Supporting improved nutrition for appropriate growth and improved long-term health outcomes ZTC831/07/2015
The first 1000 days are a critical period for growth and development Achieving optimal nutrition in infants and toddlers is a challenging issue 270 days of pregnancy 365 days of baby s 1st year 365 days of baby s 2nd year The programming which takes place during this period has a life-long impact on many aspects of future health 2 6 SCN statement June 2006 1 The window of opportunity lies from pre-conception to around 24 months of age, the critical period when the foundation for lifelong health is set... Protein and energy Average intakes exceed requirements 9,10 Vitamin D and iron Sub-optimal intakes 9,10 National dietary surveys conducted by the Department of Health and Food Standards Agency show that the diets of infants and toddlers in the UK may be sub-optimal 9,10 Physical growth (e.g. rate of growth in early life) Metabolic programming nutrition during this period has a significant influence on long-term health through metabolic programming 7 EFSA has recognised that: 11 protein intakes of infants are generally well above requirements (Scientific Opinion 2014) Early life nutrition (first 1000 days) Drives the rate of growth during the early critical period of development The optimal rate of growth is that of a breastfed baby 8 Program long-term outcomes for the baby % RNI 300 250 200 150 100 50 0 Protein intakes* of infants and young children 9 as a % of reference nutrient intake (RNI) 12 4 6 7 9 10 11 11 12 Age (months) *Derived from Department of Health National Dietary Survey. 9
Excessive protein intake in infancy and early childhood is linked with later overweight and obesity Obesity is a major challenge Consequences of increased protein intake in the first year of life 13 A higher protein intake is associated with higher weight in the first 2 years of life, but has no effect on length Lower protein intake in infancy might diminish the later risk of overweight and obesity, with their associated adverse health consequences Childhood overweight and obesity is now a more important cause of poor health worldwide than childhood underweight 14 Overweight and obesity prevalence in children aged 2 4 years (England 2012) 15 3 Increase in BMI during first 2 years of life (kg/m 2 ) 13 Boys BMI increase (kg/m 2 ) 2 1 0 2.5 Low protein intake 2.9 High protein intake p=0.001 for difference in BMI z score Obese 10% Overweight (including obese) 22% Girls Obese 8% Overweight (including obese) 21% Overweight = 85th <95th UK National BMI centile Obese = 95th UK National BMI centile
Nestlé and SMA Nutrition are the infant feeding protein experts committed to appropriate growth Improved SMA Follow-on Milk: balanced protein content Long heritage in pioneering protein technology, with five decades of expertise dedicated to supporting appropriate growth in formula-fed babies A unique formula with improved protein quality and protein content* Research shows the importance of providing the right amount of protein in the diet to help support appropriate growth 21 23 Research shows that iron requirements are high in infants aged 6 12 months 24 Wysoy, a soya formula, was developed for infants who are allergic to cows milk protein or lactose-intolerant 1960s 1970s A major advance in infant formula was the development of the first high-quality, whey-dominant formula with a composition of whey protein and casein similar to that of breast milk Helping infants achieve the recommended intakes of micronutrients Fortified with iron which UK dietary surveys show can be lacking in infant diets 9 Iron which helps to support normal cognitive development Omega 3 & 6 to help support normal growth and development Vitamin D and calcium to help support the normal growth and development of bone 1980s Partially hydrolysed whey-based formula developed to reduce the risk of eczema in infants 16 First alpha-lactalbuminenriched first milk developed and shown to have prebiotic effect 17 19 2000s ESPGHAN 2014 24 From the age of 6 months, all infants and toddlers should receive iron-rich foods, including meat products and/or iron-fortified foods The only whey-dominant follow-on milk 25 27 2010s Further improvements to alpha-lactalbumin-enriched protein in first milks with clinical evidence of more appropriate growth pattern 20 The UK Department of Health supports the use of whey-based formulas, if breastfeeding is not possible, throughout the first year and beyond 28 Improved SMA Follow-on Milk Protein g/100ml 1.3 [Whey:casein] [65:35] α-lac enriched? ** * Compared to our current SMA Follow-on Milk. the beneficial effect of essential fatty acids is obtained with a daily intake of 10 g of linoleic acid and 2 g of α-linolenic acid. ** SMA Follow-on Milk powder only.
SMA Toddler Milk : nutritionally tailored for toddlers Summary Improved formula with lower protein content and increased vitamin D* Research shows the importance of providing the right amount of protein in the diet to help support appropriate growth 21 23 Evidence shows that toddlers who consumed fortified milks (compared to those whose main milk was cows milk) had higher mean intakes of vitamin D and iron, and a lower intake of protein 29 Specially tailored combination of nutrients for toddlers the programming that takes place during the first 1000 days of life has a significant impact on later health outcomes The diets of many infants and toddlers may be sub-optimal: average protein intakes often exceed requirements, increasing the risk of later overweight and obesity intakes of essential nutrients including iron and vitamin D may be sub-optimal Nestlé and SMA Nutrition have a long heritage in the development of formula milks with nutritional content tailored to specific requirements at different stages of development Fortified with: Vitamin D & Calcium Omega 3 & 6 Iron Vitamin D and calcium to help support the normal growth and development of bone Iron which helps to support normal cognitive development Omega 3 & 6 to help support normal growth and development Improved SMA Follow-on Milk has a balanced protein content, helping to support the nutritional needs of infants during this critical period of development Improved SMA Toddler Milk contains a specially tailored combination of nutrients to support the needs of active toddlers 2 X 200 ml servings of SMA Toddler Milk 24 % RI 30 Vitamin D 108% Iron 60% Calcium 58% Vitamin C 107% *Compared to our current SMA Toddler Milk. the beneficial effect of essential fatty acids is obtained with a daily intake of 10 g of linoleic acid and 2 g of α-linolenic acid. RI: Reference Intake the amount of vitamins and minerals required per day by young children to help meet their daily nutritional requirements. IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding should continue for as long as possible. SMA Follow-on Milk is only suitable for babies over 6 months as part of a mixed diet. It should not be used as a substitute for breast milk during the first 6 months of life. The decision to start weaning or to use follow-on milk before 6 months, should be made only on the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist, based on your baby s specific growth and development needs. SMA Toddler Milk is suitable for young children from 1 3 years, as part of a healthy balanced diet and it is not a breast milk substitute. Breastfeeding should continue for as long as possible.
References SMA Follow-on Milk for infants 6 12 months 1. United Nations System 2006. Standing Committee on Nutrition. Third World Urban Forum, Vancouver. Available at: http://www.unscn.org/files/statements/the_double_ Burden_of_Malnutrition_A_Challenge_for_cities_ Worldwide.pdf (accessed 19 September 2014). 2. Vickers MH. Nutrients 2014; 6: 2165 2178. 3. Brands B et al. Acta Paediatr 2014; 103: 578 585. 4. Langley-Evans SC. J Hum Nutr Diet 2014; doi: 10.1111/jhn.12212. [Epub ahead of print] 5. Koletzko B et al. Proc Nutr Soc 2012; 71: 371 378. 6. Koletzko B et al. Am J Clin Nutr 2011; 94(suppl): 2036S 2043S. 7. Lucas A. J Nutr 1998; 128(2 Suppl): 401S 406S. 8. WHO Multicentre Growth Reference Study Group. Acta Paediatr Suppl 2006; 450: 76 85. 9. Lennox A et al. (2013) Diet and Nutrition Survey of Infants and Young Children. Available at: https://www.gov.uk/ government/publications/diet-and-nutrition-survey-ofinfants-andyoung-children-2011 (accessed 10 June 2015). 10. Bates B et al. (2012) NDNS Headline Results from Years 1, 2 and 3 (Combined). Department of Health and Food Standards Agency. Available at http://www.natcen.ac.uk/ media/175123/national-diet-and-nutrition-survey-years- 1-2-and-3 (accessed 10 June 2015). 11. EFSA (European Food Safety Authority) (2014) Scientific Opinion on the Essential Composition of Infant and Follow-on Formulae. EFSA Journal 2014; 12(7): 3760. 12. DH (Department of Health) (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. HMSO, London. 13. Koletzko B et al. Am J Clin Nutr 2009; 89: 1836 1845. 14. World Health Organization. Obesity and overweight. Available at: http://www.who.int/mediacentre/factsheets/ fs311/en/ (accessed 19 September 2014). 15. Health Survey for England 2012. Health and Social Care Information Centre, Available at: http://healthsurvey. hscic.gov.uk/media/1027/chpt-11_children s-bmi-.pdf (accessed 10 June 2015). 16. von Berg A et al. J Allergy Clin Immunol 2003; 111: 533 540. 17. Lien EL et al. J Pediatr Gastroenterol Nutr 2004; 38: 170 176. 18. Bettler J and Kullen MJ. J Pediatr Gastroenterol Nutr 2007; 44(Suppl 1): e197. PN1 11. 19. Kullen M et al. J Pediatr Gastroenterol Nutr 2009; 48(suppl 3): e88. 20. Trabulsi J et al. Eur J Clin Nutr 2011; 65: 167 174. 21. Weber M et al. Am J Clin Nutr 2014; 99: 1041 1051. 22. Thorisdottir B et al. Ann Nutr Metab 2013; 63: 145 151. 23. Gunther AL et al. Am J Clin Nutr 2007; 85: 1626 1633. 24. Domellöf M et al. J Pediatr Gastroenterol Nutr 2014; 58: 119 129. 25. SMA Nutrition data on file. 26. Aptamil datacard for Follow-on Milk. January 2015. 27. Cow and Gate datacard for Follow-on Milk. January 2015. 28. NHS Choices. Types of infant formula. October 2014. http://www.nhs.uk/conditions/pregnancy-and-baby/ Pages/types-of-infant-formula.aspx#close (accessed 10 June 2015). 29. Sidnell A et al. Nutrient and energy intakes vary depending on the predominant type of milk fed to children aged 12 18 months in the United Kingdom: secondary analysis of data from the Diet and Nutrition Survey of Infants and Young Children (DNSIYC). Poster presented at ESPGHAN Annual Meeting, 6 9 May 2015, Amsterdam. PO-N-0388. 30. EC (European Commission) (2006). Directive 2006/141/EC on infant formulae and follow-on formulae and amending Directive 1999/21/EC. European Commission. Improved protein quality and protein quantity* Contains 1.3 g protein/100 ml the lowest protein content of all UK follow-on milks 1 3 Research shows the importance of providing the right amount of protein in the diet to help support appropriate growth 4 6 Designed to complement the weaning diet, providing important nutrients shown to be at risk in UK infant diets 7 As a percentage of an infant s daily requirements, 500 ml of SMA Follow-on Milk provides: 8 75% 45% >100% iron calcium vitamin D help support normal growth and development of bone The Department of Health recommends that cows milk should not be introduced as a drink until 12 months of age The only whey-dominant follow-on milk SMA Follow-on Milk has a whey:casein ratio of 65:35 The UK Department of Health supports the use of whey-based formulas, if breastfeeding is not possible, throughout the first year and beyond 9 *Compared to our current SMA Follow-on Milk. References: 1. cow and Gate datacard for Follow-on Milk. Available at http://www.in-practice.co.uk/product-info/standardmilks-0 1-years/follow-on-milk-for-babies-6-monthsplus/ (accessed May 2015). 2. aptamil datacard for Follow-on Milk. Available at https:// www.aptamilprofessional.co.uk/pdf/datacard-aptamil- Follow-On201306131134.pdf (accessed May 2015). 3. hipp datacard for Follow-on Milk. Available at http:// www.hipp4hcps.co.uk/dynamic-content/media/ Milks_nutritional_data.pdf (accessed May 2015). 4. Weber M et al. Am J Clin Nutr 2014; 99: 1041 1051. 5. thorisdottir B et al. Ann Nutr Metab 2013; 63: 145 151. 6. Gunther AL et al. Am J Clin Nutr 2007; 85: 1626 1633. 7. lennox A et al. (2013) Diet and nutrition survey of infants and young children. Available at: https://www.gov.uk/ government/publications/diet-and-nutrition-survey-of infants-andyoung-children-2011 (accessed 10 June 2015). 8. ec (European Commission) (2006). Directive 2006/ 141/EC on infant formulae and follow-on formulae and amending Directive 1999/21/EC. European Commission. 9. nhs Choices. Types of infant formula. October 2014. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/ types-of-infant-formula.aspx#close (accessed May 2015).
SMA Toddler Milk for toddlers aged 1 3 years Improved formula with lower protein content* Contains 1.5 g/100 ml protein significantly lower than cows milk Research shows the importance of providing the right amount of protein in the diet to help support appropriate growth 1 3 Designed to complement the weaning diet, providing important nutrients shown to be at risk in UK toddler diets 4 As a percentage of an infant s daily requirements, 2 x 200 ml servings of SMA Toddler Milk provides: 5 108% 58% 60% 107% vitamin D calcium iron which helps to support normal cognitive development vitamin C help support normal growth and development of bone IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding should continue for as long as possible. SMA Follow-on Milk is only suitable for babies over 6 months as part of a mixed diet. It should not be used as a substitute for breast milk during the first 6 months of life. The decision to start weaning or to use follow-on milk before 6 months, should be made only on the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist, based on your baby s specific growth and development needs. SMA Toddler Milk is suitable for young children from 1 3 years, as part of a healthy balanced diet and it is not a breast milk substitute. Breastfeeding should continue for as long as possible. *Compared to our current SMA Toddler Milk. References: 1. Weber M et al. Am J Clin Nutr 2014; 99: 1041 1051. 2. Thorisdottir B et al. Ann Nutr Metab 2013; 63: 145 151. 3. Gunther AL et al. Am J Clin Nutr 2007; 85: 1626 1633. 4. Gibson S & Sidnell A. Nutrition Bulletin 2014; 39 (2): 172 180. 5. ec (European Commission) (2006). Directive 2006/141/EC on infant formulae and follow-on formulae and amending Directive 1999/21/EC. European Commission.