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“The Golden First 1000 days”
Improving Infants and young children health Symposium
Dear Doctor,
Early infant feeding not only influences physical growth and
development, but also the incidence of gastrointestinal, respiratory and
allergic disease in early childhood, as well as possibly metabolism and
health in later childhood and adulthood.*
The scope of the symposium is to focus on the importance of nutrition
in the first 1000 days. This period is crucial to set the basis for a healthy
growth and development. Early infant nutrition exerts both short- and
long-term effects on his health, by programming its immunological,
metabolic and microbiological development. We will discuss the
potential of interventions, nutritional challenges during critical period of
weaning and special conditions as gastroenteritis.
We look forward to making this a most rewarding and memorable
symposium for you.
WHO RECOMMENDATIONS
The World Health Organization (WHO) has recommended that pregnant women and new mothers should be informed of the benefits and superiority of
breastfeeding - in particular the fact that it provides the best nutrition and protection from illness for babies.
Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet
both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will
have a negative effect on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breastfeed.
Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is
exclusively bottle-fed, more than one can (400g) per week will be needed, so the family circumstances and cost should be kept in mind. Mothers should be
reminded that breast milk is not only the best, but also the most economical food for babies.
If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasizing that unboiled water, unboiled
bottles or incorrect dilution can all lead to illness.
*ESPGHAN Committee on Nutrition, JPGN 2001; 32:256.
“The Golden First 1000 days”
Improving Infants and young children health Symposium
Agenda
Friday 11th May
Registration & Welcome
10:00 - 10:15
NNI Introduction
10:15 - 10:30
F. Haschke
H. Anwar
Nutrition during “The First 1000 days” and
Non Communicable Diseases later life
10:30 - 11:00
F. Haschke
Management of infants and young children
during gastro-enteritis
11:00 - 11:30
M. Rawashdeh
Meeting the nutritional challenges during
weaning period
11:30 - 12:00
H. Anwar
Q&A
12:00 - 12:15
Lunch
12:15 - 2:30
Chairman Dr. Farman Zandi
Nutrition During “The First 1000 Days”
And Noncommunicable Diseases (Ncds)
Later In Life
Prof. Ferdinand Haschke, MD, PhD
Nestle Nutrition Institute; Vevey, Sitzerland
Dept. Pediatrics, Medical University Vienna, Austria
Nutrition during the first 1000 days, which includes the period from conception to the
post-weaning period at 2 years of age influences growth and cognitive development
but is also important for the development of NCDs later in life. NCDs (e.g. metabolic
diseases such as cardiovascular events, type-II diabetes, and obesity and other
diseases such as allergy and lung disease, cognitive decline and cancer) will account
for almost 80% of all deaths globally during the next decade. 3 examples are
presented how early nutrition interacts with our genes and epigenetic factors and how
the potential impact on NCDs could be.
(1) Tissue content of docosahexanoic acid (DHA) is related to health outcomes including cardiovascular and mental health. In addition to DHA intake, frequently found
polymorphisms in the fatty acid desaturase (FADS) gene cluster have marked effect on
DHA status. FADS gene variants modulate DHA status during pregnancy as well as
concentrations in breast milk. Screening programs at durin early pregnancy and in
newborns could identify those mothers and infants with the “wrong” FADS gene
variants who could benefit from DHA supplements. (2) Intrauterine malnutrition, in
particular low supply of Vit B12 and folate can result in epigenetic modification of key
genes function. The malnourished fetus would be programmed to store all energy in
the body, which would increase the risk for adult obesity and associated metabolic
diseases if the child grows up in an environment where food is in abundance and physical activity is low. This epigenetic modification of key genes function can be transferred from one to the next generation. It is likely that postnatal nutrition during the first
few months of life, in particular high protein intake is another risk factor for development of obesity later in life. (3) Among NCDs, allergy is associated with significant
morbidity. In children with a positive family history for allergic diseases, exclusive
breastfeeding or feeding hypoallergenic infant formula reduces the risk of allergic
manifestations and atopic eczema until school age by approximately 30-50%. It has
been suggested that the function of those genes which control long-term immunemodulation (“oral tolerance”) can be influenced by early postnatal nutrition, which is
the reason for improved outcome.
Intensive research during the oncoming years will result in better understanding the
interactions between nutrition during the first 1000 days, NCDs, and the function of
key genes. Both gene polymorphisms and epigenetic modifications which are important for long-term health outcome have now been described in humans. This is an
exciting new field in pediatric nutrition, which will provide more insights how the phenotype is interlinked with the genotype.
Nutritional Management for infants
with Gastro-enteritis
Professor M Rawashdeh, MD, FRCP
Despite the great advances in the understanding and management of diarrheal
diseases in childhood, these still account for a large proportion of childhood morbidity
and mortality in developed and developing countries alike. Most deaths occur during
infancy. Dehydration, associated with electrolyte disturbance and metabolic acidosis,
is the most frequent and dangerous complication. The degree of dehydration is best
assessed by prolonged capillary refill, abnormal skin turgor and absent tears.
Oral rehydration solution (ORS) is effective in the treatment of dehydration, both at
home or hospital and can be introduced orally or by nasogastric tube. Rehydration
using ORS should be achieved within 4 to 6 hours.
When rehydration is achieved, an age-appropriate diet should be promptly resumed,
as "resting the gut” proved to be an inappropriate approach. Breastfed, formula-fed
infants or children receiving semisolid or solid foods should continue their usual food
immediately. Foods high in simple sugars should be avoided. Carbonated soft drinks,
juice, gelatin desserts, and other highly sugared liquids should be avoided. Juicecentered diet can provide suboptimal nutrition. Certain guidelines have recommended
avoiding fatty foods, but maintaining adequate calories without fat is difficult, and fat
might have a beneficial effect of reducing intestinal motility. Vomiting child should be
offered frequent small feedings (every 10 to 60 minutes) of any tolerated foods or oral
rehydration solutions. Lactose-free formulas are unnecessary in most cases. In
patients with true lactose intolerance, lactose-free formula is recommended for four to
six weeks.
Regrading (milk dilution) is unnecessary and is associated with prolonged symptoms
and delayed nutritional recovery. Children should maintain caloric intake during acute
episodes, and subsequently should receive additional nutrition to compensate for any
shortfalls arising during the illness.
It is now recommended that (10-20 mg of zinc is given daily for 10 to 14 days) to all
children with diarrhea. Lactobacillus (probiotics) species are both safe and effective as
treatment for children with infectious diarrhea.
Antimicrobials should not be used routinely. Aniemetics and antidiarrheal drugs are
not recommended.
Meeting the nutritional challenges
during weaning period
Dr. Hanan Anwar
Medical Director, Nestle Nutrition
Middle East & North East African Region
Highlighting the importance of early nutrition and appropriate feeding practices: The
time from birth to 2 years of age is a ‘critical window’ for the promotion of optimal
growth, health and behavioral development.
Longitudinal studies have consistently shown that this is the peak age for growth
flattening, deficiencies of certain micronutrients, and common childhood illnesses. In
addition, poor infant feeding practices may be coupled with higher rates of infectious
diseases.
In this connection, it has been shown that severe malnutrition during the first two years
of life may have an adverse impact on physical and cognitive development. Moreover,
studies report that after the age of 2 years, it is very difficult to reverse stunting of
growth that has occurred earlier in life. Consequently, it is essential to ensure that
caregivers are provided with appropriate guidance regarding optimal feeding of
infants and young children.
As endorsed by the PAHO and WHO guidelines, exclusive breastfeeding should be
encouraged and supported from birth to at least 6 months of age. Complementary
foods should be introduced at around 6 months, while breastfeeding is continued.
This period is commonly known as weaning.
The term “to wean” is reputedly derived from an AngloSaxon word “wenian “, meaning
“to accustom”. It applies to that phase during which the infant having previously been
fed solely on milk gradually becomes accustomed to a variety of other foods until the
ability to deal with general family diet.
The weaning period is a transitional period of high risk for the child not just because of
the high incidence of diarrhea but also on account of the administration of unsuitable
foods and/or poor hygienic conditions during its preparation; but mostly through the
inappropriate utilization of food supplements insufficient to fulfill the child's needs.
Special attention should be paid to some of the micronutrients that could become
compromised during this period, for example, iron, zinc and vitamins A and D.
Amount of food needed, food consistency, Nutrient content of complementary foods,
fluids needs safe preparation and storage of weaning food and feeding during and
after illness are main issues during this period as well.