Early Infant Nutrition

8/13/2019 Early Infant Nutrition

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Early Infant Nutrition : short & Longterm effects

Dr. Mohamed R. Cheickali


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AgendaTo understand:

1. Growth of breastfed and formula fed infants

2. Protein is one mechanism for growth differences

3. Difference between Breast Milk and Infant formula in Protein Quality andQuantity

4. New Technique to improve protein quality and reduce quantity


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Recent trends in infant nutritionEarly infant feeding not only influences physicalgrowth and development, but also theincidence of gastro-intestinal , respiratory ,

and allergic disease in early childhood , as well as possibly metabolism and health in laterchildhood and adulthood

ESPGHAN Committee on NutritionJPGN 2001;32:256


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Is Chubby . Cute Baby .Healthy ?
http://www.google.co.uk/imgres?imgurl=http://www.baby-product-guides.com/wp-content/uploads/2009/12/happy-baby.jpg&imgrefurl=http://www.baby-product-guides.com/&usg=__xuOtsNcF1Dri_5mJ04Nqka3v89Y=&h=401&w=299&sz=93&hl=en&start=12&zoom=1&um=1&itbs=1&tbnid=RT6LsW5lM--SBM:&tbnh=124&tbnw=92&prev=/search?q=happy+baby+pictures&um=1&hl=en&safe=active&biw=1659&bih=904&tbm=isch&ei=tuvtTc7oO4iUOrCEmZcI


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Obesity in the world

300 million obese

15-30% obese in industrialized nations

WHO: at least 20 million children under age 5 yrsoverweight globally in 2005( Factsheet 311, Sep. 2006 )


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Childhood Obesity is Complex


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early nutrition (i.e.) from fetal timeto 2 years may impact long-term bodycomposition


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Human milk is the Gold Standard for Infant Nutrition

Composition of Breast Milk Protein Carbohydrates Fats Vitamins Minerals Bioactive Substances

Immunoglobulins

If a mother cannot or chooses not to breast feed,infant formula is the next best alternative


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Growth of the Breastfed Infant is theGold Standard for infant Growth

Several studies have shown thatformula fed infants are larger than breastfed infants by the end of thefirst year of life

Kramer et al (2004)Republic of Belarus16,755 infants

Agostoni et al (1990)Italy119 infants

Dewey et al (1993)United States80 infants


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The WHO Multicentre Growth Reference Study

The World Health Organization recognized breastfed and formula fed infantsgrow differently

Conducted extensive research in 6 countries : Brazil, Oman, India, Ghana,Norway, US

Longitudinal- 800 children total (140 per site)

Followed monthly from birth to 24 monthsCross sectional-7560 total (1260 per site)

Children 18 to 71 months measured once

Based on these 8360 infants exclusively fed human milk for at least 3months, New Growth Reference Standards were developed for global usage


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Used to compare thegrowth of study group to thegrowth of a reference group

Represents the deviationof the group from the mean value of

a reference population

Nearly all infants (95%) in apopulation will be within

-2.0 and +2.0 Z-scores

Z-score -3 -2 -1 0 1 2 3

95% of data

Researchers use Growth Z-scores to communicate growth differences amongsubjects

Pediatricians use Percentiles on Growth Charts


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The DARLING Study showed Growth Differences between Breastfed andFormula fed Infants During 1 st Year of Life

The DARLING Study, Dewey et al AJCN, 1993

Z - S

C O R E ( W e i g h t f o r

l e n g

t h )*FF significantly greater weight for length

compared to BF infants


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Protein requirements in infants

Fomon et al. Dewey et al.Age (m) Growth. Inev. Loss Total Total

(g/kg/d) (g/kg/d)

0-1 1.03 0.95 1.98 1.99

1-2 0.78 0.93 1.71 1.59

2-3 0.56 0.90 1.46 1.19

3-4 0.38 0.89 1.27 1.06

4-5 0.30 0.88 1.18 0.92

5-6 0.29 0.89 1.18 0.92

6-9 0.26 0.91 1.17 0.85

9-12 0.20 0.94 1.19 0.78

Protein requirements forgrowth represent more thanhalf of the protein needsduring the first months oflife.

The growth rate slows downrapidly with age, and thusthe requirements for protein


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0.000.200.400.60

0.801.001.201.401.601.802.002.202.40

0-1 1-2 2-3 3-4 4-5 5-6 6-9 9-12

P r o

t e i n ( g / 1 0 0 k

c a

l )

Age Interval (mo)

Requirement

Ziegler 2010

Starter Formula Follow-up Formula

New Starter Formula


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Excessive protein intake has been hypothesized as one potential riskfactor for later development of obesity

The early protein hypothesis Koletzko et al , 2005

Dietary proteins by influencing secretion of hormones such as insulin and insulingrowth factors (IGFs) may influence growth and adiposity in infants and children


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Effect of feeding type on insulin secretion in infants

Lucas et al, 1981

Urinary C-peptide/creatinine (nmol/mmol)

0

1

2

3

4

5

6

7

BF F 1.9 g protein/100 kcal

F 2.6 protein/100 kcal

Axelsson et al, 1989

p < 0.01

Insulin secretion is higher in FF vs BF infants. This effect is prevented whenformula contains lower amount of proteins


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Insulin-secretagogue amino-acids

F 2.4 F 1.9

Arginine 81 95*

Isoleucine 97 74*

Leucine 140 131*

Phenylalanine 47 47

Valine 208 146*

Plasma concentrations ( m ol/l) of insulin-secretagogue amino acids of 112 day -old infants

fed either a whey predominant formula (WPF) or a modified sweet whey formula (MSWF)

Protein/energy ratio of 2.4 and 1.9 g prot/100 kcal for WPF and MSWF, respectively

*p value < 0.05

Adapted from Ziegler et al, 2003


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Feeding type and IGF-1 levels in infants

FF infants have greater serum IGF-1 levels than BF infants.Plasma IGF-1 levels are directly correlated with the Z score for weight, BMI andtricipital skin-fold thickness in 2 months-old infants

Savino et al, 2005

Savino et al, 2005


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presented by Prof Koletzko, Univ. of Munich, at the European Congress onObesity, Budapest, April 2007.

A low protein content infant formula fed during first year of life (starter infantat 1.8 g protein/ 100 kcal and follow up formula at 2.25g protein / 100 kcal)

Metabolic and endocrine benefits as well as a body growth rate during the first2 years close to that of breastfed infants, compared to the feeding of highprotein formulae during the first year of life.

contributes to the growing body of scientific evidence that early nutritioncan exert important long term programming effects on early development andlater health.


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Comparison of protein fractionsfrom human and cows milk

0

10

20

30

40

50

60

70

80

90

100

Human Milk Cow s Milk

lactoferrin immunoglobulins serum albumin-lactoglobulin

-lactalbumin

-casein -casein

-casein -casein

Whey 60%

Casein 40%

Whey

CaseinCasein 80%

Whey 20%

P r o t e i n f r a c t

i o n s

( % )

Total proteins (g/dl):

Human milk: 0.89

Cow milk: 3.30

It is virtually impossible to obtain an aminoacid profile that is similar tohuman milk with the usual ingredients (skim milk and whey)


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Tryptophan the limiting AA in reducingprotein content in infant formulas

Human milk (1.5 g prot/100 kcal)

Casein predominant formula (2.5 g prot/100 kcal)

Whey predominant formula (2.5 g prot/100 kcal)

m g a a

/ 1 0 0 k c a

l

0.0

50.0

100.0

150.0

200.0

250.0

I s o

l e u c i n

e

L e u c i n e

L y s i n e

M e

t h i o n i n e

P h e n y l a

l a n i n e

T h r e o n i n e

T r y p

t o p

h a n

V a l i n e


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-lactoglobulin

. .. thus in creasing -lactalbumin (rich in tryptophan)

Remove CGMP ... (over-rich in threonine

but poor in tryptophan)

Others

Immunoglobulins

Serum-albumin

32%

23.4%

Non-Protein Nitrogen

13%

12.8%

6.4%

3.2%

9.5%

New fractionation process*: CGMPelimination

* Nestl Patent : EP 0 880 902 A1


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-lactalbumin enriched formula

0 0.5 1 1.5 2 2.5

Human milk

Casein predominantformula

Classical Whey formula

-LactalbuminEnriched whey formula

g/16 g N

Tryptophan levels in different formula and human milk

0 5 10 15 20

Breastfed

-Lactalbumin enrichedwhey formula(2.0 g prot/100 kcal)

Classical Whey formula

mg/L

Serum tryprophan levels in FF and BF infants

Heine et al Acta Peaediatr 85: 1996

(2.5 g prot/100 kcal)NS


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F 2.2

F 1.8

HM

Indispensable amino acids and urealevels in plasma

Infants fed the F1.8 formula showed

both plasma amino acid and urealevels closer to BF infants than thosefed the classical WF

0

1

2

3

4

3 0 d 6 0 d 1 2 0 d

P l a

s m a

U r e a

( m m o

l / l )

*

*

0

80

120

160

200 ILE

LEU

VAL

THR

TRPMET

HIS

LYS

PHE

mM/ml


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Metabolic balance study showedsimilar nitrogen retention

Crossover, randomized, double blind 8 babies (1-4 months):Classical Whey Formula (WF): 2.2 g protein / 100 kcalModified Sweet Whey Formula (MSWF): 1.8 g protein / 100 kcal

Nitrogen intake and excretion werelower in MSWF fed infants butnitrogen retention was identical in both groups

Absorption and retention of calcium,magnesium and phosphorus weresimilar with the 2 formulas

Ziegler et al, 2002

*p < 0.01

0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

3 0 0

3 5 0

4 0 0

*

*

Intake Urinaryexcretion Retention

WF2.2

MSWF1.8


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Growth parameters within the rangeof breastfed infants

9. Raiha et al. Protein Nutrition During Infancy.: effects on growth and metabolism. In: Martorell R, eds Nutrition and Growth.Nestl Nutrition Workshop Series, vol. 47, New York: Raven Press 2000.

WeightGain

(g/day, 0-90 days)

Adequate Growth rate

Body MassIndex

(kg/m2, at 90 days)

HeadCircumference

(mm, 0-90 days)


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Protein intake and IGF-1 levels

Infants fed a low protein formula show lower IGF-1 levels than those fed a classicalformula

0 25 50 75 100 125 50

60

70

80

90

100

Whey predominant formula(2.4 g protein/100 kcal)

MSW formula(1.9 g protein/100 kcal)

P < 0.05

Days after birth

I G F - 1

( n g

/ m l )

Steenhout et al, 2005


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calculated risk for obesity during adolenscence(based on early weight gain)

for infants fed low protein formula

- 13%

vs. infants fed high protein formula


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ConclusionsReducing the protein content in the starter formulas may attenuate themetabolic and renal overloads in the immature baby.

Targeted fractionation of the sweet whey proteins allowed theelaboration of a new formula:

With low protein content and better amino acid profile Safe and able to support growth rates similar to those obtained by

breast feeding

Resulting in plasma AA profile closer to breast feeding Resulting in reduced plasma urea and urinary nitrogen excretionthan standard, whey adapted formulas: smaller renal overload

OBESITY PREVENTION : early (fetal, 0-2 years) nutrition isimportant in prevention


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THANK YOU

Early Infant Nutrition

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