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

BMA Board of Scienceknown as prebiotics (distinct from ‘probiotics’ or so-called ‘friendly’ bacteria, which are not currentlyadded to formula). Pre-formed nucleotides are thought to be required for the growth of rapidlydividing cells in bone marrow and intestinal epithelium, and also to enhance beneficial intestinalbacterial growth. There is currently no strong evidence that these additives have health benefits.Complementary feedingComplementary feeding is the term used for the introduction of foods other than milk (sometimescalled weaning foods or ‘solids’). It is recommended that complementary feeds are introduced fromthe age of six months onwards, and that infants progress onto the same foods as the rest of thefamily by around one year. The optimal diet for infants at this stage is not known, and is certainly not‘innate knowledge’ for parents. Detailed guidelines are available on suitable foods at every stage(see Appendix 4). Key recommendations are a varied diet, adequate energy density, high-quality(preferably animal) protein sources, and fresh fruit and vegetables.Vitamin supplements for infantsAdvice in the UK is that healthy breastfed infants under six months do not require supplementsprovided the mother has adequate vitamin status. 117 If there is any doubt about this, supplementsshould start at one month. From six months, infants receiving breast milk as their main drink shouldhave vitamin A and D supplements, but these are not required by infants on formula-milk, which isfortified with vitamins. Pre-term infants are a special case and require supplements from birth.Between one and five years, it is recommended that all children have vitamin A and D supplementsunless their diet is diverse and plentiful and there is good exposure to sunlight. There are manypreparations available. 152, 158 Supplementary vitamins are available free for families receiving certainbenefits under the Healthy Start scheme, and all families can buy these preparations.Developing country perspective on complementary feedingInfants in developing countries are at increased risk of undernutrition after six months, whenbreast milk alone is no longer nutritionally adequate but complementary foods are frequently ofvery low nutritional quality. 3, 159 The WHO has developed guidelines for infant feeding 159 which aresuitable for use in all countries (see Appendix 4). Educational interventions and supplementationprogrammes, designed to improve the quality of complementary feeding, have been shown toreduce or prevent stunting in vulnerable infants. 123Determinants of infant weight gain and growthA characteristic of the healthy infant is rapid, though also rapidly decelerating, weight gain and lineargrowth, but the factors which determine these processes and the relative accrual of lean and fatbody mass are still poorly understood. Given adequate postnatal nutrition, babies who experiencedintra-uterine growth restriction due to placental insufficiency, small maternal size, maternalundernutrition or smoking tend to show ‘catch-up’ weight gain and growth, while macrosomicbabies of mothers with gestational diabetes ‘catch-down’. Early postnatal growth rates thereforecompensate for intra-uterine restriction or enhancement of growth. 160 Boys gain weight and growslightly faster than girls in early infancy. Weight gain and growth are modified by the type of feedused. Formula-fed babies gain weight and length faster than breastfed babies after the age of threeto four months (see Figure 11). 160-162 Small-for-gestational-age (SGA) babies grow faster on enrichedthan on standard formula. 163 Infant feeding is largely demand-driven in that mothers tend to offerfeeds when the baby appears to want them, and appetite is likely to be one of the factorsinfluencing weight gain. Recurrent infections are a major cause of poor infant weight gain andgrowth in developing countries.36Early life nutrition and lifelong health