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

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BMA Board of ScienceConclusions• Many young women have diets of poor quality and inadequate nutritional status. Lesshealthy diets are more common among women of low educational attainment, and amongwomen who have low income and who are food insecure. Although evidence of effectiveinterventions to improve the diets of young women is limited, this does not mean that thegoal should not be pursued vigorously. Both nutrition education and counselling have beenshown to improve women’s nutrition knowledge and behaviour.• Breastfeeding rates are low in the UK, and it is less common among disadvantaged women.Interventions that educate women about the benefits and practice of breastfeeding, andthat promote baby friendly policies and practice, are effective at promoting the initiationand prolonging the duration of breastfeeding.• Current studies of complementary feeding show wide variations in practice in the UK.There are few studies of interventions to influence the timing and nutritional content ofcomplementary feeding in developed countries.• Infant diet is strongly linked to mother’s diet – suggesting that interventions to improve thediets of young women will also have direct consequences for children’s diets.• Effective interventions are needed to improve the nutrition of young women of childbearingage. Such interventions may influence the way in which mothers feed their children as wellas influencing the diets of women themselves. They will therefore have beneficial healtheffects across generations.• Efforts to encourage the initiation and to prolong the duration of breastfeeding need tocontinue and be extended. The ten steps to successful breastfeeding and the Baby FriendlyHospital Initiative guidelines should become a minimum standard of care. Action is alsoneeded to improve the opportunities for women to breastfeed in public places and tosupport continued breastfeeding in women who return to work.• The Healthy Start scheme provides support for eligible women and children throughprovision of food vouchers and vitamin supplements, and needs to be promoted widely.Its impact on the nutrition of mothers and young children should be evaluated at anational level.• Other gaps in the evidence should be addressed including interventions to supportbreastfeeding mothers in the workplace and interventions to optimise the timing andcontent of complementary feeding.Early life nutrition and lifelong health 65
BMA Board of ScienceAppendix 1: Epigenetic processesIn addition to the sequence of nucleotide bases which comprise the genetic code, and which areinherited from the parents (the genotype) the characteristics of an individual (their phenotype) areaffected by epigenetic processes, which alter the ways in which genes are switched on and off.Epigenetic processes do not affect the DNA sequence, but do alter gene expression. Epigeneticchanges occur during development and can be affected by the environment before and after birth.Figure 15: Components of the epigenetic codeMeThe two main compomentsof the epigenetic codeMeMeDNA methylationMethyl marks added to certainDNA bases repress gene activity.MeHistone tailsHistone modificationA combination of differentmolecules can attach to the ‘tails’of proteins called histones. Thesealter the activity of the DNAwrapped around them.HistonesChromosomesDiagram of chromosome being unravelled to show deoxyribonucleic acid (DNA) wrapped around histone proteincores to form nucleosomes. Protruding histone ‘tails’ are subject to a range of chemical modification which canalter structure and make genomic DNA more accessible to transcription. CG base pairs of the DNA can also bemodified by methylation, which silences transcription. Thus these processes can affect gene expression, andhence development and phenotypic characteristics, without altering the genomic DNA code itself.Source: Qui J (2006) Epigenetics: unfinished symphony. Nature 441: 143-5.66Early life nutrition and lifelong health
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