Nutrition Publication

NNIW55 - The impact of Maternal Nutrition on the Offspring

Editor(s): G. Hornstra, R. Uauy. vol. 55

Related Articles

Maternal Nutrition and Adverse Pregnancy Outcomes: Lessons from Epidemiology

Author(s): M.S. Kramer

Until recently adverse pregnancy outcomes such as stillbirth, infant mortality,and low birth weight (including its components, preterm birth andintrauterine growth restriction (IUGR)) provided a coherent ‘package’ ofadverse pregnancy outcomes with consistent geographic and temporaltrends. The poorest developing countries were generally those with the highestrates of all of these adverse outcomes, whereas northern Europe, Japan,and other highly developed industrialized countries had the lowest rates. Interms of temporal trends, most of these adverse pregnancy outcomes weredecreasing over time in both developed and developing countries.

Metabolic Disease: Evolutionary, Developmental and Transgenerational Influences

Author(s): P.D. Gluckman, M.A. Hanson

There is a rising incidence of metabolic syndrome (non-insulin-dependentor type-2 diabetes, obesity and cardiovascular disease) in both the developedand developing worlds. It is generally assumed that this rapid increase issimply a reflection of the marked change in dietary and exercise behaviorsof children, adolescents and adults. These factors play a dominant role, butother factors must be involved to explain the changing pattern of disease.This chapter reviews the growing evidence that the developmental andenvironmental history of both the individual and his/her population areimportant factors.

Essential Fatty Acids during Pregnancy Impact on Mother and Child

Author(s): G. Hornstra

Certain fatty acids are indispensable for human development and health,but cannot be synthesized de novo by humans. Therefore, they need to beconsumed with the diet. These fatty acids are collectively known as ‘essentialpolyunsaturated fatty acids’ (EPUFAs) and comprise the ‘parent’ essentialfatty acids (EFAs) and their longer chain, more unsaturated derivatives, thelong-chain (LC) polyunsaturated fatty acids (PUFAs). EFAs and LC-PUFAsare important structural and functional membrane components. In addition,some LC-PUFAs are precursors of prostanoids (prostaglandins and thromboxanes)and leukotrienes, local hormone-like substances with importantbioregulatory functions [1].

Special Problems of Nutrition in the Pregnancy of Teenagers

Author(s): P.B. Pencharz

From a biological standpoint the main nutritional issues in teenagepregnancy are that the adolescent mother may still be growing and hencewould then have nutrient needs for the growth of her own body as well as theneeds for the products of conception (expanded blood volume, uterinegrowth, placenta and fetus). The very recent Dietary Reference Intakes onMacronutrients [1] lists protein deposition rates ranging from 39 mg/kg/dayduring the 12th year of life, 23 mg/kg/day during the 14th year to only 8 mg/kg/day during the 16th year of life. Therefore growth in lean mass is rapidfrom 12 to 15 years, slows during the 16th year and on average has ceased ingirls by 17 years of age. These results are derived from a recently publishedcross-sectional study of total body potassium using whole body counting [2].Since potassium is primarily located within the cell, total body potassiumprovides a good estimate of lean body mass and body protein, and hencethese results have greatly expanded our knowledge of growth and bodycomposition. Based on these data it could be predicted that teenagers 16years would be those at highest risk of an adverse pregnancy outcome (i.e.low birth weight and increased perinatal mortality).

Future Challenges of Nutrition in Pregnancy and Lactation

Author(s): B. Lönnerdal

We have recently moved from an era when malnutrition during pregnancyand lactation was widespread in many areas of the world, to a time when ageneral lack of food is becoming more uncommon. However, the quality ofthe food is still a problem and micronutrient deficiencies are very common,not only in developing countries but also in segments of the population inindustrialized countries. Many programs are being launched to combat thesemicronutrient deficiencies, ranging from supplementation, fortification, foodmodification/diversification and altered food preparation methods to nutritioneducation. Progress to date has unfortunately been limited.

Nutrient Effects upon Embryogenesis: Folate, Vitamin A and Iodine

Author(s): T.H. Rosenquist, J.G. Van Waes, G.M. Shaw, R. Finnell

The period of human ‘embryogenesis’, the foundation of this chapter, isgenerally taken to include the initial 8-week period of human development,from fertilization through organogenesis. Knowledge of the effects of nutrientsupon the normal development of the embryo during this period typically hasbeen acquired by observation of the effects that accompany some perturbationof the delivery of a given nutrient; therefore this chapter will focus upon theresults of ‘perturbed’ delivery of folic acid, vitamin A, and iodine.

Energy Requirements during Pregnancy and Consequences of Deviations from Requirement on Fetal Outcome

Author(s): N.F. Butte

Energy requirements as defined in the 1985 FAO/WHO/UNU report onEnergy and Protein Requirements [1] should support a body size and compositionand level of energy expenditure (EE) consistent with good health, andallow for economically necessary and socially desirable physical activity. Inpregnancy, extra energy is needed to cover the costs of maternal and fetaltissue accretion, and the rise in EE attributable to basal metabolism andphysical activity. Because of uncertainties regarding desirable gestationalweight gain (GWG), maternal fat deposition, putative reductions in physicalactivity and energetic adaptations to pregnancy, controversy remains regardingenergy requirements during pregnancy [2].

Potential Effects of Nutrients on Placental Function and Fetal Growth

Author(s): G.C. Di Renzo, G. Clerici, I. Neri, F. Facchinetti, G. Caserta, A. Alberti

Intrauterine nutritional deficits can trigger adaptation mechanisms withmodifications that can predispose an individual’s later life to various pathologies(cardiovascular, metabolic, endocrine). It is difficult to individualize both thenutrient or nutrients responsible for the damage and the relation betweencause and effect quantitatively (nutritional effect entity) and timing (time lagfor the start of the pathology). It is therefore not easy to prove that placentalfunction and fetal growth can be deeply influenced by specific nutrientsrather than by variation in the intake of calories, that is to say by nutritionas a whole.

Dietary Essential Fatty Acids in Early Postnatal Life: Long-Term Outcomes

Author(s): R. Uauy,C. Rojas, A. Llanos, P. Mena

The formation of long-chain (LC) polyunsaturated fatty acids (PUFAs)from the parent essential fatty acids (EFAs) in early life is limited, thusinfants are dependent on the exogenous provision of LC-PUFAs from humanmilk or supplemented formula. LC-PUFAs are structural components of alltissues, they are indispensable for cell membrane synthesis and for the functionof key organelles such as mitochondria, endoplasmic reticulum andsynaptic vesicles; and also for membrane receptors and signal transductionsystems. The brain, retina and other neural tissues are particularly rich inLC-PUFAs; if diet is deficient in LC-PUFAs during early life, neural structuraldevelopment and function are affected. LC-PUFAs also serve as specificprecursors for 20-carbon eicosanoid production (prostaglandins, prostacyclins,thromboxanes, and leukotrienes). Recently docosanoids derived from22-carbon LC-PUFAs have been identified and their capacity to protectneural tissue from hypoxia-reperfusion injury characterized. Eicosanoids anddocosanoids act as autocrine and paracrine mediators. They are powerfulregulators of numerous cell and tissue functions (e.g. thrombocyte aggregation,inflammatory reactions and leukocyte functions, cytokine release andaction, vasoconstriction and vasodilatation, blood pressure control, bronchialconstriction, and uterine contraction).

Nutrient-Induced Maternal Hyperinsulinemia and Metabolic Programming in the Progeny

Author(s): M.S. Patel, M. Srinivasan, S.G. Laychock

Although the early development of living creatures is primarily influencedby the genetic instructions acquired at the time of conception, the environmentunder which the organism develops limits the expression of these geneticinstructions. Fetal and neonatal growth in mammals is a complex processinvolving cross talk between the fetal genome, the maternal intrauterine environmentand the early postnatal nutritional experience. Hence the well-beingof the mother (with optimal nutrition) during pregnancy is of pivotal importancefor optimal growth of the fetus and, in this context, the quality andquantity of nutrition in the mother have been identified as important factorscontributing to the metabolic programming of the fetus. Metabolic programmingis the phenomenon by which a nutritional stress/stimulus overlappingwith the critical window of early development of specific organs permanentlyalters the physiology and metabolism of the organism thereby predisposing itfor adult-onset disease conditions.

Maternal Malnutrition and the Risk of Infection in Later Life

Author(s): S.E. Moore, A.C. Collinson, P.T. N’Gom, A.M. Prentice

Considerable evidence now exists to suggest that events during early lifecan influence future susceptibility to certain non-communicable diseases(NCDs). The fetal origins hypothesis states that cardiovascular disease andnon-insulin-dependent diabetes originate through adaptations that the fetusmakes when it is undernourished. These adaptations, which include slowing ofgrowth, permanently change the structure and function of the body [1]. Wehave now added to the NCD observation with evidence from rural Gambia thatwe have found that an individual’s susceptibility to infectious diseases may alsobe programmed by events early in life, particularly maternal undernutrition. Inthis review, we describe the existing evidence to support the hypothesis thatimmune function may be permanently programmed by nutritional status earlyin life, and describe the findings from our ongoing program of work in this area.

Size and Body Composition at Birth and Risk of Type-2 / Diabetes A Critical Evaluation of ‘Fetal Origins’ Hypothesis for Developing Countries

Author(s): C.S. Yajnik

India and other developing countries are experiencing a rapidly escalatingepidemic of diabetes and cardiovascular disease. Over the past 25 years therehas been a 5-fold increase in the prevalence of type-2 diabetes and coronaryheart disease (CHD) [1, 2]. It is predicted that by 2025 India will have morethan 60 million diabetic patients and that CHD will be the leading cause ofdeath in adults. This phenomenal rise in diabetes and CHD has been ascribedto the so-called epidemiologic, nutritional and economic transition.

Relationship between Maternal Obesity and Adverse Pregnancy Outcomes

Author(s): D.K. Waller, T.E. Dawson

In the last three decades, the proportion of children and adults who areobese or overweight has increased rapidly in the United States and otherdeveloped countries. Moreover, the frequency of obesity is now increasing indeveloping countries such as China. This increase is of great concern becauseobesity is associated with a wide range of metabolic abnormalities and anincreased risk of many different types of diseases.

Dietary Intervention during Pregnancy and Allergic Diseases in the Offspring

Author(s): S. Salvatore, K. Keymolen, R.K. Chandra, Y. Vandenplas

In 1903 Baron Clemens von Pirquet [1], an Austrian pediatrician, proposedthe terms allergy and allergen after observing that some of his patients had‘altered responses’ to certain substances. Hypersensitivity causes objectivelyreproducible symptoms or signs, initiated by exposure to a defined stimulusat a dose tolerated by normal subjects. Atopy is a personal or familial tendencyto produce IgE antibodies in response to low doses of allergens, usuallyproteins, and to develop typical symptoms such as asthma, rhinoconjunctivitis,or eczema/dermatitis. Allergy is a hypersensitivity reaction initiated byimmunologic mechanisms [2]. In atopy, genetic predominance is moreimportant. In allergy, environmental factors are more relevant.

Cardiovascular Disease in Survivors of the Dutch Famine

Author(s): O.P. Bleker, T.J. Roseboom,A.C.J. Ravelli, G.A. Van Montfrans, C. Osmond, D.J.P. Barker

Small size at birth is linked with an increased risk of coronary heart disease (CHD) and its biological risk factors [1]. These findings have led to the fetal origins hypothesis which proposes that CHD originates through developmental plasticity, the biological phenomenon by which a single genotype can give rise to a range of different structures and functions in response to environmental conditions during development. More specifically, the hypothesis proposes that CHD originates through fetal responses when nutrient supply fails to meet demand.