Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceExecutive summaryStudies of human populations show clear links between variability in early life environment and riskof later ill health and chronic disease. A critical aspect of environment is the interaction of nutritionwith other stressors. Nutrition is important in terms of its quantity and also in the balance of foodsand their components, both macronutrients and micronutrients such as minerals and vitamins. Aninadequate or unbalanced dietary intake can lead to ‘malnutrition’: the consequences of whichembrace the range from under-weight, through the normal range to overweight. The health andother consequences of malnutrition across the entire spectrum are cause for considerable concernin all societies, especially among the poor and most economically deprived. The risk for this burdenof ill health is set in train from very early life, providing opportunities for effective interventions atall ages. Future research will help identify further opportunities for effective interventions throughbetter definition of biomarkers of risk, and underlying mechanisms.In developed societies many women consume poor quality diets, which may result in nutritionaldeficiencies on the one hand and overweight and obesity on the other. In developing societiesmaternal under-nutrition remains a major problem but maternal overweight is also of concern.Effective interventions are therefore needed to improve the nutrition of young women of childbearingage in many societies. Less healthy diets are more common among women of low educationalattainment, and among women who have low incomes and who are food insecure. Both nutritioneducation and counselling have been shown to improve women’s nutrition knowledge andbehaviour. These approaches need to be increased to be effective at a population level and otherinterventions developed to improve the diets of young women as a matter of urgency.Our understanding of the specific mechanisms through which maternal nutrition leads to longtermeffects is limited in humans, but there is strong evidence relevant to human disease fromstudies in animals that changing nutrition in pregnancy can produce effects on the offspring.Underlying mechanisms use developmental plasticity to produce adaptive responses to nutritionalcues crossing the placenta from the mother. Some cues may even operate in the periconceptionalperiod, before the woman knows she is pregnant. Positive steps therefore need to be taken toensure that young people understand the importance of health and well-being before pregnancy– giving attention to their diet, maintaining a healthy body weight, stopping smoking and limitingalcohol consumption.Infants are particularly vulnerable because of their immaturity and the nutritional demands of rapidgrowth and development. Exclusive breastfeeding is recommended for at least the first six monthsof life and is associated with reduced susceptibility to infection. The preferred growth associatedwith breastfeeding enables normal cognitive and physical development and may protect againstobesity and chronic disease in adult life. Breastfeeding rates are unacceptably low in the UK andespecially so among disadvantaged women. Mothers may need personal support to establishsuccessful breastfeeding and wider society should support parents in the initiation andprolongation of the duration of breastfeeding. Interventions which educate women about thebenefits and practice of breastfeeding, and which promote baby friendly policy and practice, areeffective at promoting the initiation and prolonging the duration of breastfeeding. The ten steps tosuccessful breastfeeding and the Baby Friendly Hospital Initiative guidelines should become aminimum standard of care. Action is also needed to improve the opportunities for women tobreastfeed in public places and to support women who return to work to continue breastfeeding.There are wide variations in complementary feeding [weaning] practice in the UK. The influence ofthe timing and nutritional content of complementary feeding and the specific effects of variationsin quality of complementary feeding on current and later health in countries such as the UK arestill to be determined. There are wide variations in infant size, weight gain, linear growth and bodyEarly life nutrition and lifelong health 1