Literature review for - Flourish Paediatrics

moderates the influence of prenatal effects that might program less health beneficial outcomes. After
birth, breastfeeding and the appropriate introduction of complementary foods (around six months)
results in a growth trajectory that is within the lower risk part of the U-shaped growth curve.
Later introduction of complementary foods was associated with lower adult adiposity. In an analysis of
pooled data, 10912 subjects aged, 15-41 years, from five prospective birth-cohort studies in low-
/middle-income countries (Brazil, Guatemala, India, Philippines and South Africa) found a relationship
between later introduction of complementary foods and adult adiposity. Body mass index changed by
0.19 kg/m 2 (0.1, 0.37) and waist circumference by 0.45 cm (0.02,0.88) per 3-month increase in age (Fall,
Borja et al. 2010).
The Copenhagen Perinatal Cohort was established in 1959–1961 (n = 5068) with regular follow-up.
With the group now in their early 40s, this study suggests that introduction of complementary foods at a
later age (within the range of 2 to 6 mo) is protective against overweight in adulthood. The study did
not support a protective effect of a longer duration of BF against obesity. The risk of overweight at age
42 years decreased or tended to decrease, with increasing age (in mo) at introduction of spoon-feeding
[odds ratio (OR): 0.94; 95% CI: 0.86, 1.02], vegetables (OR: 0.90; 95% CI: 0.81, 0.98), meat (OR: 0.93;
95% CI: 0.87, 1.00), and firm food (OR: 0.92; 95% CI: 0.86, 0.98) but not egg (OR: 0.98; 95% CI: 0.91,
1.05) (Schack-Nielsen, Sorensen et al. 2010).
Implications for public health
In the past decade the concepts of developmental origins adult disease, early life programming and
epigenetics have become better established (Waterland and Michels 2007; Waterland 2008). They
provide a theoretical basis for understanding for patterns of chronic disease. For example in Australia
the differential in morbidity and mortality between Aboriginal Australians and other Australians is a
good public health example. The theory provides a theoretical basis for several public health nutrition
interventions including:
Prevention programs that aim to divert foetal programming must involve nutrition and health
throughout the life cycle, beginning with the nutrition of young girls (Yajnik 2010)
prenatal care—nutrition and health care programs to minimise the number of low-birthweight babies
and thin babies (ponderal index