Nestle Nutrition workshop series. Paediatric programme最新文献

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. High intakes of ω-6 fatty acid and low intakes of ω-3 fatty acids compromise long-chain ω-3 fatty acid accumulation in tissues, and this is avoided by dietary docosahexaenoic acid. In addition to the well-known roles in neural development, newer studies are beginning to question the importance of ω-3 fatty acids as a contributor of metabolic development in other organs, with possible implications for the development of feeding behavior and integration of the nutrient energy supply.

Consumption of cow's milk is recommended in many countries. Observational and intervention studies show that cow's milk most likely has a positive influence on growth in children. The strongest evidence comes from observational studies and intervention studies in low-income countries, but there are also observational studies from high-income countries showing positive associations between milk intake and growth. Milk seems thus to have a specific stimulating effect on linear growth, not only in developing countries with high rates of malnutrition, but also in industrialized countries. However, it is not known which components in milk stimulate growth. Possible components are proteins, minerals, vitamins or combinations of these. Cow's milk proteins have a high protein quality, and whey has a slightly higher quality than casein, according to some indices based on amino acid composition. Studies, mainly from sport medicine, have suggested that whey protein also has the potential to increase muscle mass. Whether whey improves body composition to a larger extent than other milk proteins is not clear. The mechanism behind a possible growth-stimulating effect of milk and milk components is likely to be through a stimulation of insulin-like growth factor-I synthesis and maybe insulin secretion. In conclusion, there is strong evidence that milk stimulates linear growth. The mechanism is not yet clear, and more intervention studies are needed to understand which components in milk are responsible for the growth stimulation. The effects of milk on linear growth and adult height may have both positive and negative long-term implications.

Acne vulgaris, the most common skin disease of western civilization, has evolved to an epidemic affecting more than 85% of adolescents. Acne can be regarded as an indicator disease of exaggerated insulinotropic western nutrition. Especially milk and whey protein-based products contribute to elevations of postprandial insulin and basal insulin-like growth factor-I (IGF-I) plasma levels. It is the evolutional principle of mammalian milk to promote growth and support anabolic conditions for the neonate during the nursing period. Whey proteins are most potent inducers of glucose-dependent insulinotropic polypeptide secreted by enteroendocrine K cells which in concert with hydrolyzed whey protein-derived essential amino acids stimulate insulin secretion of pancreatic β-cells. Increased insulin/IGF-I signaling activates the phosphoinositide-3 kinase/Akt pathway, thereby reducing the nuclear content of the transcription factor FoxO1, the key nutrigenomic regulator of acne target genes. Nuclear FoxO1 deficiency has been linked to all major factors of acne pathogenesis, i.e. androgen receptor transactivation, comedogenesis, increased sebaceous lipogenesis, and follicular inflammation. The elimination of the whey protein-based insulinotropic mechanisms of milk will be the most important future challenge for nutrition research. Both, restriction of milk consumption or generation of less insulinotropic milk will have an enormous impact on the prevention of epidemic western diseases like obesity, diabetes mellitus, cancer, neurodegenerative diseases and acne.

Until the early 20th century, a wet nurse was the only safe alternative to breastfeeding, one reason being that each species has a unique composition of its milk. When techniques for chemical analyses of milks and assessment of the energy requirements of infants became available during the 19th century, reasonably safe breast milk substitutes started to be developed. Successively, these were developed into modern infant formulas during the 20th century using human milk composition as reference and cow's milk as protein source. Even with a composition similar to human milk there are differences in performance between formula-fed and breastfed infants. Novel ingredients and new techniques within the dairy industry will contribute to minimize these differences and so might techniques in molecular biology allowing large scale production of recombinant human milk proteins. This technique may be used for production of bioactive substances present in low concentrations in human milk but absent from bovine milk with proven effect on nutrient utilization or other health benefits. For formulas containing novel ingredients with potent biological activities produced with new techniques it will be extremely important that their safety and efficacy are rigorously evaluated because 'functional effects' are not necessarily the same as health benefits.

Novel dairy fractions have been isolated and are now commercially available. Several of them have been shown to have biological activities in various test systems. α-Lactalbumin was first isolated to provide a good source of tryptophan, often the first limiting amino acid in infant formulas, but has then been shown to be digested into smaller peptides with antimicrobial and prebiotic activities, immunostimulatory effect and acting as enhancers of mineral absorption. Lactoferrin bioactivities include antibacterial and antiviral effects, regulation of immune function, stimulation of intestinal proliferation and differentiation and facilitating iron absorption, but these activities may have been limited due to earlier contamination with LPS. Lactoferrin free of lipopolysaccharide may prove to be more effective with regard to exerting these activities. Osteopontin is a heavily phosphorylated and glycosylated protein that modulates immune function and stimulates Th1/Th2 switching, and, possibly, also affects bone mineralization and growth. Biological activities of lactoferrin may be facilitated by osteopontin. Milk fat globule membranes are a fraction that has previously been excluded from infant formulas, but components of this fraction have been shown to exhibit antimicrobial activities and to prevent infection. Further clinical studies are needed on infants fed formulas with these components incorporated.

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. The survey was conducted within the framework of 'Start Healthy Stay Healthy' program in Russia, sponsored by Gerber, Nestlé Nutrition.

Results: Incidence of breastfeeding among children of various age was as follows: from 2 to 4 months: 70%, from 4 to 6 months: 60%, from 6 to 9 months: 46%. The most common weaning food was fruit juice (59.4% of children), followed by fruit puree (18%) and cereals (6.4%). 4.4% of respondents used cow's milk as the first weaning food. It was found that examined children were slightly taller (z score for height-forage, 0.11) and heavier (z score for weight-for-age, 0.63) than the WHO standards.

Conclusions: Evaluation of infant/toddler feeding and weaning practice will help to develop guidelines and educational programs to prevent nutrition-related diseases in Russia.

Cow's milk products have a central role in treatment of under nutrition, and the introduction of products with a high milk content (F-100 and ready to use therapeutic foods) has resulted in marked improvements in weight gain and reduction in mortality. Milk also has a specific effect on linear growth. Milk protein has a high quality score (PDCAAS) and contains many peptides and other bioactive factors, which might have special effects on recovery from under nutrition. Milk is an important source of minerals supporting growth (type II nutrients), such as potassium, magnesium, phosphorus and zinc, and the high lactose content also seems to support growth due to a prebiotic effect and improved absorption of minerals. The risk that the use of cow's milk products suppresses breastfeeding should be prevented by supporting mothers in breastfeeding. There is consensus that children with severe under nutrition should be treated with products with high milk content, but because of the high cost of milk there is a need to perform more studies to determine the minimal amount of milk protein needed to make a clinically relevant difference in treating the 36 million children with moderate wasting. Such studies should not only focus on weight gain but also on linear growth, body composition, physical activity and cognitive development.

This review evaluates evidence for benefits of including animal source foods (ASF) in the diets of children in developing countries. In observational studies, a higher usual intake of ASF in such countries is associated with better growth, status of some micronutrients, cognitive performance, motor development and activity. Only three randomized trials supplemented children with milk and compared outcomes with a nonintervention control group. Both height and weight growth were improved, although in Kenya height was increased only in younger schoolers who were stunted at baseline. Meat supplements have been evaluated in only two randomized controlled trials, in Kenya and Guatemala (mean baseline age 8 years and 1 year, respectively); growth was no better than in an equicaloric control group. Meat improved cognitive function and activity in Kenya; milk was less effective than meat for improving cognitive function and physical activity, perhaps due to its lower content of iron, zinc, or riboflavin. Meat and especially cow's milk are excellent sources of vitamin B(12), a micronutrient commonly deficient in populations which consume low amounts of ASF. Other micronutrients such as iron have been added to cow's milk and resulted in improved nutritional outcomes for children.

The potential for lactose intolerance causes 25-50 million Americans and an unknown number of people around the world to avoid milk. Milk avoidance is a significant risk factor for low bone density. Individuals who avoid milk, due to intolerance or learned aversion, consume significantly less calcium and have poorer bone health and probable higher risk of osteoporosis. Lactose intolerance is easily managed by: (1) regular consumption of milk that adapts the colon bacteria and facilitates digestion of lactose; (2) consumption of yogurts and cheeses and other dairy foods low in lactose; consumption of dairy foods with meals to slow transit and maximize digestion, and use of lactose-digestive aids. As dairying spreads around the world to new markets and dairy foods become the dominant source of calcium in these markets, the potential for lactose intolerance will grow. Management of lactose intolerance globally will require both education and product development.