Dr Nicholas Embleton is Consultant Neonatal Paediatrician, Newcastle Hospitals NHS Foundation Trust, and Honorary Reader in Neonatal Medicine, Newcastle University, Newcastle upon Tyne, UK. He qualified in medicine in 1990 and has developed a broad portfolio of translational research (see www.neonatalresearch.net).
The idea that nutrition may act during a critical window early in development to permanently affect, or ‘program’ (1), long-term health first emerged from studies in animals (2), but is now strongly supported in humans. Nutrition throughout the life course, including fetal life, infancy, the preschool, or toddlers years, and in adolescence impacts on long-term health, a hypothesis known as the developmental origins of adult disease hypothesis (3), based on the concept of nutritional programming.
In humans, the strongest evidence for nutritional programming has been obtained for the longterm benefits of breast-feeding. Breast-feeding, not only has benefits for short-term health, but has been shown to have major advantages for long-term cognitive function (4,5), atopic disease6, bone health (7) and risk of obesity (8,9) and cardiovascular disease (10). There is particularly strong evidence that breast-feeding can improve later cognitive development, a hypothesis supported by several systematic reviews, evidence of a dose-response association (11), data from a cluster randomised trial (12), as well as evidence of benefits of breast-feeding on visual development (13) and structure of the brain (11,14). The mechanisms for these effects are uncertain, but include differences between human milk and formula in concentrations of biologically active factors such as nucleotides (13), lipids, and the milk fat globular membrane, and differences in patterns of growth (15).
This presentation will give an overview of the role of human milk intake on long-term health, focusing particularly on benefits for cognitive function and risk of obesity (13,14). It will highlight the key role of promoting exclusive breast-feeding (13), optimising the pattern of infant weight gain (15), and the importance of experimental (randomised) studies in interpreting the effects of early nutrition on later health. Finally, it will consider the implications of nutritional programming for nutritional, clinical and public health practice.
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