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

BMA Board of Sciencemicronutrient supplementation trials. 9 Birth weight is a crude measure of fetal development, andmay under-estimate effects on specific fetal tissues and organs. The Gambia high-energy biscuittrial, and a recent trial of multiple micronutrient supplementation in Indonesian mothers, reportedreduced infant mortality 242 but opposing results were found in two earlier trials in Nepal. 243 Moremeasurements of functional outcomes such as growth and risk factors for later disease arerequired in such trials.Developing country perspectiveThe BMA report Improving the health of the world’s poor (2007), highlights the persistingproblems of poverty and undernutrition in many developing countries and its effects onmaternal, fetal and infant health. Young women often have little control over family financesand food purchases, and come last in the family hierarchy in terms of access to food. Babiesborn to undernourished women are more likely to be born pre-term and/or be growthrestricted. Sub-optimal breastfeeding practices and poor-quality complementary feedingfrequently follow and set the infant on course to becoming a stunted child, with impairedphysical development and cognitive ability. An especially adverse situation, in terms of adulthealth, comes from poor nutrition in early life followed by obesity in later life. Thiscombination is increasingly common in developing countries and carries a high risk of adulthypertension, diabetes and cardiovascular disease. 19 Of the eight United Nations MillenniumDevelopment Goals, Numbers 1 (Eradicate extreme poverty and hunger), 4 (Reduce childmortality) and 5 (Improve maternal health) directly relate to the issues discussed in this report.In addition Number 2 (Achieve universal primary education), and 3 (promote gender equalityand empower women) are related goals. While progress towards these is being made, it islikely that many of them will not be met by the target year of 2015.Guidelines for improving the diets of young women in the UKThere have been consistent dietary messages to adults over many years to encourage consumptionof fruit and vegetables, starchy foods and oily fish, and to limit consumption of dietary fat, salt andadded sugar. The recommendations for a ‘healthy’ diet were based on evidence of the role of dietin the aetiology of cardiovascular disease and some cancers, 244, 245 and recently specific advice onoily fish consumption, salt and vitamin D intakes has been updated. 246-248 Dietary guidelines arecomparable across the developed world. Current UK advice is depicted in the Eatwell platemodel. 249 While this advice may be widely understood, the most recent National Diet and NutritionSurvey (NDNS) shows that many adults do not comply with these dietary guidelines, and that the2, 250, 251diets of young adults may be a particular cause for concern (see Box 10).Early life nutrition and lifelong health 51