Lunch Buffet 13.25 15.00 Welcome to www.project-earlynutrition.eu - - PowerPoint PPT Presentation

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Lunch Buffet 13.25 15.00 Welcome to www.project-earlynutrition.eu - - PowerPoint PPT Presentation

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Note: for non-commercial purposes only Lunch Buffet 13.25 15.00 Welcome to www.project-earlynutrition.eu The Power of Programming conference Focus on early nutrition impact on non-communicable diseases, underlying mechanisms, &

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Lunch Buffet 13.25 – 15.00

www.project-earlynutrition.eu

Welcome to

Note: for non-commercial purposes only

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The Power of Programming conference

 Focus on early nutrition impact on non-communicable

diseases, underlying mechanisms, & related issues

 Presentation and discussion of current concepts and

recent results on developmental programming

 Brought to you by the research project Early Nutrition

www.project-earlynutrition.eu

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The Early Nutrition Project

 World‘s largest research project on developmental

programming of adult health

 International multidisciplinary collaboration  Explores effects of diet from pre-pregnancy to early

childhood on later adiposity (body fat content) and related health outcomes

www.project-earlynutrition.eu

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www.project-earlynutrition.eu

Budget >11 Mio€

with co-funding by NHMRC & industry partners

Co-ordination: Hauner Children’s

  • Univ. of Munich

36 research institutions, 16 countries, 3 continents

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www.project-earlynutrition.eu

First 1000 days: a window of opportunity

Nutrition and other influences during pre- and postnatal development and plasticity  lasting effects on physiology, function, health & disease risks: developmental programming

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www.project-earlynutrition.eu

Metabolic programming

<<<<<<<<<<<

Metabolic modulators

Gene expression Metabolism Endocrine

Organogenesis

Sensitive time windows of pre- and postnatal development

Early metabolic programming of lifelong health

Brands B, Koletzko B. Early nutrition and long- term obesity risk: opportunities for paediatric

  • prevention. Monatsschr Kinderheilkd

2012;160:1096–1102.

Cytogenesis

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www.project-earlynutrition.eu

WHO: obesity & consequences = 5th. leading cause of global deaths

Globally, 44% of diabetes, 23 of ischaemic heart disease, 7-41% of certain cancer burdens due to overweight/ obesity

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www.project-earlynutrition.eu

Health economic consequences

 Europe

33 million diabetics, cost for diabetes T2  15 billion €/yr. or 8% of EU total health care costs

 USA

17% of total health care costs for treatment of diabetes and

  • besity

www.diabesity.eu; BMJ 2010;341:c6014

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www.project-earlynutrition.eu

Demographic change needs early prevention for increasing healthy & productive life years

www.diabesity.eu; BMJ 2010;341:c6014

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www.project-earlynutrition.eu

Early Nutrition: key hypothesis

&

Genes Lifestyle Environment Accelerated postnatal growth hypothesis

Koletzko et al, Am J Clin Nutr. 2011;94:2036-43S.

Fuel mediated in utero hypothesis Mismatch hypothesis Fetal undernutrition & postnatal overnutrition

e.g. maternal malnutrition, placental dysfunction

Fetal overnutrition

e.g. maternal obesity, high pregnancy weight gain, diet in pregnancy, gestational diabetes

Postnatal overnutrition

e.g. overfeeding, short breast- feeding, excessive protein supply

Adiposity/Diabetes

Visceral adiposity Metabolic syndrome Insulin resistance Hypertension, CHD, Stroke Asthma

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www.project-earlynutrition.eu

The EarlyNutrition Project

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www.project-earlynutrition.eu

 11 observational cohorts: SWS, DNBC, Generation R,

HUMIS/MOBA, LISA, PreventCD, Raine, UC Irvine, Project VIVA

 9 intervention studies (RCTs): UPBEAT, SCOPE/Baseline,

CHOP, ROLO, LIMIT, AMELIE, PROTEUS, NIGO-Health

 from 13 European countries, the USA and Australia  comprising >470 000 individuals

The Early Nutrition project combines

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www.project-earlynutrition.eu

Evidence for relevant programming effects?

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www.project-earlynutrition.eu

Prenatal intervention

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www.project-earlynutrition.eu

 RCT in 2212 pregnant women, BMI>25, South Australia  Standard care, or counseling (3 x face to face, 3 x phone)

  • n balanced diet, limiting refined CHO and SAFA, and

increased physical activity

 No significant effect on LGA (primary outcome, RR 0.90)  Reduced birthweight <4000 g (RR 0.81, p=0.03, NNT 28)

Prenatal intervention

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www.project-earlynutrition.eu

Birthweight >4kg: 2x risk of later obesity

Yu et al, Obesity Rev 2011;12:525-43.

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www.project-earlynutrition.eu

Birthweight >4kg: high risk for later obesity

Birth- n Obesity (%) at age (yrs) weight 5.6 9.1 14.1 2.5-<4 kg 6035 11.2 17.8 19.4 >4 kg 915 22.5 26.3 31.2 Birthweight >4 kg = 12% of the population, but >36% of the obese children at age 14 yrs

Early Childhood Longitudinal Study, 7738 children, USA

Cunningham SA et al, NEJM 2014; 370:403-11.

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www.project-earlynutrition.eu

Intervention after birth: less protein for infants

1yr

Intervention No intervention - long term follow-up Higher protein formula Lower protein formula

1.2 g protein/dL

Double blind randomised

2 yrs 6 yrs

Fully breastfed for >3 mon.

2.05 g protein/dL IF 1.25 g protein/dL IF

RCT, childhood obesity project (CHOP study), 1678 healthy term infants enrolled in 5 European countries

Koletzko et al, Am J Clin Nutr 2009, Weber et al, Am J Clin Nutr 2014.

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www.project-earlynutrition.eu

Intervention after birth: less protein for infants

RCT, childhood obesity project (CHOP study), 1678 healthy term infants enrolled in 5 European countries

* * * *

Weber et al, Am J Clin Nutr 2014, Koletzko et al, Am J Clin Nutr 2009.

Intervention

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www.project-earlynutrition.eu

 Protein for infants   obesity at 6 yrs.

RCT, childhood obesity project (CHOP study), 1678 healthy term infants enrolled in 5 European countries

Weber et al, Am J Clin Nutr 2014, Koletzko et al, Am J Clin Nutr 2009.

Low Protein High Protein Relative Risik (OR) Breast fed 4.4% 10%

2.42

(95% CI: 1.12 – 5.25)

p=0.025

2.9%

 Promote, protect, support breastfeeding  Avoid formula with very high protein content  Avoid cows‘ milk as a drink in the 1st. year of life

(if affordable, feasible and safe)

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www.project-earlynutrition.eu

Metabolic mechanisms and markers?

Amino acids, branched chain Amino acids, urea cycle Amino acids, others Acyl-Carnitines, short-chain Acylcarnitines, medium/long Acylcarnitines, hydroxy- Acylcarnitines, dicarboxy- PC, saturated PC, mono-/bis-unsaturated PC, poly-unsaturated Lyso-PC Sphingomyelins Hydroxy-sphingomyelins Hexose

Bonferroni

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www.project-earlynutrition.eu

Epigenetic mechanisms?

genome.ucsc.edu/ENCODE

Nutrition   Gene product Phenotype & health 

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www.project-earlynutrition.eu

Epigenetic mechanisms?

Godfrey K et al, Diabetes 2011.

% body fat

(M+SEM, adj.

  • f. gender&age)
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www.project-earlynutrition.eu

Translational application

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www.early-nutrition.org

Free e-Learning f. Health Care Professionals, CME accredited (EU, USA)

  • In collaboration with Univ. of Munich & ESPGHAN
  • Supported by European Commission FP7
  • Internationally reknown experts

Available modules:

  • Breastfeeding
  • Nutrition & Lifestyle in Pregnancy
  • Complementary Feeding

Coming:

  • Infant Formula Feeding (April 2014)
  • Nutrition and Brain Development
  • Nutrition and Epigenetics
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www.project-earlynutrition.eu

The Power of Programming 2014

 4 Plenary Sessions  18 Parallel Sessions  6 Workshops / Symposia  Meet the Professors Sessions – Career Building  New Investigators Forum  520 pre-registered delegates, 54 countries (plus onsite-reg.)  14 European CME / 15 German CME credits

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www.project-earlynutrition.eu

ENA (Early Nutrition Academy) Now on Twitter: @EarlyNutrition

For live information during the Conference #PowerOfProgramming2014

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www.project-earlynutrition.eu

Welcome reception

 Thursday, March 13, 19.00 h, Old City Hall

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www.project-earlynutrition.eu

Conference Dinner

 Friday, March 14, 19.30 h, Hofbräukeller

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www.project-earlynutrition.eu

Conference Dinner: Special Guests

wikimedia

Mister Charles Robert Darwin

Natural selection

Monsieur Jean-Baptiste Pierre Antoine de Monet, Chevalier de Lamarck

Inheritance of acquired characteristics

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www.project-earlynutrition.eu

Thanks to collaborating societies

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www.project-earlynutrition.eu

Thanks for financial support

German Research Foundation

Ludwigs Maximilians University of Munich

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www.project-earlynutrition.eu

Thanks to further sponsors

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www.project-earlynutrition.eu

Thanks to a great conference organizing team

Brigitte Brands, Team Lead, Scientific Program Rebecca Spörl, Correspond.

  • Scient. Programme, Proofreadings

Simone Cramer, Overall Congress Orga Mirella Gutser, PR Congress & ENeA Kristin Duvinage, Team Support, Orga, EN Julian Decker, Team Support, CME Certificates, ENeA&PoP Chang Ming, Team Support Team Support, Finances & Adminstration Steffi Roth, Eurokongress Elisabeth Axthammer, Eurokongress

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www.project-earlynutrition.eu

Thank you for your kind attention Have an enjoyable and fruitful conference Return to The Power of Programming, fall 2016

 www.project-earlynutrition.eu