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82
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Introduction
I am a nutritional and life course epidemiologist with a passion for disease prevention. My research revolves around the influence of early life nutrition on offspring birth and later health outcomes such as body composition and obesity.
Current institution
Additional affiliations
March 2020 - present
Education
August 2010 - December 2014
August 2006 - May 2010
Publications
Publications (82)
Background: High maternal dietary glycemic index (GI) and glycemic load (GL) may be associated with adverse
offspring birth and postnatal adiposity outcomes through metabolic programming, but the evidence thus far, mainly
from studies conducted in high-risk pregnant populations, has been inconclusive. No study has examined the influence
of maternal...
In animal studies early life antibiotic exposure causes metabolic abnormalities including obesity through microbiota disruption, but evidence from human studies is scarce. We examined involvement of gut microbiota in the associations between infant antibiotic exposure and childhood adiposity.
Infant antibiotic exposure in the first year of life was...
Background
Adverse birth outcomes are major causes of morbidity and mortality during childhood and associate with a higher risk of noncommunicable diseases in adult life. Maternal periconception and antenatal nutrition, mostly focusing on single nutrients or foods, has been shown to influence infant birth outcomes. However, evidence on whole diet t...
Background
Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity.
Methods
We harmonized and po...
Background
We investigated the understudied influence of maternal diet quality, food timing, and their interactions during pregnancy on offspring metabolic health.
Methods
Maternal diet at 26–28 weeks’ gestation was assessed using a 24-h recall and adherence to the modified-healthy-eating-index (HEI-SGP) reflects diet quality. Predominant night-ea...
Background
Eating jetlag (EJL), the difference in eating times between weekdays and weekends, disrupts circadian alignment, may affect metabolic health. However, its influence on glucose tolerance and continuous glucose monitoring (CGM) during pregnancy remains unknown.
Objective
We aimed to investigate the associations between EJL and glycemic pa...
Chrononutrition, which examines the relationship between circadian rhythms and nutrition, has been associated with glycemic outcomes in adults. However, published data on delayed meal timing, increased meal frequency and frequent breakfast skipping have shown inconsistent glycemic outcomes due to variations in methodologies and populations studied....
Background
Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile...
Background
Intermittent fasting (IF) holds promise for enhancing metabolic health. However, the optimum IF forms and their superiority over continuous energy restriction (CER) remain unclear due to disconnected findings.
Methods
We systematically searched PubMed, Embase, and the Cochrane databases for meta-analyses of randomized controlled trials...
Chrononutrition, an emerging body of evidence on the relationship between biological rhythms and metabolism, has been established to be associated with glycemic responses. However, the available evidence is inconsistent, due to protocol variations. Therefore, this review aims to summarize the findings on chrononutrition characteristics and their as...
Aim
Myo ‐inositol supplementation from ~13 weeks' gestation reportedly improves glycaemia regulation in metabolically at‐risk women, with speculation that earlier supplementation might bring further improvement. However, the NiPPeR trial of a myo ‐inositol‐containing supplement starting preconception did not lower gestational glycaemia in generally...
Background
Diet quality is an essential modifiable factor that has been associated with cognitive performance and physical function. However, few studies investigated the association of diet quality trajectories with “cognitive frailty.” This study aimed to identify specific diet quality trajectories and explore their relationship with cognitive fr...
Background
Dietary factors influence cognitive functions, but most previous studies were conducted in Western settings and assessed diet only once. Trajectory analysis of diet measured at multiple timepoints can track changes in diet and identify subpopulations requiring more intervention efforts. We thus assessed associations between dietary traje...
Background:
Diet affects cognitive performance, but most previous studies only assessed diet once. Trajectory analysis of diet measured at multiple timepoints can identify subpopulations requiring more interventional efforts. We thus assessed associations between dietary trajectories and cognitive performance in older adults.
Methods:
This was a...
Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregn...
Background:
Early-life nutritional exposures may contribute to offspring epigenetic modifications. However, few studies have evaluated parental dietary quality effects on offspring DNA methylation (DNAm).
Objectives:
We aim to fill this gap by elucidating the influence of maternal and paternal whole-diet quality and inflammatory potential on off...
Purpose
There is altered breastmilk composition among mothers with gestational diabetes and conflicting evidence on whether breastfeeding is beneficial or detrimental to their offspring’s cardiometabolic health. We aimed to investigate associations between breastfeeding and offspring’s cardiometabolic health across the range of gestational glycemia...
Background
Early epidemiological studies have associated low birthweight with increased cardiovascular risk. We aimed to examine whether the fat and fat-free components of birthweight have differing relationships with childhood cardiovascular risk markers.
Methods
In the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, air displace...
Background & Aims
Maternal diet during pregnancy is a modifiable behaviour which plays an important role in maternal, neonatal and child health outcomes. Thus, knowledge of predictors of dietary quality and dietary inflammatory potential in European countries may contribute to developing maternal diet-related public health policies that target spec...
Diet-associated inflammation affects health outcomes in pregnancy and throughout childhood. Pregnancy is a sophisticated physiological process during which significant transformations occur in the maternal immune system to ensure a successful pregnancy and birth. Excessive systemic and chronic inflammation and immune activation in pregnancy have be...
Rationale
Severe fetal malnutrition has been related to an increased risk of respiratory diseases later in life, but evidence for the association of a suboptimal diet during pregnancy with respiratory outcomes in childhood is conflicting. We aimed to examine whether a pro-inflammatory or low-quality maternal diet during pregnancy was associated wit...
Objective
To identify systolic blood pressure (SBP) percentile trajectories in children and to describe the early-life risk factors and cardiometabolic correlates of those trajectories.
Study design
Using age-, sex-, and height-specific SBP percentiles based on the American Academy of Pediatrics reference, we examined SBP trajectories using latent...
We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery. Using Poisson regression with confounder adjustments, we assessed a...
Context:
Cardiometabolic profiles of different body composition phenotypes are poorly characterized in young children, where it is well-established that high adiposity is unfavorable, but the role of lean mass is unclear.
Objective:
We hypothesized that higher lean mass attenuates cardiometabolic risk in children with high fat mass.
Design, set...
The Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) is a preconception, longitudinal cohort study that aims to study the effects of nutrition, lifestyle, and maternal mood prior to and during pregnancy on the epigenome of the offspring and clinically important outcomes including duration of gestation, fetal growth,...
Introduction
The foetal programming hypothesis posits that optimising early life factors e.g. maternal diets can help avert the burden of adverse childhood outcomes e.g. childhood obesity. To improve applicability to public health messaging, we investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity...
Background:
Asthma is the most common childhood chronic health condition. Maternal antenatal diet has been associated with offspring asthma risk, but studies investigating maternal whole diet quality and inflammatory potential with long-term offspring follow-up (>5 y) are rare.
Objectives:
We aimed to elucidate these associations in a prospectiv...
The ALPHABET consortium aims to examine the interplays between maternal diet quality, epigenetics and offspring health in seven pregnancy/birth cohorts from five European countries. We aimed to use the Dietary Approaches to Stop Hypertension (DASH) score to assess diet quality, but different versions have been published. To derive a single DASH sco...
There are over 1,000,000 publications on diet and health and over 480,000 references on inflammation in the National Library of Medicine database. In addition, there have now been over 30,000 peer-reviewed articles published on the relationship between diet, inflammation, and health outcomes. Based on this voluminous literature, it is now recognize...
Background
Maternal caffeine intake is associated with adverse birth outcomes, but its long-term influence on offspring adiposity outcomes is not well studied. Furthermore, few studies have investigated paternal and grandparental caffeine intake in relation to offspring outcomes.
Objective
To study the associations between maternal, paternal, and...
Objectives:
Asthma is the most common childhood chronic health condition. Maternal antenatal diet has been associated with offspring asthma risk, but long-term offspring follow-up (> 5 years) and studies investigating maternal whole diet quality and inflammatory potential are rare. We thus aimed to elucidate these associations using data from a pr...
Findings on the relations of maternal dietary patterns during pregnancy and risk of preterm birth and offspring birth size remain inconclusive. We
aimed to systematically review and quantify these associations.We searched MEDLINE, Embase, CENTRAL, and CINAHL up to December 2017. Three
authors independently conducted a literature search, study selec...
Early childhood diet may have lifelong influences on health outcomes, yet development of indices to assess diet quality is scarce in toddlers, especially in Asian countries. We aimed to develop and evaluate a Diet Quality Index (DQI) in a multi-ethnic Asian mother–offspring cohort and identify perinatal correlates of early childhood diet. Based pri...
Background
In the face of increasing childhood obesity, identification of modifiable risk factors is urgently needed. Limited, inconclusive data have suggested quality of dietary maternal carbohydrate (glycaemic index [GI] and glycaemic load [GL]) as intervention targets. We aimed to further elucidate associations of maternal GI, GL, and insulin de...
Background
Maternal caffeine intake is associated with adverse birth outcomes, but in most studies the primary caffeine source is coffee; the influence of tea caffeine remains unclear.
Objective
The aim of the study was to examine the association between maternal caffeine intake and birth outcomes in a population with tea as the predominant caffei...
Diet in the first month postpartum, otherwise known as "the confinement diet" in Asia, has unique characteristics that are influenced by traditions, cultures, and beliefs. We aimed to characterize dietary patterns during confinement period in a multi-ethnic Asian cohort and examined their associations with postpartum depression (PPD) and anxiety (P...
Background:
Studying the determinants and the long-term consequences of fetal adipose accretion requires accurate assessment of neonatal body composition. In large epidemiological studies, in-depth body composition measurement methods are usually not feasible for cost and logistical reasons, and there is a need to identify anthropometric measures...
Background
Evidence linking maternal diet quality during pregnancy with infant birth outcomes is limited in Asia.
Objective
We investigated the association of maternal diet quality with the risk of preterm birth, offspring birth size, and adiposity in a multiethnic Asian birth cohort.
Design
Dietary intakes of 1051 pregnant women were ascertained...
Background
Quantitative magnetic resonance (QMR) has been increasingly used to measure human body composition, but its use and validation in children is limited.
Objective
We compared body composition measurement by QMR and air displacement plethysmography (ADP) in preschool children from Singapore's multi-ethnic Asian population (n = 152; mean ±...
We investigated body mass index (BMI) trajectories in the first 2 years of life in 1170 children from an Asian mother-offspring cohort in Singapore, and examined their predictors and associations with childhood cardio-metabolic risk measures at 5 years. Latent class growth mixture modelling analyses were performed to identify distinct BMI z-score (...
OBJECTIVE: Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childho...
Background
Polyunsaturated fatty acids (PUFA) are essential for offspring development, but it is less clear whether pregnancy PUFA status affects growth and adiposity.
Methods
In 985 mother-offspring pairs from the ongoing Singaporean GUSTO cohort, we analyzed the associations between offspring growth and adiposity outcomes until age 5 years and f...
Background: Dietary protein may affect glucose metabolism through several mechanisms, but results from studies on dietary protein intake and risk of gestational diabetes mellitus (GDM) have been inconsistent.
Objective: We examined the cross-sectional associations of dietary protein intake from different food sources during pregnancy with the risk...
OBJECTIVE: There have been hypotheses that early life adiposity gain may influence blood pressure (BP) later in life. We examined associations between timing of height, body mass index (BMI) and adiposity gains in early life with BP at 48 months in an Asian pregnancy-birth cohort.
METHODS: In 719 children, velocities for height, BMI and abdominal...
Background: Infant body mass index (BMI) peak characteristics and early childhood BMI are emerging markers of future obesity and cardiometabolic disease risk, but little is known about their maternal nutritional determinants.
Objective: We investigated the associations of maternal macronutrient intake with infant BMI peak characteristics and childh...
Most studies linking maternal diet with offspring adiposity have focused on single nutrients or foods, but a dietary pattern approach is more representative of the overall diet. We thus aimed to investigate the relations between maternal dietary patterns and offspring adiposity in a multi-ethnic Asian mother–offspring cohort in Singapore. We derive...
[This corrects the article DOI: 10.1371/journal.pone.0160704.].
Background:
Maternal dietary patterns during pregnancy have been shown to influence infant birth outcomes. However, to our knowledge, only a few studies have examined the associations in Asian populations.
Objective:
We characterized maternal dietary patterns in Asian pregnant women and examined their associations with the risk of preterm birth...
Background
: Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher.
Methods
: We utilized data among 1020 infants from a mother-offspring cohort, who...
Imbalanced macronutrient intakes can induce impairment of endothelial and vascular function, and further lead to metabolic and cardiovascular disease. However, little is known about the influence of such diets on endothelial and vascular dysfunction in pregnant women, even though high-fat diet is a known risk for pregnancy complications such as ges...
Healthy Eating Index for Asian Pregnant Women (HEI-AP) components breakdown.
(TIF)
Background: Infant body composition has been associated with later metabolic disease risk, but few studies have examined the association between maternal macronutrient intake and neonatal body composition. Furthermore, most of those studies have used proxy measures of body composition that may not reflect body fat distribution, particularly abdomin...
Maternal vitamin D status during pregnancy has been associated with infant birth and postnatal growth outcomes, but reported findings have been inconsistent, especially in relation to postnatal growth and adiposity outcomes. In a mother–offspring cohort in Singapore, maternal plasma vitamin D was measured between 26 and 28 weeks of gestation, and a...
To assess the association between maternal caffeine intake and risk of pregnancy loss using a systematic review and meta-analysis.
Categorical and dose-response meta-analysis of prospective studies.
Relevant articles were identified by searching MEDLINE and SCOPUS databases through 30 January 2015. Two authors independently extracted information fr...
Maternal folate, vitamin B-12, and vitamin B-6 concentrations during pregnancy have been shown to influence birth outcomes, but the evidence is inconclusive.
We aimed to examine the associations of maternal B-vitamin status with gestational age, birth weight, and length in a birth cohort study in Singapore.
Maternal blood samples (n = 999) collecte...
Background
Considerable controversy exists regarding the relation between maternal caffeine intake during pregnancy and risk of low birth weight (birth weight <2,500 g). We aim to assess this association using a systematic review and dose¿response meta-analysis of prospective studies.Methods
Potential articles were identified by searching MEDLINE a...
Studies in the general population have proposed links between nutrition and depression, but less is known about the perinatal period. Depletion of nutrient reserves throughout pregnancy and delayed postpartum repletion could increase the risk of perinatal depression. We examined the relationships of plasma folate and vitamin B12 concentrations duri...
To examine changes in food consumption during pregnancy and the postpartum period in women of major Asian ethnic groups.
Using interviewer-administered questionnaires, we assessed changes in food consumption during pregnancy (26-28 weeks' gestation) and the postpartum period (3 weeks after delivery) as compared with the usual pre-pregnancy diet.
Si...