Long term health is affected by maternal nutrition

This month, the British Medical Association (BMA) Board of Science has published a report on Early Life Nutrition and Lifelong Health.  The report reviews the evidence that the diets of women of reproductive age, and those of their foetuses and young children, are significant factors in influencing the risk of chronic diseases such as heart disease, diabetes, obesity, brittle bone disease and even some forms of cancer and mental illness, later in those children’s lives.

Lead author Professor Mark Hanson, director of the Centre for the Developmental Origins of Health and Disease at the University of Southampton, comments:

“Society and public health organisations need to pay much greater attention to these issues if the rising epidemic of these diseases is to be prevented. Tackling the diseases once children reach adulthood is often too late. By taking steps to improve maternal nutrition we could save many people from a lifetime of ill health.”

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Unbalanced nutrition can result from both inadequate and excessive dietary intakes, and both can exist at the same time in many populations. Moreover diets which lead to over-nutrition (e.g., excess calories) are often micronutrient poor.

There is strong evidence that undernutrition (stunting or wasting) during the first two years of life leads to impaired adult cognitive, physical and economic capacity, which cannot be repaired even if nutrition improves later in childhood.

Improved availability of energy-rich foods has however, enabled large numbers of people to escape from hunger. This has brought considerable benefits, but is already giving rise to obesity and obesity-related disease. Developing countries are reporting high rates of coronary heart disease (CHD) and type 2 diabetes that have appeared in one or two generations to become leading causes of morbidity and mortality. These epidemics are expected to intensify.  By the year 2030, the prevalence of diabetes is predicted to rise by over 100 per cent in India, China, sub-Saharan Africa, Latin America, the Caribbean and the Middle East; an increase far exceeding that in high-income countries (54%).

There is good evidence that an increased deposition of fat tissue in foetuses and babies is an outcome of both undernutrition and excessive nutrition.  Low birth weight babies born to underweight women in India have proportionately more fat than would be expected for their body weight.  Maternal obesity, another form of maternal malnutrition, also increases the fat tissue of the foetus and newborn baby. This phenomenon is exacerbated further if maternal obesity is complicated by gestational diabetes.

Extremes of maternal body composition, either excessive thinness or obesity, are associated with adverse patterns of foetal and infant development leading to poorer long-term health.

“It’s not only women who need to be careful about the quality of their food intake. Prospective fathers should also eat well and steps need to be taken to ensure that young people understand the importance of good nutrition as part of their lifestyle choices.”

The numbers of women who breastfeed their infants is still too low, with many women starting to breastfeed but then stopping too soon, and many infants being fed inappropriate foods at the weaning stage.  Breastfeeding rates in the UK are much lower than in many European countries. Less than1 per cent of mothers in the UK are exclusively breastfeeding at six months.

breastfeeding1

While there are gaps in the evidence about the long-term consequences of poor maternal and infant nutrition, and we do not as yet understand the mechanisms fully, it is clear that steps need to be taken to promote healthy diets in young women and their families, to encourage breastfeeding and the use of appropriate complementary foods.

More advice could be given to people with young children about the importance of a balanced diet for those children and more support could be given to women to help them start breastfeeding and to continue with it.

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Obesity in children

Overweight and obesity among children is widely regarded as being even more serious than it is among adults, with a very rapid rise in prevalence in the last two decades. Child obesity is likely to continue into adulthood, and many of the problems linked to obesity are more severe if the obesity has been present for a long period. Adults with the highest risk of diabetes, cardiovascular disorders, liver malfunction and orthopaedic dysfunction, are likely to have the most extreme levels of obesity and to have been obese since childhood[i].

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Projections of child obesity based on trends from the 1980s and 1990s indicate that the annual increase in child obesity prevalence is itself increasing[ii]. By the year 2010, some 26 million school children in the EU are expected to be overweight, of which 6 million will be obese. The numbers of overweight children will rise by some 1.3 million per year, of which the numbers of obese children will rise by over 0.3 million per year.

At a conservative estimate, over a million obese children in the EU are likely to show a range of indicators for cardiovascular disease, including high blood pressure and raised blood cholesterol levels, and to have three or more indicators of the metabolic syndrome[iii]. Over 1.4 million children could have early stages of liver disorder.

The costs of childhood obesity have not been estimated but should include lost educational opportunity. A study of children’s quality of life found the psychological effects of severe obesity to be equivalent to a diagnosis of cancer[iv].

Behaviour, learning and mental health problems in children are rising as fast as rates of obesity and diabetes. Food affects brains as well as bodies, and early malnourishment can have devastating effects on both. Conversely, improving nutrition can help reduce antisocial behaviour as well as symptoms of ADHD, dyslexia, depression and related conditions[v].

The only pan-European estimates of children’s food consumption patterns are from self-reported surveys of health behaviours of children aged 11-15 years[vi]. The most recent (for 2001-2002) found:

  • In virtually all countries fewer than 50 per cent of children ate vegetables every day. On average, 30 per cent of children said they ate vegetables daily, but the children in countries once famous for their Mediterranean diets reported lower than average levels, especially Spain, where vegetables were typically eaten daily by only 12 per cent of children.
  • In virtually all countries fewer than 50 per cent of children ate fruit every day. On average, 30 per cent of boys and 37 per cent of girls reported eating fruit daily, but in sixteen countries only 25 per cent of children were eating fruit more than once a week. Lowest levels of consumption were reported among children in Northern European countries.
  • Soft drinks and confectionery were consumed daily by about 30 per cent of children (over 40 per cent in some countries).

According to the last National Diet and Nutrition Survey in the UK[vii]:

  • 92 per cent of children consume more saturated fat than is recommended
  • 86 per cent consume too much sugar
  • 72 per cent consume too much salt
  • 96 per cent do not consume enough fruit and vegetables

Governments are trying to improve children’s diets, but young people’s exposure to marketing pressures in our time-poor, anxiety-ridden, media-driven society is at an all-time high.

Widespread action is needed to reverse current trends – and we all need to take responsibility for what we are feeding young bodies and minds.

In a Cooking for Health class focused on Healthy Cooking for Your Children, we look at:

  • The best and the worst food for children
  • Easy steps to free your child from food traps
  • Simple, child-friendly recipes
  • Practical tips to help your child make the best food choices

The class involves 100% hands-on practical cooking in a small, supervised group, combined with teaching of up-to-date information and research findings on the effects of diet on health. Clear, easy-to-follow presentations and handouts are provided with plenty of opportunity for questions and discussion.

References

[i] Policy options for responding to obesity. Summary report of the EC-funded project to map the view of stakeholders involved in tackling obesity – the PorGrow project. Dr Tim Lobstein and Professor Erik Millstone. http://www.sussex.ac.uk/spru/porgrow

[ii] Jackson-Leach R, Lobstein T. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. Int J Pediatric Obesit 2006;1:26-32.

[iii] Lobstein T, Jackson-Leach R. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. Int J Pediatric Obesity 2006;1:33-41.

[iv] Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. J Am Med Ass 2003;289:1813-9.

[v] Richardson, A. They Are What You Feed Them. Harper Thorsons (5 Jun 2006)

[vi] HBSC. Young people’s health in context: Health Behaviour in School-aged Children 2001/2002. Health Policy for Children and Adolescents 4. C Currie et al (eds) Copenhagen: WHO Regional Office for Europe, 2004.

[vii] Gregory, J. et al. National Diet and Nutrition Survey: Young People Aged 4-18 years (The Stationery Office, 2000)

 

 

 

Obesity begins at home

Researchers at the University of California have found that adolescents are more likely to eat at least five servings of fruit and vegetables a day if their parents do.  In contrast, teenagers whose parents consume fast food and fizzy drinks are more likely to do the same.

boy_with_vegetables

A survey of thousands of teenagers revealed that:

  • Teens whose parents drink soft fizzy drinks every day are nearly 40 percent more likely to drink fizzy drinks themselves than teens whose parents do not drink fizzy drinks
  • Teens whose parents eat five servings of fruit and vegetables daily are 16 percent more likely to do the same than teens whose parents who do not eat five servings a day
  • Nearly half of adolescents (48 percent) whose parents drink fizzy drinks every day eat fast food at least once a day, while only 39 percent of teens whose parents who do not drink fizzy drinks eat fast food once daily
  • 45 percent of teens whose parents do not eat five servings of fruit and vegetables daily eat fast food at least once a day, while only 39 percent of teens whose parents eat five servings a day eat fast food at least once daily

“The research shows us that one of the keys to solving the teen obesity crisis starts with parents, but we must also improve the abysmal food environments in many low-income communities,” said Dr Robert K. Ross, president and chief executive officer of the California endowment.  “While parents are the primary role models for their children and their behaviour can positively – or negatively – influence their children’s health, it is also essential that local officials representing low-income communities work to expand access to fruit, vegetables and other healthful foods”.

Educating parents about healthy food choices, as well as how to plan and prepare healthier meals, would help in rducing teenage obesity, according to the authors of the policy brief. 

They also recommend employment policies that promote a better work-life balance.  Given more flexible working hours, more families might have time to prepare food at home and engage more often in family meals – an activity that has been linked to healthier lifestyles.

For more information on courses available on choosing and preparing healthy food for your children see Healthy Cooking for Your Children.

Jane Philpott, Cooking for Health