Nutrition in early life and why it matters

Background

The next generation is expected to have a shorter life expectancy than their parents partly due to the increasing obesity epidemic and related non-communicable diseases. Nutrition during fetal and early neonatal life stages is thought to be an important factor affecting chronic disease risk throughout all stages of life. This task force focuses on how nutrition of both mothers and infants may affect the long-term health of the child.

Upcoming

The task force is working on a new activity proposal to continue their work on early growth aiming to assess how body composition at birth contributes towards the risk of non-communicable disease in adulthood.

What’s New

The expert group on ‘Early Growth Velocity and Risk of Metabolic Disorders Later in Life’ recently completed a final publication on neuro-cognitive and metabolic health outcomes of catch-up growth in small-for-gestational-age infants (E. Castanys-Muñoz et al., 2017).

Objectives

This task force aims to:

  • Provide scientific evidence to support guidelines for maternal and infant nutrition to ensure life-time optimal health; and
  • Identify risk factors for obesity and other health consequences at the earliest stages of life. Realistic and relevant dietary guidelines for expecting and new mothers will maximise good health for their infants throughout all life stages.

Impact

  • The task force assessed the neurocognitive and metabolic outcomes for pre-term and small-for-gestational-age infants that experience a phase of catch-up growth after birth in two separate papers (K.K. Ong et al., 2015; E. Castanys-Muñoz et al., 2017) and highlighted that there are gaps in our knowledge on how to modulate nutrition during this time for the long-term health benefit of infants. The first publication has been cited 15 times to date and the outcome of the manuscripts were featured amongst others at the Federation of European Nutrition Societies (FENS) 2015, Berlin, Germany, in October 2015.
  • The task force is disseminating the outcomes of their work at 4 major conferences in 2017 such as Nutrition and Growth (2-4 March 2017, Amsterdam, The Netherlands), Diabetes in Pregnancy (8-12 March 2017, Barcelona, Spain), IUNS 21st Congress of Nutrition (15-20 October 2017, Buenos Aires, Argentina), and 10th World Congress on Developmental Origins of Health and Disease (15-18 October 2017, Amsterdam, The Netherlands).

For more detailed information, please contact Dr Matthieu Flourakis at mflourakis@ilsieurope.be.

Task Force Members


* Scientific Advisor

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 assesses state-of-the-art nutritional management of GDM by means of a systematic literature review. It focuses on treatment options via diet and lifestyle based on their effect on selected maternal and fetal outcomes. Maternal outcomes covered 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, limitations and gaps in the existing literature have been identified. 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. The results have been presented at the 1st South Asia and Asia Pacific International Congress on Diabetes in Pregnancy (8-10 September 2016, Colombo, Sri Lanka) and at the 9th International DIP Symposium on Diabetes, Hypertension, Metabolic Syndrome and Pregnancy (8-12 March 2017, Barcelona, Spain).

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 are performing a critical analysis of the existing evidence of bacterial colonisation early in life through breastmilk and placental transfer. They 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.

Omega-3 and Omega-6 PUFA 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 omega-3 and omega-6 PUFA in vulnerable populations is limited or sometimes lacking. This activity has investigated the adequacy of current omega-3 and omega-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. The first publication investigated current intake of total and specific omega-3 and omega-6 PUFA in European diets for 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 omega-3 and omega-6 PUFA. The second publication will describe the relevance of omega-3 and omega-6 PUFA intake indexes and ratios compare them to absolute intake levels. The third manuscript will systematically review the health effects of arachidonic acid.

Expected Output
This multi-phase project analysed and evaluated omega-3 and omega-6 PUFA intake, highlighting any remaining knowledge gaps. Actions have been proposed where serious gaps between nutrient intake and recommendations were identified. Manuscripts 2 and 3 will tackle important identified knowledge gaps related to health effects of arachidonic acid and the relevance of omega-3 and omega-6 PUFA intake ratios versus absolute amounts.

Early Growth Velocity and Risk of Metabolic Disorders Later in Life – Completed

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 Pre-Term Infants and Later Health Outcomes: A Systematic Review’ (K.K. Ong et al., 2015). A second publication is entitled ‘Systematic Review Indicates Postnatal Growth in Term Infants Born Small-for-Gestational-Age Being Associated with Later Neurocognitive and Metabolic Outcomes’ (E. Castanys-Muñoz et al., 2017). The activity identified knowledge gaps and patterns of growth that are associated with risk of disease for small-for-gestational-age infants.

Outcome
In the activity the experts aimed to identify and summarise the published evidence on postnatal weight gain and growth in term-born small-for-gestational-age and pre-term infants. Based on the available evidence on neuro-cognition and metabolic outcomes, the experts provided guidelines on where further research is needed to ensure more conclusive data in this field.

Expert Group Members

Gestational Diabetes and Diet 

Early Bacterial Colonization and Potential Implications Later in Life

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

* ‘Indexes and Ratios’ Focus Group Members
** ‘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.
** Former employee of Mead Johnson Nutrition.

Publications

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