Early Nutrition eAcademy Southeast Asia e-Learning for Enhancing Knowledge on Nutrition during the First 1000 Days of Life

Background: The double burden of both under- and overnutrition during the first 1000 days is highly prevalent in Southeast Asia (SEA), with major implications for lifelong health. Tackling this burden requires healthcare professionals (HCPs) to acquire evidence-based current knowledge and counselling skills. We assessed the needs of HCPs in SEA and developed a continuing medical education/professional development (CME/CPD) program using an e-learning platform to reduce existing gaps. Methods: European, Thai and Malaysian universities collaborated with SEA national nutrition associations in the Early Nutrition eAcademy Southeast Asia (ENeA SEA) project. We assessed HCPs’ needs using questionnaires and mapped CME/CPD programmes and regulations through stakeholder questionnaires. Using a co-creation approach, we established an e-learning platform. Evaluation in users was undertaken using questionnaires. Results: HCPs in SEA reported major training gaps relating to the first 1000 days of nutrition and limited impact of existing face-to-face training. Existing pre/postgraduate, residency and CME/CPD programmes did not adequately address the topic. To address these gaps, we produced a targeted e-learning platform with six modules and CME-tests. National ministries, Thai and Malaysian universities, and professional associations endorsed the training platform. To date, over 2600 HCPs have registered. Evaluation shows high acceptance and a very positive assessment. Conclusions: Dedicated e-learning can reduce major gaps in HCP training in SEA regarding nutrition during the first 1000 days of life at scale and is highly valued by both users and key stakeholders

The effect of diet on the physical and mental development of children: views of parents and teachers in four European countries

Although the impact of diet on physical health is an important public health issue, less attention has been devoted to the relationship between nutrition and children's mental development. The views of parents and teachers about the extent to which diet affects physical and mental development of children were compared in four European countries. An online questionnaire (developed in English and translated) was circulated through a market research agency. Participants were parents or teachers of children aged 4-10 years without learning or behavioural issues. Questionnaires were returned by 1606 parents (401 in England, Germany and Hungary; 403 in Spain) and 403 teachers (100 in each country, except for 103 in Hungary). Teachers were older than parents (35·3 % v. 18·3 % over 45 years; P<0·001) and less likely to smoke (15·9 % v. 26·3 %, P<0·001). There was no difference between the proportions of parents and teachers who felt that a child's physical development depended very much/extremely (v. moderately/slightly/not at all) on diet (overall 79·8 %). Lower proportions of both groups thought that mental development was very much/extremely influenced by diet (67·4 %). In the regression modelling, believing that physical and mental performance was greatly influenced by diet was significantly and positively associated with living in Hungary, scoring higher on a measure of General Health Interest and (parents only) level of education attained. Differences existed among countries in most views. Lower levels of awareness of the importance of diet for brain development and cognition (compared with physical health outcomes) indicate the potential for educating consumers, especially parents with lower educational attainment

Early Influences of Nutrition on Postnatal Growth

Health and nutrition modulate postnatal growth. The availability ofamino acids and energy, and insulin and insulin-like growth factor-I(IGF-I) regulates early growth through the mTOR pathway. Amino acids andglucose also stimulate the secretion of IGF-I and insulin. Postnatalgrowth induces lasting, programming effects on later body size andadiposity in animals and in human observational studies. Rapid weightgain in infancy and the first 2 years was shown to predict increasedobesity risk in childhood and adulthood. Breastfeeding leads to lesserhigh weight gain in infancy and reduces obesity risk in later life byabout 20%, presumably partly due to the lower protein supply with humanmilk than conventional infant formula. In a large randomized clinicaltrial, we tested the hypothesis that reduced infant formula proteincontents lower insulin-releasing amino acid concentrations and therebydecrease circulating insulin and IGF-I levels, resulting in lesser earlyweight gain and reduced later obesity risk (the ‘Early ProteinHypothesis’). The results demonstrate that lowered protein in infantformula induces similar - but not equal - metabolic and endocrineresponses and normalizes weight and BMI relative to breastfed controlsat the age of 2 years. The results available should lead to enhancedefforts to actively promote, protect and support breastfeeding. Forinfants that are not breastfed or not fully breastfed, the use of infantformulas with lower protein contents but high protein quality appearspreferable. Cows’ milk as a drink provides high protein intake andshould be avoided in infancy

Early Influences of Nutrition on Postnatal Growth

Health and nutrition modulate postnatal growth. The availability ofamino acids and energy, and insulin and insulin-like growth factor-I(IGF-I) regulates early growth through the mTOR pathway. Amino acids andglucose also stimulate the secretion of IGF-I and insulin. Postnatalgrowth induces lasting, programming effects on later body size andadiposity in animals and in human observational studies. Rapid weightgain in infancy and the first 2 years was shown to predict increasedobesity risk in childhood and adulthood. Breastfeeding leads to lesserhigh weight gain in infancy and reduces obesity risk in later life byabout 20%, presumably partly due to the lower protein supply with humanmilk than conventional infant formula. In a large randomized clinicaltrial, we tested the hypothesis that reduced infant formula proteincontents lower insulin-releasing amino acid concentrations and therebydecrease circulating insulin and IGF-I levels, resulting in lesser earlyweight gain and reduced later obesity risk (the ‘Early ProteinHypothesis’). The results demonstrate that lowered protein in infantformula induces similar - but not equal - metabolic and endocrineresponses and normalizes weight and BMI relative to breastfed controlsat the age of 2 years. The results available should lead to enhancedefforts to actively promote, protect and support breastfeeding. Forinfants that are not breastfed or not fully breastfed, the use of infantformulas with lower protein contents but high protein quality appearspreferable. Cows’ milk as a drink provides high protein intake andshould be avoided in infancy

Early nutrition programming of long-term health

Increasing evidence from the EU Project EARNEST and many other investigators demonstrates that early nutrition and lifestyle have long-term effects on later health and the risk of common non-communicable diseases (known as ‘developmental programming’). Because of the increasing public health importance and the transgenerational nature of the problem, obesity and associated disorders are the focus of the new EU funded project ‘EarlyNutrition’. Currently, three key hypotheses have been defined: the fuel mediated ‘in utero’ hypothesis suggests that intrauterine exposure to an excess of fuels, most notably glucose, causes permanent changes of the fetus that lead to obesity in postnatal life; the accelerated postnatal weight gain hypothesis proposes an association between rapid weight gain in infancy and an increased risk of later obesity and adverse outcomes; and the mismatch hypothesis suggests that experiencing a developmental ‘mismatch’ between a sub-optimal perinatal and an obesogenic childhood environment is related to a particular predisposition to obesity and corresponding co-morbidities. Using existing cohort studies, ongoing and novel intervention studies and a basic science programme to investigate those key hypotheses, project EarlyNutrition will provide the scientific foundations for evidence-based recommendations for optimal nutrition considering long-term health outcomes, with a focus on obesity and related disorders. Scientific and technical expertise in placental biology, epigenetics and metabolomics will provide understanding at the cellular and molecular level of the relationships between early life nutritional status and the risk of later adiposity. This will help refine strategies for intervention in early life to prevent obesity.</jats:p