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Environmental and Physiological Barriers to Child Growth and Development

      Prentice, A.M. (The Gambia)

       The Gut Microbiome in Child Malnutrition

      Robertson, R.C. (UK)

       Intergenerational Influences on Child Development: An Epigenetic Perspective

      Silver, M.J. (UK)

       Summarizing the Child Growth and Diarrhea Findings of the Water, Sanitation, and Hygiene Benefits and Sanitation Hygiene Infant Nutrition Efficacy Trials

      Makasi, R.R. (Zimbabwe); Humphrey, J.H. (Zimbabwe/USA)

       Summary of Environmental Impacts on Nutrition

      Prentice, A.M. (The Gambia)

       Subject Index

      For more information on related publications, please consult the NNI website: www.nestlenutrition-institute.org

Preface

      Previous Nestlé Nutrition Institute (NNI) Workshops have covered the role of nutrition in health and disease at all stages of the life cycle. Proceedings and webcasts of all these workshops are freely available via the NNI website at www.nestlenutrition-institute.org.

      Unsurprisingly, there has been a particular emphasis on the nutrition of mothers and young children with the “First 1,000 days” since this is a crucial period of early development that lays the foundation for a child’s lifelong health. Relating to this period, recent workshops have focused on human milk (NNIW90), on complementary feeding (NNIW87), on protein in neonatal and infant nutrition (NNIW86), and on the low-birth weight baby – “Born too soon or too small” (NNIW81).

      This 93rd workshop in the series sought to open the aperture around the first 1,000 days and considered the importance of nutrition both prior to conception and in children beyond 2 years of age. The phrase “Global Landscape” in the title was intended to capture the 2 possible meanings of global; the geographical meaning and the “holistic” meaning in which the program covered diverse aspects of the nutritional landscape as well as the nonnutritional environmental challenges faced by so many mothers and children.

      Session I provides an updated picture of malnutrition around the world, the recent progress that has been made in eliminating malnutrition in all its forms and several data limitations to track such progress. It focuses on the residual challenges facing governments and civil society as we seek to eliminate poverty-associated malnutrition, without escalating the rates of obesity. Patterns of how and what children eat as they pass through their early life stages are described, as well as the challenges of improving children’s diets in settings worldwide and against the limitations imposed by poverty and by parents’ poor knowledge of the principles of nutrition. The importance of accurate and comprehensive food composition data to enable reliable estimates of nutrient intakes is also covered with a strong emphasis on future methodological advances and the unique challenges of micronutrients. The final chapter provides a case study on how we balance the risks and benefits of micronutrient interventions with a special focus on the most challenging of nutrients – iron – that has huge benefits but possible risks in terms of promoting infections.

      Session II covers different aspects of the role of milk in early life. New worldwide research on the determinants and content of micronutrients in human milk is described. The following chapters cover different aspects of cow’s milk with a chapter on how it influences growth with a focus on linear growth. Cow’s milk is an important source of vitamin B12, and the consequences and recommendations regarding a vegan diet without milk are presented. Low vitamin B12 levels are found in diets of many rural Indian populations and the effects through the life course was the next chapter. The session closes with a chapter on the possible role of optimized plant proteins as an alternative to dairy ingredients in treating children with severe acute malnutrition.

      Session III widens the aperture still further by considering the ramifications of environmental constraints to healthy child growth. The chapters cover the issue of how persistent gut damage and systemic inflammation can precipitate malnutrition as well as the putative effects of alterations in the gut microbiota. There has, for many years, been great interest in the possibility that growth and health in one generation might be influenced by the health of our forebears in previous generations. This question is covered from an epigenetic perspective that examines how epigenetic mechanisms mediate intergenerational effects and might possibly mediate longer-term transgenerational effects, though the evidence for the latter is mostly lacking in humans. The final chapter covers the recent findings from the very large WASH Benefits and Shine trials in Kenya, Bangladesh, and Zimbabwe and how the research and policy agenda is evolving to support much more intense “Transformative WASH” programs.

      Together the 3 sessions provide an update and overview of diverse issues relevant to the epidemiology, biology of nutrition in early life, programmatic implications, and future directions.

      Kim F. Michaelsen, Copenhagen

      Lynnette M. Neufeld, Geneva

      Andrew M. Prentice, Banjul

Foreword

      Malnutrition among children remains a persistent problem around the world. The latest UNICEF data report that nearly half of all deaths in children under 5 years of age can be attributed to undernutrition. Poor linear growth, or stunting, affects over 150 million children around the world, one-third of whom live in India. Among the 50 million children who are wasted, half are in South Asia; yet this region is also home to a large proportion of the 40 million children who are overweight.

      These disquieting results raise several questions. Despite international guidelines on early childhood feeding, why does this problem persist? There is already an extensive body of literature from studies that have tested different combinations of interventions, including dietary, behavioral, educational, and social components. Although the results from these trials can be not convincing, one thing is clear: addressing any factor (or a limited number of factors) in isolation is not enough.

      The aim of the 93rd Nestlé Nutrition Institute Workshop, which took place in India in March 29th–31st, 2019, was to map the challenges within the global landscape of childhood nutrition. The opening session led by Prof. Lynnette M. Neufeld outlined the key barriers faced in pediatric nutrition, from both the global and the local perspectives. Understanding the specific nutrition deficits of a particular population is a first step in addressing the problem. In addition, we must also understand local feeding practices, in order to identify suitable interventions that can strike a balance between effectiveness and safety. The second session chaired by Prof. Kim F. Michaelsen focused on the importance of milk in child growth and its role at different developmental stages during childhood. It also called attention to the key points to be aware of when feeding children a vegan diet and how to use plan protein combinations as a cost-effective alternative to cow’s milk proteins for the prevention and treatment of acute malnutrition.

      The final session designed by Prof. Andrew M. Prentice took a step broader in order to identify the environmental influences of nutrition. Infections from unhygienic surroundings combined with intergenerational nutritional deficits are major forces that can shape the epigenome and the infant gut microbiome. Together, these aspects of the global landscape of nutrition provide a roadmap

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