Nutrition Publication

NNIW56 - Feeding during Late Infancy and Early Childhood Impact on Health

Editor(s): O. Hernell, J. Schmitz. vol. 56

Related Articles

Subject Index

Author(s): O. Hernell, J. Schmitz

Preface and Forward

Author(s): O. Hernell, J. Schmitz

Three years ago, in May 2001, the World Health Assembly came to theconclusion that it was safe for the majority of infants to be exclusivelybreastfed for the first 6 months of life, and extending the period of exclusivebreastfeeding to that age would also be beneficial. This conclusion wastranslated into a recommendation of exclusive breastfeeding for 6 months,and while complementary feeding of high-quality should be introduced atthat age, breastfeeding should preferentially be continued beyond the secondyear of life.

The Role of Immune Tolerance in Allergy Prevention

Author(s): R. Fritsché

Immune tolerance is an essential mechanism which maintains a state ofunresponsiveness to autoantigens and food while generating protectiveimmunity against pathogens. This phenomenon was discovered by the factthat exposure to an antigen before the development of an immuneresponse specifically abrogates the capacity to respond to that antigen inlater life [1, 2]. Tolerance-inducing strategies have been demonstrated inanimal models of autoimmunity, allergy and transplant graft rejection andtherefore have opened the way for testing such approaches in humandiseases. Immune tolerance can be established by respiratory or oralexposure to the allergen.

Prevention of Food Allergy during Late Infancy and Early Childhood

Author(s): J. Schmitz

The normal immunological response to food antigens is geared to theinduction of tolerance, that is to say, unresponsiveness in the case of theirfurther ingestion. Allergic sensitization may be considered as a failure or abreaking of immunological tolerance. It is becoming clearer and clearer thatthe development of oral tolerance is highly dependent on the intestinal microflora;indeed the intestinal bacteria have the ability to induce the formation ofcytokines of Th1 immunity (particularly of INF) and also IL-10 and IL-12,which counteract the Th2-dependent allergic sensitization and favor the stateof Th1/Th2 equilibrium that prevails later in life in normal children [1].

Celiac Disease: Effect of Weaning on Disease Risk

Author(s): O. Hernell, G. Forsberg, M-L. Hammarström, S. Hammarström, A. Ivarsson

From the weaning period and onwards the intestinal mucosa is exposedto an increasing number of antigens, e.g. food components and microorganisms.Of all the antigens that reach the systemic circulation from thegut lumen, only a minority are potentially harmful to humans and need tobe defended against. The majority of intestinal antigens do not require aprotective immune response, but may even be beneficial for the individual.Thus, the mucosal immune system must have the capacity to discriminatebetween when an appropriate protective immune response to harmfulforeign antigens is required and when a muted or non-response is preferable.

Gut Microbiota in Infants between 6 and 24 Months of Age

Author(s): S. Salminen, M. Gueimonde

The indigenous microbiota of an infant’s gastrointestinal tract is createdthrough complicated contact and interaction with the microbiota of theparents and the infant’s immediate environment. Nature-induced initialcolonization is enhanced by galacto-oligosaccharides in breast milk and themicrobiota of the mother. This process directs the later microbiota successionand health of the infant throughout the rest of his/her life [1, 2]. Thus,understanding and positive guidance of the process through dietary means isan important target when facilitating the mother–infant relationship throughbirth, breastfeeding, weaning and the first years of life. This process formsthe platform for healthy gut microbiota throughout the entire life and isdescribed in figure 1 [3, 4].

Malabsorption of Carbohydrates

Author(s): C.M.F. Kneepkens, J.H. Hoekstra

Carbohydrates are responsible for 25–50% of daily energy intake. Thecarbohydrate composition of the diet changes with age. In breast milk andstandard infant formulas, lactose is the only or predominant carbohydrate;starches and other sugars follow with the introduction of ‘beikost’. In thehealthy, balanced diet of children and adults starches (and fiber) shouldprevail. The small bowel only absorbs monosaccharides, so dietary carbohydrateshave to be hydrolyzed into their constituent monosaccharidesglucose, galactose and fructose.

Chronic Nonspecific Diarrhea of Childhood

Author(s): R.E. Kleinman

Over the past half century, the entity known as chronic nonspecificdiarrhea of childhood or toddler’s diarrhea, has followed a path from casedescriptions to disease and finally, within the past 10 years, to a definedfunctional disorder. Chronic nonspecific diarrhea of childhood was originallythought to be part of the ‘celiac syndrome’. As Davidson and Wasserman [1]noted in their seminal paper published in the Journal of Pediatrics inDecember of 1966, the pioneering pediatric gastroenterologists of the time,had defined a number of specific disorders within what was then called the‘celiac syndrome’, including gluten-induced enteropathy, disaccharidasedeficiencies, lympangiectasia and abetalipoproteinemia.

Development of Motility

Author(s): A. Staiano, G. Boccia

Advances in neonatology over the past 2 decades have resulted in thesurvival of very preterm infants. However, the major limiting factor to survivalof such infants is the ability to initiate and maintain adequate nutrition.Multiple maturational events are necessary for successful enteral nutritionof the infant: coordination of sucking and swallowing; effective gastricemptying; forward propagation of small intestinal contents, and finally, colonicelimination. Since normal gastrointestinal function relies on the integratedmaturation of absorptive, secretory and motor function, a delay in any one ofthese processes will result in disturbed gastrointestinal function. Immaturegastrointestinal motility manifested by vomiting, abdominal distention, delayin stooling and constipation commonly postpone the time of full enteralfeeding in premature infants.

Motility and Allergy

Author(s): L. Bueno

Food allergy occurs in 6–8% of children and 1–2% of adults and ispermanently increasing throughout the world [1, 2]. Most of the adversereactions to food are immune-mediated reactions, and food antigens maycause IgE and non-IgE immune responses. Of the numerous symptoms of foodallergy, at least in the early stages, gastrointestinal disorders, from foodprotein-induced enterocolitis to constipation, are of paramount importanceand are often associated with proctitis.

The Role of Dietary Fiber in Childhood and Its Applications in Pediatric Gastroenterology

Author(s): F.T.M. Kokke, J.A.J.M. Taminiau, M.A. Benninga

Since the 1970s the importance of dietary fiber for human health has beenacknowledged and investigated. In the 1970s a relation was found for the firsttime between constipation, hemorrhoids and fiber-depleted food. The termdietary fiber is familiar to most people, although many do not fullyunderstand the nature of dietary fiber and its role in the diet. Dietary fiber isa normal constituent of healthy food. Both in enteral and oral feeding thepresence of fiber is necessary; not only in the face of problems likeconstipation and encopresis but also for a wide range of other disorders inadults and children such as diabetes mellitus, hypercholesterolemia, highblood pressure and colon cancer. In this chapter we will review thenomenclature, physiological properties and fate of fiber in man and itsapplications in pediatric gastroenterology [1].

Early Influences on Taste Preferences

Author(s): P. Leathwood, A. Maier

In this review, the ‘early influences’ considered include genetic, prenatal,early postnatal and childhood influences on perception and taste preferences.‘Taste’ is used in its broad sense, including taste, flavor, and texture.‘Preferences’ include responses to tastes and flavors, as well as to foods andbeverages.

Junk Food or ‘Junk Eating’?

Author(s): M. Gracey

Despite the widespread epidemic of overweight and obesity, little attentionhas been given until recently to the potential of ‘junk foods’ in its causation.This essay discusses the role of ‘junk food’ in nutrition-related disorders andsome associated factors that affect this problem. It also considers whether‘junk foods’ are intrinsically unhealthy, whether their pattern of consumptionis contributory, and whether the term ‘junk eating’ is useful.

Does Nutrition during Infancy and Early Childhood Contribute to Later Obesity via Metabolic Imprinting of Epigenetic Gene Regulatory Mechanisms?

Author(s): R.A. Waterland

An epidemic of obesity is occurring in the US and many other developedcountries, and appears to be responsible for an associated increase in theprevalence of type-2 diabetes, dyslipidemia, and hypertension. Alarmingly,this trend for increasing adiposity and its comorbidities is not limited toadults, but is also threatening children at younger and younger ages. Overthe last three decades, the prevalence of overweight among children age2–19 years has nearly doubled in the US [1].

Long-Term Effects of Weaning Habits: Type-1 Diabetes

Author(s): O. Vaarala

Type-1 diabetes is an autoimmune disease which attacks insulin-producingß cells in the pancreas. This autoimmune process is characterized by theappearance of circulating autoantibodies against ß-cell antigens, such asinsulin, glutamate decarboxylase (GAD) and tyrosine phosphatase. Theinfants of mothers with type-1 diabetes do not have autoimmune diabetesdespite the transfer of IgG antibodies, including autoantibodies to ß cells, tothe child via the placenta.

What Is Known? Short-Term and Long-Term Effects of Complementary Feeding

Author(s): K. Fleischer Michaelsen

Much is known about the short-term effects of complementary feeding(CF), especially how an optimal diet can prevent poor growth, malnutritionand nutrient deficiencies. The CF period has always been identified as a periodduring which the infant has a high risk of developing stunting, protein-energymalnutrition and specific nutrient deficiencies such as iron-deficiency anemiaand rickets. Furthermore, during this period, the risk of infectious diseasesincreases dramatically and the mortality from infectious diseases during thisage is closely associated with the nutritional status.

Educational Recommendations for Processed Foods for Infant Feeding

Author(s): P.J. Aggett

There is relatively little systematic evidence on which to base any informedadvice about the introduction of foods other than breast milk or breast milksubstitutes. Arguably once solids have become the major component of ayoung child’s diet there is even less evidence about optimum feeding [1].Typically diversification of an infant’s diet has been very much influenced byparental belief and cultural practice.

Recommendations for Physicians and Parents

Author(s): H.S.A. Heymans

In the post-war period in the Western world, consumption of food haschanged from a daily activity to fill the stomach to a social event. Daily mealsplay an important part in family life. Diners are used to tie friendships,relations, to create a suitable climate for business deals and to celebrate. Butat the same time concern about food as a factor that will influence health anddisease has been growing rapidly.