Nestlé Nutrition Workshop Series. Paediatric Programme

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Insulin and insulin-like signaling regulate survival and lifespan in a variety of animal species, from nematodes and flies to higher vertebrates and mammals. Recently, it was shown that brain IGF-I receptor and brain IRS2 control mammalian lifespan, and that this occurs through neuroendocrine mechanisms, control of energy metabolism and modified stress resistance. Furthermore, it was demonstrated that insulin receptor substrate molecules are implicated downstream of insulin and IGF receptors in the extension of lifespan...

Fetal and early life may be a critical period for the development and/or programming of metabolic systems, including the skeleton. There are increasing human data from cohort studies on the association between early life nutrition and bone development in children. Breastfed children initially have lower bone mass than bottle-fed children, but longer-term studies suggest that they have higher bone mass (size adjusted) by age 8 years, especially in children born at term. By the time of peak bone mass, both preterm and term children have higher bone mass indicating a different bone accrual trajectory curve...

The main aspects of infant feeding that have been studied in humans in association with the subsequent development of adipose tissue include breastfeeding, rapid infancy weight gain, and weaning practices. While observational studies have consistently shown a protective effect of breastfeeding on the development of obesity, these studies may be confounded by unmeasured or unknown factors, as suggested by one study using a sibling design and one study using a randomized breastfeeding promotion intervention design...

Celiac disease is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Gluten is a protein component in wheat and other cereals, including rye and barley that are generally introduced in the infant's diet at weaning. At present, two schools of thought claim that changing early feeding regimens in at-risk infants can either prevent the onset of the disease or merely delay it. Recent advances have increased our understanding of the molecular basis of this disorder and provide the rationale to perform prospective dietary interventional studies to establish the proper timing of gluten exposure to minimize the risk of developing celiac disease...

What has become familiar tends to be preferred while the unfamiliar is avoided. Additionally, liking is impacted by associative learning processes where new stimuli become liked via repeated pairings with familiar, already-liked stimuli. In addition to the ability to learn to like new foods and flavors, infants bring genetic taste predispositions to the table, including an unlearned preference for sweet and salty tastes and a tendency to reject bitter and sour tastes. When diets were plant based, unlearned preferences for sweet and salty tastes promoted intake of foods that were relatively rare in nature but were good sources of essential nutrients; the presence of the preferred basic tastes in food no longer predicts scarce nutrients...

Despite increasing efforts to prevent food allergies in children, IgE-mediated food allergies continue to rise in westernized countries. Previous preventive strategies such as prolonged exclusive breastfeeding and delayed weaning onto solid foods have more recently been called into question. The present review discusses possible risk factors and theories for the development of food allergy. An alternative hypothesis is proposed, suggesting that early cutaneous exposure to food protein through a disrupted skin barrier leads to allergic sensitization and that early oral exposure of food allergen induces tolerance...

Food habits, an integral part of all cultures, have their beginnings during early life. This chapter reviews the development of the senses of taste and smell, which provide information on the flavor of foods, and discusses how children's innate predispositions interact with early-life feeding experiences to form dietary preferences and habits. Young children show heightened preferences for foods that taste sweet and salty and rejection of that which tastes bitter. These innate responses are salient during development since they likely evolved to encourage children to ingest that which is beneficial, containing needed calories or minerals, and to reject that which is harmful...

The relationship between complementary feeding and the development of atopic disease is the source of significant interest and debate in both the scientific and lay communities. A small number of early studies, which had considerable influence on recommended feeding practices, reported protective effects associated with delaying the introduction of commonly allergenic foods such as cow's milk, egg, and nuts. Despite more conservative recommendations, however, food allergy prevalence has continued to rise. Our understanding of the development of food allergy, its relationship with IgE sensitization and atopic dermatitis, and the relationship of each of these outcomes with the timing of food introduction has evolved considerably...

The etiology of micronutrient deficiencies in infancy is well described. The deficiencies are caused by one of the following four scenarios: (a) low initial stores of micronutrients from micronutrient deficiency during gestation, premature birth or low birthweight; (b) rapid postnatal growth; (c) ingestion of foods with low concentration of micronutrients, and (d) gastrointestinal pathology resulting in the malabsorption of nutrients, including micronutrients. Understanding the cause of the deficiencies is essential in planning interventions to either prevent or treat them...

OBJECTIVES OF THE SURVEY: To evaluate infant feeding and weaning practices and anthropometric characteristics of 2-to 24-month-old children in Russia. SURVEY METHOD: A comprehensive analysis of data collected from face-to-face interviews of a random Russia representative sample of 2,500 mothers of children. We used a specially designed questionnaire that includes sections on health, especially feeding practices, food intake from the previous day and the measurement of height and weight...

Infant feeding and weaning practices in India continue to demonstrate that a significant number of infants do not receive colostrum (62.8% according to the National Family Health Survey, NFHS-2), though breastfeeding is universal and continued for a longer period. In NFHS-3 (2005-2006), there is improving trend for breastfeeding within the first hour of birth (23.4%) and exclusive breastfeeding up to 5 months (46.3%); however, weaning for semisolids is delayed (55.8% only at 6-9 months of age). The infant weaning foods are inadequate in energy-protein and micronutrients...

The purpose of this chapter is to describe the infant feeding practices among infants and toddlers (aged 0-24 months) and to describe food group consumption patterns of these infants and young children (0-48 months) participating in the 2008 Feeding Infants and Toddlers Study (FITS). The FITS 2008 is a cross-sectional survey of a national sample of US children (n = 3,273). Results indicate a longer duration of breastfeeding; however, 17% of infants received cow's milk before the recommended age of one year...

The concept of manipulating the gut microbiota through the administration of probiotics during early life in order to reduce the risk of and prevent or treat diseases, including those that manifest in later life, is appealing. However, a cautious approach is needed, and the long-term consequences of such administration should be carefully evaluated. Concerns related to the early administration of probiotics include timing, i.e. the administration often begins in early infancy, sometimes at birth, when gut microbiota is not fully established, and duration, i...

The provision of donor human milk instead of formula is an important contribution to the nutrition and protection from infections for preterm infants. Systematic reviews suggest a lower risk of necrotizing enterocolitis with pasteurized donor human milk (PDHM) as opposed to artificial formula, although evidence supporting PDHM use from randomized control trials is limited. Human milk banks (HMBs) must have a risk management system to maintain a safe product especially as many operate in an unregulated environment...

Amino acids and proteins play a pivotal role during growth and development. Besides acting as building blocks during tissue synthesis, amino acids or proteins act specifically by upregulating defense systems or by stimulating key sites in metabolic pathways. Following premature birth, the neonatologist is responsible for delivering the right amount and quality of nutrients to the neonate, while exact requirements are largely unknown. However, nutrition matters, both in quantity as well in quality, especially during the first few weeks and months of life...

Understanding the importance of dietary fat has grown beyond energy metabolism to recognition of the complex roles of fatty acids, particularly the ω-6 and ω-3 fatty acids in membrane lipids, inter- and intracellular communication and in regulating gene expression. The ω-6 and ω-3 fatty acids accumulated in developing tissues depend on the fatty acids transported across the placenta and secreted in breast milk. These in turn are dependent on maternal fatty acid intakes, which have changed dramatically in the past century with current western diets high in ω-6 linoleic acid and low in ω-3 fatty acids...

Small size at birth is associated with increased risk of a variety of common chronic diseases in adulthood. Numerous experimental studies in animals have supported the observations in humans, demonstrating that changes in nutrition in early life can lead to altered long-term health. Importantly, these effects can be independent of size at birth, and can depend on the interaction between nutritional events before and after birth. Both macro- and micronutrient intake are important. Furthermore, these effects may vary according to the nature, timing, severity and duration of the nutritional insult...

Dairy foods are widely recommended as part of a healthy diet mainly because of the ready availability of calcium but also because they are a good source of protein, minerals and fat soluble vitamins. On the other hand, dairy foods have been viewed with suspicion by many because dairy fats contain saturated fatty acids and cholesterol. It has been thought, particularly by consumers, that dairy fats may increase the risk of coronary heart disease because of the contribution they make to total saturated fat intake...

Food-derived peptides, specifically those derived from milk, may adversely affect health by increasing the risk of insulin-dependent diabetes. This position is based on the relationship of type 1 diabetes (T1D) and the consumption of variants A1 and B β-casein from cow's milk. It appears that β-casomorphin-7 (BCM-7) from β-casein may function as an immunosuppressant and impair tolerance to dietary antigens in the gut immune system, which, in turn, may contribute to the onset of T1D. There are thirteen genetic variants of β-casein in dairy cattle...