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

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, & 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

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

36 research institutions, 16 countries, 3 continents Budget >11 Mio€ with co-funding by NHMRC & industry partners Co-ordination: Hauner Children ’ s Univ. of Munich 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 www.project-earlynutrition.eu

Metabolic programming Sensitive time windows of pre- and postnatal development Cytogenesis Early metabolic Metabolic programming of modulators <<<<<<<<<<< Organogenesis lifelong health Metabolism Endocrine Brands B, Koletzko B. Early nutrition and long- term obesity risk: opportunities for paediatric prevention. Monatsschr Kinderheilkd 2012;160:1096–1102. Gene expression www.project-earlynutrition.eu

WHO: obesity & consequences = 5 th. leading cause of global deaths Globally, 44% of diabetes, 23 of ischaemic heart disease, 7-41% of certain cancer burdens due to overweight/ obesity 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 obesity www.diabesity.eu; BMJ 2010;341:c6014 www.project-earlynutrition.eu

Demographic change needs early prevention for increasing healthy & productive life years www.diabesity.eu; BMJ 2010;341:c6014 www.project-earlynutrition.eu

Early Nutrition: key hypothesis Fetal overnutrition Environment Postnatal overnutrition e.g. maternal obesity, high e.g. overfeeding, short breast- Lifestyle pregnancy weight gain, diet in feeding, excessive protein supply pregnancy, gestational diabetes Genes Accelerated Fuel mediated Adiposity/Diabetes postnatal in utero Visceral adiposity growth hypothesis Metabolic syndrome hypothesis & Insulin resistance Mismatch Hypertension, CHD, Stroke hypothesis Asthma Fetal undernutrition & Koletzko et al, Am J Clin Nutr. 2011;94:2036-43S. postnatal overnutrition e.g. maternal malnutrition, placental dysfunction www.project-earlynutrition.eu

The EarlyNutrition Project www.project-earlynutrition.eu

The Early Nutrition project combines  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 www.project-earlynutrition.eu

Evidence for relevant programming effects? www.project-earlynutrition.eu

Prenatal intervention www.project-earlynutrition.eu

Prenatal intervention  RCT in 2212 pregnant women, BMI>25, South Australia  Standard care, or counseling (3 x face to face, 3 x phone) on 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) www.project-earlynutrition.eu

Birthweight >4kg: 2x risk of later obesity Yu et al, Obesity Rev 2011;12:525-43. www.project-earlynutrition.eu

Birthweight >4kg: high risk for later obesity Early Childhood Longitudinal Study, 7738 children, USA 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 Cunningham SA et al, NEJM 2014; 370:403-11. 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 Fully breastfed  1.2 g protein/dL for >3 mon. Higher protein 2.05 g protein/dL IF formula Lower protein Double blind randomised 1.25 g protein/dL IF formula Intervention No intervention - long term follow-up 0 1yr 2 yrs 6 yrs Koletzko et al, Am J Clin Nutr 2009, Weber et al, Am J Clin Nutr 2014. 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 * * * * Intervention Weber et al, Am J Clin Nutr 2014, Koletzko et al, Am J Clin Nutr 2009. 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 Low High Relative Risik Breast Protein Protein (OR) fed 2.42 10% 4.4% 2.9% (95% CI: 1.12 – 5.25) p=0.025  Promote, protect, support breastfeeding  Avoid formula with very high protein content  Avoid cows‘ milk as a drink in the 1 st. year of life (if affordable, feasible and safe) Weber et al, Am J Clin Nutr 2014, Koletzko et al, Am J Clin Nutr 2009. 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 Bonferroni Sphingomyelins Hydroxy-sphingomyelins Hexose www.project-earlynutrition.eu

Epigenetic mechanisms? Nutrition  genome.ucsc.edu/ENCODE  Phenotype Gene product  & health www.project-earlynutrition.eu

Epigenetic mechanisms? % body fat (M+SEM, adj. f. gender&age) Godfrey K et al, Diabetes 2011. www.project-earlynutrition.eu

Translational application www.project-earlynutrition.eu

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

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 www.project-earlynutrition.eu

ENA (Early Nutrition Academy) Now on Twitter: @EarlyNutrition For live information during the Conference #PowerOfProgramming2014 www.project-earlynutrition.eu

Welcome reception  Thursday, March 13, 19.00 h, Old City Hall www.project-earlynutrition.eu

Conference Dinner  Friday, March 14, 19.30 h, Hofbräukeller www.project-earlynutrition.eu

Conference Dinner: Special Guests Monsieur Jean-Baptiste Pierre Antoine Mister Charles Robert Darwin de Monet, Chevalier de Lamarck Natural selection Inheritance of acquired characteristics wikimedia www.project-earlynutrition.eu

Thanks to collaborating societies www.project-earlynutrition.eu

Thanks for financial support German Research Foundation Ludwigs Maximilians University of Munich www.project-earlynutrition.eu

Thanks to further sponsors www.project-earlynutrition.eu

Thanks to a great conference organizing team Brigitte Brands, Team Lead, Simone Cramer, Overall Team Support, Mirella Gutser, PR Rebecca Spörl, Correspond. Scientific Program Congress Orga Congress & ENeA Scient. Programme, Proofreadings Finances & Adminstration Julian Decker, Team Support, Kristin Duvinage, Team Chang Ming, Team Steffi Roth, Elisabeth Axthammer, CME Certificates, ENeA&PoP Support, Orga, EN Support Eurokongress Eurokongress 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 www.project-earlynutrition.eu