Nutrition over the life course

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Information about Nutrition over the life course
Health & Medicine

Published on March 7, 2014

Author: g.tognon



My lecture at the course in lifecourse epidemiology, describing nutrition topics along the lifespan.

Nutrition over the life cycle Gianluca Tognon

The lifecourse model  Critical period model  Critical period influences with later modifiers of their effects  Accumulation of risks with correlated results (one adverse or protective experience brings to another adverse or protective experience)  Accumulation of risks with independent and uncorrelated results

Dietary assessment methods Food records Food frequency questionnaire 24h dietary recall Diet history

LIFECOURSE TOPICS IN NUTRITION Breastfeeding Food contaminants Children and adolescents Diet and cancer Diet and the elderly Diet and cardiovascular disease Go to the conclusions

Breastfeeding  Which are the WHO recommendations for breastfeeding?  And for complementary foods/weaning?

WHO Recommendations for breastfeeding  Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond  Breastfeeding should begin within one hour of birth  Breastfeeding should be "on demand", as often as the child wants day and night  Bottles or pacifiers should be avoided

Guidelines for complementary foods and weaning (WHO)  Start to give complementary foods at 4-6 months  7-12 months: continue breast-feeding as often as the baby wants. Give the child complementary food regularly, about 3-5 times per day  Do not give glucose drinks, sodas, and soft drinks, and avoid giving spicy foods to the baby  When the baby is already taken to eating, give mixes of complementary food  Continue to breast-feed the child up to 2 years and beyond

 breastfeeding should not be decreased when starting on solids  food should be given with a spoon or cup, not in a bottle  food should be clean, safe and locally available  ample time is needed for young children to learn to eat solid foods

Breast milk substitutes An international code to regulate the marketing of breastmilk substitutes was adopted in 1981. It calls for:  All formula labels and information to state the benefits of breastfeeding and the health risks of substitutes  No promotion of breast-milk substitutes  No free samples of substitutes to be given to pregnant women, mothers or their families  No distribution of free or subsidized substitutes to health workers or facilities Back to the questions

Children and adolescents  Malnutrition and undernutrition affect childhood health in a very serious way. These two terms are often used interchangeably, but do they really mean the same?  Which are possible causes and consequences of these conditions?

Malnutrition and Undernutrition  Malnutrition: A physical condition in which people experience either nutrition deficiencies (undernutrition) or an excess of certain nutrients (overnutrition)  Undernutrition: The physical condition resulting from deficiencies in one or several macro- and micronutrients. It impairs growth, pregnancy, lactation, physical work, cognitive function, and disease resistance and recovery

Undernutrition Undernutrition encompasses: Stunting: low height for age Wasting: low weight for age Deficiencies of vitamins and minerals

Causes of undernutrition: biological & environmental  Maternal malnutrition before and/or during pregnancy (underweight newborn)  Infectious diseases (diarrheal disease, measles, AIDS, tuberculosis and others)  Overcrowded and/or unsanitary living conditions (which increase the likelihood of infections)  Agricultural patterns, droughts, floods, wars and forced migrations

Social and economic causes  Poverty  Low/No education  Inadequate weaning practices (withdrawal of breastmilk or inadequate nutrient composition)  Social problems (child abuse, maternal deprivation, abandonment of the elderly, alcoholism, drug addiction)  Cultural and social practices (food taboos, food and diet fads)

Consequences of chronic hunger  Most undernourished people do not starve to death, they die because their health has been compromised by dehydration from infections that cause diarrhea  Undernutrition reduces mental and physical development in children and makes people susceptible to potentially fatal infections  Consequences of unrelieved hunger include stunted growth, poor learning, extreme weakness, clinical signs of protein-energy malnutrition (PEM), increased susceptibility to disease, loss of the ability to stand or walk, premature death

Undernutrition in early life and risk of obesity and T2D in adulthood  Disturbed growth due to undernutrition during fetal life, infancy or childhood results in early metabolic adaptations  These adaptations may be beneficial for shortterm survival, but can increase the risk of chronic diseases, including obesity and T2D in the long term  The combination of low birth weight and rapid childhood growth has been associated with increased central fat deposition and insuline resistance

Back to the questions

Diet and the elderly What is sarcopenia? Which dietary factors are important in its management?

Sarcopenia  Age-related loss of muscle mass, strength and performance  The decline in skeletal muscle mass with aging is attributed to a disruption in the regulation of skeletal muscle protein turnover (synthesis/turnover)  The major factors considered to be involved include inflammation, hormonal changes, neurological factors, physical inactivity and inadequate nutritional intake (vitamin D and protein intake)

 Poor muscle strength is a major public health concern in older persons because it predisposes to poorer function and greater risk of falls, disability, and death  Several chronic conditions such as stroke, diabetes mellitus, arthritis, coronary heart disease, and chronic obstructive pulmonary disease seems to be associated with steeper strength decline and low handgrip strength

 22-year follow-up data  Determinants of muscular strength decline:  physically strenuous work and becoming physically sedentary  excess body weight  smoking  cardiovascular disease, hypertension, diabetes mellitus, asthma in midlife  pronounced weight loss  chronic bronchitis

Dietary proteins  It has been suggested that 25-30 g of dietary protein per meal is required to allow an appropriate stimulation of postprandial muscle protein synthesis  Dietary protein intake should be overall equal to 1.2-1.5 g/kg/day to attenuate muscle loss compared to the recommended intake of at least 0.8 g/kg/day  Dietary protein supplementation might be a possible strategy

Vitamin D  The reduction in endogenous vitamin D synthesis together with low vitamin D intakes result in a high prevalence of vitamin D deficiency among elderly people  Low vitamin D has been associated with poor muscle mass and impaired physical performance in the elderly  The activation of the vitamin D receptor in skeletal muscle tissue seems to stimulate muscle protein synthesis, preventing atrophy  Another mechanism is the regulation of calcium pumps and therefore, calcium concentration and muscle contraction performance 7-Dehydrocholesterol Back to the questions

Food contaminants  What’s an endocrine disruptor?  Can you name at least two endocrine disruptors that can be found in food?  Why are they interesting issue for life course epidemiology?

Endocrine disruptors Endocrine disruptors are chemicals that may interfere with the body’s endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans and wildlife Dioxins PCBs Bisphenol A Polyflorinated compounds (e.g. teflon) Brominated flame retardants

Old and new acquaintances  Old acquaintances:  Dioxins (ED, carcinogenic and teratogenic)  PCBs (109 congeners, interfere with thyroid hormones, toxicity evaluated with TEF and TEQ)  PAHs (combustion products which are carcinogenic metabolites)  New acquaintances:  Perfluoroctans (ED and carcinogenic contained in cleaning products, food containers, cardboard, photographic films, shampoos, toothpastes, lubricants for bicycles, garden tools, Teflon, Goretex, pesticides)  Flame retardants (very common, ED; contain bromine, many are produce dioxins or by incineration)  Phenols (ED; contained in plastic products, degreasing solutions, paints, plastics, pesticides).  Phthalates (ED, some are carcinogenic, their use is becoming less frequent, classically in PVC and in the films)

Mother and child  Endocrine disruptors accumulates in the human (and animal) body fat tissue over the entire life  Unfortunately, one of the mechanisms through which the body eliminates chemicals is breastfeeding  However, breastfeeding is discouraged only in women who have been exposed to chemical exposure  Exposure during gestation of certain compounds (e.g. PCBs) can affect thyroid hormones and thus, nervous system’s development Back to the questions

Diet and cancer  Some years ago, the WCRF released an expert report about diet and cancer. Can you remember at least some of the recommendation made by WCRF?  What do you know about antioxidants? Are they really so important and why?

 The concentration of antioxidants from food reaches very low levels in the organism (much lower than glutathione)  Not all oxidative processes happening inside the body are necessarily negative   Bioactive substances in fruit and vegetables might work through mechanisms other than protection from oxidation and at low concentrations: no need to use supplements and supplemented foods!

INCREASED RISK DECREASED RISK Oral cavity, pharynx, larynx Alcoholic beverages Non-starchy vegetables and carotenoidrich foods Esophagus Alcoholic beverages Non-starchy vegetables, Fruit, carotenoid and vitamin C-rich fruit Stomach Salt, Salted foods Non-starchy vegetables, garlic and fruit Colon-rectus Red meat, processed meats Alcoholic drinks (men) Fiber-rich foods, Milk, Calcium, Garlic Alcoholic beverages (women) Breast pre-menopause Alcoholic beverages Breast post-menopause Alcoholic beverages Prostate High-calcium diets Convincing reduction Probable increase Licopene and selenium-containing foods Probable reduction Convincing increase Breastfeeding Modified from: WCRF 2007

INCREASED RISK Arsenic in drinking water, beta-carotene supplements Lung DECREASED RISK Fruit, carotenoid-rich foods Aflatoxins Liver Alcoholic beverages PANCREAS Skin Folate-rich foods Arsenic in drinking water Convincing reduction Probable reduction Convincing increase Probable increase Back to the questions

Diet and cardiovascular diseases  Are obese at an increased risk of mortality compared to normal weight people?  What are trans fatty acids? Why they are dangerous?  How would you define a ”Mediterranean diet pattern”?

Physiology. The health risk of obesity--better metrics imperative. Science 2013,

Trans fatty acids  Natural TFAs constitutes a small portion of the human diet and mostly come from dairy products  The intake of TFAs has increased since the advent of fat hydrogenation (e.g. margarines)  In natural isomers the double bond is generally at C11 (e.g. vaccenic acid), while in technologically-produced ones it is generally between C4 or C10  The most common TFA in partially hydrogenated vegetable oils is the elaidic acid (trans-18:1 n9/∆9), a trans isomer of the oleic acid

The Mediterranean dietary pattern • One of the most cited examples of dietary pattern, repeatedly shown to be positively associated with a good health • The first evidence of the beneficial effects of the Mediterranean diet came years ago from the Seven Country Study (Keys, 1980)

Mediterranean diet, health and longevity The Mediterranean diet was first considered protective against coronary heart diseases (de Lorgeril et al., 1999) In other studies, beneficial effects on total mortality reduction have been discovered (Trichopoulou et al., 2005) Two recent literature meta-analyses showed that the Mediterranean diet is associated with a better health status overall (Sofi et al., 2008 & 2010)

 The general features of this pattern are a high or moderately high intake of:  cereals (that in the past were largely unrefined)  olive oil (or in general higher unsaturated than saturated fat intake)  fruit, vegetables and legumes  nuts and seeds  fish  alcoholic beverages, but mostly red wine, generally during meals And a low or moderately low intake of  dairy products  meat and meat products Back to the questions High intakes Low intakes Mediterrean diet score

Final considerations

Thank you! Gianluca Tognon

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