Nutrition and Development

The British Nutrition Foundation is a registered charity. It promotes the wellbeing of society through the impartial interpretation and effective dissemination of scientifically based knowledge and advice on the relationship between diet, physical activity and health.

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.

Foreword xv Terms of Reference xvi Task Force Membership xvii 1 Introduction to Early Life and Later Disease 1 Dr Sian 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