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Preventive Aspects of Early Nutrition
Nestlé Nutrition InstituteWorkshop Series
Vol. 85
Preventive Aspects of
Early Nutrition
Editors
Mary S. Fewtrell London, UK
Ferdinand Haschke Salzburg, Austria
Susan L. Prescott Perth, Australia
The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein.© 2016 Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher.
Printed on acid-free and non-aging paper (ISO 9706)ISBN 978–3–318–05642–6e-ISBN 978–3–318–05643–3ISSN 1664–2147e-ISSN 1664–2155
Library of Congress Cataloging-in-Publication Data
Names: Fewtrell, Mary S., editor. | Haschke, F., editor. | Prescott, Susan L., editor.Title: Preventive aspects of early nutrition / editors, Mary S. Fewtrell, Ferdinand Haschke, Susan L. Prescott.Description: Basel ; New York : Karger, [2016] | Series: Nestlé Nutrition Institute workshop series, ISSN 1664-2147 ; vol. 85 | Includes bibliographical references and index.Identifiers: LCCN 2015046033| ISBN 9783318056426 (hard cover : alk. paper) | ISBN 9783318056433 (electronic version)Subjects: | MESH: Child Nutritional Physiological Phenomena | Infant Nutritional Physiological Phenomena | Pediatric Obesity--prevention & control | Hypersensitivity--prevention & control | CongressesClassification: LCC RJ206 | NLM WS 130 | DDC 613.2083--dc23 LC record available at http://lccn.loc.gov/2015046033
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V
Contents
VII Preface
X Foreword
XIII Contributors
Allergy
1 Early Nutrition as a Major Determinant of ‘Immune Health’:
Implications for Allergy, Obesity and Other Noncommunicable
Diseases
Prescott, S.L. (Australia/Western Australia)
19 The Future of Infant and Young Children’s Food: Food Supply/
Manufacturing and Human Health Challenges in the 21st Century
Venter, C. (UK/USA); Maslin, K. (UK)
29 Infant Feeding: Foods, Nutrients and Dietary Strategies to Prevent
Allergy
Beyer, K. (Germany)
35 Using Food and Nutritional Strategies to Induce Tolerance in
Food-Allergic Children
Nowak-Węgrzyn, A. (USA)
55 Summary on Allergy
Prescott, S.L. (Australia)
Obesity Prevention
59 Interrupting Intergenerational Cycles of Maternal Obesity
Gillman, M.W. (USA)
71 Development, Epigenetics and Metabolic Programming
Godfrey, K.M.; Costello, P.M.; Lillycrop, K.A. (UK)
VI
81 Endocrine and Metabolic Biomarkers Predicting Early Childhood
Obesity Risk
Socha, P. (Poland); Hellmuth, C. (Germany); Gruszfeld, D. (Poland);
Demmelmair, H.; Rzehak, P.; Grote, V.; Weber, M. (Germany); Escribano, J.;
Closa-Monasterolo, R. (Spain); Dain, E.; Langhendries, J.-P. (Belgium); Riva, E.;
Verduci, E. (Italy); Koletzko, B. (Germany) for the European Childhood Obesity
Trial Study Group
89 Effects of Early Nutrition on the Infant Metabolome
Hellmuth, C.; Uhl, O.; Kirchberg, F.F.; Grote, V.; Weber, M.; Rzehak, P. (Germany);
Carlier, C. (Belgium); Ferre, N. (Spain); Verduci, E. (Italy); Gruszfeld, D.;
Socha, P. (Poland); Koletzko, B. (Germany) for the European Childhood Obesity
Trial Study Group
101 Postnatal High Protein Intake Can Contribute to Accelerated Weight
Gain of Infants and Increased Obesity Risk
Haschke, F. (Austria); Grathwohl, D.; Detzel, P.; Steenhout, P.;
Wagemans, N.; Erdmann, P. (Switzerland)
111 Summary – Early Nutrition and Obesity Prevention
Haschke, F. (Austria)
Complementary Feeding: Taste, Eating Behavior and Later Health
113 Can Optimal Complementary Feeding Improve Later Health and
Development?
Fewtrell, M.S. (UK)
125 Learning to Eat: Behavioral and Psychological Aspects
Birch, L.L. (USA)
135 The Development of Flavor Perception and Acceptance: The Roles of
Nature and Nurture
Forestell, C.A. (USA)
145 Dietary Patterns during Complementary Feeding and Later Outcomes
Emmett, P.M. (UK)
155 Nature and Nurture in Early Feeding Behavior
Cooke, L.; Llewellyn, C. (UK)
167 Summary on Complementary Feeding: Taste, Eating Behavior and
Later Health
Fewtrell, M.S. (UK)
169 Subject Index
Contents
For more information on related publications, please consult the NNI website: www.nestlenutrition-institute.org
VII
Preface
Early-life nutrition is arguably the most critical determinant of future health. It provides the energy and critical building blocks for all development, determines our future tastes and eating behaviors, and supplies the crucial substrate for the establishment of a healthy microbiome, now recognized as one of the most im-portant determinants of immune and metabolic health. Our diets are also an increasing source of exposure to adverse elements in the environment, including contaminants and pollutants in our food and water supply, which have greater potential to affect human health early in life than at any other stage.
Optimizing early nutrition can have long-term benefits for long-term bio-logical reserve and resilience, through effects on developing structure and phys-iological responses. Greater attention to this is key to maximizing human poten-tial. Indeed, improved early-life nutrition has been a major element in dramatic improvements in life expectancy over the 20th century, particularly in high-in-come countries. However, access to healthy food remains an important factor in the wide global disparities in human health and longevity that still remain. Across the threshold of the 21st century, new nutritional challenges are emerg-ing, with overnutrition and obesity now the most significant threats to the future of human health. Rising rates of inflammatory and metabolic diseases in chil-dren now underscore the importance of understanding the impact of the early environment on immune and metabolic health. For the first time in modern history, the current generation is expected to have a shorter life expectancy than their parents, simply because of obesity and the associated increased risk of non-communicable diseases (NCDs), including diabetes, heart disease, mental ill health, some cancers, musculoskeletal disorders and immune diseases. In par-ticular, the epidemic rise in very-early-onset NCDs, such as infant allergy, pro-vide clear evidence of immune dysregulation and the rising early predisposition to inflammation.
Diet-sensitive pathways are likely to be crucial in understanding how early-life conditions influence the finely balanced development of immune and meta-
VIII Fewtrell · Haschke · Prescott
bolic responses. In particular, diet is at the center of the emerging epigenetic paradigms that may underpin the rise in several NCDs. While epigenetic mech-anisms provide a potential explanation of how nutritional exposures can affect fetal gene expression and subsequent disease risk, other diet-induced tissue compositional changes may also contribute directly to altered immune and met-abolic function, e.g. through diet-induced changes in the microbiome. A better understanding of nutritional programming of immune health, nutritional epi-genetics and the biological processes sensitive to nutritional exposure in early life may lead to dietary strategies that provide more optimal conditions during early programming, and reduce the burden of many metabolic and inflamma-tory diseases.
While there is little doubt that changing dietary patterns are at the core of this modern NCD-driven health crisis, the importance of addressing this intervention in early life is still often underestimated. However, the increas-ing burden of childhood disease underscores that without early intervention there is very little hope of averting current trends. These concepts are sup-ported by growing evidence that a ‘life course’ approach from the first mo-ments of life will be more effective in reducing the long-term disease burden. With this philosophy, there is an increased focus on the next generation of parents and promotion of their health before conception. These efforts must be firmly grounded through promoting a far greater public awareness of the long-term implications of dietary choices in pregnancy, lactation and infancy. Advocacy for early-life nutrition needs to be matched with sound evidence and consistent advice for healthcare professionals, parents and the wider com-munity. At the moment, there is still inconsistency around even basic advice such as the optimal timing of introducing complimentary foods to infants. This needs to be addressed relatively urgently. As we understand more about gene-environment interactions, it is also increasingly likely that we may need to tailor this advice according to the genetic background and environmental context.
The first two sections of this workshop consider preventive aspects of early nutrition in relation to the development of allergy and obesity, including the role of the microbiome, the use of food and nutritional strategies to induce tolerance and reduce the risk of obesity, and genetic and epigenetic aspects of metabolic programming. In the third section of the workshop, the role of complementary feeding is discussed in relation to later health outcomes, including consideration of the determinants of flavor and food preferences and eating behaviors which may shape subsequent food habits and exposures.
While the burden of modern diseases is complex and diverse, it is also clear that many NCDs share the same risk factors, with early life nutrition as a central
IXPreface
common element. This underscores the need to take a more collaborative inte-grated cross-discipline, cross-sectoral approach to solving these problems.
All of these issues need to be framed in the context of the wider environmen-tal impact and sustainability of our food choices. This raises important questions around food diversity for nutrients, taste and deriving a balanced microbiome. It also raises the challenge of balancing the demands of modern life and the need of convenience food against the potential risks that this poses.
As we investigate nutritional strategies as a critical avenue of improving health and life expectancy in the 21st century, we must consider ‘the future of our food’ in the wider context of the other social and economic challenges facing the world today.
Mary S. Fewtrell Ferdinand Haschke
Susan L. Prescott
X
Foreword
The program was based on well-established and documented evidence that early-life events, including nutrition, play a powerful role in programming a person’s development, metabolism and health for the future. The implications of early nutrition programming are significant – particularly when it comes to the risk of suffering cardiovascular diseases, diabetes and obesity, as well as effects on immune function, allergy risk, and cognitive and behavioral outcomes later in life. It was concluded that by ensuring appropriate nutri-tion early in life, we have enormous potential to improve the health of future generations.
The workshop program had three sessions. The first, led by Prof. Susan L. Prescott, addressed a fundamental topic on the role of nutrition in the determi-nation of ‘immune’ health and implications for noncommunicable diseases. An excellent group of speakers took part in this session and explored the new op-portunity to transform human health by diet, the role of gut microbiota in im-mune status, and strategies and interventions for the prevention and manage-ment of food allergies in children.
Prof. Ferdinand Haschke chaired the session on obesity prevention. During these discussions, experts in epigenetics and metabolic programming shared scientific evidence on the use of biomarkers for predicting the risk of early obe-sity and discussed potential strategies for interrupting intergenerational cycles of obesity during pregnancy, early infancy and childhood.
The final session, chaired by Prof. Mary S. Fewtrell, looked into comple-mentary feeding, with a focus on the importance of optimal complementary feeding in short- and long-term health, and how its ‘programming’ can im-pact behavioral and psychological aspects, as well food preferences, in later life.
We would like to thank the three Chairpersons Mary S. Fewtrell, Susan L. Prescott and Ferdinand Haschke for putting the excellent scientific program to-gether.
XIForeword
We would also like to thank all the speakers and scientific experts in the au-dience, who actively contributed to the workshop content and scientific discus-sions and enhanced the learning experience.
Finally, we thank Mike Eddi, Liz Greenstreet and their teams in the UK for their valuable logistical support.
Dr. Jose M. Saavedra, MD Dr. Natalia Wagemans, MD, PhD Chairman Global Head Nestlé Nutrition Institute Nestlé Nutrition Institute Vevey, Switzerland Vevey, Switzerland
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Chairpersons & Speakers
Prof. Kirsten Beyer
Augustenburger Platz 113353 BerlinGermanyE-Mail [email protected]
Prof. Leann L. Birch
Department of Foods and NutritionThe University of Georgia176 Dawson HallAthens, GA 30602-3632USAE-Mail [email protected]
Dr. Lucy Cooke
Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonGower StreetLondon WC1E 6BTUKE-Mail [email protected]
Dr. Pauline M. Emmett
Centre for Child and Adolescent HealthSchool of Social and Community MedicineUniversity of BristolOakfield House, Oakfield GroveBristol BS8 2BNUKE-Mail [email protected]
Prof. Mary S. Fewtrell
Childhood Nutrition Research CentreUCL Institute of Child Health30 Guilford StreetLondon WC1N 1EHUKE-Mail [email protected]
Assoc. Prof. Catherine A. Forestell
Department of PsychologyCollege of William & MaryTyler Hall, Room 210APO Box 8795Williamsburg, VA 23185-8795USAE-Mail [email protected]
Prof. Matthew W. Gillman
Department of Population MedicineHarvard Medical School/Harvard Pilgrim Health Care Institute133 Brookline Avenue, 6th floorBoston, MA 02215USAE-Mail [email protected]
Prof. Keith Godfrey
MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthampton General HospitalMailpoint 95Tremona RoadSouthampton SO16 6YDUKE-Mail [email protected]
Contributors
XIV Contributors
Prof. Ferdinand Haschke
Department of PediatricsParacelsus Medical UniversityMüllner Hauptstrasse 485020 SalzburgAustriaE-Mail [email protected]
Dr. Christian Hellmuth
Division of Metabolic and Nutritional MedicineDr. von Hauner Children’s HospitalUniversity of Munich Medical CenterLindwurmstrasse 480337 MunichGermanyE-Mail [email protected]
Assoc. Prof. Anna Nowak-Węgrzyn
Department of PediatricsIcahn School of Medicine at Mount SinaiJaffe Food Allergy InstituteOne Gustave L. Levy Place, Box 1198New York, NY 10029USAE-Mail [email protected]
Prof. Susan L. Prescott
School of Paediatrics and Child HealthThe University of Western Australia (M561)Princess Margaret HospitalPO Box D184Perth, WA 6001AustraliaE-Mail [email protected]
Prof. Jose M. Saavedra
Department of Pediatrics, Gastroenterology and NutritionJohns Hopkins University School of MedicineBrady 320600 N. Wolfe StreetBaltimore, MD 21287-2631USAE-Mail [email protected]
Prof. Piotr Socha
Department of Gastroenterology, Hepatology and Nutrition DisordersChildren’s Memorial Health InstituteAl. Dzieci Polskich 2004-730 WarsawPolandE-Mail [email protected]
Dr. Carina Venter
Research Associate/DietitianDivision of Allergy and ImmunologyCincinnati Children’s Hospital Medical Center3333 Burnet Avenue, MLC 7028Cincinnati, OH 45229USAE-Mail [email protected]
Participants
Margarita Thanhäuser/AustriaMartin Wald/AustriaSergey Ukraintsev/BelarusAna Paula Castro/BrazilChristiane Leite/BrazilHaiqi Li/ChinaJie Mi/ChinaXiaoyang Sheng/ChinaXiu Xu/ChinaAn an Yuan/ChinaQianqian Zhu/ChinaBertha Patricia Calderón Ortiz/ColombiaEliana Eugenia Cantillo Tinoco/ColombiaSilvana Dadán Muñoz/ColombiaWilson Daza Carreño/ColombiaJaneth Jaramillo Cabal/ColombiaNicolás Ignacio Ramos Rodriguez/ColombiaAlina Restrepo Velez/ColombiaJosé María Solano Suárez/ColombiaJiri Nevoral/Czech RepublicCamilla Trab Damsgaard/DenmarkAbdoul Gadirou Bah/FranceFarid Boubred/FranceLaurence Foix l’Hélias/FranceDéo-gratias Rugemintwaza/FranceGeorg Frey/GermanyMathilde Kersting/GermanyNina Ludwig/GermanyMike Possner/GermanyJudit Cholnoky/HungaryGárdos László/Hungary
XVContributors
Bhaskar Raju Balagopal/IndiaSridhar Ganapathy/IndiaSanjeev Kumar Ganguly/IndiaSanjay Niranjan/IndiaBinayak Roy/IndiaSantosh Theodore Soans/IndiaSuresh Kumar Surapaneni/IndiaNishant Wadhwa/IndiaMuhammad Azam/IrelandNuala Collins/IrelandDan O’Callaghan/IrelandPamela O’Connor/IrelandEleanor Power/IrelandIta Saul/IrelandMassimo Agosti/ItalyFrancesco Tandoi/ItalyAdib Moukarzel/LebanonAnna Rybak/PolandAntonio Guerra/PortugalElena Kornienko/RussiaLeyla Namazova-Baranova/RussiaXavier Dorca/SpainJosé Manuel Moreno/SpainChristian Braegger/SwitzerlandLiya Denney/SwitzerlandIrma Silva Zolezzi/SwitzerlandEvelyn Spivey-Krobath/SwitzerlandKrisztina Suhajda/Switzerland
Laura Taylor/SwitzerlandSabine von Manteuffel/SwitzerlandMaria Airainer/UKMichael Edde/UKSian Evans/UKGavin Fergie/UKJackie Gaventa/UKLiz Greenstreet/UKEllie Grove/UKKemi Ibinola/UKJulie Lanigan/UKAnirban Maitra/UKKate Maslin/UKCaroline McCormack/UKJudy Moore/UKDilip Nathan/UKSue O’Neil/UKVanessa Shaw/UKAnne Sidnell/UKAtul Singhal/UKSara Stanner/UKCharlotte Stirling-Reed/UKEmma Sutton/UKPaul Turner/UKDavid Tuthill/UKLeah Wood/UKRachel Wood/UKBarbara MacFarland/USA
