Nutrient Recommendations for Growing-up Milk: A Report of an Expert Panel.

Utilization of expert recommendations in the development of food and beverage nutritional profiles represents an opportunity to merge science and food manufacturing to deliver nutritionally optimized products into the marketplace. This report details expert panel guidelines for the design of a nutritional product for children one to six years of age. This interaction demonstrates the essential synergy between academia and food manufacturers in translating nutrient recommendations to food for their delivery to a population. Important factors for such translation are the identification of applicable nutrient recommendations and selection of an appropriate delivery matrix. This report demonstrates the translation of expert nutritional recommendations to a milk-based product for children--one to six years of age.

[Medical application of breast milk banks].

The history of breast milk banks is over 100 years. Most of the milk banks were closed because of HIV in the 80's. But more and more milk banks are re-opening and new ones are being established as the composition and superiority of breast milk are recognized again. The Human Milk Banking Association of North America and European Milk Bank Association have been set up and they have established and revised the standards and guidelines of breast milk banks. There is no doubt of the clinical effects of donor human milk on preterm infants worldwide. The Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommended that the preterm infants should use donor human milk when their own mothers' milk is not enough. The first breast milk bank was set up in China in 2013, and its clinical and social significance is worthy of further study.

Feeding the preterm infant: opportunities and challenges of bringing science to the bedside.

Designing an optimal feeding program for preterm infants is particularly challenging. These infants require individualized feeding plans and frequent medical interventions, and their health status and physical limitations necessitate specialized products. This review highlights the challenges of translating new understandings into practical application and, specifically, the challenges of translating scientific knowledge into available nutritional products that can be used to meet the special needs of preterm infants. All infant formula products are developed for use in a heavily regulated environment, which is not integrated internationally. The regulatory framework for preterm nutrition products can be particularly complex in the areas of composition and the degree of scientific and clinical support required across countries. Registration and approval of products for preterm infants in most countries must address the complexities for a population for which no well-recognized nonclinical safety or efficacy models exist. Mandatory regulatory review for science-based innovative product improvements may require two or more years. In addition, throughout years of development, industry must justify the financial support of programs that serve a small specialty segment of the market. These industry-specific challenges may be neither visible nor appreciated by the general public or health care professionals, and, yet, they are integral to the development process. Effective collaborations among academic scientists, regulatory authorities, and the industry are essential to bring science to the bedside. Without such collaborations, preterm infants, and particularly very low birth weight infants, in the neonatal intensive care unit will not be able to benefit from innovative nutrition interventions designed to improve short- and long-term clinical outcomes.

Intestinal mucosal defense system, Part 1. Consensus recommendations for immunonutrients.

When microbial communities colonize in the developing intestinal tract after birth, microorganisms interact with specific apical surface receptors on the enterocytes. This interaction triggers a response that prevents overexpression of inflammatory cytokines, thus providing protection from pathogen-induced mucosal damage. Multiple immune modulatory factors in human milk and innate humoral factors also control inflammatory responses, providing additional protective effects. Our understanding of the role of the luminal microbial communities or microbiota is growing rapidly as novel technologies provide new insights into their taxonomy, function during early development, and impact on life-long health. Multiple studies have evaluated the effects of the specific nutrients, glutamine, arginine, nucleotides, polyunsaturated fatty acids, and lactoferrin, on disease outcomes in premature infants. These studies support a role for nutrients to modulate host defense mechanisms in premature infants, to develop normal digestive function, to protect from bacterial translocation, and to preserve mucosal barrier integrity. These effects are clearly important. However, not enough is yet known to design specific clinical care practices that support a healthy microbiota.

Intestinal mucosal defense system, Part 2. Probiotics and prebiotics.

The interplay between microorganisms and the intestine of newborn infants is associated with diverse functional and clinical outcomes that result from the specific interactions among microbial communities, their products, and the unique characteristics of the gastrointestinal tract. Multiple mechanisms of action for infant formula ingredients with probiotic activity appear to exist. These mechanisms are thought to protect the host not only from intestinal diseases but also from systemic infection. However, questions about the safety of probiotics for preterm infants remain unanswered, particularly with regard to sepsis, immunomodulatory effects, and microbial resistance. Few well-designed studies have been conducted to evaluate the effects of probiotic, prebiotic, and synbiotic ingredients on relevant clinical outcomes in preterm infants. Although existing data are encouraging, there is insufficient evidence to recommend the routine use of these ingredients in all preterm infants.

[National epidemiological survey on childhood obesity, 2006].

OBJECTIVE: The purpose of the 3rd national survey on childhood obesity was conducted not only to understand the present status and trends of childhood obesity in China since the last survey conducted 10 years ago, but also to reveal the health status of preschool children at nutrition transit period and to evaluate the efficacy and sensitivity of cited reference population, criteria and cut-off point of body mass index (BMI), adiposity rebound age, waist/hip ratio and other parameters relevant to the diagnosis of obesity made by the national task force on childhood obesity of China (NTFCOC). METHODS: A total of 84,766 children aged 0 - 7 years were recruited in the survey by the random cluster sampling which represented a 1, 414, 220 children's population from 11 cities covered north, central, south and west regions of China. The criteria of screening overweight/obesity was more than 1 Z-score/2 Z-score of the medium of reference value of weight for height made by WHO. Length-height/weight for all subjects and waist/hip/thigh circumference and blood pressure data for children 3 - 6 years of age were measured. The prevalence of overweight and obesity, overweight-obesity ratio, adiposity rebound age and BMI were calculated. The enumeration and measurement data were statistically managed by chi-square test and T-test, respectively using SPSS version 12.0 and the significance level was 0.05. RESULTS: (1) The prevalence of obesity and overweight was 7.2% and 19.8% for all; 8.9% and 22.2% for boys, and 5.3% and 17.0% for girls, respectively, which is 3.6/4.7 times higher than that of 1996 respectively, the annual increase rate of obesity and overweight was in average 156% and 52%, respectively. The distribution pattern of prevalence of overweight and obesity in geographic areas and gender was that the northern regions had higher prevalence than the west and the central regions and the prevalence in boys was higher than in girls. The obesity/overweight ratio (OOR) was still at a high risk level. (2) BMI at 1 month after birth was higher than 16.5, then increased to the top of 17.8 at 1 year of age and decreased to the bottom of 15.7 at 5.5 years of age and increased a little since then. It was never higher than 18 of diagnosis point of obesity during the preschool age period. (3) The adiposity rebound age was 5.5 years of age in this study and delayed half a year as compared with that seen in 1999. The adiposity rebound ratio at first half year after birth (ARR1) was 0.56 and 0.97 at second half year after birth (ARR2) which is an acceptable level according to the cut-off point made by NTFCOC and lower than the level obtained 10 years ago. (4) The pseudo-overweight phenomenon can be seen in the western regions which was derived from linear growth retardation and showed that both the malnutrition and obesity are a health problem in the poverty and maintain area of the western regions.(5) The 12.9% of obese children who's blood pressure was higher than 95th percentile of reference value and 17.2% of them had a waist/hip ratio higher than 1.0 which is a warning point for the risk factor of CHD made by the NTFCOC. (6) The data showed that all the reference population and it's cut-off point for BMI, adiposity rebound age/ratio, waist/hip ratio etc. made by NTFCOC is valuable, reliable and practicable. CONCLUSION: The prevalence of childhood obesity and high blood pressure in obese children has been increased sharply during the recent 10 years, which is a out of control and a severe hazard to obese children. The early prevention and management of childhood obesity is urgently needed.

Emerging nutrition challenges: policies to tackle under-nutrition, obesity and chronic diseases.

On 19 May, 2008, Mexico's Secretary of Health, Dr José Angel Córdova Villalobos, hosted an event entitled Emerging Nutrition Challenges: Policies to Tackle Under-nutrition, Obesity and Chronic Diseases. Held in conjunction with the World Health Assembly (WHA) in Geneva, nearly 100 delegates from over 30 countries attended. The International Association of Infant Food Manufacturers and the International Hospital Federation supported Mexico in its sponsorship of this event. Dr Villalobos provided opening remarks including an overview of Mexico's public policies to prevent obesity and chronic diseases. Dr. Mauricio Hernández, Mexico's Undersecretary of Health, moderated as six experts from around the world spoke on issues relating to the nutrition "double burden" (i.e. malnourishment and obesity), successful interventions and policy opportunities for improving nutrition, preventing obesity and enhancing health outcomes. Following are abstracts from their presentations.