Health professionals and industry put concept of metabolic programming firmly on the international agenda at the EU supported Scientific Workshop on Early Nutrition

Citation

(2005), "Health professionals and industry put concept of metabolic programming firmly on the international agenda at the EU supported Scientific Workshop on Early Nutrition", Nutrition & Food Science, Vol. 35 No. 1. https://doi.org/10.1108/nfs.2005.01735aab.012

Health professionals and industry put concept of metabolic programming firmly on the international agenda at the EU supported Scientific Workshop on Early Nutrition

Health professionals and industry put concept of metabolic programming firmly on the international agenda at the EU supported Scientific Workshop on Early Nutrition

More than 400 participants including EU, academics and industry attended the Scientific Workshop on Early Nutrition in Paris, 5 July 2004. The Workshop was organised by the University of Munich, Germany in collaboration with the Danone Institutes and the Infant Nutrition Cluster, a collaboration of three shared cost research projects funded by the EU. Leading investigators and industry representatives came to the conclusion that metabolic programming should become an item to be put on the international agenda firmly.

Working towards effective solutions

It is clear from human and animal experiments that critical windows exist in foetal and infant life which allow different modes of nutrition to affect events in later life either beneficially or adversely. But it is also obvious that the greater the interest in this very exciting research field, the further investigators get from being able to promulgate a consistent message. Perhaps the most hopeful message, and that would explain the attendance of so many paediatricians and representatives from the infant formula industry, is that they are working towards some solutions which are in their own hands. Genetic predisposition and foetal environmental cues are certainly important- but so too are those in the early months of life.

A new way of looking at the influence of early nutrition

Alan Lucas gave a provocative paper in which he proposed that rapid weight gain during infancy is not always a good thing. He believes that many of the observational studies showing that babies who are small at birth exhibit poor health as adults can be explained by the fact that they are encouraged to grow too fast in the early years. Thus he believes that the "foetal origins hypothesis" should be replaced by the "growth acceleration hypothesis". This new way of looking at the influence of early nutrition could explain the protective effect of breast feeding on later cardiovascular risk factors since breast feeding represents a lower, albeit optimal, plane of nutrition in comparison with formula feeding. So great is the effect of early nutrition that Lucas's calculations show that they can be far greater than lifestyle modifications in adult life. Not surprisingly his views were challenged by those who have traditionally encouraged catch up growth in small babies and those who worry about translating such mixed messages to parents.

The beneficial effects of breast feeding

The rest of the evidence that breast feeding was beneficial was fairly consistent. Kim Michaelson reviewed the convincing evidence for beneficial effects of breast feeding on immune related disease and early infections. Mikael Knip thought that, although there was conflicting evidence, on the whole the evidence supported a protective effect of breast feeding on the development of type I diabetes. A recently completed systematic review, has allowed Rudiger von Kries to suggest a consistent protective effect of breast feeding on later childhood obesity. On an individual basis this effect might be quite small, but at the population level it could be large.

How can breast feeding have these effects? This is not known yet. It could be due to behavioural influences, such as suckling behaviour or self regulation of meal size and frequency, or due to the composition of breast milk such as its n-3 polyunsaturated long chain fatty acid content. Hadders-Algra spoke of the "n-3 PUFA paradox" in relation to the development of babies and young children. There seems to be no doubt that supplementation has beneficial effects on development in the first few months of life but it is difficult to show the long term effect at 1-2 years. Perhaps this is because this is the period when neurological dysfunction is rarely seen?

An alternative explanation for the protective effect of breast milk is that the lower protein content of breast milk compared with infant formula could not only explain the reduced growth acceleration, but also the reduced stimulation of the insulin like growth factor axis, a key mechanism involved in body mass control. Preliminary evidence for this latter mechanism was presented by Socha. His results came from the EU Childhood Obesity Programme, an intervention trial in newborn infants comparing formula with different protein contents and breast fed babies.

Of course, the mechanism of protection of breast feeding might be nothing to do with the breast milk but may well lie in the fact that prolonged breast feeding will delay the introduction of cows' milk and cereals into the baby's diet. Certainly these components of an early diet have already been implicated in the emergence of type I diabetes and have been shown to raise diabetes associated antibodies (Knip).

The importance from long-term follow-up

All speakers emphasised the importance of gleaning evidence on programming from long term follow-up of experimental trials. All the retrospective observational evidence from epidemiological studies has helped to generate exciting new hypotheses. However, the type of firm evidence which is likely to be translated into practice and policy can only come from pulling together many such studies, backed up by carefully designed animal experiments to investigate mechanisms. Many speakers referred to the wisdom of the EU in funding a new large integrated project (EARNEST – Early Nutrition Programming Of Adult Health – see www.metabolic-programming.org) which attempts to do just this. Patience will be required for at least another 6 years until the first results start to emerge from this long term project.

For further information, please contact: Protein Health Communications, Winny Ooms, Tel: 32 2 716 40 15, Fax: 32 2 716 41 78, E-mail: wooms@protein-healthcom.be