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Optimal nutrition in lactating women and its effect on later health of offspring: A systematic review of current evidence and recommendations (EarlyNutrition project).
de Waard, M, Brands, B, Kouwenhoven, SMP, Lerma, JC, Crespo-Escobar, P, Koletzko, B, Zalewski, BM, van Goudoever, JB
Critical reviews in food science and nutrition. 2017;(18):4003-4016
Abstract
BACKGROUND EarlyNutrition ( www.project-earlynutrition.eu ) is an international research consortium investigating the effects of early nutrition on metabolic programming. OBJECTIVE To summarize current evidence and standards, recommendations, guidelines, and regulations on nutrition or supplements in lactating women with emphasis placed on long-term health effects in offspring, including cardiovascular disease, hypertension, overweight/obesity, metabolic syndrome, diabetes, or glucose intolerance. METHODS Medline, Embase, selected databases and websites were searched for documents published between 2010 and 2015. RESULTS Thirteen documents met the inclusion criteria. Effects of maternal long-chain polyunsaturated fatty acid (LC-PUFA) supplementation on overweight/obesity or hypertension in offspring were assessed in 10 studies. One study described the effect of maternal vitamin D supplementation on overweight/obesity, and the remaining 2 studies assessed the effects of maternal probiotic/synbiotic supplementation during lactation on overweight/obesity or metabolic syndrome in their infants. Forty-one documents contained dietary recommendations on various macro- and micronutrients for lactating women, but without consideration of our long-term health outcomes in infants. CONCLUSION Literature on nutrition of lactating women and its effect on their infants' later health with respect to metabolic programming outcomes appeared to be scarce, and focused mostly on supplementation of LC-PUFA's. No recent guidelines or recommendations were available, highlighting the significant research gaps regarding this topic.
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Persistent Organic Pollutants and Concern Over the Link with Insulin Resistance Related Metabolic Diseases.
Mostafalou, S
Reviews of environmental contamination and toxicology. 2016;:69-89
Abstract
Persistent organic pollutants (POPs) are mostly halogenated compounds tending to persist in the environment, enter into the food chain, and accumulate in fat mass of mammals due to their high lipophilicity. They include some organochlorine pesticides, polychlorinated biphenyls, brominated flame retardants and polycyclic aromatic hydrocarbons. Some of these chemicals were widely used in the past so that their residues can be detected in the human body, though their usage has been banned for years. POPs have been shown to perturb the health of biological systems in different ways evidenced by carcinogenicity and disrupting effects on endocrine, immune, and reproductive systems. There are many epidemiologic and experimental studies on the association of exposure to POPs with insulin resistance and related metabolic disorders like obesity, diabetes, and metabolic syndrome. Inflammation as a known mechanism accompanying insulin resistance has also been shown to arise in insulin target tissues exposed to POPs. This review addresses the breast milk concentration of POPs in different regions of the world, synthesizes the current information on the association of POPs with insulin resistance related metabolic disorders, and discusses the inflammation as an involved mechanism. Considering high prevalence of insulin resistance related metabolic diseases and their relation with POPs, much need is felt regarding international and regional programs to not only limit their production and usage but eliminate these persistent pollutants from the environment.
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3.
Obesity and overweight: Impact on maternal and milk microbiome and their role for infant health and nutrition.
Garcia-Mantrana, I, Collado, MC
Molecular nutrition & food research. 2016;(8):1865-75
Abstract
Obesity, particularly in infants, is becoming a significant public health problem that has reached "epidemic" status worldwide. Obese children have an increased risk of developing obesity-related diseases, such as metabolic syndromes and diabetes, as well as increased risk of mortality and adverse health outcomes later in life. Experimental data show that maternal obesity has negative effects on the offspring's health in the short and long term. Increasing evidence suggests a key role for microbiota in host metabolism and energy harvest, providing novel tools for obesity prevention and management. The maternal environment, including nutrition and microbes, influences the likelihood of developing childhood diseases, which may persist and be exacerbated in adulthood. Maternal obesity and weight gain also influence microbiota composition and activity during pregnancy and lactation. They affect microbial diversity in the gut and breast milk. Such microbial changes may be transferred to the offspring during delivery and also during lactation, affecting infant microbial colonisation and immune system maturation. Thus, an adequate nutritional and microbial environment during the peri-natal period may provide a window of opportunity to reduce the risk of obesity and overweight in our infants using targeted strategies aimed at modulating the microbiota during early life.
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4.
Infant feeding and obesity risk in the child.
Oddy, WH
Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia. 2012;(2):7-12
Abstract
Early nutrition in infancy may influence later child health outcomes including overweight through 'programming'. Systematic reviews suggest that breastfeeding is associated with a modest reduction in the risk of later overweight and obesity. This commentary explores some of these mechanisms behind this association. Generally breastfed infants are leaner than artificially (formula)-fed infants and behavioural and hormonal mechanisms may explain this difference. The theory is that a high nutrient diet in infancy adversely programs the principal components of the metabolic syndrome in the child (body mass index, blood pressure and blood lipids) by promoting growth acceleration, whereas slower growth benefits later cardiovascular disease and its risk factors. Artificial-feeding stimulates a higher postnatal growth velocity with the adiposity rebound occurring earlier in those children who have greater fatness later, whereas breastfeeding has been shown to promote slower growth. The adverse long-term effects of early growth acceleration emerge as fundamental in later overweight and obesity. The higher protein content of artificial baby milk compared to the lower protein content in breastmilk is responsible for the increased growth rate and adiposity during the influential period of infancy of formula-fed infants. Breastfeeding, on the other hand, has a protective effect on child overweight and obesity by inducing lower plasma insulin levels, thereby decreasing fat storage and preventing excessive early adipocyte development. Plausible biological mechanisms underlying the protective effect of breastfeeding against obesity are based on the unique composition of human milk and the metabolic and physiological responses to human milk.
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Post-discharge nutrition: what does the evidence support?
Greer, FR
Seminars in perinatology. 2007;(2):89-95
Abstract
Although there are no official recommendations for specific nutrient intakes in premature infants after hospital discharge, it is agreed that the goal should be to achieve the body composition and rate of growth of that of a normal fetus of the same postmenstrual age during the entire first year of life. A general recommendation to use the special formulas designed for preterm infants after hospital discharge in place of the formulas for term infants cannot be made from the available evidence at this time. Infants fed human milk after discharge are of the greatest concern as human milk does not in theory meet the requirements for growth in these infants. Such infants should remain on supplemental vitamins and Fe while breastfeeding, and growth as well as serum levels of phosphorus and alkaline phosphatase should be carefully monitored. The increased risk of preterm infants for obesity and the metabolic syndrome secondary to the metabolic/nutritional events early in life (programming) is likely to be small compared with the contribution of other risk factors, such as parental size, weight as an adolescent, and various lifestyle factors such as physical activity.
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6.
[Human milk, immune responses and health effects].
Løland, BF, Baerug, AB, Nylander, G
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. 2007;(18):2395-8
Abstract
BACKGROUND Besides providing optimal nutrition to infants, human milk contains a multitude of immunological components. These components are important for protection against infections and also support the development and maturation of the infant's own immune system. This review focuses on the function of some classical immunocomponents of human milk. Relevant studies are presented that describe health benefits of human milk for the child and of lactation for the mother. MATERIAL AND METHODS Relevant articles were found mainly by searching PubMed. RESULTS AND INTERPRETATION Humoral and cellular components of human milk confer protection against infections in the respiratory--, gastrointestinal--and urinary tract. Human milk also protects premature children from neonatal sepsis and necrotizing enterocolitis. There is evidence that human milk may confer long-term benefits such as lower risk of certain autoimmune diseases, inflammatory bowel disease and probably some malignancies. Human milk possibly affects components of the metabolic syndrome. Recent studies demonstrate long-term health benefits of lactation also for the mother. A reduced incidence of breast cancer is best documented. An increasing number of studies indicate protection against ovarian cancer, rheumatoid arthritis and type II diabetes.
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7.
High concentrations of procalcitonin but not mature calcitonin in normal human milk.
Struck, J, de Almeida, P, Bergmann, A, Morgenthaler, NG
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2002;(8):460-5
Abstract
Procalcitonin (PCT) is one of the precursors in the synthesis of calcitonin in thyroidal C-cells and other neuroendocrine cells. PCT and other calcitonin precursors in serum are present at less than 50 pg/ml in healthy individuals, but are highly elevated in serum where conditions leading to systemic inflammatory response syndrome or sepsis prevail. We measured PCT concentrations in milk and serum samples taken from 9 healthy women after delivery. PCT concentrations were below 10 pg/ml in serum samples, but were more than 100 times as high in the corresponding milk samples. PCT in milk reached a maximum within the early days after delivery, with a median peak concentration of 2310 pg/ml (range 223 - 4224 pg/ml) at day one and 2442 pg/ml (range 952 - 4488 pg/ml) at day two, then declining over the next days to a median concentration of 747 pg/ml (range 443 - 1656 pg/ml) at day 10 (p = 0.012, by Friedman ANOVA). PCT values reached a steady state of 504 pg/ml median value. Mature calcitonin values measured in parallel with a specific assay were not above the normal range of 10 pg/ml in any samples measured. The strong discrepancy between serum and milk PCT suggests that PCT (but not mature calcitonin) is synthesised in the breast of healthy mothers after delivery. The precise mechanism and the physiological relevance are unclear. Since PCT levels increase drastically in serum from patients suffering from sepsis and related conditions, and since PCT has been ascribed a pro-inflammatory function, we propose that milk PCT might contribute to the activation of the developing neonatal immune system. Similar speculations were proposed for a variety of other pro-inflammatory cytokines, which had comparable kinetics in human milk.