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Infant nutrition:The first 1000 days and thelong-term impact on health

This article is reprinted from: New Food, Volume 19, Issue 1, 2016

Nutrition in this period is particularly crucial2,3. Early nutrition wields bothshort and long-term effects on the health of an infant, by programmingthe infant’s development4. Evidence suggests that this ‘developmentalprogramming’ has a long-lasting effect on the risk of obesity in later life,and in turn, associated non-communicable diseases; type 2 diabetes,hypertension and cardiovascular disease5.

Childhood obesity is an increasingly concerning topic; in 2013 it wasestimated that over 42 million children under the age of five yearsworldwide were overweight or obese6. The latest figures in the UK foundthat over a quarter of children aged 2-10 were overweight or obese7.Overweight and obese children are likely to remain overweight or obeseinto adulthood, increasing their risks of developing non-communicablediseases at a younger age6.

Importance of breastfeedingGlobal guidelines recommend exclusive breastfeeding for the first six months of an infant’s life, and breastfeeding in combination with suitable, nutritionally balanced complementary foods beyond

that8,9. Breastfeeding is undoubtedly the best method of infant feeding, not only because breast milk is nutritionally superior, but it also has unique advantages that are not possible to replicate with bottle-feeding10.

Research into the benefits of breastfeeding for both the infant andthe mother, shows that these benefits are not due to the breast milkalone, but rather breastfeeding as a whole. Benefits for the motherinclude, but are not limited to, a reduced risk of breast and ovariancancers11,12, and a strengthening of the emotional bond with their infant.

Breastfed infants are at a reduced risk of developing allergies, gastro-intestinal and respiratory infections, and urinary tract infectionscompared to formula-fed infants13. Additionally, breastfed infants are at areduced risk of being overweight or obese in later life, and therefore at a reduced risk of the associated health issues such as hypertension,diabetes and cardiovascular disease14,15,16. A meta-analysis has shownthat the risk of becoming overweight is reduced by 4% for eachadditional month of breastfeeding and the benefits of breastfeeding arestill apparent with partial/combination feeding16.

It has been recognised by health experts, that the first 1000 days – from conception to a child’s second birthday – is acritical window of opportunity to influence the future health outcomes1. This critical period is the most influentialtime in a young child’s life, their behaviours and the nutrition they get in this time helps to set their future foundationsfor life and can have an impact on their health and happiness later in life2.

The first 1000 days and thelong-term impact on health

I N F A N T N U T R I T I O N

Reprinted from: New Food, Volume 19, Issue 1, 2016 2 www.newfoodmagazine.com

© Dmitry Lobanov / Shutterstock.com

■ Rosie LongNutrition Graduate, Nestlé UK

Breastmilk substitutesAlthough it is thought that almost all mothers canbreastfeed successfully, it has been acknowledged that asmall number of health conditions may justify therecommendation to cease breastfeeding temporarily orpermanently17, in which case there is an explicit need forsuitable breastmilk substitutes. In addition to this medicalneed, some women in the UK choose not to initiatebreastfeeding, and many of those who do start change toformula feeding within six weeks of the baby’s birth, forvarious reasons.

That being said, the duration of breastfeeding is on theincrease in the UK, with one in three mothers found to bestill breastfeeding to some degree at six months in 2010,compared to one in four mothers in 200518,19. Additionally,breastfeeding initiation is also on the rise, with figuresshowing that in 2010 81% of mothers started breast -feeding, compared to 76% in 200518,19. Although 81% ofmothers across the UK initiated breastfeeding at birth in2010, this dropped to 69% at one week, 55% at six weeks,with just 34% of mothers still breastfeeding at six months18.Additionally, 92% of infants have received some infant formula by the age of six months19.

Infant formula is commercially known as ‘First’ Infant Milk, and is theonly recommended alternative to breastmilk for infants aged youngerthan six months18,20. Infant formula is nutritionally complete and usuallymade from a base of cows’ milk. Breastmilk naturally contains all theessential nutrients an infant needs, and is adaptable to the infant’srequirements over time. Infant formula isdesigned to mimic breast milk as closely asscientifically possible21, but does not have theability to adapt in response to the infant’s needs.If an infant is not being breastfed after sixmonths, follow-on formulae are available. Theseare fortified milks with increased levels of certain nutrients, such as ironand vitamin D, designed to help meet infant’s needs at this age.

Regulations for infant formula and follow-on milksAll formulae intended for infants must be safe and suitable to meet thenutritional needs of infants and promote healthy growth anddevelopment when consumed exclusively during the first six months oflife. At six months, when complementary foods are introduced to aninfant’s diet, nutrients should be added to the formulae only in amountsnutritionally beneficial to the infant22.

Infant formulae and follow-on formulae are products designedspecifically to satisfy the nutritional needs of healthy infants. The nutritional compositions, labelling, marketing and advertising ofthese formulae are covered in the Commission Directive 2006/141/EC23.The composition of these products is tightly regulated; protein, fat,carbohydrate, minerals, vitamins are controlled and include, whennecessary, minimum and maximum values.

Protein – what is it and why is it so important?Childhood obesity is a serious public health concern. It is recognised thatbreastfed infants are the benchmark for appropriate growth in infancy;

this is because breastfeeding is the ideal way for an infant to be fed. This is reflected in the most recent WHO Growth Charts, which are based on breastfed infants24. Breastfed infants gain weight more slowly intheir first year of life than formula-fed infants, which could go some way to contributing to their decreased risk of becoming overweight orobese in later life21,25.

There are various reasons why breastfed infants are less likely to be overweight or obese in later life thanformula-fed infants. It has been suggested thatelevated intakes of protein in infancy, can have adverse effects on weight in later life26.Research suggests that the lower protein intake and slower growth of breastfed infants

could be partially responsible for the decreased risk of overweight andobesity in breastfed infants.

Protein is an essential nutrient for growth and repair of the body, andis important for the maintenance of good health. Proteins arefundamental structural and functional components of every cell in thebody, and are made up of long chains of amino acids. Out of 20 aminoacids found in proteins, eight of these are defined as essential. In infantsand young children an additional seven are considered to beconditionally essential. This is because infants and young children areunable to make enough of these amino acids rapidly enough to meettheir high needs for growth27. The amino acid content of breastmilk is thebest estimate of the requirements of an infant24. Of the essential aminoacids, four – threonine, valine, leucine, and isoleucine – have beenshown, when supplied in excess, to be associated with an increasedsecretion of insulin (insulinogenic amino acids)26.

The accelerated growth hypothesis is a proposed explanation of thecontribution of protein to childhood obesity5.

The ‘early protein’ hypothesis suggests that high protein intakesduring early life has subsequent impact on overweight and obesity risk inlater life. The proposed mechanism links excess protein intake – andtherefore excess insulinogenic amino acid intake – to hormonal

www.newfoodmagazine.com 3 Reprinted from: New Food, Volume 19, Issue 1, 2016

I N F A N T N U T R I T I O N

Breastfeeding is undoubtedly thebest method of infant feeding

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Protein is an essential nutrient for growth and repair of the body,

and is important for the maintenance of good health

responses, such as the stimulation of insulin and insulin-like growthfactor-I (IGF-1). This insulin and IGF-1 release may result in acceleratedgrowth and increased adiposity5,28,29.

Innovation and reformulation of infant formula and follow-on milksA study by Weber et al. (2014) on the effect of higher protein formu-lae during the first year of life, in comparison to lower protein formulaesupports the option to lower the protein content of infant formulae andfollow-on formulae. It was concluded that infants fed a lower proteinformula were at a reduced risk of obesity at age six30. In response to themost recent science, the European Food Safety Authority has stated thatinfants are generally receiving protein in excess, so the protein of infantand follow-on formulae could be reduced22.

In response to these statements, in recent years, some companieshave lowered the protein content of their infant formulae and follow-on formulae. However, EU regulations place limitations forprotein reduction in these products, with a minimum protein level of1.8g/100 calories required for both infant and follow-on formulae23.

Additionally, protein reduction is a complex process which affectsthe overall stability of the milk, as well as the mineral content31. It is alsoimportant when reducing the protein content of infant and follow-onformulae that the overall quality of amino acids is considered, withbreastmilk being the best model for quality24. Manipulation of the proteininvolves reducing the amount of insulinogenic essential amino acids toensure that these are not available in excess, whilst ensuring essential

amino acid needs are met. The aim of making these compositionchanges to infant formulae and follow-on formulae, is to achieve aslower growth rate of formula fed infants, comparable to that of a breastfed infant, and in turn to reduce the risk of becoming overweightor obese to formula-fed infants.

ConclusionIn conclusion, the first 1000 days – from conception to two years – is acritical time period for shaping the future of an infant. In particular,nutrition in this time frame is key for the future development and health ofinfants. The risk of childhood obesity may be significantly reduced if infants breastfeed – which remains the best possible nutrition in earlylife. However, when exclusive breastfeeding is not possible, or is notchosen, infant formulae must support the nutritional needs of the infant.Research suggests that the protein quantity and quality in infant formulaeand follow-on formulae should be addressed and adapted to moreclosely mimic the protein composition of breastmilk, in an effort toachieve a slower growth pattern, similar to that of breastfed infants.

I N F A N T N U T R I T I O N

Reprinted from: New Food, Volume 19, Issue 1, 2016 4 www.newfoodmagazine.com

1. United Nations System (2006). The double burden of Malnutrition- a challenge for cities worldwide. Third World Urban Forum SCN Statement, Vancouver 19-23 Junehttp://www.unsystem.org/scn.

2. Save the Children (2012). Nutrition in the First 1000 Days: State of the World’s Mothers 2012.Available: www.savethechildren.org.nz/assets/599/Mothers%202012%20Asia20lr.pdf. Accessed:January 2016

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16. Harder T, Bergmann R, Kallischnigg G et al. (2005). Duration of breast-feeding and risk ofoverweight: a meta-analysis. Am J Epidemiol. 162, 397-403.

17. World Health Organisation. (2009). Acceptable medical reasons for use of breast-milk substitutes.Available: http://apps.who.int/iris/bitstream/10665/69938/1/WHO_FCH_CAH_09.01_eng.pdf.Accessed: January 2016.

18. McAndrew F, Thompson J, Fellows L et al. (2012). Infant Feeding Survey 2010. Health and SocialCare Information Centre. Available: http://www.hscic.gov.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf Accessed: January 2016

19. Bolling K, Grant C, Hamlyn B et al. (2007). Infant Feeding Survey 2005. Health and Social CareInformation Centre. Available: http://www.hscic.gov.uk/catalogue/PUB00619/infa-feed-serv-2005-chap1.pdf. Accessed: January 2016

20. Department of Health. (2003). Infant Feeding Recommendations. Available: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4096999.pdf Accessed: January 2016

21. Lönnerdal B. (2008). Personalizing Nutrient Intakes of Formula-Fed Infants: Breast Milk as aModel. Nestlé Nutr Workshop Ser Pediatr Program. 62, 189-203.

22. European Food Safety Authority (EFSA), (2014). Scientific Opinion on the essential composition ofinfant and follow-on formulae. Available: http://www.efsa.europa.eu/sites/default/files/scientific_output/files/main_documents/3760.pdf Accessed: January 2016.

23. European Commission. (2006) Directive 2006/141/EC on infant formulae and follow-on formulaeand amending Directive 1999/21/EC. European Commission.

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27. British Nutrition Foundation. (2015). Protein. Available: https://www.nutrition.org.uk/nutritionscience/nutrients-food-and-ingredients/protein.html Accessed: January 2016

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30. Weber M, Grote V, Closa-Monasterolo R et al. (2014). Lower protein content in infant formulareduces BMI and obesity risk at school age: follow-up of a randomized control trial. Am Soci Nutr.99, 1041- 1051

31. Hardwick J and Sidnell A. (2014). Infant nutrition – diet between 6 and 24 months, implications forpaediatric growth, overweight and obesity. Nutrition Bulletin. 39, 354-363.

References

Rosie Long works as a Nutrition Graduate at Nestlé UK inGatwick, United Kingdom. She has recently graduated fromBournemouth University with a BSc (Hons) in Nutrition, and isan Associate Nutritionist on the UK Voluntary Register ofNutritionists. She has worked on a number of projects withinSMA Nutrition and has developed a specific scientificknowledge of infant nutrition.

About the Author