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

BMA Board of ScienceOther outcomes: bone health, coeliac disease, inflammatory bowel diseaseBreastfed infants, consistent with their smaller size, have lower bone mineral content (BMC) thanformula-fed infants. The calcium and phosphate content of formula has been shown to influenceBMC during infancy in randomised intervention studies. 209 There are, however, no data on longtermoutcomes such as adult bone density or fracture risk.A systematic review found consistent evidence from six case-control studies that longer duration ofbreastfeeding, and breastfeeding at the time of introduction of gluten containing foods, protectedagainst the later development of coeliac disease. 210 There is inconclusive evidence of protectionagainst inflammatory bowel disease. 194Other aspects of infant diet and long-term outcomesThere are very few studies relating long-term outcomes to other aspects of infant diet, for exampleeffects of different formulas, the age at which solids were started, the type and quality ofcomplementary feeds, and the use of micronutrient supplements.Lucas and Singhal have followed up children who took part in a series of randomised trials ofdifferent formula feeds as babies born pre-term or SGA. 202, 211-213 Among pre-terms those whoreceived banked breast milk had the lowest blood pressures and 32-33 split proinsulinconcentrations (an indicator of insulin resistance) at 13-16 years. Those fed enriched pre-termformula had the highest, and those fed standard formula had intermediate levels. Term SGA babiesfed standard formula had lower diastolic blood pressures at six to eight years than those fedenriched formula.The macronutrient balance of the infant diet may be important. Higher protein intakes in lateinfancy have been associated with greater adiposity in childhood. 193, 214 Another study suggestedthat animal protein (especially dairy protein), but not vegetable protein, was linked to lateradiposity. 215 The INCAP trial in Guatemala, randomised villages to receive one of two supplementsfor mothers and children: high-protein, high-energy drink (protein 6.4 g/100ml, energy 900 kcal/l)or a lower nutrient drink (energy 330 kcal/l, no protein). Both contained multiple micronutrients.People who received high-nutrient drink in utero (through their mother) and/or infancy (eitherthrough their mother’s breast milk or by direct intake) had lower adult triglyceride concentrationsand higher HDL cholesterol concentrations. 95Evidence linking the early introduction of solid feeds to allergic disease (eczema, asthma, andothers) 216 and obesity in childhood 217, 218 is inconclusive.The timing of introduction of solids and later healthIt has been suggested that introducing certain foods too early or too late during infancy increasesthe risk of developing food allergies and atopy (eczema and wheezing). The evidence base is notstrong. In the UK it is recommended that certain foods are never introduced before six months(see Appendix 4).Symptoms of food allergy and intolerance in infancy can be obvious (facial swelling, urticaria) ornon-specific (coryza, wheezing, vomiting, diarrhoea, colic, blood in the stools). The commonestallergies are to cow’s milk protein, egg, soya, wheat, nuts and shellfish. Diagnosis is based onhistory, skin prick testing, the measurement of food-specific IgE antibodies, patch tests, and food219, 220challenge testing. The latter should be carried out using a blinded format, and placebo controls.44Early life nutrition and lifelong health