef
41.
Wechsler D. Manual for the Wechsler intelligence scale for children. 3rd ed. San Antonio: Psychological Corporation; 1991.
42.
Lillycrop KA, Costello PM, Teh AL, Murray RJ, Clarke-Harris R, Barton SJ, Garratt ES, Ngo S, Sheppard AM, Wong J, Dogra S, Burdge GC, Cooper C, Inskip HM, Gale CR, Gluckman PD, Harvey NC, Chong YS, Yap F, Meaney MJ, Rifkin-Graboi A, Holbrook JD, Epigen Global Research Consortium, Godfrey KM. Association between perinatal methylation of the neuronal differentiation regulator HES1 and later childhood neurocognitive function and behaviour. Int J Epidemiol. 2015;44:1263–76.CrossRefPubMedPubMedCentral
43.
Harvey NC, Lillycrop KA, Garratt E, Sheppard A, McLean C, Burdge G, Slater-Jefferies J, Rodford J, Crozier S, Inskip H, Emerald BS, Gale CR, Hanson M, Gluckman P, Godfrey K, Cooper C. Evaluation of methylation status of the eNOS promoter at birth in relation to childhood bone mineral content. Calcif Tissue Int. 2012;90:120–7.CrossRefPubMed
44.
Peter CJ, Fischer LK, Kundakovic M, Garg P, Jakovcevski M, Dincer A, Amaral AC, Ginns E, Galdzicka M, Bryce CP, Ratner C, Waber DP, Mokler D, Medford G, Champagne FA, Rosene DL, McGaughy JA, Sharp AJ, Galler JR, Akbarian S. DNA Methylation signatures of early childhood malnutrition associated with impairments in attention and cognition. Biol Psychiatry. 2016;80:765–74.CrossRefPubMed
45.
Wilmot B, Fry R, Smeester L, Musser ED, Mill J, Nigg JT. Methylomic analysis of salivary DNA in childhood ADHD identifies altered DNA methylation in VIPR2. J Child Psychol Psychiatry. 2016;57:152–60.CrossRefPubMed
46.
Harvey NC, Sheppard A, Godfrey KM, McLean C, Garratt E, Ntani G, Davies L, Murray R, Inskip HM, Gluckman PD, Hanson MA, Lillycrop KA, Cooper C. Childhood bone mineral content is associated with methylation status of the RXRA promoter at birth. J Bone Miner Res. 2014;29:600–7.CrossRefPubMedPubMedCentral
47.
Hoyo C, Murtha AP, Schildkraut JM, Jirtle RL, Demark-Wahnefried W, Forman MR, Iversen ES, Kurtzberg J, Overcash F, Huang Z, Murphy SK. Methylation variation at IGF2 differentially methylated regions and maternal folic acid use before and during pregnancy. Epigenetics. 2011;6:928–36.CrossRefPubMedPubMedCentral
48.
49.
Heijmans BT, Tobi EW, Stein AD, Putter H, Blauw GJ, Susser ES, Slagboom PE, Lumey LH. Persistent epigenetic differences associated with prenatal exposure to famine in humans. Proc Natl Acad Sci U S A. 2008;105:17046–9.CrossRefPubMedPubMedCentral
50.
Hoyo C, Daltveit AK, Iversen E, Benjamin-Neelon SE, Fuemmeler B, Schildkraut J, Murtha AP, Overcash F, Vidal AC, Wang F, Huang Z, Kurtzberg J, Seewaldt V, Forman M, Jirtle RL, Murphy SK. Erythrocyte folate concentrations, CpG methylation at genomically imprinted domains, and birth weight in a multiethnic newborn cohort. Epigenetics. 2014;9:1120–30.CrossRefPubMedPubMedCentral
51.
Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH. International fetal and newborn growth consortium for the 21st century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st project. Lancet. 2014;384:857–68.CrossRefPubMed
52.
Utzschneider KM, Prigeon RL, Faulenbach MV, Tong J, Carr DB, Boyko EJ, Leonetti DL, McNeely MJ, Fujimoto WY, Kahn SE. Oral disposition index predicts the development of future diabetes above and beyond fasting and 2-h glucose levels. Diabetes Care. 2009;32:335–41.CrossRefPubMedPubMedCentral
53.
Phillips DI, Clark PM, Hales CN, Osmond C. Understanding oral glucose tolerance: comparison of glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and insulin secretion. Diabetic Med. 1994;11:286–92.CrossRefPubMed
Metadata
Title
Protocol for the EMPHASIS study; epigenetic mechanisms linking maternal pre-conceptional nutrition and children’s health in India and Sub-Saharan Africa
Authors
Giriraj R. Chandak
Matt J. Silver
Ayden Saffari
Karen A. Lillycrop
Smeeta Shrestha
Sirazul Ameen Sahariah
Chiara Di Gravio
Gail Goldberg
Ashutosh Singh Tomar
Modupeh Betts
Sara Sajjadi
Lena Acolatse
Philip James
Prachand Issarapu
Kalyanaraman Kumaran
Ramesh D. Potdar
Andrew M. Prentice
Caroline H. D. Fall
Lena Acolatse
Meraj Ahmed
Modupeh Betts
Giriraj R. Chandak
Harsha Chopra
Cyrus Cooper
Momodou K. Darboe
Chiara Di Gravio
Caroline H. D. Fall
Meera Gandhi
Gail R. Goldberg
Prachand Issarapu
Philip James
Ramatoulie Janha
Landing M. A. Jarjou
Lovejeet Kaur
Sarah H. Kehoe
Kalyanaraman Kumaran
Karen A. Lillycrop
Mohammed Ngum
Suraj S. Nongmaithem
Stephen Owens
Ramesh D. Potdar
Andrew M. Prentice
Ann Prentice
Tallapragada Divya Sri Priyanka
Ayden Saffari
Sirazul Ameen Sahariah
Sara Sajjadi
Harshad Sane
Smeeta Shrestha
Matt J. Silver
Ashutosh Singh Tomar
Kate A. Ward
Dilip Kumar Yadav
Chittaranjan S. Yajnik
the EMPHASIS study group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Nutrition / Issue 1/2017
Electronic ISSN: 2055-0928
DOI
https://doi.org/10.1186/s40795-017-0200-0

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