Long-Term Health Impact of Early Nutrition: The Power of Programming

Abstract

The Power of Programming conference 2016 at Ludwig-Maximilians-Universität Munich brought together about 600 researchers and other stakeholders from around the world who reviewed the recent evidence on the lasting health impact of environment and nutrition during early life, from pre-pregnancy to early childhood. The conference was hosted by the Early Nutrition Project, a multidisciplinary research collaboration funded by the European Commission with collaborating researchers from 35 institutions in 15 countries in Europe, the United States and Australia. The project explores the early origins of obesity, adiposity and associated non-communicable diseases, underlying mechanisms and opportunities for prevention. The project also proactively supports translational application of research findings. In fact, some existing evidence has already been rapidly adopted into policy, regulatory standards and practice. Further, broad dissemination of findings is achieved through the established digital eLearning platform of the Early Nutrition eAcademy, video clip-based learning and graphically supported messaging to consumers. The project demonstrated powerful effects of early metabolic programming on later health. Compared to other common prevention strategies, modifying risk trajectories in early life can achieve a much larger risk reduction and be more cost-effective. While some effective prevention strategies have been promptly implemented in policy and guidelines, legislation and practice, in other areas, the uptake is limited by a paucity of quality human intervention trials and insufficient evaluation of the feasibility of implementation and econometric impact. This needs to be strengthened by future collaborative research work.

Accelerated Weight Gain Subsequent to Postnatal Slow Weight Gain and Overweight Risk in Early Childhood: A Nested Case-Control Study

“…Although the order between weight faltering and catch-up gain was opposite, a cohort study in South Africa reported that a transient catch-up weight gain during infancy, followed by weight growth faltering, is linked to higher adiposity in early adulthood [24]. Taken these studies, systematic reviews, meta-analysis, and proposals together, 1 hypothesis might be that the association found in the 7 cases presented here between AWG and overweight status at 3 years of age is influenced by a mismatch in postnatal under-nutrition and subsequent over-nutrition until early childhood, similar to the mismatch seen between fetal programming as an epigenetic change and subsequent postnatal catch up growth [20]. However, the possibility that the regulation and programming of growth rates during postnatal early life is altered only by a short period of PSWG remains to be established.…”

“…): fetal over-nutrition, accelerated postnatal growth, and a mismatch between fetal under-nutrition and postnatal over-nutrition [19,20]. Interestingly, a large longitudinal prospective cohort study has reported that term infants exhibiting early slow weight gain (<-1.645SDS) during the first 8 weeks of life returned to a normal mean weight SDS through recovery up to 2 years of age, and also remained around a normal weight range until 13 years of age [2].…”

Impact of Micronutrient Status during Pregnancy on Early Nutrition Programming

“…During this period, phenotypic development is more susceptible to change in response to environmental factors, although there is also evidence that (a) nutritional status before conception is also important, and (b) there is ongoing plasticity (albeit more limited) beyond this period [19,20]. Early nutrition is arguably one of the most significant environmental determinants of an offspring's cell structure, epigenome, metabolome, hormones and microbiome [16,19]. Epigenetic modification of gene expression could be one of the key pathways through which early nutrition may modify the developing phenotype, thereby inducing powerful effects on long-term health trajectories and disease risk [2,20].…”

“…The most studied epigenetic modifications include histone modification, non-coding RNAs and DNA methylation [20]. Nutritional effects on the latter have been documented and represent a logical mechanism to explain the relationship between early nutrition and long-term health [2,14,16,22]. While the concept of early nutrition programming and the long-term repercussions has been widely accepted by the scientific community [16,23], this concept is still largely unknown to many women and healthcare providers.…”

“…Here, we use the term "nutrition programming", as defined before (e.g., [2,13,14]), recognising these broad-ranging consequences. This is reflected in the increasing evidence that early nutritional patterns have long-term multisystem effects on health and risk of common non-communicable diseases (e.g., obesity and metabolic disease, immune diseases, and an extensive range of inflammatory and degenerative diseases) across the life course [14][15][16].…”