Monday, February 24, 2014
The third Global Congress for Consensus in Pediatrics and Child Health (CIP, www.cipediatrics.org), sponsored by the Nestlé Nutrition Institute, was held in Bangkok, Thailand on 13th February, 2014. It offered a global academic debate platform to discuss the most acute and daily problems related to children’s health pathologies, difficulties and controversies.
The importance of infant and child nutrition for healthy growth and development is well known. However, according to scientific evidence revealed in the past few years, food consumed in these early months and years is having a much longer lasting effect and is affecting health many decades later in adulthood. Susceptibility to many widespread non-communicable diseases such as cardiovascular disease, obesity, diabetes and allergies are not solely dependent on the genes inherited from parents. It also depends on epigenetic influences during a critical period until a child’s second birthday.
New insights related to iron deficiency
Prof. Andrew Prentice (MRC International Nutrition Group at the London School of Hygiene and Tropical Medicine in the UK, and MRC Keneba in the Gambia) shared new findings related to iron deficiency. Iron deficiency in utero and in the first postnatal years can have long-term effects on children’s development, especially in relation to the brain. Since the human species has evolved to succeed on the basis of a large and complex brain, any deficits in cognitive ability contribute strongly to reductions in the ‘human capital’ of nations, as well as harming the individual. Therefore iron status is an important component in programming for a healthy life. In developed countries, iron deficiency is generally uncommon because of easy access to animal foods and food fortification. But the picture is very different in developing countries where multiple factors such as helminth infections, malaria, gut damage and poor diets contribute to creating very high levels of iron deficiency.
For decades it was assumed that young children are poorly equipped to physiologically absorb enough iron and therefore need to be given large bolus doses of easily absorbed iron. Numerous studies have recently shown that this strategy has caused an increase in infections and severe adverse events because iron feeds potential pathogens and encourages their growth. The new findings reveal that young children in highly infectious environments are actively excluding iron so that it does not increase their risk of infection. This process is orchestrated by the new discovery of a master regulator of iron metabolism called hepcidin. Hepcidin assesses both iron need and the threat of infection, and makes a physiological judgement as to when it is safe to absorb iron. These insights suggest a complete revision of our approaches to combating iron deficiency.
Pre-and postnatal nutrition and metabolic programming
Prof. Ferdinand Haschke (Nestlé Nutrition Institute in Vevey, Switzerland, and the Medical University in Vienna, Austria) highlighted that pre- and postnatal malnutrition can result in unfavourable (epigenetic) programming with lifelong consequences. In some developed countries, overweight/obesity during childhood and adolescence now affects more than 25% of the respective populations. Infants with rapid weight gain after birth have an increased risk to become obese later in life. If mothers are overweight or obese, their breastfed infants gain weight more quickly during the first six months in comparison to World Health Organization standards. On the other hand, infants from obese mothers gain less weight if breastfeeding continues beyond six months compared to infants that are fed formula, as defined by the Codex Alimentarius. Recent studies show that feeding formula with low protein content (whey based, 1,65g protein/100kcal) to infants between 3 and 12 months by overweight/obese mothers result in weight gain similar to that observed in breastfed infants. At the same time, compared to other feeding patterns, exclusive breastfeeding until six months is associated with significantly higher weight, length, and lower probability of stunting and infections.