Early-life nutritional exposures are significant determinants of the development and future
health of all organ systems. The dramatic rise in infant immune diseases, most notably
allergy, indicates the specific vulnerability of the immune system to early environmental
changes. Dietary changes are at the center of the emerging epigenetic paradigms that
underpin the rise in many modern inflammatory and metabolic diseases.
Infant food and weaning practices are highly debated with lots of unanswered questions.
It is becoming more apparent that early-life feeding may have an effect on the long-term
health of humans, particularly for noncommunicable diseases such as obesity and allergic
diseases. It is important to understand how environmental influences in early life can affect
the development of the immune system and metabolic profiling. In terms of nutrition
and diet, one should consider the role of the total/whole diet, as well as particular nutrients
in the development of noncommunicable diseases.
Food allergy is a common disease. In recent years, recommendations for the prevention
of food allergy have been shifted from avoidance strategies to active oral tolerance induction.
Due to evidence from observational studies, it has been suggested that sensitization
occurs via the skin especially in children with atopic dermatitis due to skin barrier defects,
whereas early oral introduction of the allergenic food(s) will promote tolerance. The current
evidence does not justify recommendations about either withholding or encouraging
exposure to potentially allergenic food(s) after 4 months once weaning has commenced,
irrespective of atopic heredity.
Food allergy is an important and increasing public health problem worldwide, affecting
predominantly infants and young children. There is an urgent need to develop effective
treatment strategies to restore oral tolerance in food-allergic individuals.
Factors operating in the preconception and prenatal periods, such as maternal obesity,
excessive gestational weight gain and gestational diabetes, predict a substantial fraction
of childhood obesity as well as lifelong adverse health consequences in the mother. These
periods may lend themselves to successful intervention to reduce such risk factors because
parents may be especially willing to change behavior if it confers health advantages
to their children
It is now widely recognized that the environment in early life can have important effects on
human growth and development, including the ‘programming’ of far-reaching effects on
the risk of developing common metabolic and other noncommunicable diseases in later life.
We have shown that greater childhood adiposity is associated with higher maternal adiposity,
low maternal vitamin D status, excessive gestational weight gain and short duration of
breast-feeding; maternal dietary patterns in pregnancy and vitamin D status have been
linked with childhood bone mineral content and muscle function.
There is growing evidence of long-term effects of early dietary intervention in infancy on
later obesity risk. Many studies showed reduced risk of obesity with breastfeeding in infancy,
which could be related to the reduced protein intake with human milk compared
to infant formula. In a randomized controlled trial (Childhood Obesity Project), we were
able to show that infant formula with reduced protein content results in lower BMI both
at 2 and 6 years. These effects seem to be mediated mainly by branched-chain amino acids
which stimulate the insulin-like growth factor (IGF)-1 axis and insulin release.
Breastfeeding induces a different metabolic and endocrine response than feeding conventional
infant formula, and it has also been associated with slower weight gain and reduced
disease risk in later life. The underlying programming mechanisms remain to be
explored. Breastfeeding has been reported to induce lower levels of insulin, insulin-like
growth factor-1 and some amino acids (AAs) than formula feeding. In the Childhood Obesity
Project (CHOP), infants fed a conventional protein-rich formula had a higher BMI
at 2 and 6 years than those fed a protein-reduced formula. At 6 months, higher protein
intakes induced increased plasma concentrations of branched-chain AAs (BCAAs) and
their oxidation products, short-chain acylcarnitines. With increasing BCAA levels, these
short-chain acylcarnitines increased proportionally only until a break point was reached,
after which BCAAs seemed to escape their degradation. The resulting marked elevation
in BCAA levels with high-protein (HP) intakes appears to contribute to increased insulin
levels and to affect β-oxidation of fatty acids. The ratios of long-chain acylcarnitines to free
carnitine decreased in infants who received a HP formula, which indicates a reduced initiation
of β-oxidation. We conclude that HP intakes inducing high BCAA plasma levels may
inhibit fat oxidation and thereby enhance body fat deposition and adiposity.
Worldwide, 38% of women are now overweight (BMI 25–30) or obese (BMI ≥ 30). There is
increasing evidence that maternal obesity can result in unfavorable (epigenetic) pre- and
postnatal programming of important genes of the offspring. Infants of overweight mothers
show faster weight gain during infancy, which is associated with higher risk of obesity
during childhood and adult life.
Nutrition and growth during early infancy influence later health and development, but
most research has focused on the period of milk feeding, and the possibility that the
timing, content or method of complementary feeding (CF) might have similar later effects
has received less attention. Such effects are plausible, given that the CF period is
one of rapid growth and development when infants are susceptible to nutrient deficiencies
and excesses, and during which there are marked changes in diet with exposure to
many new foods, tastes and feeding experiences.
Because infants are totally dependent upon parents (or other caregivers) for care and sustenance,
parents’ feeding practices are a key feature of the family environments in which
infants and young children learn about food and eating. Feeding practices include not
only what the child is fed, but also the how, when, why and how much of feeding. Extensive
evidence indicates that parenting behavior influences a variety of child outcomes, including
cognitive and socioemotional development, as well as the development of self-regulatory
Our ability to perceive the broad range of flavors imparted by foods involves the assimilation
of multiple chemosensory sensations: primarily those of taste and olfaction. Due to
their adaptive value, these chemosensory systems are functional before birth and continue
to mature throughout childhood. As a result, children live in their own flavor world,
preferring foods that are high in sugar and salt over those that are sour and bitter tasting,
such as fruits and vegetables.
Guidelines for healthy infant feeding provide advice on breastfeeding and complementary
feeding. The Avon Longitudinal Study of Parents and Children (ALSPAC) derived dietary
patterns in comparison to infant feeding guidelines and by using principal components
analysis (PCA). The ALSPAC cohort was recruited during pregnancy.
Obesity has reached epidemic proportions and research into its prevention is increasingly
focusing on the earliest stages of life. Avidity of appetite has been linked to a higher
risk of obesity, but studies in infancy were scarce. The Gemini twin cohort was established
to investigate genetic and environmental determinants of weight trajectories in early
childhood with a focus on appetite and the home environment.