Nestle Nutrition Institute workshop series最新文献

Humans maintain symbiotic relationships with complex microbial communities in their intestinal tracts that are paramount to their host's health and development. Given their importance, it is essential for the host to reliably acquire key members of the gut microbiota and assemble communities that provide benefits during important windows of host development. Epidemiological studies over the last 2 decades have convincingly shown that clinical and nutritional factors that disrupt early-life microbiome assembly predispose humans to infections and chronic noncommunicable diseases. These connections emphasize the importance of understanding host-microbiome assembly on a mechanistic level, the time windows that are most important for host-microbe crosstalk, and the clinical and lifestyle factors that shape and disrupt symbiotic interactions to develop therapeutic and nutritional strategies to prevent noncommunicable diseases. In this article, I will provide an evolutionary and ecological perspective on when and how humans acquire their gut microbiome, the factors that shape the assembly process, and how the process can be disrupted. I will discuss the most important time windows for both microbiome assembly and the microbiome's impact on development of the immune system. Finally, I will discuss how evolutionary and ecological principles inform strategies to support and restore the gut microbiome early in life.

Malnutrition is present in most countries of the world. This ranges from general undernutrition due to insufficient food, or poor-quality diets low in some essential nutrients, to overnutrition and obesity with energy-rich but nutrient-poor diets. The fundamental aim of dietary recommendations is to prevent deficiency diseases, and the assumptions which underpin these recommendations need to be understood when considering what advice to give to the general public or individual patients. This is particularly relevant in early life as the nutritional state and dietary intake of the mother are of major importance for both her and her baby's health. There is a particular concern with pregnancy in teenage women, as they are still likely to be growing and have different nutrient requirements compared to older women. There is now evidence of beneficial effects for both the mother and baby of supplementation of the mother's diet in those with a low nutritional status. For infants, early gut microbiome development is supported by human milk components (including oligosaccharides) and the reported health benefits are of growing interest and offer potential areas for future developments. Yet, the increasing overweight and obesity in children are a serious concern, in both developed and developing economies. Considerations of the achievements, challenges, and future directions of early life nutrition need to be addressed in a global environment in which every country in the world is experiencing some form of malnutrition. The term malnutrition encompasses a number of different scenarios ranging from undernutrition, which encompasses an inadequate nutrient intake in a diet with a low level of diversity, up to overnutrition where there is an excess of energy intake in a diet which is predominantly composed of nutrient-poor foods. The major feature of malnutrition is that there is micronutrient inadequacy, and even deficiency, which is particularly concerning in early life. The present chapter will consider the major achievements and future challenges in relation to achieving optimal nutrition in early life as well as in older children. Clearly, when considering nutrition in children, it is important to also consider the nutritional state of women before, during, and after pregnancy, as this can have a major impact on the fetus and young child. Before considering these issues in detail, this chapter will begin by addressing the basis on which nutritional recommendations are founded and the challenges that have to be met in getting novel recommendations approved by the appropriate authorities.

Micronutrient deficiencies in children can occur for multiple reasons, including poor access to food, particular dietary patterns or health conditions that may impact nutrient absorption and utilization. Reduced access to food for infants and young children can lead to malnutrition, increasing the risk of infectious diseases, poor growth, cognitive impairment, emotional dysfunction, and even death. Due to the limited foods available, children with malnutrition also often experience low micronutrient intake. Selective or picky eating is a common feeding difficulty in young children worldwide and can have adverse effects on health and development. Selective eaters generally consume a less diverse diet, leading to an imbalanced nutrient intake. Dietary supplementation provides an individually targeted approach to address micronutrient deficiencies. This strategy has been used safely and effectively to prevent micronutrient deficiencies in high-income countries for over a century. It is the mandatory or voluntary addition of essential micronutrients to widely consumed staple foods and condiments during production. However, worldwide data suggest low compliance with dietary supplementation approaches. This leaves a question mark over the effectiveness of commercial food fortification and highlights the need for improved infrastructure to ensure food fortification or micronutrient supplementation in areas where there is an increased risk of deficiencies.

"Hidden Hunger" refers to micronutrient deficiencies that are not necessarily reflected in anthropometric measurements and thus remain hidden. It affects 2 billion people globally, and occurs among infants and young children on a "healthy diet," as perceived by family members. Hidden hunger is recognizable with a high index of suspicion and hence the term "micronutrient hunger" has been proposed. Its effects are significant and include physical and mental impairment, poor health, low productivity, morbidity, and mortality. Data reported in the Global Hunger Index and Global Hidden Hunger Index are eye-openers in this context. Maternal deficiencies, changing breastfeeding trends, suboptimum infant and young child feeding practices, and universal availability and popularization of junk food result in emerging and re-emerging nutritional disorders that need to be addressed urgently. Strategies for addressing micronutrient malnutrition include supplementation, fortification, and dietary diversification. These interventions have benefits but are limited by context and resources. In the Indian context, universal salt iodization is successful; however, iron and folic acid supplementation for several decades has not produced the desired results. A multisectoral approach advocated at national and international levels with cross-disciplinary support is recommended. An overview of these issues along with practical solutions are highlighted in this manuscript.

The first 3 years of life are when dynamic neurodevelopmental processes unfold. This is marked by sensitive or critical windows of opportunities, during which the young brain is both adaptable and vulnerable. Factors like nutrient deficiencies and inadequate environmental stimulation are more likely to negatively impact early brain development, especially when necessary and timely identification and intervention are not put in place. The benefits of adequate nutrition, especially breastfeeding during the first 1,000 days, cannot be overemphasized. Evidences from newer modalities of research, utilizing magnetic resonance imaging, continue to point to the significant influence of early life nutrition on early brain development, particularly myelination. Paradigms show that a child's physical growth, activity, and overall health influence the way he interacts with the environment, laying the scaffolds for brain development and learning. Current evidences show how the recent pandemic has impacted this very foundation, affecting children's nutrition, behavior, and development. There is a renewed call for pediatricians and other healthcare practitioners in clinics and communities to more ardently screen, monitor for, and provide proper advice for concerns regarding growth and development during the first 3 years of life to help mitigate the impact of current global events on children's potential to adapt, learn, and be productive adults in the future.

By 2050, the global population is expected to reach close to 10 billion people, increasing the demand for food. To ensure sustainability in food production to meet this population increase, alternative approaches such as reducing meat consumption and incorporating plant-based alternatives are being explored. Cellular agriculture, an interdisciplinary field merging engineering and biology offers a potential solution. This approach involves the isolation and modification of animal cells for food production, using techniques like genetic engineering and creating cell-biomaterial interfaces. This approach has the potential to provide sustainable and nutritious meat and dairy alternatives while reducing environmental impact. However, challenges such as achieving the same nutritional quality and texture as animal-based products and addressing issues related to scale-up as well as costs pose barriers to commercialization. Despite these challenges, cellular agriculture has progressed rapidly and shows promise in meeting the changing demands of consumers and ensuring food security in the future.

This article explores the challenges and opportunities of applying Evidence-Based Medicine (EBM) to the field of gut microbiota research. EBM has revolutionized healthcare by integrating the best available evidence with clinical expertise and patient values. However, EBM has also faced criticisms such as overemphasizing results of randomized controlled trials and a lack of patient involvement. The article discusses these criticisms in the broader context of EBM and how they are particularly relevant to studies on gut health. This article also discusses the emergence of next-generation EBM methods, examining their potential strengths and limitations. For example, integrating next-generation EBM methods into gut microbiota studies offers the potential for improved understanding and patient-centered interventions. Still, it also raises questions about data quality, privacy, and patient involvement. This article concludes that as EBM evolves, careful attention must be paid to ensure that new methods are robust, transparent, and patient-centric, thereby contributing to better outcomes in gut microbiota research.

Eating behavior and food preferences are shaped in early life and contribute to lifelong food choices. Much of the current dietary advice for infants and toddlers focuses on the nutritional quality of foods, with less emphasis on food sensory qualities. However, exposure to age-appropriate sensory properties, such as tastes and textures, are key in shaping early-life eating behaviors and food preferences. During weaning, new-borns rely on reflexes such as sucking and rooting to get sufficient nutrient intake. Around 6 months of age infants transit from dependent feeding with liquid foods such as breast or bottle feeding, to independent feeding with solid foods. During this rapid learning period, the infant must learn to sit upright and balance their head and quickly develop in terms of oral anatomy, emerging of teeth as well as the muscle coordination needed to orally process food. Different product textures require unique oral processing skills that have to be acquired through experience with food oral breakdown and swallowing. These early food experiences shape the eating behaviors that become habitual and are carried forward into later childhood. Early life feeding strategies vary widely across populations but become all the more challenging in specific child populations such as children who received early life tube-feeding and children with developmental challenges are further complicated by anatomical issues and acquired negative associations with food. Due to the significance of early life food sensory exposure in shaping dietary behavior, there is a need for science-based recommendations to help guide this sensory learning to inform dietary behaviors in both healthy and clinical child populations.

Improved maternal nutritional status is hypothesized to promote good pregnancy and infant health outcomes but trial evidence supporting the commencement of nutritional supplementation before conception is sparse. The NiPPeR (Nutritional Intervention Preconception and During Pregnancy to Maintain Healthy Glucose Metabolism and Offspring Health) multinational double-blind randomized controlled trial conducted in the United Kingdom, Singapore, and New Zealand tested a nutritional formulation containing myo-inositol, probiotics, and multiple micronutrients (intervention), compared with a standard micronutrient supplement (control), taken at preconception and throughout pregnancy. The primary outcome of gestational glycemia at 28 weeks' gestation showed no difference. However, differences in several prespecified secondary outcomes were notable. The intervention reduced the incidence of preterm delivery particularly those associated with preterm prelabor rupture of membranes, operative delivery for delayed second stage, and major postpartum hemorrhage. It may also shorten time to conception in overweight women, to that similar to nonoverweight/obese women. Importantly, the intervention associated with a reduction in the incidence of rapid infant weight gain and high body mass index at 2 years among offspring. Such evidence indicates the potential for preconception maternal nutritional interventions to have appreciable impact in shaping the long-term health of an individual and building resilience against noncommunicable chronic diseases in the future.

Human milk is the recommended sole source of nutrition for infants during the first 6 months of age, thanks to its composition rich in nutritious and bioactive components. Progress in analytics has allowed for a detailed description of its components and their variability within and among mothers. This is especially valid for the human milk oligosaccharides (HMOs) that represent one of the major human milk compound groups. The stages of lactation and maternal genotypes are the main contributors to the variability of HMOs, although other maternal and environmental factors also contribute to the variation, which may be important for adaptation in evolutionary terms. Today, mainly individual HMOs or structural groups of HMOs were associated with infant outcome measures, ranging from anthropometry to immunity and brain development (social and cognitive skills). Mechanistic insights can partly explain some findings, yet there is a lack of consistency between the different observational studies of breastfed infants. Gaining a better understanding of the reasons behind these disparate findings is the key element going forward. Furthermore, studying human milk components, like HMOs, and their expected benefits using a systems biology approach can reveal further important insights. Here, we discuss recent findings with the perspective to learn more about the link to health outcomes.