Pediatric Nutrition in Practice

1 Specific Aspects of Childhood Nutrition

Key Words

Metabolic programming of long-term health ·

Developmental origins of adult health ·

Breastfeeding and obesity · Perinatal nutrition ·

Disease risk prevention

Key Messages

• Nutritional and metabolic factors during sensitive,
  limited periods of early human development have
  a long-term programming effect on health, well-
  being and performance in later age, extending into
  adulthood and old age


• Evidence for early programming effects arises from
  in vitro experiments, animal models, retro- and pro-
  spective epidemiological studies and controlled in-
  tervention trials


• Obstetric and paediatric medicine are expected to
  achieve a much greater role for the prevention of
  long-term disease risks in the population


• The important effects on health of early nutrition
  programming justify major investments into re-
  search and improvement of practice
  © 2015 S. Karger AG, Basel

Introduction

Epidemiological studies, numerous animal mod-
els and clinical intervention trials provide ample
evidence that nutritional and metabolic factors

during sensitive, limited periods of early human

development have a long-term programming ef-

fect on health, well-being and performance in lat-

er age, extending into adulthood and old age [1–

3]. Biological programming is defined as lasting

effects on physiology, function, health and dis-

ease risks induced by environmental cues during

limited time periods of early development and

plasticity. While the term ‘programming’ was in-

troduced into the scientific literature by Dörner

[4] already in 1974, the concept has received

broad attention primarily due to retrospective

epidemiological studies published by Barker and

others documenting inverse relationships be-

tween body weight at birth and at 1 year of age,

respectively, and the risks of hypertension, diabe-

tes and coronary heart disease ( fig.  1 ) in adult-

hood [5, 6]. These observations stimulated inten-

sive research that demonstrated powerful long-

term effects of nutrition and growth before and

after birth on later health, performance and dis-

ease risk. The exploration of underlying mecha-

nisms and the resulting effects of metabolic pro-

gramming offers tremendous opportunities for

the early prevention of major health risks already

during pregnancy and infancy, and they could

provide both obstetric and paediatric medicine

with a markedly increased role in promoting the

long-term health of the population. It is likely that

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 72–77
DOI: 10.1159/000369235

1.5 Early Nutrition and Long-Term Health

Berthold Koletzko