Post on 09-Jun-2020
Infancy’s Big Bang: Explosive Growth & Development
in Early Childhood
Robert Murray MD FAAP
Professor of Pediatrics, The Ohio State University
Ohio Chapter, American Academy of Pediatrics
Apis mellifera scutellataKiller Bees
Apis mellifera ligusticaEuropean Honey Bees
Robinson & colleagues
Genes + Experiences = Gene Expression (how we react)
Epigenetics: Which, When, & How Much Protein
Genetics: DNA Makes Protein
Cell
Social experience changesHow our genes work,
which changesHow our body works,
which changesHow we behave,
which changeswho we become
The Epigeneticsof our
“Exposome”
Miller, Jones. Toxicol Sci, 2014; 137:1-2
Epigenetics = Experiences
Diet Quality
Too little/ Nutrient Imbalance/ Too Much
Metabolism ChangesFunction Changes
DEVELOPMENT CHANGES
Body composition Heart & Blood vessels
Appetite and energy control
Tissue Structure and Function Changes
Cells Dysfunction
Tissues Remodel
What Happens to MotherHappens to Baby
Poor diet & inactivity
Under- or over-weight
Blood pressure and blood flow
Corticosteroids
Smoking, alcohol
Physical, mental stress
Toxins, drugs, chemicals
Chronic diseases (inflammation)
Blood sugar
We are born with…Genetic Potential
Ready: Brain cells, the spine, nerves and blood vessels
form and grow during pregnancy
The Big Bang: Birth Experience Information floods the body
all 5 senses
muscles
movement & balance & gravity
Explosive Early Growth
Velocity Linear growth
• 10 in 1st yr
• 4-5 in 2nd yr
• Doubled birth length by 5 yrs
Weight
• Doubled by 4 months
• Tripled by 12 months
• Then 5 lbs / year until 5 yrsGrowth Velocity and Basal Metabolic Rate x AgeSon’kin and Tambovtseva. Bioenergetics, 2012; Chap 5:121-142
Basal Metabolic Rate
The Developing Brain
Brain doubles in size in first yearTriples in size by the third year
Massive synaptic connections (700 per second) Connections stronger with use, but lost if unused
The Child Responds
The Adult Responds
What is this baby doing?
“Play” is Actually Sensory-Motor Learning
Sight, sound, smell, touch & taste
Big and small muscles
Body movements
They practice all their skills
Exploration develops the brain
Babies Seek Novelty
Mealtime is Playtime, Too
Sight
Smell
Taste
Texture
Sound
Eating skills
Explore new flavor combinations
Food preferences*“The magic of everyday moments”
Nutrients Build the Brain Collectively
• Vit B1 – utilize glucose, modulatecognition, language development, neurotransmitter synthesis
• Vit B6, B12, choline, tryptophan, tyrosine, phenylalanine, copper, histidine, threonine –synthesis of neurotransmitters
• Vit B12 – cognition, language, myelination
• Vit C – antioxidant, cognition, memory, myelination
• Vit D – prevents neurodegenerative disease
• Vit E – cell membrane integrity, antioxidant, protection of DHA
• Iron – oxygenation, synthesis of myelin & neurotransmitters, brain development, IQ
• Magnesium – energy and ion regulation, neural plasticity
• Zinc –neuromotor transmission, cell proliferation, taste
• Iodine – (via thyroid) cellular energy metabolism
• Omega 3 PUFA (DNA) – cognition, visual development
• Lutein – macular protection
• Flavonoids – protect & enhance neurons, anti-inflammatory, cognition
Anti-microbial Factors Secretory IgA,
IgM, IgG Lactoferrin Lysozyme Complement C3 Leukocytes Bifidus factor Antiviral mucins,
GAGs
Oligosaccharides
Hormones Feedback inhibitor
of lactation (FIL) Insulin Prolactin Thyroid hormones Corticosteroids,
ACTH Oxytocin Calcitonin Parathyroid
hormone Erythropoietin
Digestive Enzymes Amylase Bile acid-
stimulatingesterase
Bile-stimulatinglipases
Lipoprotein lipase Ribonuclease
Others Casomorphins d-sleep peptides DNA, RNA Long chain
polyunsaturatedfatty acids (LCP)
Carotenoids
Growth Factors Epidermal (EGF) Nerve (NGF) Insulin-like (IGF) Transforming (TGF) Polyamines
Transporters Lactoferrin (Fe) Folate binder Cobalamin binder IgF binder Thyroxine binder Corticosteroid
binder
Cytokines andAnti-InflammatoryFactors Tumor necrosis
factor Interleukins Interferon Prostaglandins a1-anti-chymotrypsin a1-anti-trypsin Platelet-activating
factor: acetyl hydrolase
Breast Milk: Nourishes & Transitions to Life Outside the Uterus
Starting First Foods
Signs of readiness • Around 6 months old
• Head control, sit with support, eat from a spoon
• Interested
Self-feeding is a learned motor skill• Coordinate sensory and fine motor skills
• Match foods to emerging developmental skills
Challenge the infant • New colors, flavors, smells, combinations
• A steady advance in textures
Goals for Complementary Feeding 6-12 months
Augment energy and nutrients
Introduce every type, flavor, texture
Promote a responsive feeding style
Ensure food acceptance
Establish an initial dietary pattern*
A Major Shift
Past:A few foods tightly
sequenced
Today:Diverse foods repeatedly
offered
What is a Dietary Pattern?
“Over the course of any given day, week, or year, individuals consumefoods and beverages in combination – an eating pattern.
It is more than the sum of its parts; it represents the totality of what individuals habitually eat and drink, and these dietary components act synergistically in relation to health"
Dietary Guidelines for Americans, 2015
Mix and Matchthe 5 Food Groups
At every meal & snack
Build upNutrient Dense Foods
in each Food Group
• Fruits• Vegetables• Whole grains• Dairy • Quality proteins
How to Build a Dietary Pattern
The Nutrient- per- Calorie Ratio
6 to12 Months
Milks lay a solid foundation•Infant formula 84%
•Breast milk 22%
Inappropriate cow milk persists
< 12 months = still 14%-20%
NHANES 2005-12 & FITS 2016
Other Foods & BeveragesFoods & Beverages % of infants
Any fruit 82.5%
100% fruit juice 47.7%
Any vegetable 74.2%
White potato 23.9%
Green vegetable 6.6%
Beef 11.3%
Hot dogs, deli 8.8%
Chicken, turkey 28.0%
Eggs 11.0%
Yogurt 15.6%
Snack/dessert/soda* 50.5%
NHANES 2005-2012 on any given recall day
Novel First Foods
IRON
pureed beef
infant cereals scrambled eggs
white & brown rice
hummus
avocado guacamole
yogurt
spinach
PeasDatesCarrotsSweet potatoPastaMango
cheese
Baby-Led Weaning & Food Acceptance
Potential Pros Cons
Babies read their own hunger-satiety signals Dependent on parent nutrition knowledge
Less risk for over eating, excess weight Underweight more common
Encourages food explorations Risk of choking/negative experience
Reported decrease in later picky eating Nutrient adequacy unknown
Castle/Jacobsen, Building Block for Life, 2014; Rapley G. Bably-Led Weaning; Schilling L & Peterson W.; Born to Eat
• Whole, unmodified foods in graspable pieces =
repeated exposures & exploration of new foods
• Spoon feeding = advancing textures 6-12 months
A Critical Transition: 12-24 Months
Food Groups Prevalence
Any fruit/ 100% fruit juice 83% / 47%
Any Vegetable 80%
White Potato 45%
Dark Green veggies 7.5% *
Yellow veggies 17.5%
Beef 33%
Deli meats, hot dogs 27% *
Cereals 72%
Pre-sweetened cereals 30%
Eggs 35% *
Yogurt 25% *
NHANES 2005-12
By the age of 2 yearsthe child will assume
the eating habitsof the family
Toddler’s Pick Up Our Snack Habits
“Snacks” are mini-meals
•91% consume snacks
•33% consume 3 or more snacks/day
•25% of daily energy
•Averages 288 kcal/ day
•Added sugars = 8-10% of kcals
Snack Foods Prevalence
Any sweet-salty snacks 92%
Any desserts 82%
Cakes & Pastries 58%
Ice cream/frozen treats 21%
Regular cookies 30%
Candy 32%
Salty snacks 53%
Sweetened beverages 54%
Muffins, donuts 11%
But also include fiber, Vitamins C, D, E, B12, calcium, iron, zinc, & potassium
What is a “Snack”?
Food type
Portion size
Time of day
Location
Purpose
Younginer et al. Appetite, 2016; 98:35-40
“A small portion of food that is given in-between meals,
frequently with an intention of reducing or preventing hunger
until the next meal time”
“Snacks are Not Real Food”Less preparation or balance needed,
For the enjoyment of the child,Helps me manage my child behavior
Scientists
Parents
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Percentage Of U.S. Children Consuming Snacks Over A Two-Day Period (1977–2006)
SOURCE Content based on authors’ assessments. NOTE Percentage of children consuming snacks on day 1 of interview, day 2 of interview, or both.
Piernas and Popkin, Health Affairs, 2010; 29:398-404
EveryU.S.
Child &Teen
Snacks
The Holy Trinity of Food Choice
CONVENIEN
CE
VALUE
Snacks can Strengthen a Dietary Pattern
Dairy
• Protein, calcium, Vits D, A, potassium, B vits, phosphorous, magnesium, zinc, niacin
Sweet Potatoes/ Squash
• Carotenoids, Vit C, potassium, fiber
Spinach, kale, watercress
• Vit A,C,K, folate, potassium, mag., iron, phytochemicals
Tomatoes, avocados
• Vit A,C, fiber, phytochemicals
Broccoli, greens, green beans
• Vit C, folate, carotenoids
Rye, wheat, oat grain products
• Whole grain, fiber, B Vitamins
Citrus fruits
• Vit C, fiber, folate, phytochemicals
Blueberries, blackberries
• Vit C, fiber, folate, potassium
Salmon & fatty fish
• Omega-3 fatty acids, protein
Nuts, seeds
• Fiber, protein, MUFA/ PUFA, omega-3 FA (walnuts), vit E (almonds), folate (peanuts)
Pack in Nutrients per Calorie Drewnowski, Fulgoni; Am J Clin Nutr; 1223s, 2014Verger EO et al, J. Nutr. 144: 929–936, 2014
Speed Snacks
Breakfast Powders & Milk130 kcals + non-fat milk = 220 kcalsHigh in potassium, Vit A, C, Calcium, Ironw/ milk it blends carbs, protein, fats
Energy Bars230 kcalsGrains, fruitHigh in potassium, Vit A, Vit C,Calcium, Iron, Vit D, Vit E, fiber,Vit B12, Magnesium, Zinc, etc.Balance: fats, carbs, protein
Foods Paired with Other FoodsSalsaHummusGuacamoleYogurtDipsDressingsCerealsSoupsSmoothies
Yogurt & …90-250 kcalCalcium, Vit DMany Vits & Minerals
Popcorn & 100% Juices100 kcal microwaved +120 kcal fruit juicesWhole grain, fiber, vitamins
Veggies in …Raw with dipsSoupsStewsStock100% Juices w/ fruitsPureed and hidden
A Healthful Diet Pattern•Plant oils
•Fish & seafood
•Lean meats
•Legumes
•Nuts & seeds
•Vegetables
•Fruits
•Dairy & yogurt
•Whole grains
•Wine
Dietary Patterns are PersonalPreferences, experiences, culture
Improvements are incremental
Added Sugars in Children’s Diets NHANES 2007-2010
Soft drinks*; 4.4
Fruit drinks*; 2.7
Sweet Bakery Products; 2.3
Other Desserts; 1.6
Other; 1.4
Candy; 1.4
Ready-to-Eat Cereals; 1.1
Sugars; 0.9
Flavored Milk; 0.8
Coffee, Tea; 0.7
Sport and energy drinks*; 0.5
Breads, Rolls, Tortillas; 0.4
Quick Breads, Bread Prod.; 0.3 Condiments, Sauces;
0.3
Yogurt; 0.2
Dairy Drinks & Substitutes; 0.2
Teaspoon Equivalentsof Added Sugars
NHANES 2007 – 2010, ages 2- 18 yearsBailey et al. Nutrients, 2018; 10 (1)
5 sources =75% Sugars
Soft DrinksFruit Drinks
Grain DessertsOther Desserts
CandyWhy Do We Discourage… * Yogurt* Flavored milks* Sweetened cereals* 100% fruit juice
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Use Added Sugars
wiselyto promote the consumption of
Nutrient Rich Foods
Snacks, Sweetened Beverages, Added Sugars, and Schools Murray R, Bhatia J and the
COUNCIL ON SCHOOL HEALTH, COMMITTEE ON NUTRITIONPediatrics 2015; 135:3 575-583
Growth & brain development require optimal nutrition
Initial feeding experiences establish the first dietary pattern
Snacks must contribute to an individual’s dietary pattern
Use added sugars wisely to promote nutrient rich foods