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

BMA Board of ScienceThere is little evidence that adding probiotics (live non-pathogenic bacteria that colonise the gut) orprebiotics (nondigestible food components such as oligosaccharides that stimulate the growth of221, 222non-pathogenic bacteria in the gut) to infant feeds reduces later food allergy/intolerance.Infant growth and long-term outcomesThere is strong and consistent evidence that undernutrition in infancy is associated with permanentadverse effects on growth and development. In a recent analysis of young adults from fivedeveloping countries, stunting and/or underweight at the age of two years were associated withreduced adult height, fewer years of attained schooling and lower adult income or assets. 19 Amongwomen, undernutrition in infancy was associated with lower birth weight in the next generation.These relationships remained after adjustment for childhood socio-economic status and parentaleducation, suggesting that they were related to infant undernutrition, rather than simply areflection of continuing disadvantage in later life. A literature review also found consistentevidence of impaired cognitive ability in children who had been undernourished (stunted orwasted) in infancy. 19Key messageThere is strong and consistent evidence that poor weight gain and growth during infancy areassociated with permanent stunting and cognitive impairment, resulting in fewer years ofattained education, and lower adult productivity and earning capacity.The relationship of infant size and growth to later health outcomes in well-nourished populationsis currently unclear and controversial. This is partly because of a paucity of data. Cohort studies oldenough to hold data on both infant size and adult disease are few. In a recent systematic reviewrelating size in infancy to the 12 diseases accounting for the highest burden of disease (ischaemicheart disease, stroke, depression, lung cancer, road traffic accidents, alcohol abuse, dementia,chronic obstructive lung disease, suicide, breast cancer and diabetes (split into type 1 and type 2))only 19 good quality studies, relating to 10 of the disease outcomes, were found. 223 The highestnumber of studies for a single disease was seven for type 1 diabetes, a disease with its onsetmainly in childhood. Three of these seven studies showed a positive association between infantweight or BMI and type 1 diabetes risk. This is consistent with the data described previouslyshowing a lower risk of type 1 diabetes in children who were breastfed (see page 42).Several studies of cardiovascular risk factors in children have shown higher blood pressure in thosewho gained more weight during infancy. 224, 225 In non-randomised analyses of Lucas’s infant feedingtrials, SGA babies who gained more weight between birth and nine months had higher diastolicblood pressure in childhood 213 and pre-term babies who gained more weight in the first two weekshad higher 32-33 split proinsulin concentrations and LDL/HDL ratios at 13-16 years. 202, 212 Greaterweight gain in infancy is consistently associated with higher BMI, and in some but not all studieswith greater adiposity, in later childhood and in adult life. 19, 226-228 These studies have led to theGrowth Acceleration Hypothesis, 229 which suggests that rapid weight gain in infancy, as well as inlater childhood, is a risk factor for later cardiovascular disease.In marked contrast to these data, retrospective studies of adult cohorts suggest benefits of infantweight gain. In the Hertfordshire cohort, men with a higher weight at one year had lowercardiovascular disease mortality (see Figure 12) 47, 230, 231 and were less likely to have impairedglucose tolerance or type 2 diabetes. 232 Men and women in Finland who developed CHD or type 2Early life nutrition and lifelong health 45