The overall objective is to evaluate the factors associated with the transmission of the Mediterranean Diet (MD) from mothers to their children during childhood up to ages 9–11, and its association with urinary metal concentrations and other cardiometabolic risk markers.
The study population consists of mothers and their children participating in the prospective INMA (Environment and Childhood) cohort study in Asturias, Gipuzkoa, Sabadell, and Valencia. Adherence to the Mediterranean Diet (MD) will be assessed using three a priori–defined dietary indices (Mediterranean Diet Score, relative Mediterranean Diet Score, and alternative Mediterranean Diet Score), calculated from validated food‑frequency questionnaires collected during prenatal visits (first and third trimesters of pregnancy) and postnatal visits (ages 4–5, 7–8, and 9–11 years).
Prospectively collected information is available on sociodemographic characteristics, lifestyle factors, and cardiometabolic risk markers (body mass index, waist circumference, blood pressure, and blood lipids). Urine samples are also available, and for most participants, measurements of arsenic species and total metals (essential and non‑essential) have already been obtained. The aim is now to analyze arsenic species (n = 40 at ages 4–5 and n = 346 at ages 9–11) and total metals (n = 100 during pregnancy, n = 130 at ages 4–5, n = 40 at ages 7–8, and n = 346 at ages 9–11) in urine samples from the remaining INMA participants.
Multivariable linear regression models and correlation analyses will be performed when MD index scores are treated as continuous variables, and multivariable multinomial logistic regression models will be used when the indices are categorized into tertiles.
