Early Nutrition and Long-Term Health

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Nutrition in early life and why it matters

Background

The next generation is expected to have a shorter life expectancy partly due to the obesity epidemic and related non-communicable diseases. Nutrition during fetal and early neonatal life stages is thought to affect chronic disease risk throughout all stages of life. The Early Nutrition and Long-Term Health Task Force particularly focuses on how nutrition of both mothers and their infants may affect the long-term health of the child.

Objectives

This task force aims (1) to provide scientific evidence to support guidelines for maternal and infant nutrition to ensure life-time optimal health; and (2) to identify risk factors for obesity and other health consequences at the earliest stages of life.

Impact

  • The task force assessed the neurocognitive and metabolic outcomes for pre-term infants that experience a phase of catch-up growth after birth and highlighted that there is a gap in our knowledge on how to nutritionally mediate this time for the long-term health benefit of infants in a publication called ‘Postnatal growth in preterm infants and later health outcomes: a systematic review’ (K. Ong et al., 2015). The follow up work on small-for-gestational-age infants, due to be published soon, was presented at the Nutrition and Growth Conference, Amsterdam, The Netherlands, in March 2017.
  • Key factors during perinatal period contributing to obesity in children have been identified and recommendations have been published on how to improve the design of mother-child studies as well as maximise the use of existing data (M. Symonds et al., 2013).
  • The task force has presented at conferences such as the International Congress on Nutrition (ICN), the European Congress on Obesity (ECO), International Society for Developmental Origins of Health and Disease (DOHaD), Power of Programming (PoP) and Diabetes in Pregnancy (DIP).

What's New

  • New publication in Annals of Nutrition and Metabolism providing a systematic review on intakes of n-3 and n-6 Polyunsaturated Fatty Acids in the European at risk population groups and a comparison to the current dietary recommendations (I. Sioen et al., 2017).
  • The task force is considering: i) continuing their work on early body composition and growth; ii) having a potential shared workshop with the Nutrition, Immunity and Inflammation Task Force to follow up on their work on early bacterial colonisation and long-term health; and iii) investigating the impact of nutrient interactions in infants.

For more detailed information, please contact Dr Bettina Schelkle at bschelkle@ilsieurope.be.

Task Force Members

Expert Groups

Gestational Diabetes and Diet 

In collaboration with the Obesity and Diabetes Task Force

Objectives
Gestational diabetes mellitus (GDM) is defined as a glucose intolerance (of any degree), which occurs during pregnancy (B. Metzger et al., 1998). It is estimated that 2-6% of pregnancies in Europe result in GDM and the numbers are much higher in Asia. High maternal weight is associated with a higher risk of GDM. Nutritional advice on GDM aims to control postprandial glucose levels and to provide adequate nutrition for the developing foetus. But as yet, there is still no consensus on the optimal nutritional recommendations for GDM management. The overall aim will be to provide a clear, comprehensive and critical overview of the current knowledge on treatment of GDM via diet.

Activity
This activity will assess state-of-the-art nutritional management of GDM by means of a systematic literature review. The focus will be on treatment options via diet and lifestyle based on their effect on selected maternal and fetal outcomes. Maternal outcomes to be included are mean glucose, fasting glucose, post-meal glucose, insulin use, HOMA-IR (HOmeostatic Model Assessment for Insulin Resistance) or any other insulin sensitivity index, HbA1c (Hemoglobin A1c), mode of delivery (number of caesarean sections), pre-eclampsia and weight gain. Fetal / neonatal outcomes included are large-for-gestational-age, small-for-gestational-age, macrosomia, neonatal hypoglycaemia requiring treatment, preterm birth, birthweight and admission to neonatal intensive care unit. Moreover, the activity will identify limitations and gaps in the existing literature. The expert group is collaborating with the International Federation of Gynecology and Obstetrics (FIGO) to ensure a more active uptake of the results by health practitioners.

Expected Output
It is anticipated that such an initiative would support the development of evidence-based recommendations by national and international policy makers. Thereby this activity will contribute to reducing short- and long-term complications for mother and baby.

Early Bacterial Colonization and Potential Implications Later in Life

Objectives
This activity aims to provide insight into the role of microbiota during the early stages of life in programming health and disease. A second aim is to review potential implications of nutritional interference on early bacterial colonisation derived from the existing evidence. The main objectives will be:

  • To review existing evidence related to bacterial colonisation early in life (bacterial transfer from the mammary gland and placenta);
  • To elucidate potential benefits of nutritional mediation of metabolic, immunological and cognitive outcomes through the modulation of microbiota.

Activity
The experts will perform a critical analysis of the existing evidence of bacterial colonisation early in life through breastmilk and placental transfer. They will examine the evidence available on how bacterial colonisation can be impacted by nutrition and whether this intervention has potential implications for future developments on maternal and infant nutrition. Further, the group will identify research knowledge gaps, especially related to programming of functional outcomes, highlighting what types of studies are needed in the near future.

Expected Outcome
The aim is to publish two review papers that compile all aspects related to bacterial colonisation early in life (from placenta and mammary gland) and the potential benefits of nutritional mediation. Identification of research gaps and new types of studies needed will be a key part of the activity. The results are expected to provide information for future nutritional strategies for pregnant women and infants to improve early programming outcomes.

n-3 and n-6 PUFAs Intakes, Ratios and Health Effects

In collaboration with the Nutrient Intake Optimisation Task Force

Objectives
Intake levels of total polyunsaturated fatty acid (PUFA) in adults are available but information on intake of specific n-3 and n-6 PUFA in vulnerable populations is limited or sometimes lacking. This activity has investigated the adequacy of current n-3 and n-6 PUFA intake in several vulnerable target groups, namely infants, children, adolescents, pregnant / lactating women and the elderly by comparing intake data with current recommendations. Based on this review, other knowledge gaps are being identified and addressed.

Activity
This expert group is developing a series of three manuscripts. In the first publication, the expert group investigated current intake of total and specific n-3 and n-6 PUFA in European diets for the identified vulnerable groups (I. Sioen et al., 2017). Along with this, the latest nutritional recommendations and their scientific criteria were examined. In addition, it assessed how different food forms and supplements can contribute to the intake of n-3 and n-6 PUFA. In the second publication, the intention is to describe the relevance of n-3 and n-6 PUFA intake indexes and ratios as well as comparing them to absolute intake levels. In the third manuscript, a systematic review will be performed on arachidonic acid and its health effects.

Expected Output
Ultimately, the project will analyse and evaluate n-3 and n-6 PUFA intake, highlighting any remaining knowledge gaps. Actions will be proposed where serious gaps between nutrient intake and recommendations are identified. Manuscripts 2 and 3 will tackle important identified knowledge gaps related to health effects of arachidonic acid and the relevance of n-3 and n-6 PUFA intake ratios versus absolute amounts.

Early Growth Velocity and Risk of Metabolic Disorders Later in Life

Objectives
Infants who have suffered a period of under-nutrition or are born pre-term or small-for-gestational-age tend to compensate and grow rapidly once their nutritional conditions improve. Rapid growth early in life may increase the risk of chronic diseases later in life. Experts have identified patterns of growth associated with disease risk which will be assessed as part of a two systematic reviews in this activity.

Activity
In a first manuscript, the expert group focused on ‘Postnatal Growth in Preterm Infants and Later Health Outcomes: A Systematic Review’ (K. Ong et al., 2015). They are following up on this publication with another one entitled ‘Postnatal Growth in Term Infants Born Small for Gestational Age Is Associated With Later Neurocognitive and Metabolic Outcomes’. The current activity identifies knowledge gaps and patterns of growth that are associated with risk of disease for SGA infants.

Expected output
In the second systematic review the experts aim to identify and summarise the published evidence on postnatal weight gain and growth in term-born SGA infants. Based on the available evidence on neuro-cognition and metabolic outcomes, the experts will attempt to identify critical postnatal windows during which growth could be influenced to improve these postnatal outcomes.

Expert Group Members

Gestational Diabetes and Diet 



Early Bacterial Colonization and Potential Implications Later in Life

n-3 and n-6 PUFA Intakes, Ratios and Health Effects



‘Arachidonic Acid and Health Effects’ Focus Group Members


Early Growth Velocity and Risk of Metabolic Disorders Later in Life

*Dr Esther Castanys-Muñoz now works for Abbott Nutrition.

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