Nutritional Implications in LBW Infants and its Long Term Outcomes: Nestle

Speaker: Dr. George Jose, Neonatologist, SH Medical Centre Presented at:  Nestlé Nutrition Institute, Delhi

Summary

Nutrition is a continuous process that begins from the very stage of conception until the foetus grows into a baby, and even later into adulthood. The human brain growth begins from 2-3 months and the first 1000 days of life is the window of intervention for adequate nutrition for the baby. Hypertension, obesity, insulin resistance, hyperlipidaemia and even coronary diseases can be the consequences of foetal under nutrition. Lack of Iron and DHA can lead to forms of cognitive dysfunction, poor scholastic performance and lesser IQ. Consequently, Breast feeding is the best form of nutrition for the Low Birth Weight babies.

The blue print of adult diseases is set during the intrauterine period and early neonatal period. There are various predictors that can help predict the long term developmental outcome of infants. The maternal factors include diet before and during and pregnancy, maternal obesity placental passage of nutrients and breast feeding. Infant related factors include breast feeding, timing and contents of complementary feeding, catch up (accelerated) growth, diet patterns and physical activity. Barker theory states that fetal malnutrition, low weight gain in infancy and excess weight in early childhood leads to chronic diseases in adulthood, CAD, HTN and type2 diabetes.

The video goes on to relate the incidents of the Dutch famine that started in November 1944 till May 1945. Rations were as low as 400-800 calories a day. After 50 years there was more type 2 diabetes and impaired glucose tolerance among people exposed to famine before birth. There was a threefold increase in CHD prevalence compared to famine unexposed cohort members. People exposed in mid or late gestation were most affected. CHD also manifested at a younger age among people conceived during the famine.

Window of intervention is during pregnancy or during early infancy between 0 to 1 years or during l to 2 years. There are many nutrients that are required for optimal brain development. Iron is important during pregnancy and post pregnancy. Around 74% of LBW are iron deficient they suffer from poor immunogenicity, cognitive skills, IQ etc. The advised dosage is food fortification with supplementation in preterm neonates-2-4mg/kg/day for 6months and maternal dose set at 40mg/day. Long Chain Poly Unsaturated fatty Acids (LCPUFA) are of two types’ linoleic acid or omega 6 and alpha linoleic acid or omega 3. The omega 3 creates DHA which is beneficial during early infancy, mid pregnancy it also helps in neurotransmission, synapsis, rods, vision, and immunity, behavioral and cognitive development.

Vitamin D3 has long term benefits like asthma, malignancy, and diabetes mellitus. Indian studies in AIIMS and PGI have suggested that the new born infants are vitamin D deficient of which sunlight is the main source. Recommended supplementation in neonates by WHO are 400000 IU/day. Sunlight recommendation is 20 to 30 min per day direct sunlight. Barkers’ theory needs to be applied to end epidemic chronic disease epidemic in infants and in adults.