Health in adults may be determined before birth

The likelihood of adults developing obesity, asthma, allergies, cardiovascular disease and many more conditions may well be determined in the womb, according to the findings of a British Nutrition Foundation’s (BNF) Task Force Report released today 21st May 2013.

Pregnant woman in kitchen eating a salad smiling

The Task Force Report 1: ‘Nutrition and Development: short- and long-term consequences for health’, was launched at BNF’s conference for health professionals at the Royal College of Surgeons in London.

The Report was compiled by a panel of eminent academic experts and looks at aspects of nutrition and early life development, including the impact of a mother’s health and eating habits on her baby, even before conception.

Professor Tom Sanders, chairman of BNF’s Task Force, explained: “Evidence suggests that poor fetal growth, especially followed by accelerated growth in infancy, may be associated with long-term adverse consequences for health. Poor fetal growth may also affect kidney development, making offspring more sensitive to the blood pressure raising effect of salt and, therefore, increasing their risk of cardiovascular disease.”

Asthma is currently one of the world’s most common chronic diseases2. At BNF’s conference Professor Graham Devereux, from the University of Aberdeen, said: “The nutrient content of the maternal diet during pregnancy, in particular vitamin E, vitamin D, zinc, selenium and polyunsaturated fatty acids, may influence the development of childhood asthma and allergic disease. There are currently a number of theories proposing the impact of particular nutrients on risk of these conditions and this is an exciting area of current research.”

The Task Force Report also looks at the causes of obesity and concludes that the increased appetite some people have in adulthood, compared to others, may have also been programmed in the womb as a result of their mother’s own diet and weight.

Almost half of all women of child-bearing age in England are overweight or obese3 and this can be the cause of a biological cycle of maternal obesity leading to health issues for children in later life.

Sara Stanner, Science Programme Manager at BNF, said: “There is now unequivocal evidence to show the biological link between obesity and weight related health issues in women and their children.

“This is a very important message in the fight against obesity. Women need to know that their weight and health, during pregnancy, and even before they conceive, plays a key part in securing a healthy long-term future for their children. Once a baby is conceived, the biological framework for its future health is already set, so, where possible, women should look to improve their health status before they conceive. A major challenge the UK faces in addressing the obesity epidemic is the fact that around half of all pregnancies in the UK are unplanned 4.”

To help women make positive changes to their health, BNF has produced a handy four-week planner containing useful information and practical advice on healthy eating and physical activity.

‘Healthy Life Planner for Woman’ is available to download free from BNF’s website: www.nutrition.org.uk.

Preventable Diseases

weaning

Obesity

26% of women and around 1 in 10 children (9.5%) in Reception class (aged 4-5 years) in England are obese

(Health and Social Care Information Centre, 2011)

Diabetes

2.9 m people in the UK have diabetes. By 2025 it is estimated this will rise to 5m. (90% will be Type 2) (Diabetes UK, 2012)

Cardiovascular disease

Cardiovascular disease (CVD) is the main cause of death in England – it caused over 147,000 deaths in 2010 (BHF, 2012)


Bone health

Almost 3m people in the UK are estimated to have osteoporosis (NOS, 2013)

Asthma

An estimated 5.2m people in the UK have asthma (Asthma UK, 2004)

Cognitive function/mental health

800,000 people have dementia in the UK and this will rise to over 1m by 2021. 1 in 3 people over the age of 65 will die with dementia (Alzheimer’s society, 2013)

Childhood cancer

Around 1,600 children are diagnosed with cancer each year in the UK. Around 1 in 500 children in GB will develop some form of cancer by age 14 (Cancer Research UK, 2012)

Cancer

Around 325,000 people were diagnosed with cancer in 2010 in the UK, that’s around 890 people every day (Cancer Research UK, 2010)

BNF Task Force Evidence

• Maternal obesity may have long-term effects on appetite regulation in the offspring making obesity more likely

• Overfeeding in infancy promotes the development of childhood obesity

• Babies who are born thin or growth retarded are 3-4 times more likely to develop diabetes in adult life, especially if they become overweight/obese as adults

• Gestational diabetes1, which is more likely in overweight and older women, can result in very large babies (macrosomia >4kg)2 who are more likely to develop diabetes in adult life

• Shortness in stature, which is determined by growth in early life, is linked with the development of high blood pressure and CVD, especially stroke, in adult life

• Smallness at birth followed by rapid postnatal growth or adult obesity increases the risk of CVD

• Poor fetal growth has lifelong adverse effects on bone health

• Maternal vitamin D insufficiency is likely to have long-term effects on the bone health of the offspring

• Poor fetal and infant growth have lifelong effects on lung capacity and function

• Childhood obesity may increase risk of asthma

breast

• Pregnant women or breastfeeding mothers do not need to avoid food allergens unless allergic themselves or advised to modify diet by their doctor. Delaying introduction of allergen-containing foods during weaning is no longer recommended unless the child is at higher risk of developing allergy (e.g. family history) or delay is advised by a doctor

• Alcohol can cause damage to an unborn baby at all stages of pregnancy. Heavy alcohol consumption in pregnancy can cause facial deformities, heart defects and learning and behavioural disorders

• Iodine is important for normal brain development. It is supplied in the maternal diet by sea fish, shellfish, seaweed and milk. Plant foods also contain iodine, but levels depend on the amount of iodine in the growing environment

• Long-chain omega-3 polyunsaturated fatty acids are needed for normal visual and brain development. The best source of preformed omega-3 fatty acids for pregnant and breastfeeding mothers is oily fish. These fatty acids are also added to many infant formulas

• Vitamin B12 deficiency in the mother can cause damage to the nervous system in infants

• High caffeine consumption during pregnancy (e.g. more than 2 cups of coffee/day) may result in poor fetal growth, especially in male babies, so caffeine intake should be limited

• Accelerated growth rate in childhood may increase risk of some cancers (e.g. colon, breast) in adult life. Accelerated growth is more likely to occur with bottle-feeding than breastfeeding.

Dietary Advice to Help Reduce and Prevent Risk

Healthy Weight

Pre-Pregnancy

Achieve and maintain a healthy weight (BMI 18.5-25) before becoming pregnant – download

the Healthy Life Planner for Women.

Pregnancy

· If overweight/obese, avoid excessive weight gain but do not try to lose weight during pregnancy.

· Good monitoring of fetal growth and development and maternal health (blood pressure and blood sugar) during pregnancy can improve birth outcomes.

Infant Life

· Exclusive breastfeeding, which is recommended for around the first 6 months, has benefits for infant growth, development and health.

· If bottle-feeding, follow the instructions for making up the feed carefully.

· Make sure your baby gets his or her immunizations – childhood diseases can cause growth faltering and have long-term effects on health.

Vitamins and Minerals


Pre-Pregnancy

· Take a daily 400 µg folic acid supplement when trying to conceive to reduce risk of a neural tube defect affected pregnancy (e.g. spina bifida).

· A daily (10µg) vitamin D supplement should be considered in the winter months.

· Vegans may need to take a vitamin B12 supplement. Seek advice from your doctor.

· Avoid other supplements especially those containing vitamin A in the form of retinol unless advised by your doctor.

· Fish advice: avoid shark, swordfish and marlin and limit intake of canned tuna to no more than 4 cans per week due to the higher levels of mercury (than in other fish), which can damage a developing baby’s nervous system.

Pregnancy

· Eating a healthy, varied diet while pregnant will help provide all the nutrients required for fetal growth and development. Week by week advice for pregnant women is available here: www.nutrition4baby.co.uk

· Take a daily 400µg folic acid supplement for the first 12 weeks of pregnancy.

· Take a daily 10µg vitamin D supplement.

· Vegans may need to take a vitamin B12 supplement. Seek advice from your doctor.

· Do not take other dietary supplements unless advised by your doctor. Iron supplements maybe advised by your doctor if you are anaemic.

· Ensure adequate intake of calcium (food sources include milk, cheese and other dairy products) and iron (include red meat and eat other iron-containing foods (wholegrain products, pulses, beans, nuts, dark green leafy vegetables) along with foods or drinks that provide vitamin C (fruit or vegetables) to help absorption.

· Avoid liver and liver products, some types of cheese (unpasteurised and mould-ripened), raw or partially cooked eggs and unpasteurised milk.

· See ‘Fish advice’ above in Pre-Pregnancy section.

· Avoiding potential allergens such as peanuts is no longer considered necessary, unless you are allergic to them or avoidance is advised by a doctor.

Infant Life

· Vitamin drops (vitamins A, C and D) should be given from 1 month of age and continued until age 5. Babies having more than 500ml/day formula don’t need these as infant formulas already contain sufficient.

· Oily fish provides beneficial omega-3 fatty acids. Boys (up to age 4) should be offered up to 4 portions of oily fish/wk, girls a max. of 2/wk (due to the potential presence of dioxins & PCBs that can accumulate in body tissues).

· Foods known to provoke allergies should be avoided before 6 months (e.g. cows milk, eggs, wheat, peanuts, nuts, seeds, fish and shellfish).

Physical Activity

Pre-Pregnancy

· Healthy adults should do at least 2.5 hours moderate intensity exercise each week (e.g. 30 mins, 5 days a week).

Pregnancy

· Being active during pregnancy helps prevent excessive weight gain and has many other benefits. Find out more at www.nutrition4baby.co.uk

Infant Life

· Encourage physical activity through floor-based play. Limit extended periods of sedentary activity in the under 5s (except time spent sleeping).

Smoking

Pre-Pregnancy

· Encourage physical activity through floor-based play. Limit extended periods of sedentary activity in the under 5s (except time spent sleeping).

Pregnancy

· Smoking (including passive smoking) should be avoided during pregnancy.

Alcohol

· General advice is to avoid alcohol during pregnancy. However, if you decide to drink, limit alcohol consumption to a maximum of 1-2 units, once or twice a week.

Coffee
· Limit intake of caffeine to no more than 200mg/day. See: http://bit.ly/165fp7Q

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