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Student summary 2014:

Contents

Background of the EARNEST Project
The Early Nutrition Programming Project (EARNEST) brought together a multidisciplinary team of international scientists and leaders in key areas of the early nutrition programming field from 40 major research centers across 16 European countries. The project had a total budget of 16.5 million Euros or 21.4 million US dollars. The project lasted from April 2005 to October 2010. [1] It investigated early nutrition programming using an approach which integrated knowledge from randomized controlled trials, prospective observational studies and animal, cellular and molecular techniques. This enables a better understanding of the extent to which nutritional influences in early life can program a person's development and metabolism in adulthood. [2]
Study Conclusions [2]
Prevention of Allergic disease and Infections
The first tests done as part the of EARNEST Project were tests relating diet with future allergic diseases and infections in newborns.
One of the first test done was from the Aarhus trial on the effect of fish oil in pregnancy on the risk of offspring allergy, overweight and blood pressure at 17-18 years did not shown significant differences in front of the mothers who received olive oil supplement during pregnancy. However, the Aarhus study has demonstrated that 2.7 grams daily of LCPUFA (long chain polyunsaturated fatty acids) in 3rd trimester may confer protection against asthma in the offspring.
The next test done was to test whether or not probiotics could offer a useful intervention strategy against allergy epidemic. The test was conclusive because the long-term benefits demonstrated here as a reduced risk of atopic eczema up to 7 years of age, i.e. beyond the intervention period and infancy.
Another test done was the NUEHEAL follow-up study. The NUHEAL follow-up study also has shown that exposure to conventional household cleaning products represents a risk factor for obstructive airway disease in children (4y) with pre-existing risk for allergic disease and the application of room disinfectants was significantly associated with an increased effect for atopic dermatitis and itchy rash.
The Child's Body Structure
Many tests were done which shows association with the mother's diet and the baby's early diet with the newborn's future body structure ie. bone mass, weight, bmi.
Concluded from one test, it is estimated that an increase of 0.2 SD in weight-for-length during the first 2 years of life is associated with a 13% higher risk for obesity at the age of 14-16 years. Moreover, the effect of the early protein intake on the metabolic-endocrine response showed that higher protein intake stimulates insulin release in infancy, which is considered to be important for modulating later body size and adiposity risk.
Another test also concluded that the intake of human milk appears to provide beneficial effects by increasing the whole body bone area and bone mineral content despite the lower intake of early calcium and phosphorus associated with the provision of un-supplemented breast milk in this study. So, human milk has a positive long-term effect on later bone mass despite its low mineral content which may reflect the presence of non-nutritional factors in human milk, such as growth factors or other hormones, that will improve bone health; these findings have implications for recommended mineral intakes for preterm infants; this is important taken into account that current high recommended intakes are often difficult to achieve in practice.
The study also performed a test using a perinatal probiotic supplementation show that this intervention is safe in terms of the growth of the 159 children up to 10 years of age and may confer beneficial effects in terms of the weight regulation.

Roc's summary
In utero neonate programming: AJCNsup Dec, 2011
- Details [links may require subscription to AJCN]

Preface - Metabolism and nutrition before and during pregnancy and after birth exert lasting effects on physiology, function, health, and performance well into adulthood and old age.

The project - The Early Nutrition Programming Project (EARNEST) brought together a multidisciplinary team of international scientists and leaders in key areas of the early nutrition programming field from 40 major research centers across 16 European countries. The project had a total budget of 16.5 million Euros. The project lasted from April 2005 to October 2010.

Developmental origins of noncommunicable disease: population and public health implications - Noncommunicable diseases (NCDs), including cardiovascular disease, diabetes, chronic lung disease, allergy, some forms of cancer, cognitive decline, osteoporosis, sarcopenia, and affective disorders, are the world's biggest killers.

Mechanism - The concept of early life programming is therefore widely accepted. These mechanisms include 1) permanent structural changes in an organ resulting from suboptimal concentrations of an important factor during a critical period of development, eg, the permanent reduction in β cell mass in the endocrine pancreas; 2) persistent alterations in epigenetic modifications (eg, DNA methylation and histone modifications) that lead to changes in gene expression (eg, several transcription factors are susceptible to programmed changes in gene expression through such mechanisms); and 3) permanent effects on the regulation of cellular aging (eg, increases in oxidative stress that lead to macromolecular damage, including that to DNA and specifically to telomeres, can contribute to such effects).

Breastfeeding protects child against obesity later in life - breastfeeding has been hypothesized as a potential priming factor against overweight. Three meta-analyses reported significant protective effects of breastfeeding against overweight in later life.

Milk/formula in first 6 months of life stimulates obesity - Background: Protein intake in early infancy has been suggested to be an important risk factor for later obesity. Conclusions: High Protein intake stimulates the IGF-I axis and insulin release in infancy. IGF-I enhances growth during the first 6 mo of life.

Solid foods just increase energy intake - Solid foods do not simply replace infant formula but increase energy intake. Time of introduction of solid food has little influence on infant growth.

Early adiposity increases type 2 diabetes and heart disease - Later risk of CHD was associated with small body size at birth and during infancy, followed by an increase in body size later in childhood. An early age at adiposity rebound was associated with a markedly increased risk of type 2 diabetes in adulthood.

Breastfeeding builds strong bones - Early body size and growth in infancy are related to bone mass in late adolescence. Furthermore, the duration of exclusive breastfeeding and the markers of bone turnover at 6 mo seem to be positively related to LS bone mass at age 17 y. - Another study confirms this - the proportion of (unsupplemented) human milk in the neonatal diet was significantly positively associated with later whole-body bone size and mineral content.

Nervous system needs fish oil pre- and early postnatally - It takes >20 y before the human brain obtains its complex adult configuration. Most dramatic neurodevelopmental changes occur prenatally and early postnatally, including a major transformation in cortical organization 3–4 mo after term. However, maternal and neonatal concentrations of DHA and arachidonic acid are associated with improved outcomes in early infancy, and concentrations of DHA are associated with favorable neurodevelopmental outcome beyond early infancy. Mother can provide DHA via breast milk, this may require taking 2g of fish oil daily.

DHA so essential that placeta delivers it from mother in utero - Considerable amounts of long-chain polyunsaturated fatty acids (LC-PUFAs), particularly arachidonic acid and docosahexaenoic acid (DHA, 22:6n–3), are deposited in fetal tissues during pregnancy; and this process is facilitated by placental delivery. This transfer rate is selective for DHA compared with other fats.

Pregnant women need supplements or 2 servings of salmon/week - Background: Oily fish provides marine n−3 (omega-3) fatty acids that are considered to be important in the growth, development, and health of the fetus and newborn infant. If pregnant women, who do not regularly eat oily fish, eat 2 portions of salmon/wk, they will increase their intake of EPA and DHA, achieving the recommended minimum intake; and they will increase their and their fetus’ status of EPA and DHA.

Environmental pollutants in foods that are not organic cause obesity and worse - Many chemicals in the environment, especially those with estrogenic activity, are able to disrupt the programming of endocrine signaling pathways established during development. Other environmental estrogens, including the environmental contaminant bisphenol A, have also been linked to reproductive problems and obesity later in life.

5.4% of women develop pre-eclampsia - Western dietary pattern, red meat, sugar-sweetened beverages, and obesity increase risk. Exercise, vitamins C and E, and fruits and vegetables reduce risk.

Vitamin C and E during pregnancy are beneficial - Oxidative stress is widely implicated in failed reproductive performance, including infertility, miscarriage, diabetes-related congenital malformations, and preeclampsia. Our research has also focused on the role of free radicals and antioxidant capacity in preeclampsia. A large observational study in US women indicating that regular use of multivitamin preparations in the periconceptual period was associated with a 45% reduction in preeclampsia risk compared with nonuse.

Despite absence of marked deficiencies, maternal diets require attention in developed nations.

Gut microbiota and probiotics in maternal and infant health - The microbiota inhabiting the intestinal tract develop an array of physiologic roles within the human body, which influences both metabolic and immune functions, particularly during early neonatal life and possibly even in utero. Transmission of bacteria from the mother to the neonate through direct contact with maternal microbiota during birth and through breast milk during lactation also seems to influence the infant's gut colonization, with potential health consequences. A few spoonfuls of yogurt daily is highly recommended.

How to promote proper children's eating behavior - Overcontrol, restriction, pressure to eat, and a promise of rewards have negative effects on children's food acceptance. Parents’ food preferences and eating behaviors provide an opportunity to model good eating habits. Satiety is closely related to diet composition, and foods with low energy density contribute to prevent overeating. Informed and motivated parents can become a model for children by offering a healthy, high-satiety, low-energy-dense diet and promoting self-regulation from the first years of life.

Early diet affects development of allergies - The results of the GINIplus and LISAplus studies mainly support the new finding regarding allergy prevention that a delayed introduction of solid foods or the avoidance of highly allergenic foods during the first year does not seem to be beneficial for allergy prevention. A very early introduction of solid foods and a high diversity before week 17 of age may increase the risk of later allergy. We showed that a high intake of margarine, vegetable oils, and some allergenic fruit and vegetables during pregnancy was associated with an increased risk of allergies, especially eczema. FULL TEXT FREE. This contains details of what is safe and what is not.

Mothers often do not realize how important diet is.

Our aging demography - Europe's population peak is currently about 40 years old. In 2060 the peak will be 70 years old. FULL TEXT FREE with graphs of population ages.

- Roc, Nutrition Investigator

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