Session 6: Infant nutrition: future research developments in Europe EARNEST, the early nutrition programming project: EARly Nutrition programming - long-term Efficacy and Safety Trials and integrated epidemiological, genetic, animal, consumer and economic research

Establishment of intestinal microbiota during early life: a longitudinal, explorative study of a large cohort of Danish infants

Fecal samples were obtained from a cohort of 330 healthy Danish infants at 9, 18, and 36 months after birth, enabling characterization of interbacterial relationships by use of quantitative PCR targeting 31 selected bacterial 16S rRNA gene targets representing different phylogenetic levels. Nutritional parameters and measures of growth and body composition were determined and investigated in relation to the observed development in microbiota composition. We found that significant changes in the gut microbiota occurred, particularly from age 9 to 18 months, when cessation of breastfeeding and introduction of a complementary feeding induce replacement of a microbiota characterized by lactobacilli, bifidobacteria, and Enterobacteriaceae with a microbiota dominated by Clostridium spp. and Bacteroides spp. Classification of samples by a proxy enterotype based on the relative levels of Bacteroides spp. and Prevotella spp. showed that enterotype establishment occurs between 9 and 36 months. Thirty percent of the individuals shifted enterotype between 18 and 36 months. The composition of the microbiota was most pronouncedly influenced by the time of cessation of breastfeeding. From 9 to 18 months, a positive correlation was observed between the increase in body mass index and the increase of the short-chain-fatty-acid-producing clostridia, the Clostridum leptum group, and Eubacterium hallii. Considering previously established positive associations between rapid infant weight gain, early breastfeeding discontinuation, and later-life obesity, the corresponding microbial findings seen here warrant attention.

The Early Nutrition Programming Project (EARNEST): 5 y of successful multidisciplinary collaborative research

Differences in nutritional experiences during sensitive periods in early life, both before and after birth, can program a person's future development, metabolism, and health. A better scientific understanding of early nutrition programming holds enormous potential for implementing preventive strategies to enhance individuals' long-term health, well-being, and performance. This understanding could reduce costs of health care and social services and may enhance the wealth of societies. The Early Nutrition Programming Project (EARNEST) brought together a multidisciplinary team of international scientists and leaders in key areas of the early nutrition programming field from 40 major research centers across 16 European countries. The project had a total budget of 16.5 million Euros and was funded by the European Communities under the Sixth Framework Program for Research and Technical Development and coordinated by the Children's Hospital at Ludwig-Maximilians-University of Munich. The integrated program of work combined experimental studies in humans, prospective observational studies, and mechanistic animal work, including physiologic studies, cell culture models, and molecular biology techniques. The project lasted from April 2005 to October 2010. After the end of the project, the Early Nutrition Academy (http://www.early-nutrition.org) continues to serve as a platform for the exchange of information, scientific collaboration, and training activities in the area of programming. This article highlights some of the scientific results, achievements, and efforts of EARNEST.

Infant formula supplementation with long-chain polyunsaturated fatty acids has no effect on Bayley developmental scores at 18 months of age--IPD meta-analysis of 4 large clinical trials

OBJECTIVES

To find out whether supplementation of formula milk by long-chain polyunsaturated fatty acids (LCPUFA) affects neurodevelopment at 18 months of age in term or preterm infants by an individual patient data (IPD) meta-analysis.

MATERIALS AND METHODS

Data of 870 children from 4 large randomised clinical trials for formula milk with and without LCPUFAs allowed for assessing the effect of LCPUFA with adjustment for potential confounders and extensive subgroup analysis on prematurity, LCPUFA source, and dosage. Any additional clinical trials examining the effect of LCPUFA supplementation on Bayley Scales of Infant Development at 18 months were regarded as relevant. Two relevant studies were identified by MEDLINE, but were not available to us. An IPD meta-analysis was performed with subgroup analyses by preterm delivery, very low birth weight (<1500 g), trials with higher amounts of docosahexaenoic acid (DHA) and arachidonic acid (AA), and specific sources of LCPUFA. The sample size of 870 children was sufficient to detect clinically relevant differences in Bayley Scales even in subgroups.

RESULTS

There were no significant differences in mental or psychomotor developmental indexes between LCPUFA-supplemented and control groups for all children or in subgroups. This was confirmed with adjustment for the possible confounders: sex, gestational age, birth weight, maternal age, and maternal smoking. The adjusted mean differences in mental developmental index and psychomotor developmental index for all of the children were -0.8 (95% confidence interval -2.8 to 1.2) and -1.0 (-2.7 to 0.7), respectively.

CONCLUSIONS

These data based on considerable sample size provide substantial evidence that LCPUFA supplementation of infant formula does not have a clinically meaningful effect on the neurodevelopment as assessed by Bayley scores at 18 months. Inclusion of all relevant data should not have led to differing conclusions except, possibly, for very-low-birth-weight infants.

Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life

OBJECTIVE

To investigate the correlation of the antioxidant vitamins status (vitamins A, E and C) during pregnancy and the intellectual development of early childhood.

METHOD

A total of 150 paired maternal-neonatal subjects were recruited into the present study. The serum concentrations of antioxidant vitamins (vitamins A, E and C) in maternal blood and cord blood after delivery were determined by high performance liquid chromatography and the intellectual development was evaluated by Gesell Development Schedules (GDS) at two-years-old.

RESULT

Children with higher cord serum vitamin E level showed higher scores of motor, adaptive domain and average compared to children with lower cord serum vitamin E level (p<0.01 or 0.05), respectively. Cord serum vitamin A level had significant positive correlation with effect on motor DQs (beta=4.227, p<0.05), and vitamin E level in cord blood showed a positive relation with motor DQ and average DQ (beta=0.329 and 0.1875, respectively, p<0.05) in multiple linear regression model. The language and social DQs were influenced by placental vitamin E transport rate (beta=3.1968 and 3.0194, respectively, p<0.05). The placental transport rate of vitamin E also was a protective factor for the prevalence of motor behavior developmental delay [OR: 0.118, 95% confident interval (95% CI), 0.018-0.765, p=0.0251], personal and social behavior developmental delay (OR: 0.052, 95% CI: 0.004-0.610, p=0.0185) and average developmental delay (OR: 0.041, 95% CI: 0.003-0.642, p=0.0229) in logistic multiple regression model.

CONCLUSION

Data suggested that vitamin A, E status and vitamin E transfer rate at delivery had beneficial influence on children's cognitive and behavior development quotients.

Prenatal nutrition: a critical window of opportunity for mother and child

The prenatal period encompasses a critical window for future health and functioning of mother and child. Attention previously focused on undernutrition risk (i.e., in developing countries and famine conditions) shifted to mismatch between prenatal 'programming' by undernutrition and postnatal overconsumption (i.e., low birthweight vs rapid postnatal growth), now to overconsumption/overweight throughout the reproductive cycle and short- and long-term health risks, including obesity, diabetes, dyslipidemia and cardiovascular disease. Moreover, overconsumption/overweight do not guarantee adequacy of critical nutrients (i.e., against birth defects or for brain development). Multinutrient supplementation - including zinc, iodine, choline and long-chain polyunsaturated fatty acids, especially n-3 - may have advantages over single-nutrient supplements, for example, iron or folate. Future nutritional care for healthy in utero programming may necessitate individual assessment and follow-up, including preconception nutritional preparation, appropriate weight gain, metabolic balance and food-based regimens enhanced by key nutrient fortification and/or supplementation, warranting further research into nutritional optimization of pregnancy outcomes.

Commentary on ‘Prebiotics, immune function, infection and inflammation: a review of the evidence’

There is a growing awareness that the gut microbiota and an appropriately functioning immune system play an important role in maintaining human health. Recent population statistics have highlighted some worrying trends, specifically that there is a growing burden of immunological disease in Western populations, that Western populations are ageing, and that obesity, with its strong inflammatory component, is reaching epidemic proportions.