Nestle Nutrition Institute workshop series最新文献

Toddlerhood, the period from 12 to 36 months, represents striking changes in children's development. Along with mastery of skills such as walking, talking, self-feeding, sleeping through the night, and bowel and bladder control, toddlers strive for autonomy as they learn to regulate their emotions. Toddlers' increasing autonomy impacts feeding behavior and may increase or restrict their food exposures. Baby-led weaning, allowing infants to participate in the family meal by selecting food and feeding themselves, exposes children to the family diet. Food neophobia, a normal developmental phase whereby children reject novel foods, may limit children's exposure to high-quality foods. Food preferences formed during toddler and preschool years often persist into adulthood, making toddlerhood an ideal time to help children build healthy habits. Toddlerhood can be both joyful and challenging as children acquire new skills and assert their autonomy. Effective parenting practices include providing age-appropriate structure and opportunities for toddlers, reading toddler's signals, and responding promptly, appropriately, and with nurturance. Responsive parenting ensures that toddlers receive the guidance and nurturant care needed to develop healthy feeding behavior and emotional well-being.

Child care has broad reach to young children. Yet, not all child care settings have nutrition standards for what and how foods and beverages should be served to infants as they transition to toddlerhood. The purpose of this paper is to describe the development of nutrition recommendations to guide feeding young children in licensed child care settings in the USA, a process that could be adapted in other countries. Nutrition standards were designed by nutrition and child care experts to address what and how to feed young children, also including the transition from infants to toddlers. Nutrition standards are important for health and can be feasibly implemented in child care settings. Feasibility considerations focused on family child care homes, which typically have fewer resources than child care centers or preschools. Infant standards include recommendations for vegetables, fruits, proteins, grains, and breast milk and other beverages. Also included are recommendations for supporting breastfeeding, introducing complementary foods, and promoting self-regulation in response to hunger and satiety. Toddler standards are expanded to address the frequency as well as types of food groups, and recommendations on beverages, sugar, sodium, and fat. Feeding practice recommendations include meal and snack frequency and style, as well as the promotion of self-regulation among older children.

Newborn infants, especially those born preterm, are at risk of infections in early life. In preterm infants, necrotizing enterocolitis (NEC), a devastating inflammatory gut condition, and late-onset sepsis (LOS) are important causes of serious morbidity and are the commonest reasons for death after the first week of life. Fresh breast milk from the infant's mother reduces the risks of these serious pathologies in a dose-dependent fashion. Considerable effort has been expended to better understand which specific components of human milk are likely to exert the greatest functional benefits, particularly those that have immune modulatory or anti-infectious properties. Lactoferrin is a whey glycoprotein present in especially high concentrations in colostrum and early milk. Studies show that lactoferrin impacts on immune function and, through a multitude of mechanisms, reduces the risk of viral, fungal, and bacterial infections. Supplemental enteral bovine lactoferrin has been tested in a series of randomized clinical trials, many of which suggested important reductions in LOS in preterm or low-birth-weight infants. However, the largest trial to date - the Enteral Lactoferrin in Neonates (ELFIN) trial - recruited 2,203 infants and failed to show any significant reductions in LOS or NEC. Challenges in conducting clinical research and the translational relevance of these studies for clinical practice will be considered.

The first 2 years of life are a critical period to promote nutrition and dietary behaviors for optimal growth and development. Exclusive breastfeeding is recommended until 6 months with the addition of safe, nutritionally adequate complementary foods thereafter. Caregiver adherence to international guidelines for feeding infants and toddlers varies depending on the setting, access to information, quality of food, and cultural beliefs. Caregiver feeding style also plays an important role in what foods and drinks are offered and whether young children accept those foods. Feeding guidelines often include what is called "responsive feeding," which is the importance of caregiver attention to child cues of hunger and satiety. While there are data on food consumption and dietary diversity in early childhood, the literature on early childhood beverage consumption is limited. With the increased consumption and availability of sugar-sweetened beverages, future research should aim to understand the status of global beverage consumption among children under 2 years old and its impact on growth and development. This chapter highlights current infant and young child feeding recommendations, what young children eat and drink, and the role that parental feeding styles can have on diet and early childhood outcomes.

Vitamin B12 is a fascinating nutrient in that it is made by microbes but is essential for human metabolism. Humans can get it only from animal origin foods. Dietary deficiency rather than an absorption defect (Pernicious anemia, intrinsic factor defect) is the commonest cause of deficiency in the world, contributed by cultural and economic imperatives. Indians have a large prevalence of subclinical B12 deficiency due to vegetarianism. Birth cohort with long-term serial follow-up (Pune Maternal Nutrition Study) has helped reveal the life-course evolution of B12 deficiency: genetics, transplacental and lactational transfer from the mother, influence of family environment, rapid childhood and adolescent growth, and low consumption of milk all made a contribution. A novel association of low maternal B12 status was with fetal growth restriction and increased risk factors of diabetes in the baby. After demonstrating adequate absorption of small (2 μg) dose of vitamin B12, and a noticeable improvement of metabolic parameters in a pilot trial, we planned a supplementation trial in adolescents to improve outcomes in their babies (a primordial prevention called Pune Rural Intervention in the Young Adolescent). The results are awaited. The long-term effects in the babies born in the trial will contribute to a better understanding of the Developmental Origins of Health and Disease.

Well-nourished mothers are assumed to produce adequate concentrations of nutrients in their milk for optimal infant growth and development and infants should be exclusively breastfed during the first 6 months. It is important to know the nutrient content of human milk as this information is used to set recommended adequate intakes (AIs) for infants. Our review of existing information reveals that the AI recommendations are based on poor data. The milk content of a few nutrients may not be adequate to provide requirements for 6 months even in well-nourished mothers. Importantly, the concentrations of many micronutrients in milk are low when the mother consumes a poor quality diet. Our new efficient methods for milk nutrient analysis have enabled us to illuminate the large differences in milk micronutrient concentrations across populations, to examine the effects of milk collection protocols on nutrient concentrations, and to study the effects of maternal supplementation in pregnancy and/or lactation on milk micronutrient and infant status. The ongoing Mothers, Infants and Lactation Quality study proposes to answer some of these uncertainties. Two hundred and fifty healthy, well-nourished, unsupplemented mother-infant dyads in each of the 4 countries are being studied. The range of milk nutrient concentrations across the first 9 months postpartum will provide "Reference Values" against which other studies and surveys can evaluate the quality of milk and possibly target nutrients for treatment with supplements or fortification.

The development of the mammary glands and the process of lactation is an integral component of mammalian evolution, and suckling has been essential for the survival of the neonates of most mammalian species. The colostrum and milk, the major products of lactation, contain a wealth of biologically active products derived from the immunologic and microbiological experiences in the maternal circulation and in the maternal mucosal surfaces. These include major immunoglobulin isotypes in the maternal circulation, secretory IgA, a variety of soluble proteins, casein, nutritional components, hormones, a large number of cellular elements and their secreted functional products (cytokines and chemokines), several peptides, lipids, polysaccharides and oligosaccharides, and a diverse spectrum of microorganisms. During the past few decades, significant new information has become available about the evolutionary biology of mammalian lactation, the functional characterization of antibody and cellular immunologic products, the role of oligosaccharides and other proteins and peptides, and about the distribution and biologic functions of the microbiome observed in human products of lactation. This workshop explores this information in some detail in a series of presentations. A brief overview of the earlier observations on the immunologic aspects of lactation is presented here, and detailed reviews of more recent observations are reported in subsequent presentations in this workshop.

At the beginning of the 21st century, some pioneer studies provided evidence of the existence of a site-specific human milk microbiota. Hygienically collected milk samples from healthy women contain a relatively low bacterial load, which consist mostly of Staphylococcus, Streptococcus, lactic acid bacteria, and other gram-positive bacteria (Corynebacterium, Propionibacterium, and Bifidobacterium). DNA from strict anaerobic bacteria is also detected in human milk samples. The origin of human milk bacteria still remains largely unknown. Although the infant's oral cavity and maternal skin may provide microbes to milk, selected bacteria of the maternal digestive microbiota may access the mammary glands through oral- and enteromammary pathways involving interactions with immune cells. In addition, when milk is collected using external devices, such as breast pumps, some microorganisms may arise from unhygienic handling as well as from the water used to clean and rinse the devices, for example. The human milk microbiota has a wide spectrum of potential uses. Most of them have been focused on the infant (including the preterm ones), but some bacterial strains present in human milk have also a big potential to be used to improve the mother's health, mainly through the prevention or treatment of infectious mastitis during lactation.