Jump to first page
The Impact of Early
Nutrition on Health and
Disease
Melinda S. Sothern, PhD
Prevention of Childhood Obe...
Jump to first page
Increasing Prevalence
of Overweight Children
0
5
10
15
20
25
30
35
1960 1980 2000
At Risk for Overweigh...
Jump to first page
Risk Factors for Obesity and
Chronic Disease
Socioeconomic Status
Ethnicity
Parental Obesity - under 6 ...
Jump to first page
As children mature, their weight condition
is a stronger predictor of adult obesity.
100%
50%
0%
Age 6 ...
Jump to first page
Parental Obesity
If both parents are non-obese the child
has only a 7% chance of developing
obesity.
If...
Jump to first page
Prevalence of Obesity
in Young Adulthood
If the child is overweight the
risk is...
Age No Parents
Obese...
Jump to first page
Obesigenic Families
A recent study examined the self-reported physical
activity and dietary intake patt...
Jump to first page
GENETICS PERMITS OBESITY.
ENVIRONMENT CAUSES OBESITY.
Hill & Dietz
Jump to first page
Early Nutrition and
Children

Metabolic changes
accompany excess body fat
during critical periods of e...
Jump to first page
Early Nutrition and
Metabolic Health

The intrauterine period is a
critical period for the
development...
Jump to first page
Birth weight and
Overweight Children

Low birth weight is associated
with impaired insulin
sensitivity...
Jump to first page
Birth weight and
Overweight Children

IUGR causes metabolic
disorders and ultimately
promotes diabetes...
Jump to first page
Jump to first page
Jump to first page
Jump to first page
Jump to first page
Birth weight and
Overweight Children

Law and Dietz propose that
weight and adiposity are
entrained du...
Jump to first page
Birth weight and
Overweight Children

The local availability of nutrients
during pregnancy, especially...
Jump to first page
Developmental
Plasticity

A critical period when a system
is plastic and sensitive to the
environment....
Jump to first page
Developmental
Plasticity

One genotype can give rise to
a range of different
physiological or morpholo...
Jump to first page
Fetal Origins
Hypothesis

Chronic diseases originate in
developmental plasticity, in
response to under...
Jump to first page
Fetal Origins
Hypothesis

Three processes explain why
individuals born with low birth
weight are more ...
Jump to first page
Fetal Origins
Hypothesis

Reduced number of
nephrons:
 Leads to increased blood
flow through each
glo...
Jump to first page
Fetal Origins
Hypothesis
 Setting of hormones and
metabolism
 Undernourished infant
establishes a “th...
Jump to first page
Fetal Origins
Hypothesis
 Setting of hormones and
metabolism
 High blood glucose
concentrations negat...
Jump to first page
Fetal Origins
Hypothesis
 Increased vulnerability to
adverse environmental
influences in later life.
...
Jump to first page
Jump to first page
The Four Birth
Phenotypes
 Thin
 Short
 Short and Fat
 Large Placenta
Barker, 1999
Jump to first page
The Four Birth
Phenotypes
 Thin:
 Insulin resistance during
childhood
 Metabolic syndrome
 Adaption...
Jump to first page
Four Birth Phenotypes
 Short:
 Short stature in relation to head
circumference
 Reduced abdominal ci...
Jump to first page
The Four Birth
Phenotypes
 Short and Fat
 Insulin deficient
 High rates of non-insulin
dependent dia...
Jump to first page
The Four Birth
Phenotypes
 Large Placenta
 Disproportionately large
in relation to the baby’s
weight
...
Jump to first page
Pre-Pregnancy BMI

Genetic and nutritional
components

Low BMI is a marker for low
tissue nutrient re...
Jump to first page
Jump to first page
Pre-Pregnancy BMI
Results of study of 6690 women:
Normal weight and below the Institute
of Medicine (IO...
Jump to first page
Weight Gain during
Pregnancy
Results of study of 6690 women:
Women gaining 11.5-16 kg =
moderately high...
Jump to first page
Gestational Diabetes

Common in gestational
diabetes

Abnormally high plasma
glucose and fatty acid
c...
Jump to first page
Gestational Diabetes

Produces excessive fetal
adiposity characteristics

Infants remain obese into
c...
Jump to first page
Nutrient Intake during
Pregnancy

Fatty acid intake contributes to
growth of lipid tissues in the
fetu...
Jump to first page
Jump to first page
30 Minute
Rule
Research indicates that
after 30 minutes of mental
work the ability to
concentrate begin...
Jump to first page
Anything is Better than
Sitting!
Flex at Your Desk
Hot Seat (chair squats)
Raise the Roof (overhead pre...
Jump to first page
Childhood Growth
and Chronic Disease

Rates of disease is predicted
more strongly by rates of weight
g...
Jump to first page
Childhood Growth
and Chronic Disease

Compensatory growth reduces
life-span.

Rapid growth is associa...
Jump to first page
Childhood Growth
and Chronic Disease

Small and thin babies lack
muscle.

Muscle deficiency persists
...
Jump to first page
Feeding during
Catch-Up Growth

Infants with a slower rate of
intrauterine growth are unlikely
to ever...
Jump to first page
Feeding during
Catch-Up Growth

Getting bigger faster is
detrimental

Optimal neurodevelopmental
outc...
Jump to first page
Catch-up Growth
Hypothesis.

Aggressive feeding to induce
catch-up growth, especially
high fat intake,...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth

Low Pre-pregnancy BMI

Pre...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Low Pre-pregnancy BMI

Stron...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Pre-gestational Diabetes

In...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Malnourishment

Deficient or...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Smoking

Pregnant smokers ha...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Smoking and Caffeine

Pregna...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Compromised Immune System

D...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Stress in Early Pregnancy

W...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Short Inter-pregnancy Interva...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Early Pregnancy

Within 2 ye...
Jump to first page
Nutritional Risk Factors for
Fetal Growth Restriction and
Pre- Term Birth
Multi-fetal Pregnancy

Weigh...
Jump to first page
Jump to first page
Summary
Increased adiposity at both end
of the birth weight spectrum:
1) Higher BMI = Higher
Birthweigh...
Jump to first page
Summary
Once the fetus is programmed by either
under-nutrition and growth
restriction, or over-nutritio...
Jump to first page
30 Minute
Rule
Research indicates that
after 30 minutes of mental
work the ability to
concentrate begin...
Jump to first page
Anything is Better than
Sitting!
Flex at Your Desk
Hot Seat (chair squats)
Raise the Roof (overhead pre...
Jump to first page
Breast feeding Obesity
& Chronic Disease

Recent research strongly
suggests that postnatal
nutrition i...
Jump to first page
Breast feeding Obesity
& Chronic Disease

There is evidence for a
significant relationship
between bre...
Jump to first page
Breast feeding Obesity
& Chronic Disease

The prevalence of obesity in 5-6 year-
old children who were...
Jump to first page
Breast feeding Obesity
& Chronic Disease

Breast feeding is associated with
improved immune function.
...
Jump to first page
Food Attitude and
Practices in Young
Children

How parents present food to
their young children greatl...
Jump to first page
The strategy of
having a child eat a
food in order to obtain
a reward tends to
reduce the child’s
likin...
Jump to first page
Food Attitude and
Practices in Young
Children

Pressure to eat and concern for
child’s weight are asso...
Jump to first page
Food Attitude and
Practices in Young
Children

Children will eat less if served
less or if allowed to ...
Jump to first page
Nutrition Tips for
Kids at Risk for Obesity &
Chronic Disease
Jump to first page
Jump to first page
Jump to first page
Jump to first page
“I do like vegetables…
That’s why I hate to see them brutally killed and eaten!”
Jump to first page
Jump to first page
Jump to first page

Let baby’s appetite determine
what and how much to feed.

Teach young children that
it’s OK to leave...
Jump to first page

Observe the child’s eating
and physical activity
behaviors.

Schedule frequent sessions
with the ped...
Jump to first page

Discourage consumption of
high sugar beverages.

Select healthy fruits and snacks
as treat foods, i....
Jump to first page

Require that all drinks and foods be
consumed at the kitchen or dining
table or other designated area...
Jump to first page

Always require children to eat a
healthy breakfast.

Discourage snacking after
dinnertime.

Childre...
Jump to first page

Don’t place a moral value on food.

Teach children that all food is OK;
some is “grow tall or big” f...
Jump to first page

Create a safe home food
environment:
 Gradually replace non-nutritious foods
in the home. Involve ch...
Jump to first page

Create a safe home food
environment:
 Allow infrequent consumption of non-
nutritious foods away fro...
Jump to first page
The Ultimate
Parent Tip
Stop nagging. Praise
children who select healthy
snacks. Ignore unhealthy
nutri...
Jump to first page
What if the Parents say:
You know, I’m big,
my momma was big,
my grandma was
big…..We’re just big
peopl...
Jump to first page
Parent Tip
Even if your child is genetically
designed to be overweight, his
or her environment can be
a...
Jump to first page
30 Minute
Rule
Research indicates that
after 30 minutes of mental
work the ability to
concentrate begin...
Jump to first page
Anything is Better than
Sitting!
Flex at Your Desk
Hot Seat (chair squats)
Raise the Roof (overhead pre...
Jump to first page
Any QuestionsAny Questions?
Say: Time to
Play!
Katy Kangaroo
Patty Panther
Molly Monkey
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The Pennington Biomedical Research Center Prevention of Childhood ...

  1. 1. Jump to first page 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)
  2. 2. Jump to first page Increasing Prevalence of Overweight Children 0 5 10 15 20 25 30 35 1960 1980 2000 At Risk for Overweight Overweight Source: U.S. Centers for Disease Control; Ogden, et al, JAMA, 2002 >85th percentile for Body Mass Index >95th percentile for Body Mass Index
  3. 3. Jump to first page 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
  4. 4. Jump to first page 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.
  5. 5. Jump to first page 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
  6. 6. Jump to first page Prevalence of Obesity in Young Adulthood If the child is overweight the risk is... Age No Parents Obese > 1 Parent Obese 1-2 8% 40% 3-5 24% 62% 6-9 37% 71% 10-14 64% 79% 15-17 54% 73% Whitaker, et al, NE J Med, 1997
  7. 7. Jump to first page 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
  8. 8. Jump to first page GENETICS PERMITS OBESITY. ENVIRONMENT CAUSES OBESITY. Hill & Dietz
  9. 9. Jump to first page 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
  10. 10. Jump to first page 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
  11. 11. Jump to first page 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
  12. 12. Jump to first page 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
  13. 13. Jump to first page
  14. 14. Jump to first page
  15. 15. Jump to first page
  16. 16. Jump to first page
  17. 17. Jump to first page 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
  18. 18. Jump to first page 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
  19. 19. Jump to first page 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
  20. 20. Jump to first page 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
  21. 21. Jump to first page Fetal Origins Hypothesis  Chronic diseases originate in developmental plasticity, in response to under-nutrition during fetal life and infancy. Barker, 1995; Barker, 2002
  22. 22. Jump to first page 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
  23. 23. Jump to first page 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
  24. 24. Jump to first page 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
  25. 25. Jump to first page 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
  26. 26. Jump to first page 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
  27. 27. Jump to first page
  28. 28. Jump to first page The Four Birth Phenotypes  Thin  Short  Short and Fat  Large Placenta Barker, 1999
  29. 29. Jump to first page The Four Birth Phenotypes  Thin:  Insulin resistance during childhood  Metabolic syndrome  Adaption to undernutrition though endocrine and metabolic changes. Barker, 1999
  30. 30. Jump to first page 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
  31. 31. Jump to first page 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
  32. 32. Jump to first page 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
  33. 33. Jump to first page 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
  34. 34. Jump to first page
  35. 35. Jump to first page 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
  36. 36. Jump to first page 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
  37. 37. Jump to first page 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
  38. 38. Jump to first page 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
  39. 39. Jump to first page 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
  40. 40. Jump to first page
  41. 41. Jump to first page 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.
  42. 42. Jump to first page 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
  43. 43. Jump to first page 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
  44. 44. Jump to first page 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
  45. 45. Jump to first page 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
  46. 46. Jump to first page 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
  47. 47. Jump to first page 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
  48. 48. Jump to first page 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
  49. 49. Jump to first page 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
  50. 50. Jump to first page 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
  51. 51. Jump to first page 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
  52. 52. Jump to first page 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
  53. 53. Jump to first page 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
  54. 54. Jump to first page 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
  55. 55. Jump to first page 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
  56. 56. Jump to first page 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
  57. 57. Jump to first page 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
  58. 58. Jump to first page 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
  59. 59. Jump to first page 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
  60. 60. Jump to first page
  61. 61. Jump to first page 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
  62. 62. Jump to first page 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
  63. 63. Jump to first page 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.
  64. 64. Jump to first page 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
  65. 65. Jump to first page 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
  66. 66. Jump to first page 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
  67. 67. Jump to first page 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
  68. 68. Jump to first page 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
  69. 69. Jump to first page 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
  70. 70. Jump to first page 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
  71. 71. Jump to first page 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
  72. 72. Jump to first page 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
  73. 73. Jump to first page Nutrition Tips for Kids at Risk for Obesity & Chronic Disease
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  77. 77. Jump to first page “I do like vegetables… That’s why I hate to see them brutally killed and eaten!”
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  80. 80. Jump to first page  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
  81. 81. Jump to first page  Observe the child’s eating and physical activity behaviors.  Schedule frequent sessions with the pediatrician for advise and monitoring. Nutrition and At-Risk Youth
  82. 82. Jump to first page  Discourage consumption of high sugar beverages.  Select healthy fruits and snacks as treat foods, i.e. grapes, raisins, etc. Nutrition and At-Risk Youth
  83. 83. Jump to first page  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
  84. 84. Jump to first page  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
  85. 85. Jump to first page  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
  86. 86. Jump to first page  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
  87. 87. Jump to first page  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
  88. 88. Jump to first page 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
  89. 89. Jump to first page 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
  90. 90. Jump to first page 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
  91. 91. Jump to first page 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.
  92. 92. Jump to first page 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
  93. 93. Jump to first page Any QuestionsAny Questions? Say: Time to Play! Katy Kangaroo Patty Panther Molly Monkey

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