This Task Force report reviews the evidence that the seeds of many adult diseases are sown in utero and in infancy. The report, written by experts in the field, summarises current knowledge in this area. It illustrates how early life nutrition can bring about changes in organ development and function, thus programming risk of disease in adult life. It also considers what might be done in early life to reduce the burden of future ill health.
Nutrition and Development: Short– and Long–Term Consequences for Health includes chapters on the history of this topic area, normal growth and development, and current recommendations and practice in relation to nutrition and diet in early life. Chapters exploring the possible mechanisms and pathways of critical windows for development cover the effects of diet and nutrition in early life on organ and skeletal development, the role of sex hormones in programming disease susceptibility, the establishment of gastrointestinal microbiota, and the impact of early life nutrition on cognitive and neurological development.
This new report:
- describes how development occurs and explores how changes in the fetal and postnatal environment, such as over– or under–nutrition, can result in permanent alterations in function;
- explains how diet and nutrition in early life can affect risk of adult disease, with specific chapters on allergic disease and asthma, bone health, cancer, cardiovascular disease, cognitive function, diabetes and obesity;
- includes a summary of the key points, as well as recommendations in each chapter to help fill the gaps in our knowledge;
- provides an overview of the main messages in a practical question and answer format suitable for lay readers.
Nutrition and Development is an important information resource for those involved in research and teaching in the health sciences sector and will also be of use to those involved in making decisions about health policy. It will be of interest to a broad range of health professionals, the food industry and those who write and broadcast about the effects of food on health.
Table of Contents
Foreword xv
Terms of Reference xvi
Task Force Membership xvii
1 Introduction to Early Life and Later Disease 1
Dr Siân Robinson
1.1 Environmental influences on development 1
1.2 Links between early life and adult disease 3
1.3 Biological mechanisms 7
1.4 Nutrition of mothers and children 8
1.5 Nutrition of young women today 11
1.6 Key points 11
1.7 Key references 12
2 Normal Growth and Development 13
Professor J. Harry McArdle, Dr Laura A. Wyness and Dr Lorraine Gambling
2.1 Introduction 13
2.2 Prenatal development 13
2.3 Embryo development 16
2.4 Fetal development 16
2.5 Fetal development overview 18
2.6 Birthweight 22
2.7 Postnatal growth and development 24
2.8 Growth monitoring (growth charts) 24
2.9 Secular growth trends 25
2.10 Canalisation, catch–up and catch–down growth 25
2.11 Key points 26
2.12 Recommendations for future research 27
2.13 Key references 27
3 Maternal Nutrition and Infant Feeding: Current Practice and Recommendations 28
Dr Alison M. Lennox, Professor Judith L. Buttriss and Helena J. Gibson–Moore
3.1 Introduction 28
3.2 Characteristics of pregnant women in the UK 28
3.3 Current practice and recommendations: pre–pregnancy 32
3.4 Current practice and recommendations: during pregnancy 35
3.5 Current practice and recommendations: lactation 41
3.6 Infant feeding: issues relating to evidence base 42
3.7 Current practice and recommendations: breastfeeding 43
3.8 Current practice and recommendations: formula feeding 50
3.9 Current practice and recommendations: weaning/complementary feeding 53
3.10 Allergy 67
3.11 Conclusions 68
3.12 Key points 69
3.13 Recommendations for future research 70
3.14 Key references 70
Appendix 3.1: Historical perspective on breastfeeding and artificial feeding 71
Breastfeeding 71
Artificial infant formula 73
4 Mechanisms and Pathways of Critical Windows of Development 75
Professor Harry J. McArdle and Dr Lorraine Gambling
4.1 Introduction 75
4.2 Embryo stages 75
4.3 Development of placenta 75
4.4 Nutritional programming: the effect of nutrition on fetal development 77
4.5 Potential mechanisms of nutritional programming 80
4.6 Conclusions 84
4.7 Key points 85
4.8 Recommendations for future research 85
4.9 Key references 85
5 Perinatal Effects of Sex Hormones in Programming of Susceptibility to Disease 86
Professor Richard M. Sharpe
5.1 Introduction 86
5.2 Timing of masculinisation and its body–wide effects 86
5.3 Disorders of masculinisation 87
5.4 Male female differences in disease risk: the potential role of perinatal androgens 88
5.5 Fetal growth, susceptibility to intrauterine growth restriction and its long–term consequences, including timing of puberty 88
5.6 Growth hormone insulin–like growth factor–I axis 90
5.7 Brain and behavioural effects 90
5.8 Sex differences in eating disorders, neuronal mechanisms and adipose tissue distribution 90
5.9 Cardiovascular disease/hypertension 92
5.10 Kidney disease/hypertension 92
5.11 The immune system 93
5.12 Lung development and disease risk 93
5.13 Effects of maternal diet/obesity and infant feeding choices 93
5.14 Fetal programming and epigenetic mechanisms 95
5.15 Conclusions 95
5.16 Key points 95
5.17 Recommendations for future research 96
5.18 Key references 96
6 Neurological Development 97
Professor Julian G. Mercer
6.1 Introduction 97
6.2 The developing brain 99
6.3 Brain energy balance circuits and peripheral feedback signals 101
6.4 Nutritional influences on the developing brain 106
6.5 Programming mechanisms 110
6.6 Nutritional interventions 112
6.7 Conclusions 113
6.8 Key points 114
6.9 Recommendations for future research 115
6.10 Key references 115
7 Establishing of Gut Microbiota and Bacterial Colonisation of the Gut in Early Life 116
Dr Anne L. McCartney
7.1 Introduction 116
7.2 Acquisition of the gut microbiota 117
7.3 Factors affecting the infant gut microbiota (acquisition and development) 118
7.4 The gut microbiota of exclusively milk–fed infants 120
7.5 The effects of weaning on the infant gut microbiota 123
7.6 Potential long–term effects: implications for obesity 128
7.7 Conclusions 128
7.8 Key points 128
7.9 Recommendations for future research 129
7.10 Key references 129
8 Nutrition and Development: Obesity 130
Professor Lucilla Poston
8.1 Introduction 130
8.2 Inadequate in utero nutrition: a risk factor for obesity in later life? 130
8.3 Breastfeeding and risk of obesity in later life 132
8.4 Maternal diabetes and obesity: early life determinants of offspring obesity? 132
8.5 Interventions to reduce offspring obesity? 135
8.6 Interventions in pregnant diabetic women 136
8.7 Interventions in obese pregnant women 137
8.8 Mechanisms underlying the early life origins of obesity; role of animal studies 138
8.9 A central role for disturbance in pathways of appetite regulation 139
8.10 Conclusions 141
8.11 Key points 141
8.12 Recommendations for future research 142
8.13 Key references 142
9 Nutrition and Development: Type 2 Diabetes 143
Dr Susan E. Ozanne
9.1 Introduction 143
9.2 Relationships between birthweight and type 2 diabetes 144
9.3 Postnatal growth 144
9.4 Evidence for the role of early nutrition in humans influencing type 2 diabetes risk 145
9.5 Evidence for the role of early nutrition in animal models influencing type 2 diabetes risk 145
9.6 Conclusions 148
9.7 Key points 148
9.8 Recommendations for future research 149
9.9 Key references 149
10 Nutrition and Development: Cardiovascular Disease 150
Dr Paul D. Taylor and Professor Thomas A. B. Sanders
10.1 Introduction 150
10.2 Evidence–based on clinical endpoints 151
10.3 Postnatal growth 152
10.4 Programming of atherosclerosis 153
10.5 Programming of blood pressure 157
10.6 Animal models of nutritional manipulation in early life 158
10.7 Conclusions 162
10.8 Key points 162
10.9 Recommendations for future research 162
10.10 Key references 163
11 Nutrition and Development: Cancer 164
Professor Paul Haggarty and Professor Steven Darryll Heys
11.1 Cancer incidence and trends 164
11.2 Cancer biology 165
11.3 Evidence linking early nutrition to cancer 166
11.4 Possible mechanisms linking early nutrition to cancer risk 168
11.5 Conclusions 174
11.6 Key points 175
11.7 Recommendations for future research 175
11.8 Key references 176
12 Nutrition and Development: Bone Health 177
Dr Vicki Quincey, Professor Elaine Dennison, Professor Cyrus Cooper and Dr Nicholas C. Harvey
12.1 Early life origins of osteoporosis 177
12.2 Maternal nutrition in pregnancy 180
12.3 Postnatal calcium and vitamin D nutrition 184
12.4 Calcium and vitamin D nutrition in older children 186
12.5 Vitamin D: problems with defi ning normality 186
12.6 Physical activity and bone health in childhood 188
12.7 Conclusions 189
12.8 Key points 189
12.9 Recommendations for future research 190
12.10 Key references 190
13 Nutrition and Development: Asthma and Allergic Disease 191
Professor Graham S. Devereux and Dr Nanda Prabhu
13.1 Introduction 191
13.2 Pathogenesis 191
13.3 Increasing prevalence of asthma and allergic disease 193
13.4 Impact of asthma and allergic disease 193
13.5 Importance of antenatal and early life influences on asthma and allergic disease 194
13.6 Maternal dietary food allergen intake during pregnancy and breastfeeding 195
13.7 Breastfeeding and childhood atopic dermatitis and asthma 198
13.8 Infant dietary food allergen intake 198
13.9 Early life nutrient intake 199
13.10 Obesity and childhood asthma and allergic disease 203
13.11 Conclusions 203
13.12 Key points 204
13.13 Recommendations for future research 204
13.14 Key references 205
14 Nutrition and Development: Early Nutrition, Mental Development and Mental Ageing 206
Professor Marcus Richards, Dr Alan Dangour and Professor Ricardo Uauy
14.1 The importance of mental development and ageing 206
14.2 Maternal diet during pregnancy 207
14.3 Breastfeeding 209
14.4 Post–weaning diet 212
14.5 Conclusions 213
14.6 Key points 214
14.7 Recommendations for future research 215
14.8 Key references 215
15 Putting the Science into Practice: Public Health Implications 216
Professor Judith L. Buttriss, Sara A. Stanner and Professor Thomas A. B. Sanders
15.1 Introduction 216
15.2 Summary of the Task Force s fi ndings for various chronic conditions 218
15.3 Diet and lifestyle themes relevant to pregnancy and early life 228
15.4 Diet and lifestyle themes relevant to early feeding and weaning 240
15.5 Vulnerable groups 242
15.6 Diet and lifestyle recommendations 245
15.7 Role of health professionals 247
15.8 Recommendations 250
15.9 Key points 254
15.10 Key references 255
16 Conclusions of the Task Force 256
16.1 Chapter 1 257
16.2 Chapter 2 257
16.3 Chapter 3 258
16.4 Chapter 4 258
16.5 Chapter 5 259
16.6 Chapter 6 259
16.7 Chapter 7 260
16.8 Chapter 8 260
16.9 Chapter 9 260
16.10 Chapter 10 261
16.11 Chapter 11 261
16.12 Chapter 12 261
16.13 Chapter 13 262
16.14 Chapter 14 262
16.15 Chapter 15 263
17 Recommendations of the Task Force 265
17.1 Priorities for future research on current practice in relation to early life development 265
17.2 Priorities for future research on mechanisms and pathways of early life development 265
17.3 Priorities for future research: specifi c diseases 267
17.4 Recommendations to key stakeholders 268
18 Nutrition and Development: Answers to Common Questions 273
18.1 Nutrition and development 273
18.2 Developmental programming hypotheses 273
18.3 Normal growth 273
18.4 How development occurs and factors that can affect it 274
18.5 Infl uences of perinatal sex hormone exposure on programming of disease susceptibility 275
18.6 Cognitive and neurological development 276
18.7 Infl uences of gut microbiota on programming of disease susceptibility 276
18.8 Obesity 277
18.9 Diabetes 278
18.10 Cardiovascular disease 278
18.11 Cancer 279
18.12 Bone health 280
18.13 Allergic diseases and asthma 281
18.14 Mental health and cognitive behaviour 282
18.15 Dietary and lifestyle advice for early life 282
18.16 Policies relating to early life nutrition and development 286
Glossary 287
References 294
Index 342
