Nutrition and Growth

B. Koletzko, R. Shamir, D. Turck, M. Phillip

• Publisher: S. Karger
• Year: 2016
• ISBN:
  9783318057065
• Topic: Medicine
• Subtopic: Gastroenterology & Hepatology

It is a well-known fact that children's growth depends on the quality of their nutrition. However, the mechanisms of fetal and child growth and their interactions with nutrition have not yet been fully elucidated and still pose a challenge to those engaged in the field. Exchanging concepts and knowledge among professionals of various disciplines thus remains very important. This second 'Yearbook' provides an update on the research published between 2013 and 2015. An international team of experts presents papers that shed light on the mechanisms of interaction between nutrition and growth, and provide insight to the readers. Each paper is briefly summarized and supplemented with editorial comments which evaluate the clinical importance of each article and discuss its application.This 'Yearbook' is an important tool for practicing physicians, including pediatricians, subspecialists in pediatric gastroenterology, metabolism and nutrition, and endocrinology. Nutritionists and dieticians, as well as other health professionals involved in the care of children, will also find this to be a useful resource.

Koletzko B, Shamir R, Turck D, Phillip M (eds): Nutrition and Growth: Yearbook 2016.
World Rev Nutr Diet. Basel, Karger, 2016, vol 114, pp 21-49 (DOI: 10.1159/000441810)

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Obesity, Metabolic Syndrome and Nutrition

Shlomit Shalitin¹ · Tadej Battelino² · Luis A. Moreno³

¹The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; ²UMC-University Children's Hospital, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; ³GENUD (Growth, Exercise, Nutrition and Development) Research, University School of Health Sciences, University of Zaragoza, Zaragoza, Spain

Over the span of the last decades there has been an alarming increase in childhood obesity, which tends to track into adulthood. Childhood obesity is associated with significant risk for the development of comorbidities such as type 2 diabetes, dyslipidemia, hypertension, metabolic syndrome and early cardiovascular events. Early life may be a ‘critical period’ when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk. Insight into the potential impact of modifying early-life risk factors on later obesity can be gained by evaluating their combined effects [1]. The association between breastfeeding status and childhood overweight is inconclusive. However, it seems that a longer duration of exclusive breastfeeding is associated with a lower risk of becoming overweight [2]. The encouragement and support of breastfeeding and other healthy feeding practices are especially important for low socioeconomic children who are at increased risk of early childhood obesity [3]. Infant formula with lower protein content may also reduce BMI and obesity risk later [4]. There is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (before 4 months), may increase the risk of childhood overweight [5].

Studies have revealed an association of hypovitaminosis D with insulin resistance [6] and cardiometabolic risk factors from childhood [7]. Recently it was reported that the fat mass and obesity-associated (FTO) genotype effects are more pronounced among children with insufficient vitamin D levels [8]. The consumption of sugar-sweetened beverages (SSBs) is another risk factor for obesity [9, 10] with an association of higher SSB consumption and metabolic syndrome components in overweight/obese and glucose-intolerant children [11]. Additionally, dietary pattern, food content [12, 13] and frequency [14], amount of food intake [15] and breakfast consumption [16], and TV viewing and other screen activities [17] may also have an impact on body weight and on markers of the metabolic syndrome.

This chapter reviews a selection of important articles published between July 2013 and June 2015 focused on the relation between nutrition, obesity and metabolic syndrome in childhood and in young adults.

Lactation and Early Feeding

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Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention

Robinson SM^1,2, Crozier SR¹, Harvey NC^1,2, Barton BD¹, Law CM⁴, Godfrey KM^1,2, Cooper C^1-3, Inskip HM¹

¹Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; ²The National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, UK; ³NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK; ⁴UCL Institute of Child Health, London, UK

Am J Clin Nutr 2015;101:368-375

Note: This article is discussed also in the chapter by Michaelsen et al. [this vol., pp. 103-119].

Background: There is increasing interest in understanding the role of early environmental factors in the risk of excess weight gain because this is the period in which appetite and the long-term regulation of energy balance are permanently programmed. The objective of this study was to examine the relation between the number of early-life risk factors and obesity outcomes among children in a prospective birth cohort (Southampton Women's Survey).

Methods: Data were available for 991 mother-child pairs with children born between 1998 and 2003. Five risk factors were defined: maternal obesity (prepregnant BMI >30), excess gestational weight gain (Institute of Medicine, 2009), smoking during pregnancy, low maternal vitamin D status (<64 nmol/l) and short duration of breastfeeding (none or <1 month). Body composition was examined when the children were aged 4 and 6 years. BMI, overweight or obesity (International Obesity Task Force) and fat mass by dual-energy X-ray absorptiometry were assessed.

Results: Of the children, 148 (15%) had no early-life risk factors, 330 (33%) had 1 early-life risk factor, 296 (30%) had 2 early-life risk factors, 160 (16%) had 3 early-life risk factors and 57 (6%) had 4 or 5 early-life risk factors. At both 4 and 6 years, there were positive graded associations between number of early-life risk factors and each obesity outcome (all p < 0.001). After taking confounders into account, the relative risk of being overweight or obese for children who had 4 or 5 risk factors was 3.99 (95% CI: 1.83, 8.67) at 4 years and 4.65 (95% CI: 2.29, 9.43) at 6 years compared with children who had none (both p < 0.001).

Conclusions: The authors concluded having a greater number of early-life risk factors was associated with large differences in adiposity and risk of overweight and obesity in later childhood, thus favoring the idea of promoting early interventions to change these modifiable risk factors in order to prevent childhood obesity.

Comments

One of the main critical periods in the development of obesity is the perinatal period. During this time-window, infants are exposed to several environmental factors. It is important to identify not only independent risk factors, but also their potential combined effect. In this article, the authors address the issue of the combined effect of five early and recently identified environmental risk factors (maternal obesity, excess gestational weight gain, smoking during pregnancy, low maternal vitamin D status and short duration of breastfeeding) on body fat composition outcomes. All the former risk factors are potentially modifiable through behavior change interventions. An important strength of this study is the use of dual-energy X-ray absorptiometry to assess body composition. The majority of studies assessing obesity as the main outcome use only BMI, which is an indirect estimate of total body fat, but does capture both fat and fat-free mass. Age at introduction of solid foods was not considered as a risk factor because they did not observe independent associations with adiposity in their cohort. There is no doubt weaning is a critical period in terms of exposure to foods, and maybe other weaning-related aspects, such as type of foods and timing of their corresponding introduction, should be considered in the future [18, 19]. A strength of the study is that final models were further adjusted for childhood levels of physical activity (assessed at 4 years) and quality of childhood diet (prudent diet scores determined at 3 and 6 years). Physical activity and diet intake are not easy to measure before the age of 6 years, but it is worth making the effort to measure them, even though the results need to be based on parent-reported information.

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Exclusive breastfeeding is inversely associated with risk of childhood overweight in a large Chinese cohort

Zheng JS¹, Liu H², Li J², Chen Y², Wei C², Shen G², Zhu S², Chen H², Zhao YM¹, Huang T³, Li D¹

¹Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China; ²Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China; ³Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

J Nutr 2014;144:1454-1459

Background: The association between breastfeeding status and childhood overweight is still under discussion. Given that the social patterns of breastfeeding behavior are different between different geographical regions, it is important to understand the association between breastfeeding and childhood overweight in different areas of the world, like China. The aim of the present study was to investigate the relation between exclusive breastfeeding and childhood overweight risk in children 4-5 years of age in Southeast China.

Methods: Among 97,424 children enrolled between 1999 and 2009 in the Jiaxing Birth Cohort, 42,550 were included in the final analysis with complete records on breastfeeding status and anthropometric measurements at 4-5 years of age (48-60 months). Breastfeeding status was categorized into 3 groups at each visit in the first 6 months: exclusive, nonexclusive and never breastfeeding. Exclusive breastfeeding for ≥ 3 months was defined when the mothers reported exclusive breastfeeding during both the 1- and 3-month visits. Similarly, exclusive breastfeeding for ≥6 months was defined when exclusive breastfeeding was reported at each of the 3 visits (1, 3 and 6 months). The same strategy applied to the assessment of never breastfeeding at 1, 3 and 6 months of age. Overweight and being at risk of overweight were identified as a BMI-for-age z-score ≥2 and between 1 and 2...