Thursday, December 12, 2013
- Obesity during pregnancy affects the long-term health of the offspring
- Formula with a protein content that more closely matches breastmilk can prevent accelerated infant growth and later obesity in infants born to overweight and obese mothers
- A healthy nutritional intake in early life is most likely to help reduce the risk of allergies and other noncommunicable diseases
Suntec, Singapore, November 2013 – ‘Programming for a Healthy Life: The Story of the First 1000 Days’ was the focus of a Nestlé Nutrition Institute satellite symposium held during the 8th World Congress on Developmental Origins of Health and Disease (DOHaD). DOHaD is an international, learned society (and registered charity) which aims to promote research into developmental origins of health and disease. The 8th World Congress addressed the growing awareness of the implications of maternal well-being on long term health and was themed ‘From Science to Policy and Action’.
At the Nestlé Nutrition Institute satellite international experts considered the role of nutrition in maternal and infant health. They highlighted that making positive changes to nutritional intake, even prior to conception, has potentially long-term effects on child health such as reduced risk for allergies or obesity.
Obesity during pregnancy affects the long-term health of the offspring
“About 20% of women in our antenatal clinics are clinically obese”, highlighted Professor Lucilla Poston, head of the Division of Women’s Health at King’s College, London, UK, concerning the epidemic of maternal obesity which is rising in line with global trends. Maternal obesity is well known to be associated with gestational diabetes, pre-eclampsia, stillbirth, congenital defects and neonatal complications.
However, as Professor Poston pointed out, obesity in pregnant women appears to have more insidious consequences for the long-term health of the offspring. Thought to be due to a ‘programming’ effect in utero, maternal obesity has metabolic consequences that are associated with larger babies who are at higher risk of becoming overweight or obese later in life. This, in turn, has long-term health consequences including increased risk of metabolic and cardiovascular diseases in adulthood. Large trials, such as the UPBEAT trial, are underway to investigate how lifestyle interventions, including nutrition, can reduce these negative effects of obesity during pregnancy.1
Avoiding excess protein intake in infancy can reduce accelerated growth and later obesity in infants born to overweight mothers
“There is clearly a connection between accelerated infant growth and later obesity”, confirmed Professor Ekhard Ziegler from the Department of Pediatrics at the University of Iowa, USA, and “protein intakes during infancy may play a decisive role”. It has been demonstrated in several studies that high protein intake in infancy results in increased adiposity. Professor Ziegler presented results from a recent intervention trial in children born to overweight and obese mothers that underlined this effect further. Infants who received a follow-on formula with low protein content had lower weight gain and body mass index during the intervention period and lasting until 2 years of age, as compared to those who received a formula with higher protein content. Summarising, he speculated that follow-on formula with protein content is closer to that of breast milk and may protect high-risk infants against future obesity.
A healthy nutritional intake in early life is most likely to help reduce the risk of allergies and other noncommunicable diseases
The importance of early nutrition in preventing NCDs, such as allergies and cardiovascular disease, was underlined by Professor Susan Prescott, of the University of Western Australia in Perth. She said: “We are seeing a pandemic of NCDs of almost every kind, affecting all organ systems, and we know that nutrition is at the core of this”. Prevention is the ultimate approach to reducing this burden, and the greatest potential for this lies in early life when the physiological, structural, immune, and metabolic response patterns that influence future disease susceptibility are determined.
There is already substantive evidence that a ‘healthy start to life’ can reduce the risk of both early and later NCDs.2,3 It is important to target preventive strategies as early as possible, even before conception, as part of a life-course approach to reducing the risk of disease in the next generation. Allergy is the NCD with the earliest onset, beginning within weeks or months of birth, and its risk factors are pro-inflammatory, including modern dietary patterns, environmental pollutants, microbial patterns, and stress. Professor Prescott points out that: “Maternal obesity is a chronic inflammatory state that influences the developing foetal immune system”, and childhood obesity is linked with a higher allergy risk, especially food allergy.
How best to prevent food allergy is still the subject of research. Breast feeding is recommended, but if this is not possible, hydrolysed formula may be indicated for infants at high risk of food allergy. Delaying the introduction of potential food allergens beyond 6 months of age may actually increase the risk of food allergies, rather than prevent them, and the timing of introducing such foods to the infant diet is the subject of ongoing research.
1. Poston L, Briley AL, Barr S, Croker H, Coxon et al. Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial. BMC Pregnancy Childbirth. 2013 Jul 15; 13(1):148. [epub ahead of print]
2. Hanson M, Gluckman P. Developmental origins of noncommunicable disease: population and public health implications. Am J Clin Nutr 2011.
3. Hanson M, Gluckman P, Nutbeam D, Hearn J. Priority actions for the non-communicable disease crisis. Lancet 2011; 378:566-7.