Last week I was lucky enough to attend the “Preventative Aspects of Early Nutrition” conference from 17-19th November 2014. During the event there were a number of high profile speakers on topics of infant nutrition such as allergy, obesity prevention and complementary feeding.
I decided to write up learning points from each speaker and, as I was doing so, found it incredibly interesting to see so many of the very same messages that we use to talk to parents about infant feeding backed up by more and more research.
I therefore think it is important to develop some take home messages that I would like to pass on to parents and any early years workers, which I hope will help to influence parenting decisions and therefore improve the health of our next generations.
A Summary – The take home messages:
- Effects of early environment really do last a lifetime. Even before conception a child’s risk of obesity and other related diseases can be determined.
- Maternal obesity before and during pregnancy can impact strongly the child’s chance of being overweight themselves – obesity can therefore become an endless cycle.
- Pre, during and post pregnancy are all potential times for intervention but mothers are more willing to change behaviours during pregnancy and during infancy metabolic changes are easier to make than as we get older.
- If mother has a poor diet during pregnancy, the foetus will adapt and genetic mutations will occur which may affect long term health.
- Parental obesity, mother’s smoking, gestational diabetes, mother’s dietary intake during pregnancy, low breastfeeding and the child’s feeding patterns will ALL influence the child’s risk of obesity and other diseases.
- High protein intake during the first and second years of life can increase risk of obesity – therefore lower protein infant formulas could help and reducing intake of child’s dairy food in the second year of life may also be important.
- Children’s food preferences start during gestation when mum’s diet influences the amniotic fluid surrounding the foetus.
- High intake of sweetened beverages, low intake of fruit and vegetables and high protein (dairy) intake all potential problems in the first year of life.
- Children learn to like new foods through repeated exposure during complimentary feeding it is therefore essential that new tastes are frequently offered. Offering new tastes over 2 or 3 days can increase acceptance.
- Responsive feeding is essential – listening to child’s cues of hunger and fullness and not feeding on demand, as are family mealtimes
- Bacteria in the gut are essential to our health as they help break down foods and deliver nutrients
- Pre-prepared or commercial baby foods have less vitamins and minerals, antioxidants and less microbial organisms than homemade baby foods
- Obese children are more likely to have lower levels of microbiota (gut bacteria)
- Current evidence doesn’t suggest any benefit to delaying intake of allergen risk foods after 4 months of age to avoid allergies in later life.
The Full Conference Key Learnings
Day ONE – Allergy prevention
Early Nutrition as a major determinant of immune health – implications for allergy, obesity and other NCDs
- Early Nutrition is a major determinant of immune health – it poses implications for allergy, obesity and other Non Communicable Diseases (NCDs e.g. Cardiovascular disease, cancer and diabetes) http://www.who.int/mediacentre/factsheets/fs355/en/
- Effects of early environment can last a lifetime – even before conception there can be a risk to the child of early and delayed onset of NCDs
- We now have increased rates of maternal obesity, which poses major problems and increases pro-inflammatory mediators – inflammation in turn increases risk of NCDs
- Maternal exposures (e.g. diet, environment etc) influence foetal immune development and any factors that influence the immune system also influences a number of other factors, including disease risk.
- 25% infants have eczema and 10% have a food allergy – in 0-4 year old children there has been a 5fold increase in allergy referrals in last 15 years (US data)
- A few examples of things that have immune system and metabolic effects include physical activity (being active), getting outdoors (vitamin D, sunlight), UV (not too much), pollutants (envioronment to live or work) and diet (low fibre and low omega 3-PUFAs).
Diet, gut, microbiota and western lifestyle diseases
- Diet is critical to modern lifestyle diseases
- The microbiota (description) in the gut are essential to break down elements of our food and therefore in helping with disease prevention.
- Research shows death rates are higher in those who consume less fibre
- Eating a high fibre diet for just a few days changes the gut’s microbiota enormously
- Fibre, phytonutrients and omega 3 Fatty acids are all beneficial for gut health
- Artificial sweeteners, red meat, saturated fat, sugar and omega 6 fatty acids all have the potential to have negative effects on the gut health
- This is in line with advice around other diseases and healthy eating.
The Future of infant and young children’s Food: Food Supply, Manufacturing and Human Health Challenges in the 21st Century
- Mother’s obesity before and during pregnancy affects risk of obesity in a child, even before they are actually conceived!
- Commercial baby foods are the fastest growing food category and now a 872million pound industry in the UK alone.
- The processes involved in preprepared foods means that commercial foods have less vitamins and minerals, less antioxidants and also less (or no) microbial organisms
- This may affect gut health, especially when low levels or certain bacteria in the gut is linked with obesity in children.
- Home prepared weaning foods ARE superior
Infant Feeding: Foods, nutrients and dietary stratergies to prevent allergies
- Having a single child, a C-section, use of disinfectant and use of antibiotics all affect microbial exposure and risk of food allergy
- Probiotics show conflicting results but MYA be useful in decreasing eczema – more research is needed
- Vitamin D may be useful given during pregnancy to reduce risk of food allergies to baby.
- Exposure of allergen risk foods may be useful through breastmilk
- Evidence does not suggest that avoidance of complementary foods after 4 months is necessary to reduce risk of food allergies.
Using food and nutritional strategies to induce tolerance in food allergic children
- 8% of US children have a food allergy and therefore this is a serious public health concern
- Many milk allergic children grow out of it after the first 6 years of life.
- Extensively heated milk and egg diets benefit the majority of (75-80%) milk and egg allergic patients
- There is no evidence that permanent oral tolerance can be induced by any treatment.
Day Two – OBESITY PREVENTION
Opportunities for interrupting intergenerational cycles of obesity
Factors predicting childhood obesity include:
- Mother’s weight before pregnancy
- Excessive gestational weight gain
- Maternal smoking during pregnancy
- Gestational diabetes
- Cesarean delivery
- Rapid early infant weight gain
- Infant feeding practices and
- Sleep duration
- Cycle of obesity:
- Mother starts obese (before even becoming pregnant) àMother gains weight during pregnancy à mother gets gestational diabetes à Post pregnancy weight is maintained à Altered foetal growth means foetus/baby’s body composition is altered à child becomes obese à child is obese as an adult and (if female) becomes pregnant.
So, where should we intervene?
- Pregnancy and during infancy may be key areas for intervention as mothers are generally more willing to change behaviours
- Early life is more adaptable
- Entering pregnancy with a healthy weight lowers all risks
- Need to intervene in all areas.
Development, epigenetics and metabolic programming
- Weight gain during pregnancy, obesity, gestational diabetes and consumption of a high GL diet have lasting effects on offsprings obesity risk.
- Risks are 4 x worse if the following is true:
Mother has a BMI over 25
Mother smokes during pregnancy
Short breastfeeding duration or no breastfeeding
Poor diet during pregnancy
Low vitamin D levels
- If mother has a poor diet, the foetus will adapt and genetic mutations will occur which may affect long term health.
- In order to survive in a less than ideal situation (i.e. not enough nutrients for growth and development due to poor maternal diet) babies adapt and will often be born premature, at low birthweight or with a higher percentage of body fat.
- We need to intervene and more research is also needed into preconception and how we can alter this cycle
Endocrine/Metabolic Biomarkers predicting early childhood obesity risk
- Breastfeeding is associated with a decreased risk of obesity and other disorders in later life compared to infant formula feeding.
- High protein intake in formula milk may be a major causal factor
- Compared to a lower protein infant formula, conventional infant formula induced faster weight gain and BMI in the first two years of life (no difference in length growth though)
Maternal- and early childhood obesity. Outcomes of clinical studies
- Prevention measures of childhood and adult obesity should start during the first 1000 days of life
- After birth, promotion of breastfeeding is most important to prevent excessive weight gain during infancy
- High protein intake during the first year (or two) of life can slow down ‘rapid weight gain’ which is associated with higher risk of obesity in later life
- Low protein formula milks have been tested and can slow down rapid growth whilst still allowing for healthy growth.
Infant feeding and opportunities for obesity risk reduction
- Childhood obesity begins very early (around 9 months of age) and by the age of 2 years of age, family eating practices are often well established
- Parental feeding practices and the environment can play a big role in childhood obesity
- Responsive feeding is essential – listening to child’s cues of hunger and fullness and not feeding on demand
- Low breastfeeding rates, intake of sweetened beverages, low fruit and vegetable intakes and high protein intakes are ALL the main problems in the first year of life
- Breastfed infants MAY develop a feeding style that allows for stronger self-regulatory intake.
- Preference for sweetened and salty foods is easily encouraged but acceptance of bitter foods needs to be taught – something that many parents fail to do.
- Fat is not actually a problem in itself as intakes fairly low but the TYPE of fat is important as high intakes of saturated fat are seen in this age group
- Encourage family mealtimes, water intake over anything else and a ‘healthy diet’ as well as responding to child’s cues effectively – essential for healthy growth and development of children.
Day THREE – Complementary feeding; taste, eating behaviour and later health
Can optimal complementary feeding improve later health and development?
- Complementary feeding can influence outcomes by having lasting effects on food preferences, appetite and eating behavior.
- Research in this field is challenging as mothers have strong opinions on ways to feed their children
- Evidence suggests that there may be an increased risk of obesity if solids are introduced before 15 weeks of age – there is little evidence that timing is influential beyond this age.
- Research seems to suggest it doesn’t matter when you introduce gluten (between 4 and 6 months) as long as you are breastfeeding at the time of gluten introduction as this will reduce the risk of coeliac disease.
- High protein intakes could increase risk of obesity but research indicates this is not protein from meat or vegetables but more than from dairy sources.
- Limited other date on introduction of solid food other than must be after 15 weeks to prevent obesity – must take individuals into account.
Learning to Eat: Behavioral and Psychological aspects
- Feeding practices are evolved based on threats of food scarcity and therefore we often: overfeed with big portions, offer food too frequently, feed to soothe, force feed, and offer preferred foods we know will go down easily
- Familiarisation is key to acceptance and early familiarization occurs pre and post-natally and can influence baby’s preference for tastes and flavours.
- Interventions include:
Finding soothing alternatives so feeding is not the default
Introducing a sleep routine
Listening to hunger/fullness cues
Delaying solid introduction
Learning to like new foods – repeat exposures necessary and often new taste offered over just 2-3 days can increase acceptance.
The Development of Flavour perception and Acceptance: The Roles of Nature Vs Nurture
- By the last trimester, taste and flavor receptors are functional and the foetus is capable of detecting the flavor profile of the mother’s amniotic fluid
- Therefore amniotic fluid and the breastmilk after birth are flavoured by foods that the mother eats
- These early experiences contribute to individual preferences anf food acceptance in the infant.
- Children who are formula fed do not get such a wide variety of flavours and therefore may be less accepting of different falvours
- Children who are repeatedly exposed to a variety of healthy foods learn to like those foods.
- Those routinely fed sweet and salty foods learn to prefer these foods.
- During pregnancy, lactation and infant feeding mothers can influence healthy eating habits and therefore long term health benefits for their children.
- Innate responses are VERY adaptive – we can alter the preferences we are born with. But children’s senses are being overwhelmed with sugar, fat and salt.
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