Betydningen af amning og overgangskost for at forebygge senere fedme

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1 Betydningen af amning og overgangskost for at forebygge senere fedme KL møde 9.juni 2016 Kim Fleischer Michaelsen Institut for Idræt og Ernæring Københavns Universitet 1

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4 Lancet breastfeeding series Victora et al 2016 Effects of breastfeeding on later overweight and obesity Based on meta-analysis by Horta et al Overall effect - OR 0 74 ( ) In High Income Countries, residual confounding by Socio Economic Position is a possibility; However, the effect size was similar in studies from Low- and Middle Income Countries (a third of all studies). 23 high-quality studies showed a smaller pooled reduction of 13% (95% CI 6 19) Conclusion: Suggestive evidence of protection, including high-quality studies and those from low-income or middle-income settings

5 Better sateity regulation Breastmilk composition and taste changes during a feeding provides satiety signals to stop suckling The BF infant plays a more active role Low protein content and bioactive factors in human milk could play a role 5

6 AJCN

7 Telephone based support prolongs breastfeeding duration in obese women: A randomized trial E Malchau Carlsen, A Kyhnaeb, K Renault, D Cortes, KF Michaelsen, O Pryds Am J Clin Nutr obese mothers randomised to structured interview and at least nine supportive telephone calls or standard care Improved support increased: Excl BF from median of 40 d to 120 d, p=0.003 Any BF from 108 to 184 d, p=

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9 Nye anbefalinger fra SST mhp at nedsætte protein indtaget mhp at reducere risikoen for fedme Ingen mælkeprodukter før 12 mdrs alderen kun modermælk og modermælkserstatning Mælkeindtag fra 1 år ca 350 ml. Max 500 ml Ingen skyr, fromage frais og ymer før efter 2 års alderen Letmælk fra 1 år fra 2 år fedtfattig mælk

10 Food Nutr Res Higher protein intake in infancy and early childhood is convincingly associated with increased growth and higher body mass index in childhood. The first 2 years of life is likely most sensitive to high protein intake. Protein intake between 15 E% and 20 E% in early childhood has been associated with an increased risk of being overweight later in life, but the exact level is yet to be established.

11 B-24 Project Dietary Guidelines for Americans from birth to 24 mo (NIH, CDC, FDA, USDA) Kim F Michaelsen and Frank R Greer: Protein needs early in life and long term health AJCN 2014; 99: 718S-22S Emerging evidence that high protein intake during the first two years is a risk factor for later overweight and obesity. Prudent to avoid high protein intake during the first two years of life: Lowering upper limit of protein content of formulas and limiting intake of cow s milk.

12 Protein intake 9-12 months and BMI at 6 years * Different from Q4 * * Protein intake 9 mo: 15 E% +/ mo: 16 E% +/- 3 Gunnarsdottir and Thorsdottir. Int J Obesity 2003

13 Protein-adiposity hypothesis tested in the CHOP study Koletzko et al. AJCN 2009 Infants randomised to infant formula with low or a high protein content starting within 8 weeks 0-4 mo: LP: 1.77g/100kcal - HP: 2.2g/100kcal 4-12 mo: LP: 2.90g/100kcal HP: 4.4g/100kcal Cow s milk: 5.2 g/100 kcal Low protein diet: slower growth rates during the first year of life at 2 years lower BMI

14 6 y follow-up of CHOP study Weber et al AJCN 2014

15 Andre pointer fra den nye vejledning Mælkeindtag fra 1 år ca 350 ml. Max 500 ml Ingen skyr, fromage frais og ymer Letmælk fra 1 år fra 2 år fedtfattig mælk Junior mælk growing up milk (1-3 år) anbefales ikke. Jernholdig kost vigtig fra 6 mdr: Kød, fisk, af og til jernberiget grød, evt MME i grød og mos, leverpostej, frikadeller og fiskefrikadeller Gerne fede fisk, men ikke rovfisk inkl tun (dåse tun?) Baby-led-weaning diskuteres, men anbefales ikke generelt 15

16 Large differences in dietary protein content Breastmilk 5E% Infant formula 7-9E% Foods for MAM 10E% Family Food 15-20E% Whole cow s milk 20E% Skimmed milk 39E% Meat 30-60E% 16

17 Ralle G. 23. feb kl. 10:21 Gør som du vil. Hvis du følger alle de råd der kommer, risikere du at dø af en trykfejl

18 Role of fats in the first two years of life as related to later development of NCDs Review by Agostoni et al - Nutr Metab Cardiovasc Dis 2012 Proceedings - WHO meeting on complementary feeding and later NCD There is no evidence of any convincing association between fat intake during the 6-24-mo period and later indices of adiposity.

19 Early fat intake and later obesity Prevalence of overweight in 6-14 year old children and changes in fat energy percentage in 1-2 year old children Rolland-Cachere and Scaglioni: Role of Nutrients In Promoting Adiposity Development - e-book.ecog-obesity.eu

20 Risiko for kvælning? Spiseproblemer maskeres? Får de der har forsinket udvikling energi nok? Baby-led-weaning 20

21 1 Baggrund 2 Monitorering af børns vækst 3 Nyfødtes vækst 4 Vægtøgning gennem spædog småbørnsalderen 5 Tidlig opsporing af overvægt 6 Længde/højde-vækst 7 Hovedomfang 8 Særlige grupper 60 sider

22 Danish 2014 vs WHO standard Boys

23 Dias 23

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26 Exclusively breastfed boy: 5 mo: 12.1 Kg BW: 3828 g SKOT III BMI 25 mo: 14.8 kg

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