The impact of early nutrition on health: key findings from the Cebu Longitudinal Health and Nutrition Survey (CLHNS).

INTRODUCTION: The Philippines' Cebu Longitudinal Health and Nutrition Survey (CLHNS) is one of the longest running birth cohort studies in Southeast Asia. This paper illustrates the pathways through which maternal and infant nutrition influence later health outcomes using selected CLHNS findings.

METHODS: The CLHNS initially examined the determinants and consequences of low birth weight and early nutrition on child growth and development. It has since expanded to study other health, nutrition, and demographic issues in the life course of the cohort participants such as the consequences of early nutrition on adult health.

RESULTS: CLHNS findings have documented important effects of poor maternal nutrition beyond impaired foetal growth (manifested through low birth weight). Mothers who had lower energy intakes and poorer nutritional status during pregnancy had offsprings who were at risk of having higher blood pressure measurements in adolescence. Infants born small at birth were not only more likely to be stunted through adolescence, but were also at greater risk of cardiovascular disease later in life. Among the males, those born thin at birth and have high BMI in adulthood had increased risk of elevated systolic blood pressure. Early infant feeding also had long-term effects on health. Breastfeeding not only protected against morbidity and stunting in childhood, but also lowered the risk of insulin resistance and high triglyceride levels in adulthood among the males. Delayed complementary feeding was associated a with lower risk of overweight in young adulthood. An intergenerational matrilineal effect was also observed among the participants, with maternal birth weight being positively associated with offspring birth weight.

CONCLUSION: The CLHNS findings support the WHO recommendations for exclusive breastfeeding until six months, timely introduction of complementary foods, and continued breastfeeding until two years. Since child nutrition begins in utero, programs should focus on improving maternal nutrition during pregnancy to minimise the risk of low birth weight.