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    The Pennington Biomedical Research Center Prevention of Childhood ... The Pennington Biomedical Research Center Prevention of Childhood ... Presentation Transcript

    • The Impact of Early Nutrition on Health and Disease Melinda S. Sothern, PhD Prevention of Childhood Obesity Laboratory Pennington Biomedical Research Center Louisiana State University (LSU)
    • Increasing Prevalence of Overweight Children Source: U.S. Centers for Disease Control; Ogden, et al, JAMA, 2002 >85th percentile for Body Mass Index >95th percentile for Body Mass Index
    • Risk Factors for Obesity and Chronic Disease
      • Socioeconomic Status
      • Ethnicity
      • Parental Obesity - under 6 years of age
      • Body Mass Index - over 6 years of age
      • Critical development periods
        • Birth - Low Birth Weight
        • 5-9 years (adiposity rebound)
        • Puberty (12-15 years of age)
      • Formula versus Breastfeeding
      • Poor Nutrition - Food Preferences
      • Sedentary Behaviors
    • As children mature, their weight condition is a stronger predictor of adult obesity. 100% 50% 0% Age 6 Age 12 Age 21 Years Parent’s Weight Child’s Weight 80% of overweight 12 year olds will become obese adults.
    • Parental Obesity
      • If both parents are non-obese the child has only a 7% chance of developing obesity.
      • If one parent is obese the risk of developing obesity is increased to 40%.
      • If both parents are obese the risk for developing obesity doubles to 80%.
      Whitaker, et al, NE J Med, 1997
    • Prevalence of Obesity in Young Adulthood If the child is overweight the risk is... Whitaker, et al, NE J Med, 1997
    • Obesigenic Families
      • A recent study examined the self-reported physical activity and dietary intake patterns of parents and changes in weight status (body mass index and skin folds) over 2 years in offspring.
            • Girls of parents with high dietary intake and low physical activity (obesigenic) had significantly greater increases in weight status.
            • Family environment may explain increased weight status in children over and above genetic susceptibility.
      Davison and Birch, Int’l J of Ob 2002
    • GENETICS PERMITS OBESITY. ENVIRONMENT CAUSES OBESITY. Hill & Dietz
    • Early Nutrition and Children
      • Metabolic changes accompany excess body fat during critical periods of early development.
      • These changes promote an increased risk for Type 2 diabetes in adolescence and adulthood.
      McGarry, 2002; Ong, 2000; Barker, 1995; Law, 1996; Neel, 1962
    • Early Nutrition and Metabolic Health
      • The intrauterine period is a critical period for the development of metabolic abnormalities later in life.
      • A programming response is established by the interaction of the infant and their early environment.
      McGarry, 2002; Ong, 2000; Barker, 1995; Law, 1996; Neel, 1962
    • Birth weight and Overweight Children
      • Low birth weight is associated with impaired insulin sensitivity, obesity and cardiovascular risk factors later in life.
      • The relationship may be due to intrauterine growth retardation (IUGR)
      McGarry, 2002; Ong, 2000; Barker, 1995; Law, 1996; Neel, 1962
    • Birth weight and Overweight Children
      • IUGR causes metabolic disorders and ultimately promotes diabetes mellitus.
      • The impact of IUGR is exacerbated in susceptible populations exposed to early environments conducive to obesity.
      McGarry, 2002; Ong, 2000; Barker, 1995; Law, 1996; Neel, 1962
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    • Birth weight and Overweight Children
      • Law and Dietz propose that weight and adiposity are entrained during early life.
      • Research points to nutrition-induced changes in the hypothalmic-pituatary-adrenal axis in the mother and the fetus .
      McGarry, 2002; Ong, 2000; Barker, 1995; Law, 1996; Neel, 1962
    • Birth weight and Overweight Children
      • The local availability of nutrients during pregnancy, especially protein intake, has strong implications for future metabolic health.
      • Adjustments to protect brain tissue preferentially over visceral and somatic growth result in an altered metabolic profile.
      McGarry, 2002; Ong, 2000; Barker, 1995; Law, 1996; Neel, 1962
    • Developmental Plasticity
      • A critical period when a system is plastic and sensitive to the environment.
      • Followed by a los of plasticity and a fixed functional capacity.
      West-Eberhard, 1989
    • Developmental Plasticity
      • One genotype can give rise to a range of different physiological or morphological states in response to different environmental conditions during development.
      West-Eberhard, 1989
    • Fetal Origins Hypothesis
      • Chronic diseases originate in developmental plasticity, in response to under-nutrition during fetal life and infancy.
      Barker, 1995; Barker, 2002
    • Fetal Origins Hypothesis
      • Three processes explain why individuals born with low birth weight are more vulnerable to later chronic disease:
        • Reduced number of nephrons
        • Setting of hormones and metabolism
        • Increased vulnerability to adverse environmental influences in later life.
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • Fetal Origins Hypothesis
      • Reduced number of nephrons:
        • Leads to increased blood flow through each glomerulus (kydney)
        • Eventually leads to glomeruli-sclerosis
        • High blood pressure
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • Fetal Origins Hypothesis
        • Setting of hormones and metabolism
          • Undernourished infant establishes a “thrifty” way of handling food
          • Persistence of a fetal response to maintain blood glucose concentrations to the brain.
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • Fetal Origins Hypothesis
        • Setting of hormones and metabolism
          • High blood glucose concentrations negatively impact glucose transportinto the muscles.
          • Decreased muscle growth
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • Fetal Origins Hypothesis
        • Increased vulnerability to adverse environmental influences in later life.
          • Low SES and poverty
          • Psychosocial consequences associated with low social class.
      Brenner, 1993; Keller, 2003; Phillips, 1996
    •  
    • The Four Birth Phenotypes
        • Thin
        • Short
        • Short and Fat
        • Large Placenta
      Barker, 1999
    • The Four Birth Phenotypes
        • Thin:
          • Insulin resistance during childhood
          • Metabolic syndrome
          • Adaption to undernutrition though endocrine and metabolic changes.
      Barker, 1999
    • Four Birth Phenotypes
        • Short:
          • Short stature in relation to head circumference
          • Reduced abdominal circumference
          • Liver dysfunction
          • Elevated LDL cholesterol
          • Elevated plasma fibrinogen
          • Brain sparing circulating adaptations
          • Cardiac output is diverted to the brain at the expense of the trunk
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • The Four Birth Phenotypes
        • Short and Fat
          • Insulin deficient
          • High rates of non-insulin dependent diabetes
          • Maternal hyperglycemia
          • Imbalance in the supply of glucose and other nutrients to the fetus.
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • The Four Birth Phenotypes
        • Large Placenta
          • Disproportionately large in relation to the baby’s weight
          • Increased blood pressure
          • Adaptive response to extract more nutrients from the mother.
      Brenner, 1993; Keller, 2003; Phillips, 1996
    • Pre-Pregnancy BMI
      • Genetic and nutritional components
      • Low BMI is a marker for low tissue nutrient reserves
      • High BMI is a marker for elevated glucose and fatty acide concerntrations
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    •  
    • Pre-Pregnancy BMI
      • Results of study of 6690 women:
      • Normal weight and below the Institute of Medicine (IOM) recommendations = an increased risk of small-for-gestational-age infants.
      • Higher than the IOM = increased incidence of Cesarean Delivery
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    • Weight Gain during Pregnancy
      • Results of study of 6690 women:
      • Women gaining 11.5-16 kg = moderately high risk for macrosomia (fetal obesity, with excessive adipose tissue development)
      • Women gaining >16 kg were at greatest risk for macrosomia
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    • Gestational Diabetes
      • Common in gestational diabetes
      • Abnormally high plasma glucose and fatty acid concentrations produce high fetal levels.
      • High levels lead to excessive insulin production
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    • Gestational Diabetes
      • Produces excessive fetal adiposity characteristics
      • Infants remain obese into childhood.
      • Adolescents develop early signs of insulin resistance
      • Propagation of the diabetic condition has been passed on for five generations in animal studies.
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    • Nutrient Intake during Pregnancy
      • Fatty acid intake contributes to growth of lipid tissues in the fetus.
      • Essential fatty acid nutrition is correlated with reduced fetal growth and head circumference.
      • Fish oil supplementation in the third trimester improves neonatal neurodevelopment.
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    •  
    • 30 Minute Rule Research indicates that after 30 minutes of mental work the ability to concentrate begins to decline. Sitting burns only 33-50 calories per hour.
    • Anything is Better than Sitting!
      • Flex at Your Desk
      • Hot Seat (chair squats)
      • Raise the Roof (overhead press)
      • Stand and stretch
      • Off the Wall (wall push-ups)
      • Tippy Toes (calf raise)
      • Music break (dance to one song)
      • Stand like a tree and balance
      • Reward positive behavior with indoor or outdoor play periods
    • Childhood Growth and Chronic Disease
      • Rates of disease is predicted more strongly by rates of weight gain than by the measure of childhood BMI.
      • Compensatory growth when under-nutrition is followed by improved nutrition
      Huxley, 2002; Barker, 2002; Middowson, 1972; Metcalfe, 2001
    • Childhood Growth and Chronic Disease
      • Compensatory growth reduces life-span.
      • Rapid growth is associated with persisting hormonal changes that promote large body size.
      Huxley, 2002; Barker, 2002; Middowson, 1972; Metcalfe, 2001
    • Childhood Growth and Chronic Disease
      • Small and thin babies lack muscle.
      • Muscle deficiency persists because the critical period for development is before birth.
      • Rapid, weight gain leads to high fat to muscle ratio and eventual insulin resistance.
      Huxley, 2002; Barker, 2002; Middowson, 1972; Metcalfe, 2001; Erikkson, 2002
    • Feeding during Catch-Up Growth
      • Infants with a slower rate of intrauterine growth are unlikely to ever grow normally.
      • Low nutrient intake and reduced growth in SGA infants is associated with improved insulin sensitivity.
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    • Feeding during Catch-Up Growth
      • Getting bigger faster is detrimental
      • Optimal neurodevelopmental outcome is achieved with:
        • Slower growth rate of pre term infants
        • Breastfeeding
      Hay, 2003; Neggers, 2003; Catalano, 2003; Gershwin, 2000
    • Catch-up Growth Hypothesis.
      • Aggressive feeding to induce catch-up growth, especially high fat intake, is strongly associated with:
        • Obesity
        • Insulin resistance
        • Diabetes in later life.
      Cianfarani, 1999; Erikson, 2003; Eriksson, 2002
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Low Pre-pregnancy BMI
      • Pre-gestational Diabetes
      • Malnourishment
      • Smoking
      • Caffeine
      • Compromised Immune System
      • Maternal stress response
      • Short Inter-pregnancy Intervals
      • Early Pregnancy
      • Multi Fetal Pregnancy
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Low Pre-pregnancy BMI
      • Strongest predictors of pre-term birth and fetal growth retardation
      • Interacts with smoking and stress.
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Pre-gestational Diabetes
      • Increased risk of fetal growth restriction
      • Related to the increased incidence of chronic hypertension and diabetic nephropathy.
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Malnourishment
      • Deficient or excessive consumption and/or absorption of select nutrients
      • Disease, diet-nutrient interactions, drug-nutrient interactions and lifestyle habits (alcohol and tobacco) affect absorption.
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Smoking
      • Pregnant smokers have poorer nutrient intakes of most micronutrients.
      • Pregnant smokers require more micronutrients.
      • Smoking combined with caffeine is negatively associated with birth weight
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Smoking and Caffeine
      • Pregnant smokers have poorer nutrient intakes of most micronutrients.
      • Pregnant smokers require more micronutrients.
      • Smoking combined with caffeine is negatively associated with birth weight
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Compromised Immune System
      • Disease state compromises nutrient uptake
      • Poor nutrition compromises the immune system
      • Chronic infection leads to maternal catabolism and nutrient competition between mother and placenta
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Stress in Early Pregnancy
      • Work strain
      • Poor nutrition
      • Stress on neuro-endocrine-immune interactions increases the risk for infections
      • The timing of prenatal stress is the most important factor
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Short Inter-pregnancy Intervals
      • Closely spaced pregnancies (<18 months)
      • Insufficient time to replace nutrients used during the previous pregnancy
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Early Pregnancy
      • Within 2 years of menarche
      • Low nutrient reserves because of recent use of nutrients to facilitate growth.
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Nutritional Risk Factors for Fetal Growth Restriction and Pre- Term Birth
      • Multi-fetal Pregnancy
      • Weight gain is positively and llinearly related to birth weight in twin pregnancy
      • Declining weight gain late in pregnancy is associated with low birth weight twins.
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    •  
    • Summary
      • Increased adiposity at both end of the birth weight spectrum:
      • 1) Higher BMI = Higher Birthweight
      • 2)Higher central obesity = low birth weight
      Naggers, 2003; Catalarc, 2003; Gershwin, 2000; Matthews, 2000, Brown, 2000; King, 2003
    • Summary
      • Once the fetus is programmed by either under-nutrition and growth restriction, or over-nutrition and obesity, metabolic disease is inevitable.
      • Prevention of childhood obesity is critical and may have lifelong, multi-generational , impact.
      Snoeck, 1990; Singhal, 2003, Hay, 1997, Albertsson-Lwikland, 1997; Neggers, 2003; Cianfarani, 1999
    • 30 Minute Rule Research indicates that after 30 minutes of mental work the ability to concentrate begins to decline. Sitting burns only 33-50 calories per hour.
    • Anything is Better than Sitting!
      • Flex at Your Desk
      • Hot Seat (chair squats)
      • Raise the Roof (overhead press)
      • Stand and stretch
      • Off the Wall (wall push-ups)
      • Tippy Toes (calf raise)
      • Music break (dance to one song)
      • Stand like a tree and balance
      • Reward positive behavior with indoor or outdoor play periods
    • Breast feeding Obesity & Chronic Disease
      • Recent research strongly suggests that postnatal nutrition is an important factor in the development:
          • obesity,
          • insulin resistance
          • dyslipidemia
          • other chronic diseases.
      Von Kries, 1999; Liese, 200; Das, 2001; Dietz, 2001
    • Breast feeding Obesity & Chronic Disease
      • There is evidence for a significant relationship between breastfeeding and future obesity.
      • Breastfeeding may reduce the risk for adult obesity and metabolic disease.
      Von Kries, 1999; Liese, 200; Das, 2001; Dietz, 2001
    • Breast feeding Obesity & Chronic Disease
      • The prevalence of obesity in 5-6 year-old children who were never breast fed is almost double that of breast fed children.
      • The risk of childhood obesity declines as the duration of breast feeding increases.
      Von Kries, 1999; Liese, 200; Das, 2001; Dietz, 2001
    • Breast feeding Obesity & Chronic Disease
      • Breast feeding is associated with improved immune function.
      • Obesity may be associated with inflammatory disease.
      Von Kries, 1999; Liese, 200; Das, 2001; Dietz, 2001
    • Food Attitude and Practices in Young Children
      • How parents present food to their young children greatly impacts their food preferences.
      • Providing rewards for eating nutritious foods initially enhances preference, but has a negative effect later when the reward is removed.
      Birch, Ch. Dev., 1980 and 1995; Spruijt-Metz, 2002
    • The strategy of having a child eat a food in order to obtain a reward tends to reduce the child’s liking for the food she is rewarded for eating. Birch, Young Children, 1995 Food Preferences
    • Food Attitude and Practices in Young Children
      • Pressure to eat and concern for child’s weight are associated with increased fat in children.
      • If left unattended, children will select foods they enjoy and leave behind foods they dislike.
      Birch, Ch. Dev., 1980 and 1995; Spruijt-Metz, 2002
    • Food Attitude and Practices in Young Children
      • Children will eat less if served less or if allowed to serve themselves.
      • As children mature, parental influence is reduced and the influence of peers may change food preferences.
      Birch, Ch. Dev., 1980 and 1995; Spruijt-Metz, 2002
    • Nutrition Tips for Kids at Risk for Obesity & Chronic Disease
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    • “ I do like vegetables… That’s why I hate to see them brutally killed and eaten!”
    •  
    •  
      • Let baby’s appetite determine what and how much to feed.
      • Teach young children that it’s OK to leave food on the plate.
      Nutrition and At-Risk Youth
      • Observe the child’s eating and physical activity behaviors.
      • Schedule frequent sessions with the pediatrician for advise and monitoring.
      Nutrition and At-Risk Youth
      • Discourage consumption of high sugar beverages.
      • Select healthy fruits and snacks as treat foods, i.e. grapes, raisins, etc.
      Nutrition and At-Risk Youth
      • Require that all drinks and foods be consumed at the kitchen or dining table or other designated area.
      • Schedule mid-morning and mid-morning healthy snacks - make them attractive.
      Nutrition and At-Risk Youth
      • Always require children to eat a healthy breakfast.
      • Discourage snacking after dinnertime.
      • Children who eat late dinners or snacks are less hungry in the morning.
      Nutrition and At-Risk Youth
      • Don’t place a moral value on food.
      • Teach children that all food is OK; some is “grow tall or big” food and some is not.
      • Never give food as a reward.
      Nutrition and At-Risk Youth
      • Create a safe home food environment:
        • Gradually replace non-nutritious foods in the home. Involve children with shopping.
        • Display and keep within reach nutritious foods naturally low in fat and sugar.
      Nutrition and At-Risk Youth
      • Create a safe home food environment:
        • Allow infrequent consumption of non-
        • nutritious foods away from the home.
        • Downsize: Place foods in serving size containers.
      Nutrition and At-Risk Youth
    • The Ultimate Parent Tip Stop nagging. Praise children who select healthy snacks. Ignore unhealthy nutrition and re-direct. Offer choices, “Do you want strawberries, carrots or melon for your snack.” Sothern, et al, Trim Kids, 2001
    • What if the Parents say: You know, I’m big, my momma was big, my grandma was big…..We’re just big people. Sothern, et al, Trim Kids, 2001
    • Parent Tip Even if your child is genetically designed to be overweight, his or her environment can be adjusted to combat this predisposition. Your child may become chubby even with adjustments. He or she does not have to be doomed to a life of ill health. Weight management is the key. Sothern, et al, Trim Kids, 2001
    • 30 Minute Rule Research indicates that after 30 minutes of mental work the ability to concentrate begins to decline. Sitting burns only 33-50 calories per hour.
    • Anything is Better than Sitting!
      • Flex at Your Desk
      • Hot Seat (chair squats)
      • Raise the Roof (overhead press)
      • Stand and stretch
      • Off the Wall (wall push-ups)
      • Tippy Toes (calf raise)
      • Music break (dance to one song)
      • Stand like a tree and balance
      • Reward positive behavior with indoor or outdoor play periods
    • Any Questions? Say: Time to Play! Katy Kangaroo Patty Panther Molly Monkey