Table 4.

The impact of maternal nutrition on offspring cancer related outcomes

Reference (year). country, study type	Subjects (n, age range)	Data collection method	Maternal nutrition exposure	Outcome in offspring
Aschim EL, et al [30] (2005). Norway, Case Control Study	1790, 21-45 y	Male offspring from women giving birth at the National Hospital in Oslo, Norway each month from 1931-1955. Linked to national testicular cancer cases register.	Maternal exposure to famine (impact on BMI)	Testicular Cancer (TC): Reduction in maternal weight of between 2-3 kg from 1941-1945 compared to 1951-1955 (BMI 26.3 vs 27.9) correlated with a reduction in TC incidence (465 vs 535, Spearman’s rho = 1.00, P < 0.01; Pearson r = 0.95, P = 0.02).
Ekamper P, et al [22] (2015). Netherlands, Retrospective Cohort	41 096 men (22 952 exposed), 63 y	Male conscripts born between 1944 and 1947 in famine affected areas by the DFBC. Linked to military records of health and mortality.	Exposure to famine during pregnancy (<900 kcal/d)	Cancer Related Mortality and Malignant Neoplasms: 5011 subjects had died at the time of analysis. Cancer accounted for 38.7% of recorded deaths. There was no significant increase in cancer related mortality following gestational exposure to famine (HR = 0.98, 95% CI = 0.87-1.11). Reduced risk of malignant neoplasms in offspring following maternal exposure prior to pregnancy was found (HR = 0.85, 95% CI = 0.74- 0.99). Highest number of neoplasms recorded for digestive organs (30%) and respiratory organs (29%). Famine exposure in the first trimester of gestation increases mortality from other natural causes (HR = 1.24, 95% CI = 1.03-1.49) – includes diabetes and cerebrovascular disease.
Van Abeelen AF, et al [21] (2012). Netherlands, Retrospective Cohort	1991, 18-64 y	Offspring from the DFBC. Linked to Statistics Netherlands mortality data.	Exposure to famine during pregnancy	Cancer Related Mortality: 206 (10%) had died at the time of analysis. Women exposed to famine in early gestation had a significantly higher risk of cancer mortality (HR = 2.3, 95% CI = 1.1-4.7, P = 0.03), and breast cancer mortality (HR = 8.3, 95% CI = 1.1-63.0, P = 0.04). Men exposed to famine in early gestation showed a non-significant reduction in cancer mortality (H = 0.3, 95% CI = 0.0-1.9, P = 0.19). Exposure to famine in mid and late gestation was not associated with significantly increased cancer related morality in men or women.
Painter RC, et al [19] (2006). Netherlands, Case Control Study	475 women, 61-62 y	Offspring from the DFBC (Linked to Statistics Netherlands mortality data.).	Exposure to famine during pregnancy	Breast Cancer: Overall, when adjusted for maternal body mass index, the hazard ratio of breast cancer in offspring of women exposed to famine during pregnancy was significant higher (HR = 4.0, 95% CI = 1.1-14.5), particularly for those exposed in early gestation (HR = 7.1, 95% CI = 1.6-32.0).
Sanderson M, et al [31] (1998). USA, Case Control Study	946 (510 cases), 45 y	Data collected from the mothers of women in two population-based case–control studies of breast cancer in women under the age of 45 y	Gestational weight gain	Breast Cancer: Gestational weight gain of 11-15 kg was associated with an increased risk of breast cancer (OR = 1.5, 95% CI = 1.1- 2.0); however, women whose mothers gained 15.5 kg or more were not at an increased risk. No association between maternal coffee consumption or anaemia status was found.
Eriksson JG, et al [18] (2014). Finland, retrospective cohort	N = 13 345, 70-80 y	Offspring of the HBC– maternal BMI measured prior to delivery and linked to offspring’s national health records	Maternal overweight in pregnancy	Cancer Incidence and cancer related death: Offspring’s risk of cancer incidence was not significantly associated with maternal BMI (HR for trend per kg/m2 = 1.017, 95% CI = 0.998-1.036, P = 0.08). There was also no significant association found for maternal BMI and offspring risk of cancer related death (HR for trend = 1.013, 95% CI = 0.983-1.044, P = 0.4).

HR – hazard ratio, CI – confidence interval, BMI – body mass index, y – year