Early Nutrition: the opportunity for childhood obesity prevention

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Spain Member of the ESPGHAN Committee on

1 Early Nutrition: the opportunity for childhood obesity prevention Prof. Cristina Campoy Department of Paediatrics. University of Granada. Spain Member of the ESPGHAN Committee on Nutrition HIGH LEVEL GROUP ON NUTRITION AND PHYSICAL ACTIVITY 23 NOVEMBER 2016

and surpass 21% in women Change 1975-2014

2 Obesity amongst women 2014 By 2025, global obesity prevalence will reach 18% in men and surpass 21% in women Change NCD Risk factor Collaboration, Lancet

3 Prevalence of overweight and obesity in European children and adolescents M: 6.7% F: 7.7% Approximately 43 million children worldwide are estimated to be encountering a problem of obesity; 21-24% children and adolescents are overweight, and 16-18% of individuals have abdominal obesity M: 6.7% F: 5.8% M: 2.5% F: 3.6% M: 6.1% F: 4.1% M: 4.2% F: 2.7% M: 4.3% F: 1.9% Moreno, Pigeot, Ahrens (eds.): Epidemiology of overweight and obesity in children and adolescents. Springer, New York 2011

4 CAUSES OF CHILDHOOD OBESITY Symonds ME, Mendez MA, Meltzer HM et al. Early life nutritional programming of obesity: Mother-Child Cohort Studies. Ann Nutr Metab 2013; 62: Prof. Cristina Campoy. University of Granada.

5 Factors influencing obesity development along childhood Body fat % 35.0 Girls over- fat 30.0 normal- fat Birth 2 mo 4 mo 6 mo 12 mo 24 mo 4 y 6 y 8 y 10 y 12 y 14 y 16 y 18 y Intrauterine Nutrition nutrition Early programming Early postnatal Adiposity rebound Puberty Early postnatal nutrition Early programming Adiposity rebound Sedentarism Physical Activity and Fitness Energy and Macronutrients intake Sedentarism Physical activity and fitness Energy and macronutrient intake Dietary patterns Social and cultural aspects Affective and personal aspects Affective and personal aspects Puberty Genotype Genotype/ / Genetic predisposition (Moreno LA et al. World Rev Nutr Diet 2013;106:119-26)

Mother obesity/diabetes determines pathologic phenomena in the mothers and

.) Morbility (Gestational diabetes, pre-eclampsia, ) Anesthesic

.) FETUS & NEONATE Congenital Defects Perinatal Death Placental dysfunction

6 Mother obesity/diabetes determines pathologic phenomena in the mothers and their offspring MOTHERS Mortality (Venous thrombo-embolism,..) Morbility (Gestational diabetes, pre-eclampsia, ) Anesthesic complications Perinatal complications (Caesaream section, Haemorrhage,..) FETUS & NEONATE Congenital Defects Perinatal Death Placental dysfunction Stillbirth IUGR Macrosomia Shoulder distocy Prof. Cristina Campoy. University of Granada. ccampoy@ugr.es

7 HOW MOTHER S OBESITY AFFECTS THE OFFSPRING? Prof. Cristina Campoy. University of Granada. ccampoy@ugr.es (Adamo et al, 2012)

9 ESPGHAN Committee on Nutrition Coming papers related to the EU Platform topics 1. Complementary Feeding 2015: An updated Commentary by the ESPGHAN Committee on Nutrition 2. Sugar in infants, children and adolescents. A position paper of the ESPGHAN Committee on Nutrition

11 Gene: Environment interaction Bad genes Bad environment Disease

12 Potential environmental epigenetic regulators - animal models Maternal care & stress Endocrine disruptors Folate and micronutrients Multiple dietary compounds Assisted reproduction - superovulation and/or embryo culturing Alcohol exposure Smoking Pollution/heavy metals/particulates Many others emerging

13 Maternal diet and the neonatal epigenome a focus on folate Increasing dietary methyl donors Wolff GL, et al. FASEB J. 1998; 12: 950

14 Vitamin B2 Vitamin B6 Vitamin B12 Choline Folate one carbon donors Diet SAM-e primary methyl donor in all eukaryotes Addition of methyl group to DNA

15 THEME [KBBE ] [Long-term influence of early nutrition on health] Grant agreement nº:

27 Cohort studies analyzing epigenetic influences and the persistence of such signatures GUSTO study (Asia) Danish Cohort Early Nutrition Project (Europe) Nutritional intervention studies in obese pregnant women Limit Trial (Australia) Upbeat Study (UK) Nigo-Health (Spain) Rolo Study (Ireland)

obese pregnant women 1555 women from 8 UK inner city hospitals.

28 UPBEAT UPBEAT A randomised controlled trial of a complex (diet and physical activity) intervention to prevent gestational diabetes and LGA infants in obese pregnant women 1555 women from 8 UK inner city hospitals. UK Pregnancy Better Eating and Activity Trial Poston et al, Lancet Diabetes and Endocrinology 2015

SCIENTIFIC EVIDENCES Evidence that diet and lifestyle modifications during pregnancy can reduce the increased risk of obesity in offspring of obese pregnant women helping to break an

Evidence that excessive weight gain in pregnancy and/or rapid early infant weight gain leads to later obesity will help to formulate policies to reverse the increasing rates of

29 SCIENTIFIC EVIDENCES Evidence that diet and lifestyle modifications during pregnancy can reduce the increased risk of obesity in offspring of obese pregnant women helping to break an intergenerational cycle of obesity and related disorders. Evidence that excessive weight gain in pregnancy and/or rapid early infant weight gain leads to later obesity will help to formulate policies to reverse the increasing rates of childhood obesity and co-morbidities. Evidence that dietary modifications in infancy, in particular relating to breastfeeding and complementary feeding practices, as well as novel compositional approaches to infant formula, can reduce the risk of obesity and related disorders in offspring.

36 5000 students all over the world In English, and translated into Chinese and Arabian, and comming in Spanish!

37 THANK YOU VERY MUCH FOR YOUR ATTENTION!

Early Origins of Metabolic Disease and Aging

1 Early Origins of Metabolic Disease and Aging Janet C. King, Ph.D. Senior Scientist, Children s Hospital Oakland Research Institute And Professor Emeritus, UC Berkeley & Davis 2 The Maternal Nutrition-Offspring