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The lasting legacy of early nutrition

Ludwig Maximilian University of Munich

In a long-term, collaborative, EU-funded project led by LMU's Berthold Koletzko, researchers have studied the lasting impact of early nutrition on health. A conference in Munich highlighted the latest results of their efforts.

17 October 2016 - MedicalXpress

In a long-term, collaborative, EU-funded project led by LMU's Berthold Koletzko, researchers have studied the lasting impact of early nutrition on health. A conference now underway in Munich highlights the latest results of their efforts.

Over the course of several years, an international consortium of researchers worldwide have investigated how early (pre- and early postnatal) nutrition influences one's health in later years. Specialists at 35 institutes in 12 countries have contributed to the project EarlyNutrition, which is coordinated by LMU's Professor Berthold Koletzko.

An international conference entitled "The Power of Programming 2016" is being held at LMU on 13-15 October, which will review the latest results. Based on these findings, the scientists involved have also formulated recommendations for pregnant women and their doctors. In the following interview, Berthold Koletzko explains how early nutrition influences health throughout later life, and how the attendant risk of obesity can be minimized.

The project EarlyNutrition is designed to investigate the long-term effect of early nutrition on health. Can you briefly summarize the most significant results?

Berthold Koletzko: The quality of the mother's nutrition—both during and before her pregnancy—and the quality of the foods the child receives in the first 2 years of post-natal life have a measurable impact on metabolism and health throughout later life.

  • If the mother is overweight when she becomes pregnant, her child has a two-fold higher risk of being obese as an adult.
  • In comparison with bottle-feeding of conventional baby formula, breast-feeding reduces by 10-20% the child's long-term risk of becoming overweight.
In particular, the protein content of conventional baby formula, and of the complementary foods provided during weaning, has a marked impact on later health outcomes. The use of alternatives with lower amounts of protein at this stage has a clear, positive effect on the child's subsequent health.

Why does early nutrition make such a big difference on the course of one's health throughout life? What are the mechanisms that account for this?

Koletzko: On the one hand, the hormones that regulate many bodily functions play a significant role. For example, our studies have shown that protein-rich infant formula activates the production of growth regulators such as insulin.

Insulin is also an important factor in the prenatal phase: If the mother is significantly overweight, the unborn child is exposed to excessively large amounts of glucose and insulin, and these two substances promote growth, deposition of fat and the formation of adipose tissue – which are known to increase the risk of obesity in postnatal life.

In addition, levels of the so-called branched amino acids are very strongly increased by the intake of protein-rich baby foods. We have indications that these compounds also promote weight gain via a specific regulatory pathway.

Furthermore, our results imply that certain other factors to which the child is exposed in utero can have a lasting effect on gene regulation by intervening in the regulation of epigenetic mechanisms.

One such deleterious factor is smoking, in particular during the first trimester of pregnancy. The consequences for the child can be observed up until the time when he or she first goes to school: This alone doubles the risk of becoming overweight. Other epigenetic changes during prenatal development are associated with higher levels of body fat.

How long does this early critical period last?

Koletzko: So far, we have looked at the first 1000 days, i.e., the prenatal period and the first two years of life, during which the child develops rapidly and its rate of growth is high.

During this phase the degree of developmental plasticity is particularly high, the tissues and organs are built up and assume their physiological functions.

But I believe that, in addition to these first 1000 days, we need to look more closely at the period preceding pregnancy. For it is becoming clear that the metabolic conditions prevailing at this time – which in turn reflect the quality of nutrition prior to pregnancy – play an essential role during pregnancy.

What is your advice to expectant mothers?

Koletzko: Women should do all they can to get their weight down to near normal for their stature before they become pregnant.

Sticking to a balanced diet—i.e., one rich in vegetables and fish, supplemented with folic acid—prior to pregnancy is also a sensible measure.

Women who prefer not to eat fish should also supplement their food intake with the omega-3 fatty acid DHA (docosahexaenoic acid). During pregnancy the demand for certain critical nutrients rises far more sharply than the demand for energy. By the end of her pregnancy, a woman needs to generate only 10% more energy than before.

In other words, one doesn't need to eat for two, but one should certainly think for two.

Is it possible to adjust or reset this type of metabolic programming at a later stage?

Koletzko: Yes. In the context of the obesity risk, for example, the quality of early nutrition sets the organism off in one direction or the other, as it were. Nevertheless, one can take steps to gain or lose weight at any time in one's life.

Of course, as we all know, reducing one's weight is easier said than done, and indeed it can be very difficult to maintain one's weight over long periods. – And that is why the metabolic programming that takes place in our earliest years is so important for the health of the population as a whole.

Currently, not only Western countries, but societies all over the world, are experiencing a wave of excess body weight and obesity, which has serious repercussions both for the life expectancy of those affected and for our healthcare systems. In Europe, the costs of the treatment of, for example, diabetes now account for 8% of all healthcare costs, and the figure is steadily rising.

What effect will the project itself have on future research directions in the field?

Koletzko: On the basis of the results we have, we now want to improve the quality of baby food. As part of the project, we have already carried out tests of a newly developed infant formula, which contains less protein than those now on the market.

Among children who were fed with the new formula, the incidence of excessive weight and obesity on entry to school was reduced by two-thirds relative to those who received conventional baby food. We are very happy that many manufacturers have already responded to these findings, and have begun to change the composition of their products.

The next step for us is to optimize the quality of the protein included in baby formula. In addition, we want to take a closer look at the weaning period and the complementary foods given during the transition from liquid to solid food. We have developed the outlines of preventive strategies for this phase, which we now want to test. Our overall goal is to elucidate further the fundamental mechanisms that underlie the metabolic and epigenetic regulation of cell programming in humans.