Nestle Nutrition Institute workshop series最新文献

Our diets are the greatest determinant of health, and what we eat is sustained and shaped by the food we produce. Food systems have increased production to feed the growing world population, which has also led to a dietary transition, with increases in energy and protein intakes, and only modest improvements in micronutrient density. Thus, undernutrition has decreased globally, while non-communicable diseases are dramatically increasing. Today, food systems are being threatened by global warming. Conversely, food systems are a major contributor to climate change and environmental degradation, generating one-quarter of all greenhouse gasses, using half of the world's habitable land, and are the largest source of water pollution. The greatest contributor to this environmental degradation is the production of animal-based foods, particularly meat. Food systems must ensure access to safe, nutritious, and sustainable foods (e.g., improving yields, reducing waste, and greenhouse gas emissions), decreasing animal-based food production, and increasing plant-based foods, which can positively impact our diets. On the "demand side", shifting our current diets from high animal-based foods to plant-based diets will decrease global mortality and disability. Our diet is at the intersection of our health and our planet's health and, thus, a major instrument to improve both.

A woman is born with her life-time supply of eggs, and these are surrounded by a group of cells, the follicular cells, which form the ovarian follicles. The ovarian follicles will determine a woman's entire reproductive lifespan (presence of menstrual cycles and length of fertility) and healthspan (i.e., quality of life). The ovarian follicles are at their peak numbers in utero and start to decline upon birth. This decline continues nonlinearly throughout the girls' growth to adolescence and in adulthood. This decline also represents the inevitable loss of fertility, culminating in women's menopause, where the ovaries have too few ovarian follicles left to result in monthly menstrual bleeding. The role of these ovarian follicles is vital for a woman's fertility as they safeguard the eggs within them. Importantly, the hormones secreted by the ovarian follicles (e.g., estradiol) maintain a woman's healthspan by ensuring optimal cardiovascular, musculoskeletal, and neurocognitive health. Conditions that accelerate the loss of these ovarian follicles or shorten the already limited ovarian lifespan will result in systemic issues detrimental to women's health. Yet, the biological processes that determine the ovarian clock remain understudied and this phenomenon needs attention to ensure that novel diagnostics and therapeutics are discovered for optimal women's reproductive health.

Although malnutrition in the form of child wasting, stunting, and micronutrient deficiencies remain prevalent on many of the poorest and war-torn places on earth, there has been major progress in other regions and the direction of travel remains generally good. However, as countries pass through the economic transition there has been a seemingly inevitable rise in overweight and obesity with its attendant personal health costs (reduced life span due to obesity-related chronic conditions) and a rise in the societal costs of care. Strategies, by healthcare professionals and others, to combat the two sides of the malnutrition coin must be built on a solid foundational knowledge of the causes of each condition. The individual, nutritional, and environmental drivers are summarized here. It is sometimes helpful to focus on a single unifying concept as a way of rationalizing the causes and required solutions; namely the nutrient density of foods. Malnutrition is caused, inter alia, by foods lacking in sufficient energy, protein, and micronutrients. The same is true for obesity which, in large part, is driven by foods overly dense in energy but lacking other critical nutrients. Food quality therefore emerges as a key concept that healthcare professionals can adopt as they educate parents and children at the microlevel and schools, health systems, and government bodies at the macrolevel.

There has been a significant increase in the number of people shifting towards plant-based dietary patterns over the past decade due to interest in protecting the health of the planet as well as improving human health. Studies have shown that vegetarian diets are associated with a lower prevalence of obesity in adults and children; therefore, moving towards a vegetarian diet in childhood may help prevent obesity later in life. The VeChi study in Germany found that on average vegetarian and vegan children grew equally well as omnivorous children. It is important to ensure that children following plant-based diets have adequate amounts of key nutrients, such as energy, fats, iron, calcium, iodine, vitamin B12, and omega-3 fats. In the VeChi studies, vegan children had the lowest intakes of calcium and iodine out of the three diet groups. The vegan children also had the lowest vitamin B12 intakes without supplements, but when supplements were taken into account, they had the highest vitamin B12 intakes. Iron intake in vegetarian children is consistently reported as higher than in omnivorous children. However, iron stores (indicated by low ferritin levels) tend to be lower in vegetarian compared to omnivorous children, due to decreased bioavailability of non-haem iron found in plant foods. When introducing solids, iron-rich foods should be offered early and paired with iron enhancers such as vitamin C and beta-carotene to improve iron absorption.

The community of microorganisms colonizing the gut changes during the first postnatal years of life. This ecosystem, henceforth described as the microbiome, modulates infant physiology and health, but uncertainty remains about the significance of variation in microbiome composition and function. Some may be tolerable, yet some microbiomes may be less healthy than others. Most efforts to identify parameters of microbiome health focus on adults, and derived concepts may not directly translate to early life that is characterized by dynamic and sequential changes. Data suggest that an orderly progression from an immature neonatal microbiome to a mature adult state is preferable to delayed or over-rapid development. This can be parameterized as a "microbiome development trajectory". Diet modifies early life microbiome development and is the principal modifiable factor to this end. Infants fed with infant formulas show different microbiome development trajectories from breastfed infants. Early data suggest that formulas containing a specific blend of human milk oligosaccharides partially mitigate this difference. Introduction of a complementary diet complexifies the identification of diet-microbiome development interactions. A better understanding will only be achievable through detailed, longitudinal characterization of large cohorts.

In the early era of neonatal intensive care (about 5-6 decades ago), most nutritional approaches were based largely on the physician's intuition, previous experience, and patient's signs and symptoms. This resulted in a large heterogeneity of diagnostic, preventative, and therapeutic measures. More recently, evidence-based approaches, such as data reviews and clinical trials, form the foundation for nutritional guidelines used in most Neonatal Intensive Care Unit (NICUs). These are derived from population statistics aimed toward the average and, thereby, meet the needs of many of these infants, but because of the extreme heterogeneity of the preterm population, they marginalize others. Helpful scoring programs are now available to identify malnutrition in populations of preterm infants using defined indicators. However, similar to growth curves, they do not provide proactive guidance. Newly developed precision-based approaches using algorithms and predictive analytics based on artificial intelligence (AI) and machine learning (ML) will provide for a priori-based preventative approaches. It is likely that these will employ technologies that cluster infants into different risk categories that can then be investigated mechanistically with multiomic integrations that provide mechanistic interactions and provide clues to biomarkers that can be used for the discovery of biomarkers that can be utilized for the development of preventative strategies.