What is new in nutrition for the first 1000 days?: DSM Nutritional Products satellite symposium at the Power of Programming
Manfred Eggersdorfer, Professor for Healthy Ageing at Groningen University and Senior Vice-President for Nutrition Science and Advocacy at DSM Nutritional Products, emphasized the importance of good nutrition during the first 1,000 days – from conception to the child’s second birthday – for life-long health. He then introduced the three experts who were going to discuss the latest science on vitamins K and D and long-chain polyunsaturated fatty acids (LC-PUFA) in early life.
Henkjan Verkade, Professor of Pediatrics at the University Medical Center Groningen explained that vitamin K needs bile acids and an intestinal transporter (NPC1L1) to be absorbed. To avoid bleeding in newborns, many countries recommend intramuscular injection or supplementation, either daily or with mega-doses. This is particularly relevant for breastfed infants, as absorption from breastmilk is low due to the high cholesterol levels. Cholesterol and vitamin K are absorbed similarly and there is consequently competition, which could be overcome by a single high dose of vitamin K. If the addition of milk fat globule membranes, which are rich in cholesterol, to infant formula becomes the norm, the same will apply to formula fed infants. In infants with biliary atresia, insufficient bile acid impairs vitamin K absorption. For Professor Verkade, the most promising method is consequently a single intramuscular dose of vitamin K at birth.
This was followed by an introduction to vitamin D in pregnancy and lactation by Irene Cetin, Professor of Obstetrics and Gynecology at the University of Milano. She highlighted the importance of vitamin D to conceive, but also to maintain a normal pregnancy. Moreover, it seems to reduce the risk of developing complications such as preeclampsia and plays a crucial role in the development of the fetal bones, but also the immune system and in allergy prevention. Unfortunately, a significant number of pregnant women worldwide have inadequate vitamin D levels. As it is difficult to cover the needs through the diet and endogenous synthesis, she recommended daily supplementation of pregnant and lactation women with 600 IU and infants with 400 IU.
Berthold Koletzko, Professor of Paediatrics and Head of the Division of Metabolic and Nutritional Medicine at University of Munich Medical Centre discussed the importance of LC-PUFA, in particular arachidonic acid (AA) and docosahexaenoic acid (DHA) for growth and particularly cognitive development during pregnancy, infancy and early childhood.
The capacity of infants to produce LC-PUFA from shorter versions is very limited and they depend on adequate intakes from breastmilk, formula or supplements. To achieve adequate DHA levels in breastmilk, maternal intakes of ≥200 mg/d are necessary. This is particularly important as a significant number of persons are very inefficient at producing LC-PUFA from shorter version due to a genetic variation.
There is evidence that DHA can only function optimally when adequate amounts of AA are available. Therefore, Professor Koletzko is worried about the consequences of the new European legislation, which states that infant formula should provide up to 1% of fatty acids as DHA without a proportional increase in the intake of AA.
Witt, M., et al. (2016). "Prophylactic dosing of Vitamin K to prevent bleeding." Pediatrics 137(5)
Saraf, R., et al. (2016). "Global summary of maternal and newborn vitamin D status – a systematic review." Maternal & Child Nutrition 12(4): 647-668
Koletzko, B., et al. (2014). "Current Information and Asian Perspectives on Long-Chain Polyunsaturated Fatty Acids in Pregnancy, Lactation, and Infancy: Systematic Review and Practice Recommendations from an Early Nutrition Academy Workshop." Annals of Nutrition and Metabolism 65(1): 49-80