Preventive Aspects of Early Nutrition Nestlé Nutrition Institute Workshop Series

Preventive Aspects of Early Nutrition Nestlé Nutrition Institute Workshop Series Vol. 85 Preventive Aspects of Early Nutrition Editors Mary S. Fewtrell London, UK Ferdinand Haschke Salzburg, Austria Susan L. Prescott Perth, Australia Nestec Ltd., 55 Avenue Nestlé, CH–1800 Vevey (Switzerland) S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com Library of Congress Cataloging-in-Publication Data Names: Fewtrell, Mary S., editor. | Haschke, F., editor. | Prescott, Susan L., editor. Title: Preventive aspects of early nutrition / editors, Mary S. Fewtrell, Ferdinand Haschke, Susan L. Prescott. Description: Basel ; New York : Karger, [2016] | Series: Nestlé Nutrition Institute workshop series, ISSN 1664-2147 ; vol. 85 | Includes bibliographical references and index. Identifiers: LCCN 2015046033| ISBN 9783318056426 (hard cover : alk. paper) | ISBN 9783318056433 (electronic version) Subjects: | MESH: Child Nutritional Physiological Phenomena | Infant Nutritional Physiological Phenomena | Pediatric Obesity--prevention & control | Hypersensitivity--prevention & control | Congresses Classification: LCC RJ206 | NLM WS 130 | DDC 613.2083--dc23 LC record available at http://lccn.loc.gov/2015046033 The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein. © 2016 Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher. Printed on acid-free and non-aging paper (ISO 9706) ISBN 978–3–318–05642–6 e-ISBN 978–3–318–05643–3 ISSN 1664–2147 e-ISSN 1664–2155 Basel · Freiburg · Paris · London · New York · Chennai · New Delhi · Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney Contents VII Preface X Foreword XIII Contributors Allergy 1 Early Nutrition as a Major Determinant of ‘Immune Health’: Implications for Allergy, Obesity and Other Noncommunicable Diseases Prescott, S.L. (Australia/Western Australia) 19 The Future of Infant and Young Children’s Food: Food Supply/ Manufacturing and Human Health Challenges in the 21st Century Venter, C. (UK/USA); Maslin, K. (UK) 29 Infant Feeding: Foods, Nutrients and Dietary Strategies to Prevent Allergy Beyer, K. (Germany) 35 Using Food and Nutritional Strategies to Induce Tolerance in Food-Allergic Children Nowak-Węgrzyn, A. (USA) 55 Summary on Allergy Prescott, S.L. (Australia) Obesity Prevention 59 Interrupting Intergenerational Cycles of Maternal Obesity Gillman, M.W. (USA) 71 Development, Epigenetics and Metabolic Programming Godfrey, K.M.; Costello, P.M.; Lillycrop, K.A. (UK) V 81 Endocrine and Metabolic Biomarkers Predicting Early Childhood Obesity Risk Socha, P. (Poland); Hellmuth, C. (Germany); Gruszfeld, D. (Poland); Demmelmair, H.; Rzehak, P.; Grote, V.; Weber, M. (Germany); Escribano, J.; Closa-Monasterolo, R. (Spain); Dain, E.; Langhendries, J.-P. (Belgium); Riva, E.; Verduci, E. (Italy); Koletzko, B. (Germany) for the European Childhood Obesity Trial Study Group 89 Effects of Early Nutrition on the Infant Metabolome Hellmuth, C.; Uhl, O.; Kirchberg, F.F.; Grote, V.; Weber, M.; Rzehak, P. (Germany); Carlier, C. (Belgium); Ferre, N. (Spain); Verduci, E. (Italy); Gruszfeld, D.; Socha, P. (Poland); Koletzko, B. (Germany) for the European Childhood Obesity Trial Study Group 101 Postnatal High Protein Intake Can Contribute to Accelerated Weight Gain of Infants and Increased Obesity Risk Haschke, F. (Austria); Grathwohl, D.; Detzel, P.; Steenhout, P.; Wagemans, N.; Erdmann, P. (Switzerland) 111 Summary – Early Nutrition and Obesity Prevention Haschke, F. (Austria) Complementary Feeding: Taste, Eating Behavior and Later Health 113 Can Optimal Complementary Feeding Improve Later Health and Development? Fewtrell, M.S. (UK) 125 Learning to Eat: Behavioral and Psychological Aspects Birch, L.L. (USA) 135 The Development of Flavor Perception and Acceptance: The Roles of Nature and Nurture Forestell, C.A. (USA) 145 Dietary Patterns during Complementary Feeding and Later Outcomes Emmett, P.M. (UK) 155 Nature and Nurture in Early Feeding Behavior Cooke, L.; Llewellyn, C. (UK) 167 Summary on Complementary Feeding: Taste, Eating Behavior and Later Health Fewtrell, M.S. (UK) 169 Subject Index For more information on related publications, please consult the NNI website: www.nestlenutrition-institute.org VI Contents Preface Early-life nutrition is arguably the most critical determinant of future health. It provides the energy and critical building blocks for all development, determines our future tastes and eating behaviors, and supplies the crucial substrate for the establishment of a healthy microbiome, now recognized as one of the most important determinants of immune and metabolic health. Our diets are also an increasing source of exposure to adverse elements in the environment, including contaminants and pollutants in our food and water supply, which have greater potential to affect human health early in life than at any other stage. Optimizing early nutrition can have long-term benefits for long-term biological reserve and resilience, through effects on developing structure and physiological responses. Greater attention to this is key to maximizing human potential. Indeed, improved early-life nutrition has been a major element in dramatic improvements in life expectancy over the 20th century, particularly in high-in- come countries. However, access to healthy food remains an important factor in the wide global disparities in human health and longevity that still remain. Across the threshold of the 21st century, new nutritional challenges are emerging, with overnutrition and obesity now the most significant threats to the future of human health. Rising rates of inflammatory and metabolic diseases in children now underscore the importance of understanding the impact of the early environment on immune and metabolic health. For the first time in modern history, the current generation is expected to have a shorter life expectancy than their parents, simply because of obesity and the associated increased risk of noncommunicable diseases (NCDs), including diabetes, heart disease, mental ill health, some cancers, musculoskeletal disorders and immune diseases. In particular, the epidemic rise in very-early-onset NCDs, such as infant allergy, provide clear evidence of immune dysregulation and the rising early predisposition to inflammation. Diet-sensitive pathways are likely to be crucial in understanding how early- life conditions influence the finely balanced development of immune and meta- VII bolic responses. In particular, diet is at the center of the emerging epigenetic paradigms that may underpin the rise in several NCDs. While epigenetic mech- anisms provide a potential explanation of how nutritional exposures can affect fetal gene expression and subsequent disease risk, other diet-induced tissue compositional changes may also contribute directly to altered immune and metabolic function, e.g. through diet-induced changes in the microbiome. A better understanding of nutritional programming of immune health, nutritional epigenetics and the biological processes sensitive to nutritional exposure in early life may lead to dietary strategies that provide more optimal conditions during early programming, and reduce the burden of many metabolic and inflammatory diseases. While there is little doubt that changing dietary patterns are at the core of this modern NCD-driven health crisis, the importance of addressing this intervention in early life is still often underestimated. However, the increasing burden of childhood disease underscores that without early intervention there is very little hope of averting current trends. These concepts are sup- ported by growing evidence that a ‘life course’ approach from the first mo- ments of life will be more effective in reducing the long-term disease burden. With this philosophy, there is an increased focus on the next generation of parents and promotion of their health before conception. These efforts must be firmly grounded through promoting a far greater public awareness of the long-term implications of dietary choices in pregnancy, lactation and infancy. Advocacy for early-life nutrition needs to be matched with sound evidence and consistent advice for healthcare professionals, parents and the wider com- munity. At the moment, there is still inconsistency around even basic advice such as the optimal timing of introducing complimentary foods to infants. This needs to be addressed relatively urgently. As we understand more about gene-environment interactions, it is also increasingly likely that we may need to tailor this advice according to the genetic background and environmental context. The first two sections of this workshop consider preventive aspects of early nutrition in relation to the development of allergy and obesity, including the role of the microbiome, the use of food and nutritional strategies to induce

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