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

BMA Board of ScienceChapter 3: Infant nutritionIntroductionInfancy refers to the first one to two years after birth. It is a period of rapid growth in weight,length and brain size and rapid social, cognitive and motor development. These changes carry highnutritional needs at a time of total dependence on carers who may have little knowledge aboutnutrition or the special requirements of infancy. During the first 12 months of life, the infant mustmake a transition from a milk-only diet to one containing the diversity of foods eaten by the restof the family. Good nutrition is essential for the infant to maintain and develop its immatureimmune defences as it meets pathogens for the first time. Patterns of weight gain and growth,and nutritional experience, in infancy can have long-term effects on health (see page 40).Key MessageInfancy is a period of high nutrient requirements, to support rapid growth (including braingrowth) and critical social, cognitive and motor development.Breast milk is the ideal food for newborn babies and currently in the UK, exclusive breastfeeding isrecommended until the age of six months. Other (often termed ‘complementary’) foods are thenintroduced and gradually increased in variety and quantity. It is not known what constitutes theideal diet during this transition but there are well-established guidelines on nutrient requirements 116and on foods and feeding practice. 117, 118 In the UK, there are wide variations in infant feedingpractices and in how closely parents follow these guidelines (see page 31). For discussion on thecontraindications to breastfeeding see page 35.In all populations infancy is a period of relatively high mortality. The infant mortality rate (IMR) inEngland and Wales (five per 1,000 live births in 2006) has fallen continuously for the past 100years (14.3 in 1976; 105 in 1910). 119 Just over half the deaths are neonatal and related tocongenital abnormalities, low birth weight and pre-term birth. 120 There are marked regionaldifferences in IMR. In 2006, it was highest, 6.4, in the West Midlands and lowest, 4.0, in SouthWest England. There are also strong social class differentials. 121 It is not known to what extentthese inequalities have a nutritional basis.Developing country perspective on infant nutritionInfant undernutrition is a huge problem in developing countries. It is estimated that 178 million(32%) children under five years are stunted, 55 million are wasted, and micronutrientdeficiencies are widespread and frequently multiple. 3 Undernutrition causes three milliondeaths among children under the age of five in developing countries every year. Infancy is theperiod when growth commonly starts to falter and it is difficult to reverse stunting after theage of two years. 122 The main causes are inadequate food (energy, animal protein andmicronutrients) and high rates of infection. Sub-optimal breastfeeding and poor qualitycomplementary foods are key factors. 123 Efforts to improve nutrition in developing countriesshould focus on pregnant women and infants to get the maximum benefits for growth,124, 125development, health and later economic productivity.Early life nutrition and lifelong health 25