NUTRITION TODAY& HEALTH TOMORROW

Index

1 HERO INSTITUTE FOR INFANT NUTRITION

2 INFANT NUTRITION

2.1. Nutrition Basics

2.1.1. - Nutrition Basics

2.1.2. - Nutrition Process

2.2. Baby feeding

2.2.1. - Baby Digestive System

2.2.2. - Baby Feeding

2.2.3. - Product Definition

2.3. Obesity

2.4. Obesity-related diseases

2.5. Allergy

3 NUTRITION TODAY & HEALTH TOMORROW

3.1. Early Nutrition

3.2. NT&HT Strategy

3.3. NT&HT Communication

3.3.1. - Positioning Concepts

3.3.2. - Strategic Concepts

3.3.3. - Improved Compositions

4 REFERENCES

NUTRITION TODAYHEALTH TOMORROW

INDEX

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06

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30

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38

44

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58

64

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90

1. HERO INSTITUTE FOR INFANT NUTRITION

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NUTRITION TODAYHEALTH TOMORROW

04 / 05

Hero Institute for Infant Nutrition.Hero Group strives to develop, innovate,and remain dedicated to products of superiorquality in order to exceed the consumer'schanging and increasing expectations.

To achieve these so high objectives, isrequired a high excellence level in quality,research and development executionprocesses in the product development, anda total coordination between each R&Ddepartment.

Due to the geographic dispersion of the R&Ddepartments in the companies of the HeroGroup, the Hero Institute for InfantNutrition has been created to ensure thecoordination in all the activities of research,development and new technologies alongthe Hero Group.

This Institute is sited in Alcantarilla (Murcia,Spain), and leads the network of local R&Ddepartments (USA, Turkey, Swiss, Sweden…).

The Hero Institute for Infant Nutrition isdistributed in several laboratories, officesand documentation services.

The laboratories are designed and equippedwith the latest technologies available fortheir specific purpose: TechnologicalDevelopment in Infant Formula, Cereals,Special Products, Instrumental Analysis,Biotechnology…

The scientific program of the Hero Groupleans on a multidisciplinary, highly skilledwork party that works together to make ourexcellence in product development cometrue.

Collaborations with external knowledgeholders are developed in several fields,involving Universities, Hospitals, PublicResearch Centers , Sp in-of fs andTechnological Institutions to achieve ourobjectives.

Both domestic and external projects onapplied research and experimentaldevelopment carried out ensure thedevelopment of the Hero companies in ourcore categories, serving our demandingconsumers worldwide, going forth to achieveour aim: lead the infant nutrition market.

Mission of the Institute

The role of the Hero Institute for InfantNutrition is helping to ensure a healthy life,providing a healthy nutrition, offeringproducts that will contribute to improve thehealth during all the life.

The Hero Institute for Infant Nutritioncompromises to develop its activity in severalfields:

Adapt, when possible, the Hero Groupproduct portfolio to the best valuablecomposition for infant nutrition.

Provide comprehensible information toconsumers and healthcare providers aboutthe product portfolio.

Provide an adequate education in healthynutrition.

Develop responsible marketing practicesaccording to legislation procedures andguidelines.

Promote a healthy lifestyle in all the HeroGroup companies.

HERO INSTITUTE

2. INFANT NUTRITION

06 / 07

Nutrition BasicsNutrition BasicsNutrition Process

Baby feedingBaby Digestive SystemBaby FeedingProduct Definition

Obesity

Obesity-related diseases

Allergy

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Infant Nutrition

NUTRITION TODAYHEALTH TOMORROW

2.1 NUTRITION BASICS

INFANT NUTRITION

08 / 09

Nutrition is the set of processes by which the organism receives, transforms and uses the chemicalsubstances contained in foods. This concept shall be differentiated of Feeding, that is the act toprovide foods to the body, and ingest them in a of conscious and voluntary form.

These chemicals of foods are the Nutrients that are used by the body for growth, maintenance,and energy providing.

Nutrients can be classified in two main groups:

Macronutrients: are required by the body in relatively large amounts:Proteins.Fats.Carbohydrates.Dietary Fibre.Water.

Micronutrients: are needed in minute amounts:Minerals.Vitamins.

Nutrient Balance: Carefully planned nutrition must provide an energy balance and a nutrientbalance. Excess intake of macronutrients can lead to obesity and related disorders (DiabetesMellitus, Hypertension, Coronary Hearts disease...); excess intake of micronutrients can be toxic.Also, the balance of various types of nutrients can influence the development of disorders. Lackof nutrients can result in deficiency syndromes or other disorders (Undernutrition).

2.1 Nutrition Basics

Nutrition BasicsEnergyMacronutrients

ProteinFatsCarbohydratesFiberWater

MicronutrientsMineralsVitamins

Nutrition Process

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2.1.1

2.1.2

NUTRITION TODAYHEALTH TOMORROW

2.1.1 Nutrition Basics

2. INFANT NUTRITION

The amino acid composition of protein varieswidely.

Biological value (BV) reflects the similarityin amino acid composition of protein to thatof animal tissues; thus, BV indicates whatpercentage of a dietary protein providesessential amino acids for the body and is aestimation of the nutritional quality of theprotein: animal proteins (meat, milk, egg...)have good quality and most of vegetableproteins (cereals, mainly) have less quality.

A perfect match is egg protein, with a valueof 100. Animal proteins in milk and meathave a high BV (~90).

FUNCTION. Proteins are required for severalfunctions:

Structural Proteins - provides support forstructures and tissues.

Storage Proteins - store amino acids.

Antibodies - specialized proteins involvedin immune system.

Energetic Function - if the body is notgetting enough calories from dietarysources or tissue stores (particularly of fat),protein may be used for energy, obtaining4 kcal/g.

Regulation of cell activity - modulates celland tissue metabolic processes, andcoordinates certain bodily activities.

Transport proteins.

TABLE 1. AMINO ACID

Essential

IsoleucineLeucineLysineMethioninePhenylalanineThreonineThryptophanValineHistidine (*)

Non Essential

AlanineArginineAsparagineAspartic AcidCysteineGlutamic AcidGlutamineGlycineProlineSerineTyrosine

(*) the capability to synthesize Histidine is compromised in infants, so is considered essential.

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Foods provide the body with energy. Thisenergy keeps your heart beating, your brainactive, and your muscles working. The energyis measured in calories (Kcal).

Calories effectively act as the fuel that powersour bodies and enables us to function, inthe same way that the wind moves the vanesof the windill.

Balancing energy intake with energyexpenditure is necessary for a desirablebody weight. Energy expenditure dependson age, sex, weight and metabolic andphysical activity. If energy intake exceedsexpenditure, weight is gained.

Conversely if we use more energy than weconsume we use up fat to provide us withmore energy.

Carbohydrates, fats, and proteins are thenutrients that are sources of energy; fatsproduce 9 kcal/g (37 kJ/g); proteins andcarbohydrates produce 4 kcal/g (17 kJ/g).

Energy Protein

They are the structural element basic in allthe body cells. Every cell in the human bodycontains protein. It is a major part of theskin, muscles, organs, and glands. Proteinis also found in all body fluids, except bileand urine.

A protein is a large molecule composed ofone or more chains of amino acids (buildingblock of the proteins) in a specific orderdetermined by the base sequence ofnucleotides in the DNA coding for the protein.

When proteins are digested, amino acidsare left. The human body requires a numberof amino acids to grow and breakdown food.

CLASSIFICATION.Amino acids are classifiedinto two groups:

Essential amino acids cannot be made bythe body and must be supplied by food.Sources of essential amino acids includemilk, cheese, eggs, certain meats,vegetables, nuts, and grains.

Non essential amino acids are made bythe body from the essential amino acidsor normal breakdown of proteins.

Macronutrients

Fats are compounds formed from chemicalscalled fatty acids.

CLASSIFICATION. Fatty acids are classifiedin three major types depending on the typeof bonds in their molecular structure.

Saturated Fatty Acids: These fatty acidsare predominant in meats and dairyproducts and several vegetable oils (palm,coconut…). Palmitic and Estearic acidsare typical saturated fatty acids.

Monounsaturated Fatty Acids: When thepresence of monounsaturated fatty acidsis high, fat tends usually to be liquid.These fatty acids are abundant in oliveoil. Oleic acid is the most importantmonounsaturated fatty acid.

Polyunsaturated fatty acids: Fats high inpolyunsaturated fatty are usually liquidand have tendency to oxidation. Fish oils,sunflower and soy oils have high levels ofthese fatty acids. Essential Fatty Acids(Linoleic and Alpha-Linolenic) are includedin this group; essential fatty acids have tobe present in the diet because theorganism hasn't the ability to synthesizethem; they are precursors of long-chainpolyunsaturated fatty acids like Arachidonic(ARA) and Docosahexaenoic (DHA) acids,that play important nutritional roles inbrain and visual development.

Fats

Carbohydrates are one of the most plentifulorganic components in foodstuffs and have,mainly, an energetic role.

They occur naturally in fruits, milk and milkproducts, vegetables, and are also found inprocessed and refined sugars (refined sugarsprovide calories, but lack in vitamins,minerals and fiber).

CLASSIFICATION. Carbohydrates areclassified as simple or complex. Theclassification depends on the chemicalstructure of the particular food source andreflects how quickly the sugar is digestedand absorbed.

Simple carbohydrates are composed ofsmall molecules, generally monosaccharidesor disaccharides, which increase plasmaglucose levels rapidly. Monosaccharidesinclude fructose (found in fruits), galactose(found in milk) and others. Disaccharidesinclude lactose (found in dairy), maltose(found in vegetables) and some others.

Complex carbohydrates are composedof larger molecules, which are brokendown into monosaccharides. Complexcarbohydrates increase plasma glucoselevels more slowly but for a longer time.Starches and f iber are complexcarbohydrates.

FUNCTION. The primary function ofcarbohydrates is to provide energy for thebody, especially the brain and the nervoussystem. The liver breaks down carbohydratesinto glucose (blood sugar), which is used forenergy by the body.

Carbohydrates

Fatty acids can form compounds fromcombination of several fatty acids or evenother elements:

Simple lipids: They include fatty acids andthe compounds formed from combinationof fatty acids and glycerol (mono-, di- andtriglycerides).

Complex lipids: they include nitrogenor phosphorous in their composition.Among the complex lipids, importantstructural types are phosphoglycerides,phosphosphingolipids, and glycolipids.They are key components in cell membranesand play a role transporting lipids in thebloodstream.

FUNCTION. Fats are energetic nutrient(produce 9 kcal/g), but also are required forseveral functions:

Structural elements - form cell membraneand nerve structures.

Essential components in several synthesis.

Transport functions.

2. INFANT NUTRITION

Macronutrients Macronutrients

Dietary fiber is the portion of food which isnot digested nor absorbed into the body,because we don't have the enzymes requiredto its digestion. This includes plant non-starch polysaccharides, oligosaccharides,lignin, and some resistant starch.

CLASSIFICATION.There are two forms of dietary fiber: solubleand insoluble.

Soluble fiber attracts water and turns togel during digestion. This slows digestion.Soluble fiber is found in oat bran, barley,nuts, seeds, beans, lentils, peas, and somefruits and vegetables. Soluble fiber hasbeen scientifically proven to lowercholesterol, which can help prevent heartdisease.

Insoluble fiber is found in foods such aswheat bran, vegetables, and whole grains.It appears to speed the passage of foodsthrough the stomach and intestines andadds bulk to the stool.

FUNCTION.Dietary fiber adds bulk to the diet. Becauseit makes you feel full faster, it can behelpful in controlling weight.

Fiber aids digestion, helps preventconstipation, and is sometimes used forthe treatment of diverticulosis, diabetesand heart disease.

Eating a large amount of fiber in a shortperiod of time can cause intestinal gas(flatulence), bloating, and abdominalcramps. This usually goes away once thenatural bacteria in the digestive systemget used to the increase in fiber in thediet. Adding fiber gradually to the diet,instead of all at one time, can help reducegas or diarrhea.

Too much fiber may interfere with theabsorption of minerals such as iron, zinc,magnesium, and calcium.

Fiber

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Water is the body's principal chemicalcomponent, making up, on average, 60percent of the body weight. Every systemin the body depends on water.

Every day we lose water through the breath,perspiration, urine and bowel movements.For the body to function properly, we mustreplenish its water supply by consumingbeverages and foods that contain water.

Lack of water can lead to dehydration, acondition that occurs when the body doesníthave enough water to carry out normalfunctions.

FUNCTIONS:Moistens tissues such as those in themouth, eyes and nose.

Regulates body temperature.

Protects body organs and tissues.

Helps prevent constipation.

Lubricates joints.

Lessens the burden on the kidneys andliver by flushing out waste products.

Carries nutrients and oxygen to cells.

Helps dissolve minerals and othernutrients to make them accessible to thebody.

WaterMacronutrients Macronutrients

Minerals are inorganic substances needed by the body in small amounts to help it function properly and stay strong. The body uses minerals formany different jobs, including building bones, making hormones and regulating your heartbeat.

There are two kinds of minerals: macrominerals and trace minerals.

Macrominerals are minerals your body needs in larger amounts. They include calcium, phosphorus, magnesium, sodium, potassium and sulfur.

The body needs just small amounts of trace minerals. These include iron, manganese, copper, iodine, zinc, cobalt, fluoride and selenium.

The best way to get the minerals the body needs is by eating a wide variety of foods.

Minerals

MINERAL

CALCIUM

COPPER

FLUOR

IODINE

IRON

MAGNESIUM

PHOSPHOROUS

POTASIUM

SODIUM

ZINC

MANGANESE

SELENIUM

ACTIONS

Important role in forming bones and teeth; helps with blood clotting, and muscleand nerve function.

Formation of red blood cells, helps in keeping the blood vessels, nerves, immunesystem, and bones healthy.

Reduce tooth decay, and help maintain bone structure.

Helps converting food into energy; is needed for normal thyroid function.

Part of hemoglobin; helps your blood carry oxygen to your body's tissues andmuscles; needed to make energy; supports immune system health; prevents onetype of anemia.

Production and transport of energy, contraction and relaxation of muscles, synthesisof protein, assists several enzymes functioning.

Formation of bones and teeth, utilization of carbohydrates and fats and in thesynthesis of protein for the growth, maintenance, and repair of cells and tissues,contraction of muscles, functioning of kidneys. Maintaining the regularity of theheartbeat, and nerve conduction.

Involved in electrical and cellular body functions, assists in the regulation of theacid-base balance, assists in protein synthesis from amino acids and in carbohydratemetabolism, building of muscle and for normal body growth.

Regulates blood pressure and blood volume, critical for the functioning of musclesand nerves.

Smell and taste senses. Needed for the body's defensive (immune) system toproperly work. Plays a role in cell division, cell growth, wound healing, and thebreakdown of carbohydrates.

Influences the synthesis of mucopolysaccharides, stimulates hepatic synthesis ofcholesterol and fatty acids, and is a cofactor in many enzymes. Bone formation.

Helps making antioxidant enzymes, seems to stimulate antibodies after receivinga vaccination, help protect the body from the poisonous effects of heavy metals.

SOURCES

Salmon, sardines, milk, cheese, yogurt, calcium-set tofu, Chinese cabbage, kale, broccoli.

Shellfish, whole grains, beans, nuts, potatoes,organ meats, dark leafy greens, dried fruits.

Fluoridated water, seafood, tea and gelatin.

Iodized salt, seafood.

Meat, fish, poultry, lentils, beans and cereals.

Meats, seafood, milk, cheese, yogurt, greenleafy vegetables, bran cereal, nuts.

Milk, yogurt, cheese, whole-grain breads andcereals, peas, meat, fish, eggs.

All meats, fish, soy products, vegetables, fruits,Milk and yogurt.

Table salt, milk, beets, and celery, processedmeats and fast foods.

Beef, pork, lamb, peanuts, peanut butter, andlegumes.

Nuts, legumes, tea, and whole grains.

Vegetables, fish, shellfish, red meat, grains,eggs, chicken, liver, and garlic.

2. INFANT NUTRITION

Micronutrients

TABLE 2. MINERALS

Vitamins are organic substances that your body needs to grow and develop normally. There are 13 vitamins needed by the body, which can usuallybe obtained from the diet. The body can also produce vitamins D and K.

Vitamins are classified depending on the solubility of the vitamin in water or fat.

Water-soluble vitamins are vitamin C (ascorbic acid) and 8 members of the vitamin B complex: biotin, folic acid, niacin, pantothenic acid, riboflavin(vitamin B2), thiamin (vitamin B1), vitamin B6 (pyridoxine), and vitamin B12 (cyanocobalamine).

Fat-soluble vitamins are vitamins A (retinol), D (cholecalciferol and ergocalciferol), E ( -tocopherol), and K (phylloquinone and menaquinone).

Only vitamins A, E, and B12 are stored to any significant extent in the body; the other vitamins must be consumed regularly to maintain tissue health.

Each vitamin has specific functions. Low levels of certain vitamins during a long time make the body develop a deficiency disease.

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VitaminsMacronutrients

WATER-SOLUBLE VITAMIN

VITAMIN C

VITAMIN B1 (Thiamine)

VITAMIN B2 (riboflavin)

VITAMIN B3 (Niacin)

VITAMIN B5 (Panthotenic Acid)

VITAMIN B6 (Pyridoxine)

VITAMIN B12(Cyanocobalamine)

FOLIC ACID

BIOTIN

TABLE 3. WATER-SOLUBLE VITAMIN

ACTION

Is essential for the healing of wounds, and for the repairand maintenance of cartilage, bones, and teeth. Participatesin the growth of tissues, and plays an antioxidant effect.

Helps the body cells convert carbohydrates into energy.Essential for the functioning of the heart, muscles, andnervous system.

Important for body growth and red blood cell production,helps in releasing energy from carbohydrates.

Assists in the functioning of the digestive system, skin, andnerves. conversion of food to energy.

It helps break down carbohydrates, proteins, and fats.Is essential to growth.

Helps the immune system to produce antibodies. Maintainsnormal nerve function and forms red blood cells. Helpsbreaking down proteins.

Important for metabolism.Formation of red blood cells and in the maintenance of thecentral nervous system.

Helps form red blood cells, synthesis of proteins and DNA.Helps tissues grow and cells work.

Helps break down proteins and carbohydrates.

SOURCE

All fruits and vegetables.

Fortified breads, cereals, pasta, whole grains (especially wheatgerm), lean meats (especially pork), fish, dried beans, peas,and soybeans.

Lean meats, eggs, legumes, nuts, green leafy vegetables, dairyproducts, and milk.

Dairy products, poultry, fish, lean meats, nuts, and eggs.

Eggs, Fish, Milk and milk products, Whole-grain cereals, Legumes,Yeast, Broccoli and other vegetables in the cabbage family,White and sweet potatoes, Lean beef.

Beans, nuts, legumes, eggs, meats, fish, whole grains, andfortified breads and cereals.

Eggs, meat, poultry, shellfish, milk, and milk products.

Beans and legumes, Citrus fruits and juices, Wheat bran andother whole grains, Dark green leafy vegetables, Poultry, pork,shellfish, Liver.

Eggs, Fish, Milk and milk products, Whole-grain cereals, Legumes,Yeast, Broccoli and other vegetables in the cabbage family,White and sweet potatoes, Lean beef.

FAT-SOLUBLE VITAMIN

VITAMIN A

VITAMIN D

VITAMIN E

VITAMIN K

TABLE 4. FAT-SOLUBLE VITAMIN

ACTION

Forms and maintain healthy teeth, skeletal and soft tissue,mucous membranes, and skin. Produces pigments in the retinaof the eye.

Promotes absorption and use of calcium and phosphate forhealthy bones and teeth.

Antioxidant protects body tissue from damage caused by freeradicals. Formation of red blood cells and helps the body to usevitamin K.

Blood clotting.

SOURCE

Dark green and yellow vegetables and yellow fruits, and inanimal sources (liver, milk, butter, cheese, and whole eggs).

Dairy products, Fish, Oysters, Fortified cereals, Margarine.

Margarine and vegetable oil, wheat germ, green leafy vegetables.

Spinach, lettuce, kale, cabbage, cauliflower, wheat bran, organmeats, cereals, some fruits, meats, dairy products, eggs.

2. INFANT NUTRITION

When we eat foods, they are not in a formthat the body can take advantage of themto nourish itself; food and drink must bereduced to small molecules of nutrientsbefore they are absorbed into the blood andcarried to cell throughout the body.

Digestion is the process by which food anddrink are broken down into their smallerparts so that the body can use them.

Digestion involves the mixing of food, itsmovement through the digestive system,and the chemical breakdown of the largemolecules of food into smaller molecules.

THE PROCESS OF DIGESTION

Digestion process begins in the mouth, whenwe chew and swallow, and is completed inthe small intestine, where nutrients areabsorbed. The movement of the food throughthe digestive system ends up when the foodis eliminated in the anus.

2.1.2 Nutrition Process

Image 1.Nutrition process from mouth to the anus.

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MOUTH

Chewing breaks food into smaller pieces.

Salivar enzymes break down complex carbohydrates into simple sugars.

STOMACH

Acidic environment for a better enzymatic action.

Protein are broken down into short chains of aminoacids.

Stomach empties its content slowly into the small intestine.

SMALL INTESTINE

Alkaline environment.

LIVER: Bile is produced in the liver, and stored in the gallbladder. Whenfood arrives to the small intestine, bile is released, mixing with fats in thefood; bile acids dissolve fats in water.

PANCREAS: secretes the pancreatic juice into duodenum; it containsenzymes that are used to absorb nutrients:

Lipase breaks down fatty substances into fatty acids and monoglycerides.

Protease splits up proteins.

Amylase converts starch to sugar.

All of the nutrients are absorbed through the cells in the intestinal walls,called villi.

Waste products after absorption and undigested portions of food, arepropelled into large intestine.

Image 2.Mouth and stomach.

Image 3.Liver, pancreas and small intestine.

2. INFANT NUTRITION

LARGE INTESTINE

It concentrates, stores and secretes food wastes. As material passesthrough the large intestine it becomes progressively drier and moresolid in consistency and the waste matter forms into faeces, or "stools".

Bacteria produce enzymes acting in remaining food residues and fiber,producing short chain fatty acids and gas.

The Rectum is essentially a storage reservoir at the end of the largeintestine and adjacent to the anus for accumulating the faeces priorto elimination from the body.

After the digestion process, nutrients have been metabolized andabsorbed, entering the blood stream:

Carbohydrates: All the digestible carbohydrates are converted toglucose and other monosaccharides, being transported to bloodstream.

Protein: are split up to amino acid, which are absorbed and transportedto bloodstream.

Fats: Are separated into fatty acids, glycerin or combinations withpancreatic, intestinal juices and bile. They move across the intestinalwall separated, and enter the blood stream combined with a proteinthat carries them to the heart and all the body.

Image 4.Large intestine.

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TISSUE TRANSPORTATION

Once the nutrients enter the blood stream, may be carried until severaldestinations, depending on the needs in that moment, and each oneof the possibilities are signaled by hormonal responses.

Nutrients may be taken to:

Tissues, to be used in cell metabolism.

Liver, to be transformed into more needed nutrients.

Adipose tissue, being stored.

TISSUE DIFUSSION

The substances transported in the blood stream are distributed throughthe little capillaries.

These capillaries are the smallest of a body's blood vessel, that enablethe interchange of water, oxygen, carbon dioxide and other nutrientsand waste chemical substances between blood and surrounding tissues.

Cell absorption is the last step in the digestion process; nutrients areabsorbed into the cells, and then are digested, transformed and useddepending on the needs and type of cell.

This is a hormone-controlled process, using substances like insulin tomanage the use of the nutrients in the cells.

Once inside the cells, the intracellular enzymes transform the nutrientsin cellular metabolism substrates.

2. INFANT NUTRITION

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2.2 BABY FEEDING

Baby Feeding

2.2.1

2.2.2

2.2.3

Baby digestive system

Baby feeding

Product definitionInfant FormulaFollow-on FormulaCerealsBaby Foods

22

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2.2

Head control and back support makepossible successful ingestion andswallowing of semisolid foods.

Have neuromuscular coordinationenought to form food bolus, transfer itto the oropharynx and swallow it.

Able to digest complex carbohydrates.

Full protein digestion and absorption.

Full fat digestion and absorption.

Full renal solute load management.

First Solid food introduction.

Breastfeeding permitted: Rootingreflex, suck-and-swallow mechanism.

Gag reflex interfere with theintroduction of solid foods.

Able to digest simple carbohydrates(lactose, saccharose).

Low protein digestion because of lowpepsin activity. Absorption of entire proteinsfrom breast milk (immunoglobulin orallergenic proteins).

Insufficient fat absorption becausepancreatic lipase and bile salts are low.

Low renal solute load management.

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Liquids

Birth to 3 month 4 to10 month

Puréed foods

2.2.1 Baby Digestive System

Chewing, teeth development.

Can swallow thicker boluses of food.

Can feed themselves with fingers orusing spoons or drinking cups.

10 to12 month > 12 month

Smashed&chopped foods

Family foods

RENAL SOLUTE LOAD

Renal solute load refers to the sum of solutes that must be excreted by the kidneys. It mainly comprises nonmetabolizable dietary components, primarilythe electrolytes sodium, chloride, potassium and phosphorus, which have been ingested in excess of body needs, and metabolic end-products, ofwhich the nitrogenous compounds resulting from the digestion and metabolism of protein are the most important.

Potential renal solute load refers to solutes of dietary and endogenous origin that would have to be excreted in urine if none were diverted into thesynthesis of new tissue or lost through non-renal routes.

The newborn baby has limited renal capacity to deal with a high solute load and at the same time conserve fluids.

By around 4 months, renal function has matured considerably and infants can conserve water better and deal with higher solute concentrations.

Munching reflex, and first teethappear.

Have enought tongue coordination toenable them to swallow thicker bolusesof food.

Can sit unsupported,and swallowthicker boluses of food.

2. INFANT NUTRITION

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Birth to 3 month

1 2 3 5 6 7 8 9

LIQUIDS PUREED FOODS

Breastfeeding exclusively Breastfeeding

Infant Formula Follow-on Formula

Gluten-free cereals Cereals containing Gluten

Fruit Purée

Vegetables

Meat puree, yogur and dairies

White Fish

INTRODUCTION OF SOLID FOODS.

It is mostly recommended introducing solid food between age 4 month and 6month while continuing breastfeeding or bottle-feeding.Early solids should be plain and introduced gradually one at time (one new,"single Ingredient" food be introduced per week so that food allergies can beidentified).The texture of solid foods fed to the infant will vary depending on age andindividual ability, can gradually be introduced by increasingly coarser textures,egg,from rice cereal to soft table food to chopped table food. By the end of thefirst year, chopped table foods should be the basis of the diet.Adequate nutrients should be provided for normal growth and steady-but notexcessive-weight again. The amount should be regulated by the infants appetite,provided that the growth rate is normal.

2.2.2 Babyfeeding

Breastfeeding is advocated as best forthe baby. If breastfeeding is not possibleor preferable, baby can be bottled withinfant formula.

4 to 6 monthExtrusion reflex disappears. This is thetime when most infants are introducedgradually to solid foods. Baby is stillbeing provided the usual feedings ofbreast milk, or with follow-on formula.

7 to 9 monthBaby drools more than usual and chewsjust about anything.

INFANT FORMULA(Birth – 6 mo)

FOLLOW-ON FORMULA(6 – 36 mo)

CEREAL-BASED FOODS(5 – 36 mo)

CANNED FOODS(5 – 36 mo)

4

BREASTFEEDING.

Breastmilk is the nutrition of choice; it hasmultiple advantages to the child (nutritionaland cognitive; protection against infection,allergies, obesity, Crohn’s disease anddiabetes) and mother (reduced fertility duringlactation; more rapid return to normalprepartum condition; protection againstosteoporosis, obesity and ovarian andpremenopausal breast cancers).

Breastfeeding is recommended exclusivelyuntil 6th month and then continue for atleast 12 month of age.Before 4 month, solid food is not needednutritionally and the extrusion reflex, inwhich the tongue pushes out anythingplaced in the mouth, makes feeding ofsolids difficult.

10 11 12 1 year 2 years

MASHED FOODS FAMILY FOODS

Breastfeeding WEANING

Follow-on Formula

Cereals containing Gluten

Fruit Purée

Vegetables

Meat puree, yogur and danies

White fish

Legumes

When the baby is 1 yearold, begins a new

feeding stage.

Gradually, the baby isintroduced to more

coarse textured foods,so the baby gets used to

piecemeal foods.

10 to 12 monthAt 12 month weaning is recommended(transition from breastmilk to othersources of nourishment).

1st yearThe rate of growth begins to slow down.Mostly babies can feed themselves with fingers, using spoons or drinking from cup. Firstteeth appears.Follow-on formula is maintained until 36 month. Food texture might include little piecesnot pureed (smashed, grated…) so the baby can chew, improving the teeth development.

Follow-on Formula

Cereals Gluten

Fruit Puree

Vegetables

Meat puree, yogur and danies

White fish

Legumes

Complete egg

2. INFANT NUTRITION

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3

Birth 4-6 months 12 months + 12 months

Breastfeeding exclusively, or Infant Formula (*) Breastfeeding or Follow-on Formula Toddler Formula

Cereal-based foods (**)

Baby Foods (**)

(*) Infant Formula shall be used only if breastfeeding is not possible. (**) Used depending on introduction of solid foods recommendations.

Several products may be used during the first year of age, as seen in table 5.

Table 5. Baby Feeding: Practical Guide

2.2.3 Product Definition

Infant formula1 means a breast-milksubstitute specially manufactured to satisfy,by itself, the nutritional requirements of infantsduring the first months of life up to theintroduction of appropriate complementaryfeeding.

This product is processed by physical meansonly and so packaged as to prevent spoilageand contamination under all normal conditionsof handling, storage and distribution in thecountry where the product is sold.

ESSENTIAL COMPOSITION.

Infant formula is a product based on milkof cows or a mixture thereof and/or otheringredients which have been proven to besuitable for infant feeding.

The nutritional safety and adequacy ofinfant formula shall be scientificallydemonstrated to support growth anddevelopment of infants.

All ingredients and food additives shall begluten-free.

ENERGY: Infant formula prepared readyfor consumption in accordance to theinstructions of the manufacturer shall containper 100 ml not less than 60 kcal (250 kJ)and not more than 70 kcal (295 kJ) of energy.

PROTEIN: The protein used shall be ofnutritional equivalent to that of a casein,and must contain an available quantity ofeach essential and semi-essential aminoacid, at least equal to that contained in thereference protein (breast milk).

FAT: Lauric and miristic acids, trans fattyacids, erucic acid and phospholipids shallbe limited. Linoleic Acid (LA) and -LinolenicAcid (ALA) contents are limited, and mustmaintain a ratio LA/ALA between 5:1 and15:1.

CARBOHYDRATE: Lactose should be thepreferred carbohydrate in formula basedin cow’s milk protein and hydrolisedprotein, avoiding additions of sucrose andfructose.

VITAMINS: Vitamin A, Vitamin D3,Vitamin E, Vitamin K, Thiamine, Riboflavin,Niacin, Vitamin B6 (Pyridoxine), VitaminB12 (Cyanocobalamin), Pantothenic Acid,Folic Acid, Vitamin C, Biotin.

MINERALS: Iron, Calcium, Phosphorous,Magnesium, Sodium, Chloride, Potassium,Manganese, Iodine, Selenium, Copper,Zinc, maintaining a relation betweenCalcium and Phosphorous shall be between1:1 and 2:1.

OPTIONAL INGREDIENTS: Taurine, Cho-line, Myoinositol, L-carnitine, Docosahexa-noic Acid (DHA), Eicosapentanoic Acid(EPA) and Arachidonic Acid (ARA).

CONSISTENCY AND PARTICLE SIZE:free of lumps and of large coarse particlesand suitable for adequate feeding of younginfants.

Follow-on formula2 means a food intendedfor use as a liquid part of the weaning dietfor the infant from the 6th month on and foryoung children.

Is a food prepared from the milk of cowsand/or other constituents of animal and/orplant origin, which have been proved tobe suitable for infants from the 6th monthon and for young children, processed byphysical means only so as to preventspoilage and contamination under allnormal conditions of handling, storageand distribution.

When in liquid form, is suitable for useeither directly or diluted with water beforefeeding, as appropriate. In powderedform it requires water for preparation.The product shall be nutritionally adequateto contribute to normal growth anddevelopment when used in accordancewith its directions for use.

ESSENTIAL COMPOSITION.

ENERGY: shall provide not less than 60kcal (or 250 kJ) and not more than 85kcal (or 355 kJ).

PROTEIN: Protein of nutritional qualityequivalent to that of casein or other proteinin inverse proportion to its nutritionalquality. Essential amino acids maybe added to improve protein quality andnutritional value, only in amountsnecessary for that purpose.

FAT: The content of Lauric and miristicacids, Trans fatty acids, erucic acid andphospholipids shall be limited. LinoleicAcid (LA) and -Linolenic Acid (ALA) contentsare limited, and must maintain a ratioLA/ALA between 5:1 and 15:1.

1CODEX STAN 72 (1981) – Codex standard for infantformula and formulas for special medical purposesintended for infants.

2CODEX STAN 156 (1987) - Codex standard forfollow-up formula.

Infant FormulaProduct Definition

Follow-on Formula

2. INFANT NUTRITION

Product Definition

CARBOHYDRATES: The product shallcontain nutritionally available carbohydratessuitable for the feeding of the older infantand the young child in such quantities asto adjust the product to the energy densityin accordance with the requirements.

VITAMINS: Vitamin A, Vitamin D3,Vitamin E, Vitamin K, Thiamine, Riboflavin,Niacin, Vitamin B6 (Pyridoxine), VitaminB12 (Cyanocobalamin), Pantothenic Acid,Folic Acid, Vitamin C, Biotin.

MINERALS: Iron, Calcium, Phosphorous,Magnessium, Sodium, Chloride, Potassium,Manganese, Iodine, Selenium, Copper,Zinc, maintaining a relation betweenCalcium and Phosphorous shall bebetween 1:1 and 2:1.

OPTIONAL INGREDIENTS: Othernutrients may be added when required toensure that the product is suitable to formpart of a mixed feeding scheme intendedfor use from the 6th month on.

CONSISTENCY AND PARTICLE SIZE:free of lumps and of large, coarse particles.

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Processed cereal-based3 foods areprepared primarily from one or more milledcereals, which should constitute at least 25%of the final mixture on a dry weight basis.

Four categories are distinguished:

Products consisting of cereals which areor have to be prepared for consumptionwith milk or other appropriate nutritiousliquids;

Cereals with an added high protein foodwhich are or have to be prepared forconsumption with water or otherappropriate protein-free liquid;

Pasta which are to be used after cookingin boiling water or other appropriateliquids;

Rusks and biscuits which are to be usedeither directly or, after pulverization, withthe addition of water, milk or other suitableliquids.

ESSENTIAL COMPOSITION.

The four categories listed are preparedprimarily from one or more milled cerealproducts, such as wheat, rice, barley,oats, rye, maize, millet, sorghum andbuckwheat.

They may also contain legumes (pulses),starchy roots (such as arrow root, yam orcassava) or starchy stems or oil seeds insmaller proportions.

The requirements concerning energy andnutrients refer to the product ready foruse as marketed or prepared accordingto the instructions of the manufacturer,unless otherwise specified.

ENERGY DENSITY: The energy density ofcereal-based foods should not be less than3.3 kJ/g (0.8 kcal/g).

PROTEIN. The chemical index of the addedprotein shall be equal to at least 80% ofthat of the reference protein casein or theProtein Efficiency Ratio (PER) of the proteinin the mixture shall be equal to at least70% of that of the reference protein casein.In all cases, the addition of amino acidsis permitted solely for the purpose ofimproving the nutritional value of theprotein mixture, and only in the proportionsnecessary for that purpose.

CARBOHYDRATES: Sucrose, fructose,glucose, glucose syrup or honey may beadded to cereals but limiting the amountof added carbohydrates.

FAT: The lipid content, and specially lauricacid and myristic acid, is limited. Shallhave a minimum content of linoleic acid.

VITAMIN: Vitamin B1 (Thiamine), VitaminD and Vitamin A contents shall be withinlimits required.

MINERAL: Mineral contents shall be limited(sodium) or have minimum amounts(calcium).

OPTIONAL INGREDIENTS: Otheringredients suitable for infants who aremore than six months of age and for youngchildren can be used.

CerealsProduct Definition

3CODEX STAN 074 (1981) - Codex standard forprocessed cereal-based foods for infants and youngchildren.

CONSISTENCY AND PARTICLE SIZE:

Processed cereal-based foods shouldhave a texture appropriate for the spoonfeeding of infants or young children ofthe age for which the product isintended.

Rusks and biscuits may be used in thedry form so as to permit and encouragechewing or they may be used in a liquidform, by mixing with water or othersuitable liquid, that would be similar inconsistency to dry cereals.

Baby foods4 are foods intended primarilyfor use during the normal infant's weaningperiod and also for the progressive adaptationof infants and children to ordinary food.They may be either in ready-to-eat form orin dry form requiring reconstitution with wateronly.

Baby foods in ready-to-eat form areprocessed by heat before or after beingsealed in their containers, and Baby foodsin dry form are processed by physical means,in each case so as to prevent spoilage.

ESSENTIAL COMPOSITION.

Baby foods may be prepared from anysuitable nutritive material that is used,recognized or commonly sold as an articleor ingredient of food, including spices.

Vitamins and minerals may only be addedin accordance with the legislation of thecountry in which the food is sold.

The amounts of sodium derived from theadded vitamins and/or minerals shall belimited, even not permitted in fruit productsand dessert products based on fruit.

CONSISTENCY AND PARTICLE SIZE:

Ready-to-eat baby foods are homoge-neous or comminuted in the followingforms:

Strained: food of a fairly uniform, smallparticle size which does not require anddoes not encourage chewing beforebeing swallowed.

Junior: food that ordinarily containsparticles of a size to encourage chewingby infants and children.

Dry baby foods, after reconstitution withwater or other suitable liquid, approxi-mate to the consistency and particle sizeof strained or junior foods.

4CODEX STAN 73 (1981) – Codex standard for cannedbaby foods.

Baby Foods

2. INFANT NUTRITION

Product Definition

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2.3 OBESITY

Definition and values

Main causes for obesity

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Obesity2.3

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Obesity is a complex and multifactorialdisease that happens when weight is inranges that are greater than what is generallyconsidered healthy for a given height. Ithappens when genetic, diet and lifestylehabits factors cause an energy imbalancebetween ingested energy and energyexpenditure.

That imbalance produces a pathologic fataccumulation, increasing mortality, andmorbidity.

Obesity can also affect infancy and childhood.This is particularly troubling because theextra weight often starts kids on the path tohealth problems confined to adults, such asdiabetes, high blood pressure and highcholesterol.

Obesity rates are measured with the BodyMass Index ( BMI = Kg/m2 ), with two mainvalues; people with BMI>25 are consideredto be in overweight, and people with BMIover 30 are considered obese.

1.FAMILY HISTORY AND GENETICS.

Overweight and obesity tend to run infamilies. Your chances of being overweightare greater if one or both of your parentsare overweight or obese. Your genes alsomay affect the amount of fat you store inyour body and where on your body you carrythe extra fat. Children adopt the habits oftheir parents.

2.DIET MODIFICATIONS.

Diet has changed to a high-dense food, highin fats and sugar but low in vitamin, mineraland other nutrients that cause an energyimbalance that may promote weight gain.

3.LIFESTYLE HABITS.

Sedentary lifestyle, with low physical activityand unhealthy eating patterns (snacks, fastfoods) increases the obesity risk

ENERGY.

An excess in energy intake can produce anenergy imbalance if there is not enoughenergy consumption (in case of sedentarylifestyle habits).

Added to this situation, children haveincreased the consumption of high-denseenergy foods which provide an excess ofenergy but a poor intake of nutrients, andan increased food intake, possibly relatedwith the appetite modulation.

FATS.

Fats metabolism is highly energetic profitablethan carbohydrate and protein metabolismbecause the low energy required for trigly-ceride synthesis. When the energy balanceis positive, a portion of the dietary fat isdeposited directly in the adipose tissue withlow energy burn.

Saturated fatty acids are mainly stored, andunsaturated fatty acids are mainly metabo-lized, so unsaturated are the chosen onesfor dietary uses. Also, fat doesn’t add bulkto the food, so it doesn’t make people feelfull, producing a hyperphagic effect that mayproduce a weight increase.

CARBOHYDRATES.

The present carbohydrate relevance is basedin the increase of carbohydrate in childrendiet, as a consequence of recommendationsto reduce fats in diet.

Single carbohydrates are broken down inglucose and other monosaccharides,increasing the glucose blood levels and sothe energy providing substrate. Complexcarbohydrates are composed of big moleculesthat break down in monosaccharides.

Definition and valuesObesity

Main causes for obesity Diet modificationsObesity

Complex carbohydrates increase the glucoseblood levels more slowly than singlecarbohydrates, but the glucose level lastsmore time than in single ones.

Dietary carbohydrates have changed sincelast years; in the present time, are beingused carbohydrates with a high GlycemicIndex: an indicator of the ability of differenttypes of foods that contain carbohydrate toraise the blood glucose levels within 2 hours.Foods containing carbohydrates that breakdown most quickly during digestion havethe highest Glycemic index. Values vary from100 (higher, glucose) to 1 (lower).

Glycemic Index is important because of theconsequences of intaking a high Glycemicfood:

CH breaks down quickly in glucose,increasing blood levels and producing ahigh release of insulin (hiperinsulinemia),stimulating the glucose absorption andstorage in cells.

In the liver, glucose is metabolized toglucagon (stored in the liver) or lipoproteinsthat are released to bloodstream. Lipopro-teins reach the adipose tissue and thereare metabolized to triglycerides that willbe stored increasing the adipose tissuemass.

Also, a high Glycemic index food promoteshyperphagic, so increases the food intake.

FIBER.

High dietary fiber intake has been shown topromote weight loss, maybe because theincomplete digestion and low energy absorp-tion of the fiber.

The fiber gives bulk to the food, increasingthe chewing and the stomach strain, so itmay reduce appetite and reduce the energy

intake. It also slows the stomach emptyingand reduces the glucose and insulin response.

PROTEINS.

A high protein intake at 12 months of agehas been shown related to obesity at 7 years.

Early protein hypothesis postulates that ahigh protein intake during the first monthsof life may increase the risk for obesity.

It has been shown that the protein-relatedrisk varies depending on the source; BMIand body fat percentage are more affectedby the animal protein than by vegetableones. Especially high affection is producedby milk or dairy protein.

Lifestyle habits

There are some habits related with food andattitudes that suppose a risk for the health;the modification of those habits could leadto a reduction of risks to develop chronicdiseases:

Physical Inactivity, high salt, sugar or meatintakes, and eating high-dense energeticfoods increase the risk for chronic diseases.

Another factor to consider is that during thefirst years of life the baby adopts lifestylehabits that will form the profiles lastingduring the whole life.

That is something that concerns nutritionbecause additions of sugar or salt to thebaby food may instill unfavorable habits tothe baby; later in time, he or she will preferfoods with high salt or sugar contents, andthus may increase the risk for develop achronic disease.

2. INFANT NUTRITION

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2.4 OBESITY-RELATED DISEASES

Obesity-related diseasesDiabetes

Type 2 diabetes is a disease in which bloodsugar levels are above normal. High bloodsugar is a major cause of coronary heartdisease, kidney disease, stroke, amputation,and blindness.

Type 2 diabetes is the most common type ofdiabetes. This form of diabetes is most oftenassociated with old age, obesity, family historyof diabetes, previous history of gestationaldiabetes, and physical inactivity. The diseaseis more common among certain ethnicpopulations.

More than 85 percent of people with type2 diabetes are overweight; the cause is stillunknown, but it may be related with an insulinresistance: Insulin carries sugar from bloodto the cells, where it is used for energy.When a person is insulin resistant, bloodsugar cannot be taken up by the cells,resulting in high blood sugar. In addition,the cells that produce insulin must work extrahard to try to keep blood sugar normal. Thismay cause these cells to gradually fail.

Risk for developing type 2 diabetes may belowered by losing weight and increasing theamount of physical activity, helping to controlthe blood sugar levels and prevent or delaycomplications.

Obesity is a risk factor for late developmentof chronic diseases.

If the present obesity trend is maintained,obesity-related diseases such as diabetesmellitus (type 2 diabetes), blindness, coronaryheart disease and kidney disease maybecome usual diseases of the children.

Even those unfat children, excessive saturatedfats, sodium intake and others in diets, maypredict a high risk to develop chronic diseases.

2.4 Obesity-related diseases

Diabetes

Coronary heart diseaseand stroke

Hypertension

Metabolic Syndrome

Cancer

Osteoporosis

Caries

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2. INFANT NUTRITION

Coronary heart disease means that theheart and circulation (blood flow) are notfunctioning normally. Often, the arterieshave become hardened and narrowed.

If you have coronary heart disease, you maysuffer from a heart attack, congestive heartfailure, sudden cardiac death, angina (chestpain), or abnormal heart rhythm.

In a heart attack, the flow of blood andoxygen to the heart is disrupted, damagingportions of the heart muscle. During a stroke,blood and oxygen do not flow normally tothe brain, possibly causing paralysis or death.

People who are overweight are more likelyto develop high blood pressure, high levelsof triglycerides (blood fats) and LDLcholesterol (a fat-like substance often called“bad cholesterol”), and low levels of HDLcholesterol (“good cholesterol”). These areall risk factors for heart disease and stroke.In addition, excess body fat-especiallyabdominal fat-may produce substances thatcause inflammation. Inflammation in bloodvessels and throughout the body may raiseheart disease risk.

Weight loss may improve blood pressure,triglyceride, and cholesterol levels; improveheart function and blood flow; and decreaseinflammation throughout the body.

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Hypertension is sustained elevation of bloodpressure (blood pressure is the force of yourblood pushing against the walls of yourarteries when heart beats).

Hypertension with no known cause (primary;formerly, essential hypertension) is mostcommon. Hypertension with an identifiedcause (secondary hypertension) is usuallydue to a renal disorder. Usually, no symptomsdevelop unless hypertension is severe orlong-standing.

As you gain weight, the amount of bloodcirculating through your body increases. Thisputs added pressure on your artery walls.In addition, excess weight often is associatedwith an increase in heart rate and a reductionin the capacity of your blood vessels totransport blood. All of these factors canincrease blood pressure.

Many other factors can affect blood pressure,including the condition of your kidneys,nervous system, or blood vessels, and thelevels of different body hormones.

Nutrition can too affect blood pressure;certain foods can increase blood pressure.Too much salt in the diet can lead to highblood pressure, because the body holdsextra water to wash the salt from the body;the added water puts stress on your heartand blood vessels, and may cause bloodpressure to rise.

The metabolic syndrome is a group ofobesity-related risk factors for coronary heartdisease and diabetes. A person with metabolicsyndrome has approximately twice the riskfor coronary heart disease and five timesthe risk for type 2 diabetes.

The metabolic syndrome is strongly linkedto obesity, especially abdominal obesity.Other risk factors are physical inactivity,insulin resistance, genetics, and old age.

Obesity is a risk factor for the metabolicsyndrome because it raises blood pressureand triglycerides, lowers good cholesterol,and contributes to insulin resistance. Excessfat around the abdomen carries even higherrisks.

It may be possible to prevent the metabolicsyndrome with weight management andphysical activity. For patients who alreadyhave the syndrome, losing weight and beingphysically active may help prevent or delaythe development of diabetes, coronary heartdisease, or other complications.

Obesity-related diseasesCoronary heart disease and stroke Hypertension Metabolic Syndrome

Obesity-related diseases Obesity-related diseases

Cancer occurs when cells in one part of thebody, grow abnormally or out of control.

Being overweight may increase the risk ofdeveloping several types of cancer, includingcancers of the colon, esophagus, and kidney.Overweight is also linked with uterine andpostmenopausal breast cancer in women.

Gaining weight increases the risk for severalof these cancers; fat cells may releasehormones that affect cell growth, leading tocancer.

Healthy eating and physical activity habitsmay lower cancer risk. Fruit, vegetables andcereal-based diets seem to prevent somecancer (colon), and diets with a high fatconsumption may increase the risk for them.

Osteoporosis is a disease that thins andweakens the bones to the point that theybecome fragile and break easily. Womenand men with osteoporosis most often breakbones in the hip, spine, and wrist, but anybone can be affected.

Getting too little calcium over lifetime canincrease your risk for osteoporosis; notgetting enough vitamin D can also increaseyour risk for osteoporosis. Vitamin D isimportant because it helps the body absorbcalcium. An overall diet adequate in proteinand other vitamins and minerals is alsoessential for bone health.

There is no direct relation between obesityand osteoporosis; it is the low physical activity,not exercising and being inactive, or stayingin bed for long periods what can increasethe risk of developing osteoporosis.

Like muscles, bones become stronger withexercise. Bone is made up of calcium, protein,and other minerals. Getting enough calciumhelps protect bones by slowing bone loss.Vitamin D helps your body absorb calcium.Exposure to sunlight causes your body tomake vitamin D.

Tooth decay is a destruction of the toothenamel.

Caries is often triggered by frequent andprolonged exposure to liquids and solid foodcontaining sugars. Bacteria that live in themouth thrive on these foods, producing acidsthat attack tooth enamel. Over a period oftime, these acids destroy tooth enamel,resulting in tooth decay.

Breast milk by itself is the healthiest foodfor babies’ teeth, day or night. It tends toslow bacterial growth and acid production.However, when breast milk is alternatedwith sugary foods or drinks, the rate of toothdecay can be faster than with sugar alone.

Again, there is no direct relation with obesity,but one of the factors that increase theobesity risk (high sugar intake) can themodulate caries risk, too

Cancer Osteoporosis Caries

2. INFANT NUTRITION

Obesity-related diseases Obesity-related diseases Obesity-related diseases

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2.5 FOOD ALLERGY

Food Allergies

Symptoms

Risk factors

Treatment

Gluten

Allergic Response

Food Intolerance

Sugar intolerance

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Allergy

2.5.1

2.5.2

2.5.3

Food Allergy2.5

Symptoms usually begin immediately, seldommore than 2 hours after eating.

Abdominal pain

Angioedema

Diarrhea

Difficulty swallowing

Itching

Fainting

Nasal congestion

Nausea

Shortness of breath

Stomach cramps

Vomiting

Itchy lips, tongue or throats

Swollen lips

Other symptoms that may occur in foodallergies.

Rarely, the symptoms may begin hours aftereating the offending food.

If symptoms are developed shortly aftereating a specific food, you may have a foodallergy.

The process of eating and digesting foodaffects the timing and the location of areaction.

Key symptoms include hives, and wheezing.In severe reactions, may occur low bloodpressure and blocked airways.

A life-threatening complication is ana-phylaxis, a severe, whole-body allergic reac-tion that happens with airway blockage,cardiac arrest (no effective heartbeat),respiratory arrest (no breathing) and shock,and can result in death.

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Certain factors may increase the risk ofdeveloping a food allergy:

Family history. If other allergies (asthma,hay fever, eczema…) are common in thefamily, the person is at increased risk offood allergies. A child who has one parentwith an allergy has about 48% chance ofdeveloping an allergy. If both parentssuffer from allergies, the child has abouta 70 percent chance of developing allergy.

Age. Infants and toddlers are more likelyto suffer from allergy. As the child growsolder, the digestive system matures andthe body is less likely to absorb food orfood components that trigger allergies.

In a true allergy, the immune systemmistakenly identifies a specific food or acomponent of food as a harmful substance.

The immune system triggers certain cells toproduce immunoglobulin E (IgE) antibodiesto fight the culprit food or food component(the allergen). The next time even the smallestamount of that food is eaten, the IgE antibo-dies sense it and signal the immune systemto release histamine and other chemicalsinto the bloodstream.

These chemicals cause a range of allergicsigns and symptoms. Histamine is partlyresponsible for most allergic responses.

2.5.1 Food Allergies

SymptomsFood Allergies

Risk factorsFood Allergies

Food allergy is treated by avoiding the foodsthat trigger the reaction.

FOOD ALLERGY PREVENTION IN BABIES.

In children, the great majority of foodallergies are triggered by certain proteinsin eggs, fish, selfish, cow’s milk, wheat andsoybeans.

How the baby is introduced to solids can bean important factor in how the child reactsto foods throughout his life. Starting solidstoo early can trigger food allergies, eczemaand asthma, as can exposing the baby toviruses during the first three months of hisor her life.

It is well documented that prolongedexclusive breastfeeding results in a lowerincidence of food allergies.

From birth until somewhere between fourand six months of age, babies possess whatis often referred to as an "open gut." Thismeans that the spaces between the cells ofthe small intestines will readily allow intactmacromolecules, including whole proteinsand pathogens, to pass directly into thebloodstream.

This is great for the breastfed baby as itallows beneficial antibodies in breast milkto pass more directly into baby's bloodstream,but it also means that large proteins fromother foods (which may predispose baby toallergies) and disease-causing pathogenscan pass right through, too.

During baby's first 4-6 months, while thegut is still "open," antibodies (sIgA) frombreast milk coat baby's digestive tract andprovide passive immunity, reducing thelikelihood of illness and allergic reactionsbefore gut closure occurs.

Baby starts producing these antibodies onhis own at around 4-6 months, and gutclosure should have occurred by this timealso. Once the baby's system has had timeto mature, it will be time to introduce solids.

The order of introduction of solid foods isthe one commented in the baby feedingsection (see page 24).

When offering a new type of food, babymust always be fed it for several days in arow before starting another new food. Thismakes it easier to detect food allergies,which can present with diarrhea, vomiting,coughing, hives or a rash. Mixed ingredientfoods must not be offered until it’s sure thatthe baby isn't allergic to any of the individualingredients.

Gluten is a protein found in various cerealgrains (wheat, rye, and also in barley andoat).

Celiac sprue is an immunologically mediateddisease in genetically susceptible peoplecaused by intolerance to gluten, resultingin mucosal inflammation, which causesmalabsorption.

Symptoms usually include diarrhea andabdominal discomfort. Diagnosis is by small-bowel biopsies showing characteristic thoughnot specific pathologic changes of villousatrophy that resolve with a strict gluten-freediet.

A person with celiac disease may have nosymptoms. People without symptoms arestill at risk for the complications of celiacdisease, including malnutrition. The longera person goes undiagnosed and untreated,the greater the chance of developingmalnutrition and other complications.Anemia, delayed growth, and weight lossare signs of malnutrition: The body is justnot getting enough nutrients. Malnutritionis a serious problem for children becausethey need adequate nutrition to developproperly.

A gluten-free diet, when followed carefully,helps prevent symptoms of the disease.

Treatment Gluten

2. INFANT NUTRITION

Food Allergies Food Allergies

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THE FIRST TIME THE ALLERGY-PRONE PERSON RUNS AN ALLERGEN:

Antigen

THE SECOND TIME THE PERSON HAS A BRUSH WITH THE ANTIGEN:

Antigen

Antigen stimulates B-UMPHOCYTE

Blymphacyte

B-UMPHOCYTEproduces plasma cells

Plasma cells

Plasma cells secreteallergen-specificantibody (lgE)

Antibodies (lgE)

These lgE attach themselves to mastcells (plentiful in Gastrointestinaltract, nose, eyes and lungs).

lgE-primedMast cell

Antigen stimulates lgE inthe mast cell and getcaptured by them.

Mast cells withlgE binded toantigens

The lgE primed mastcells release itschemicals

Chemicals

The person will sufferthe symptoms of theallergy

SYMPTOMS APPEAR:Abdominal pain AngioedemaDiarrhea Difficulty swallowingNasal congestion ItchingFainting Shortness of breathVomiting Stomach crampsNausea Itchy lips, tongue or throatsSwollen lipsImage 5.

Allergic response

Food intolerance is a digestive systemresponse rather than an immune systemresponse.

It occurs when something in food irritates aperson’s digestive system or when a personis unable to properly digest, or break down,the food. Intolerance to lactose, which isfound in milk and other dairy products, isthe most common food intolerance.

Symptoms of food intolerance includenausea, stomach pain, gas, vomiting,heartburn, diarrhea…

Sugars like lactose, saccharose and maltoseare broken down to single sugars (glucose)in the small intestine by enzymes producedin intestine cells. That single sugars areabsorbed into the bloodstream through theintestine walls.

When the body is deficient in one of theseenzymes, sugars are not digested and can’tbe absorbed, remaining in the small intestine.

The high concentration of sugars promotesa great amount of liquids to get into thesmall intestine, causing diarrhea. Also, thatunabsorbed sugars are fermented by themicrobiota in the large intestine, causingabdominal bloating, excessive intestinal gas,nausea, and abdominal cramping.

Lactose intolerance can begin at differenttimes in life. In Caucasians, it usually startsto affect children older than age 5. In African-Americans, lactose intolerance often occursas early as age 2.

Lactose intolerance is sometimes seen inpremature babies. Children who were bornat full term generally do not show signs oflactose intolerance until they are at least 3years old.

Removing milk products from the diet usuallyimproves the symptoms. Other sources ofcalcium should be added to the diet if milkproducts are removed.

Not having milk in the diet can result in ashortage of vitamin D, riboflavin, and protein.Therefore, a milk substitute is needed.

Antibodies circulate in the bloodstream and arepresent in almost all bodily fluids. They help tocapture unwanted invaders. People who haveallergies have an antibody called ImmunoglobulinE, or IgE.

When allergens first enter the body of a personpredisposed to allergies, a series of reactionsoccurs and allergen-specific IgE antibodies areproduced. Following IgE production, theseantibodies travel to cells called mast cells, whichare particularly plentiful in the nose, eyes, lungsand gastrointestinal tract. The IgE antibodiesattach themselves to the surface of the mast cellsand wait for their particular allergen.

Each type of IgE has specific “radar” for one typeof allergen only. That's why some people are onlyallergic to cat dander (they only have the IgEantibodies specific to cat dander) and others seemto be allergic to everything (they have many moretypes of IgE antibodies.)

The next time an allergic individual comes intocontact with the allergens to which he or sheis sensitive, the allergens will be captured bythe IgE. This initiates the release of chemical“mediators” such as histamine and other chemicalsfrom the mast cells. These mediators produce thesymptoms of an allergic reaction, such as swellingof tissues, sneezing, wheezing, coughing andother reactions.

The allergic reaction typically continues: thesenewly released mediators recruit other inflamma-tory cells to that site, resulting in additionalinflammation. Many symptoms of chronic allergicdisease -such as swelling, excessive mucus andhyperresponsiveness to irritating stimuli- are theresult of tissue inflammation due to ongoingexposure to allergens.

It is not yet fully understood why some substancestrigger allergies and others do not, nor why everyperson does not develop an allergic reactionafter exposure to allergens. A family history ofallergies is the single most important factor thatpredisposes a person to develop allergic disease.

Sugar IntoleranceFood Intolerance

2.5.3 Food Intolerance

2. INFANT NUTRITION

2.5.2 Allergic Response

3. NUTRITIONTODAY & HEALTHTOMORROW

STRATEGY44 / 45

Early nutrition

NT&HT Strategy

NT&HT Communication

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3.1

3.2

3.3

NUTRICION TODAY &HEALTH TOMORROW Strategy

3.

NUTRITION TODAYHEALTH TOMORROW

3.1 EARLY NUTRITION

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Early Nutrition

Breastfeeding

Proteins

FatsReduction of saturated fatMinimization of trans fatReduction of cholesterol levelsPresence of essential fatty acidsSupplementation with long-chain polyunsaturated fatty acids

CarbohydratesOptimized carbohydrate assimilation and prebiotic effectSingle sugar reduction

Probiotic and PrebioticProbioticPrebiotic

Dietary supplementsNucleotidesTaurineInositolCholineCarnitine

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565656575757

3.1.1

3.1.2

3.1.3

3.1.4

3.1.5

3.1.6

NUTRITION TODAYHEALTH TOMORROW

3. NTHT STRATEGY

3.1

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3.1. Early NutritionIt is well recognized that nutritional deficiencies early in life have a direct impact on the healthof the individual.

Energy and nutrient malnutrition, and specific micronutrient deficiencies, if not corrected promptly,usually lead to growth retardation and functional and structural alterations that are frequentlyirreversible.

In this context, it is evident that nutrition during childhood has a significant impact on the healthof the adult. These effects are related to impaired structure, size and/or function that developover variable periods of time, and may be expressed only after the child has reached adult age.

Early nutrition is defined like the nutrition during early phases of human development that canalter organ function, and thereby predispose or program individuals to adult disease.

Over the past decade, epidemiological studies in several countries have shown that size at birthand/or placental weight is related to adult health and disease.

An additional issue in this context is nutrition in infancy (pre- and post-weaning) and its importancein the manifestation of obesity in later life.

Dietary factors during the sensitive period of infancy and early childhood are increasingly recognizedas being potentially critical for adult disease and predisposition to obesity.

3. NTHT STRATEGY

3.1.1 BreastfeedingNewborn feeding must supply all themetabolic requirements to achieve a correctdevelopment and get an adequatematuration of vital organs such as kidneys,liver, brain, etc.

Breast milk is the perfect feeding source forbabies, because it contains appropriateamounts of carbohydrates, proteins andfats, and also provides digestive enzymes,minerals, vitamins and hormones that arerequired during first months of development.

Breast milk also contains antibodies fromthe mother that promote the immune systemmaturation in the baby.

Breastfeeding is recommended as the bestoffer for baby feeding during the first yearof life:

Its higher nutritional quality, defined asthe balance of nutrients provided by breastmilk, minerals, and probiotics andPrebiotics providing.

Immune specific and unspecific support:Breast milk contains many immune factorswhich give the infant passive protectionagainst infections.

Breastfeeding also modulates the child’sown system and it seems that thismodulation has long-term effects. Theimmune modulating effects are likely toinfluence allergic diseases duringchildhood.

Antigenic exposure minimization.

High hygienic qualities; milk goes throughbreast (its production place) directly to thebaby digestive system.

Psychological reasons, including higherstimuli for babies.

Supports the development and maturationof the digestive tract.

Also, breastfeeding has benefits for themother, such as reduced fertility duringlactation; more rapid return to normalprepartum condition, protection againstosteoporosis, obesity, and ovarian andpremenopausal breast cancers.

Exclusive breastfeeding (or infant formulafeeding) is recommended to be the idealnutrition and sufficient to support optimalgrowth and development for approximatelythe first 4 to 6 months after birth.

Furthermore, it is recommended thatbreastfeeding continue for at least 12months, and thereafter for as long asmutually desired, although after 1 year,breastfeeding should complement a fulldiet of solid foods and fluids.

In conclusion, there is convincing evidencethat Breastfeeding has positive long termeffects on development and health reachinginto childhood and, in some cases, intoadulthood.

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3.1.2 ProteinsThe early protein intake hypothesis5 postulatesthat high protein intakes during the firstmonths of life increase the risk of obesity.

It has been studied whether a critical periodof protein intake for later obesity may existearly in childhood, and the relation betweenprotein intake from different sources andbody mass index (BMI) and body fatpercentage (%BF) at older age.

A higher animal protein (especially dairy)intake at 12 month was related to a higherBMI at 7 years, which was not explained byfamily and maternal characteristics. A similarbut weaker tendency was obtained withanimal protein intake at 5-6 years. Higherprotein intake from vegetable sources at 12month and 5-6 years was not associated.

Results show that a high protein intakeduring the period of complementary feedingand the transition to the family diet mightbe decisive.

The mechanism6 behind the early proteinhypothesis is thought to be that an increasedinsulin secretion of insulin and insulin growthfactor 1 (IGF-1) triggers the multiplicationand differentiation of preadipocytes, andinfancy and early childhood may representa time window when high protein intakescan exert these adverse effects.

The results support the hypothesis that theend of the first year of life, when childrenundergo the transition from breast milk offormula feeding to a diet based on familyfoods, may be the critical phase with respectto protein intake and subsequent obesityrisk. Animal and in particular dairy proteinintake might be responsible for thisassociation.

Infant formula and follow-on formula shallreduce its protein content to prevent theBMI and %BF increase and reduce the riskfor obesity.

5Günther AL, Remer T, Kroke A, Buyken AE (2007).Early protein intake and later obesity risk: which proteinsources at which time points throughout infancy andchildhood are important for body mass index andbody fat percentage at 7 y of age? Am J Clin Nut,Dec; 86 (6): 1765-72.

6Günther LBA,Buyken AE and Kroke A (2007) Proteinintake during the period of complementary feedingand early childhood and the association with bodymass index and percentage body fat at 7 y of age.Am J Clin Nutr, June; 85 (6): 1626-1633.

3. NTHT STRATEGY

3.1.3 Fats Reduction of saturated fat(balanced fatty acid profile)

Fats FatsMinimization of trans fat

Fat is an important part of a healthy diet;during the first months of life. Little kids,especially, need a certain amount of fat intheir diets so the brain and nervous systemdevelop correctly.

All fats may be included as a part of healthyeating; it's the type of fat that is eaten moreor less what matters.

Diets high in saturated fat have been linkedto chronic disease, specifically, coronaryheart disease, because it raises LDLcholesterol. A balanced fatty acid profileshall be used, with a low insaturatedfat content and high in mono andpolyunsaturated fats.

During food processing some fats are createdwhen liquid oils are converted into solid fats(Hydrogenation). This creates partially-hydrogenated oils that tend to keep foodfresh longer while on grocery shelves.

The problem is that these partially-hydrogenated oils contain trans fats whichcan also increase low-density lipoproteinLDL-cholesterol and decrease high-densitylipoprotein (HDL) cholesterol - risk factorsfor heart disease.

Trans fats are worse for cholesterol levelsthan saturated fats because they raise badLDL and lower good HDL. They also fireinflammation, an overactivity of the immunesystem that has been implicated in heartdisease, stroke, diabetes, and other chronicconditions. Even small amounts of Trans fatin the diet can have harmful health effects.

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Reduction of cholesterol levelsFats Fats

Presence of essential fatty acids Supplementation with long-chainpolyunsaturated fatty acids

Fats

There is compelling evidence that theatherosclerosis (fatty deposits of plaque inartery walls) or its precursors begins inchildhood and progresses slowly intoadulthood7. Then it often leads to coronaryheart disease. Furthermore, there is evidencethat:

Elevated cholesterol levels early in lifemay play a role in the development ofatherosclerosis in adults.

Eating patterns and genetics affect bloodcholesterol levels and coronary heartdisease risk.

Lowering levels in children and adolescentsmay be beneficial.

Many laboratories, clinical, pathological andepidemiological studies have clearlyestablished that high blood cholesterol levelsplay a role in developing coronary heartdisease in adults. Several studies also haveshown that fatty buildups in arteries beginin childhood and are more likely with higherblood cholesterol levels.

Essential fatty acids (EFAs) are linoleic acid,an 6 (n-6) fatty acid, and linolenic acid, an

3 (n-3) fatty acid.Other 6 acids (eg, arachidonic acid) andother 3 fatty acids (eg, eicosapentaenoicacid, docosahexaenoic acid) are requiredby the body but can be synthesized fromEFAs.

7T. A. Demmers , P. J. H. Jones , Y. Wang , S. Krug, J. E. Heubi School of Dietetics and Human Nutrition,McGill University, Ste. Anne de Bellevue, Canada,Division of Pediatric Gastroenterology, Hepatologyand Nutrition, Cincinnati Children's Hospital MedicalCenter, Cincinnati, United States

The fetus and newborn infant can convertthe parent fatty acids linoleic acid (18:26)and alfa-linolenic acid (18:33) to AA andDHA respectively. But the desaturationenzyme systems in the human fetal liverseem to be immature and unable to supplysufficient LCPUFA to meet the high require-ments until 16 weeks after term age.

This means that during early developmentLCPUFA supply is largely dependent ondietary intake of AA and DHA. For thefetus this implies that it is dependenton maternal intake of LCPUFA; the younginfant has to rely on LCPUFA supply in milk.Breast milk does contain LCPUFA in levelsdepending on maternal consumption, butthe standard Hero formulas for term infantslack these fatty acids.

Studies have shown that EFAs and LC-PUFAs levels must be controlled througha fine balance, because of their bodilyeffects: Some studies show evidences thatsupports the hypothesis that increased8

consumption of n - 6 PUFAs, in associationwith a high LA/LNA ratio, may favourthe continuous development of adiposetissue during the pregnancy/lactation periodand during infancy, which are periods highlysensitive to nutritional stimuli, at a timewhen physical activity should be rather similarbetween individuals.

This dynamic phase of development mayincrease the size of precursor pools and maysubsequently lead to adult obesity, owingto continuous intake of n - 6 PUFA-enricheddiets. Whether prevention appears as a keyissue, the fatty acid composition of dietaryfats early in life should be reconsidered ina more balanced and rational manner inorder to prevent a further increase ofchildhood obesity among future generations.

Both linoleic and linolenic acid use the sameenzyme ( 6-desaturase), so LA/LNA ratiodownregulates the conversion in 3 or 6

LC-PUFAs.Regarding pregnancy, recent data show theimportance of LNA in development, as lowintrauterine availability of -linolenic acid(18:3 n6) is related to low birth weight andpresumably to low fat mass.

Docosahexanoic Acid(DHA)

6(linoleic acid)

Arachidonic Acid(AA)

3(linoleic acid)

Eicosapentanoic Acid(EPA)

Image 6.Essential fatty Acids synthesis.

3. NTHT STRATEGY

Omega 6 series: Several studies havesuggested a reduction in Linoleic Acid andArachidonic Acid intakes, to avoid possibleadverse effects due to accretion of ARAand excessive production of its oxygenatedderivatives (eicosanoids) which would thencompete with those of the n3 series. Thatis because ARA is very adipogenic andplays in preadipocytes the role of aprecursor of prostacyclin; this suggests anadipogenic role of prostacyclin. EPA andDHA inhibit the stimulating effect of ARAin prostacyclin production.

Omega 3 series: n3 PUFA are essentialnutrients owing to the crucial role of itsmetabolic end-product DHA, especially inregard to the maturation of visual andbrain function (they are an integral partof cell membranes throughout the bodyand affect the function of the cell receptorsin these membranes). They also bind toreceptors in cells that regulate geneticfunction. Likely due to these effects,omega-3 fats have been shown to helpprevent heart disease and stroke, may helpcontrol lupus, eczema, and rheumatoidarthritis, and may play protective roles incancer and other conditions.

In addition, they provide the starting pointfor making hormones (Prostacyclin,thromboxane, and prostaglandin) thatregulate blood clotting, contraction andrelaxation of artery walls, and inflammation.

Clinical studies using high intakes of LNAhave demonstrated that the endogenousconversion of LNA to DHA is strongly limitedand insufficient to cover the DHA require-ments, so must be supplemented.

LC-PUFA (both w3 and w6) and EFAs mustbe supplemented in infant foods, but levelsshall be controlled to prevent an excessivew6 intake that could lead to obesity or othercomplications.

Limiting Linoleic Acid intake to adequatelevels, and maintaining a fine balancebetween LA and LNA intake, will promotean acceptable adipose tissue development.

Supplementation in preterm and term infantscan induce a better neurodevelopmentaloutcome at school age.

8G. Ailhaud and P. Guesnet (2004): Fatty acidcomposition of fats is an early determinant of childhoodobesity: a short review and an opinion, obesity reviews(2004) 5, 21-26

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3.1.4 Carbohydrates Optimized carbohydrateassimilation and prebiotic effect

Carbohydrates CarbohydratesSingle Sugar Reduction

Infant cereal is the 1st food included in theweaning diet, having high energy densitydue to their carbohydrates content (dextrin,starch and dietary fiber).

In general, starch cereals are consideredhighly digestible, but efficient digestion hasbeen shown to be critical for babies, sincepancreatic amylotic activity does not fullydeveloped until 18 month of age. This isthe reason infant cereal processing includesheat and enzymatic treatment ( -amylase)to increase the digestibility of starch, andglucose and energy availability.

Industrial processing9 causes an increase indextrin and the subsequently modificationof starch, which is mainly dextrinized starchin commercial products. The digestibilityof the product is higher, but it also producesa high glycemic answer because of its fastrelease of sugars after hydrolysis. Undiges-tible starch is fermented by friendly micro-biota, and metabolites from fermentationcontribute to maintenance on colon health,and have beneficial effects on glucose andlipid metabolism. The product shall containa mixture of carbohydrates digestible inbabies under 18 months preventing highglycemic peaks and promoting prebioticeffect.

Dietary carbohydrates are broken down inglucose and other monosaccharides,increasing the glucose levels in bloodstream.

It has been showed that there is a directrelation between high glycemic index andincrease of weight; carbohydrates with ahigh glycemic index may increase plasmaglucose to high levels rapidly. It is hypothe-sized that, as a result, insulin levels increase,inducing hypoglycemia, adipose tissueformation and hunger, which tends to leadto consumption of excess calories and weightgain. These effects are predicted to resultin a less favorable lipid profile and increasedrisk of obesity, diabetes mellitus, and com-plications of diabetes if present.

Complex carbohydrates (found in wholegrains), on the other hand, are broken downmore slowly, allowing blood sugar to risemore gradually. Also, sugar can enhancethe taste of some foods, making the childget used to tasty foods, rejecting those tasty-less foods and taking only those with plentysugars. That lifestyle habit is predicted tolead to consumption of excessive energy andweight gain. In addition, eating too manysugary foods can also lead to tooth decay.

A reduction of single sugars to adequatelevels can promote a moderate glycemicresponse preventing weight gain, tooth decayand adoption of unhealthy lifestyle habits.

9Bernal MJ, Periago MJ, Ros G (2002) Effects ofProcessing on Dextrin,Total Starch, Dietary Fiber andStarch Digestibility in Infant Cereals, J Food Science67(3):1249-1254

3. NTHT STRATEGY

3.1.5 Probiotic and Prebiotic

Probiotic PrebioticProbiotic and Prebiotic Probiotic and Prebiotic

Probiotics are "live microorganisms whichwhen administered in adequate amountconfer a health benefit on the host" (FAO2001).

Research has suggested that probiotics can:

Help reduce the risk of certain diarrhea.

Enhance the immune function10.

Protect against pathogenic bacteria.

Help in digestion and absorption of severalnutrients11.

Prebiotics12 are food ingredients thatselectively stimulate the growth and activityof beneficial microorganisms in the colon.

Fructo-oligosaccharides (FOS) and Galacto-oligosaccharides (GOS) are the majorprebiotics. They are resistant to digestion inthe upper gastrointestinal tract and are,therefore, able to stimulate the growth ofBifidobacterium and Lactobacillus strainsfarther down in the large intestine.

In vivo, they do not support the growth ofpathogens, and have shown to increase theabsorption of calcium and magnesium anddecrease triglycerides.

12Collins MD, Gibson GR (1999). Probiotics, prebiotics,and synbiotics: approaches for modulating the microbialecology of the gut. Am J Clin Nutr, May; 69 (5):1052S-1057S.

10Fukushima Y, Kawata Y, Hara H, Terada A, MitsuokaT (1998). Effect of a probiotic formula on intestinalimmunoglobulin A production in healthy children, IntJ Food Microbiol. Jun 30; 42 (1-2): 39-44

11Scholz-Ahrens KE, Ade P, Marten B, Weber P, TimmW, Açil Y, Glüer CC, Schrezenmeir J (2007). Prebiotics,Probiotics, and Symbiotic Affect Mineral Absorption,Bone Mineral Content, and Bone Structure. J. Nutr,March; 137 : 838S-846S

3.1.6 Dietary Supplements

Nucleotides Taurine

A dietary supplement, is a preparationintended to supply nutrients that are missingor are not consumed in sufficient quantityin a person's diet.

These elements are added to foods becausethey can enhance several body functions(brain, visual, nervous) and improve theabsorption of other nutrients and tissue andbone development.

Dietary Supplements

Nucleotides are compounds that play a keyrole in numerous intracellular biochemicalprocesses. They are synthesized de novoby the body utilizing amino acid precursorsor salvaged from degraded nucleic acidsand nucleotides.

Nucleotides participate in several biochemicalprocesses that are essential to the functionof the living body:

As nucleic acids: being the monomericunits they carry the genetic code as DNAand RNA.

In biosynthesis: for example, UDP-galactose in the synthesis of lactose orUDP-glucose in the process of glycogenesis.

As components of co-enzymes: NAD, FADand coenzyme A.

As biological regulators: cyclic AMP initiatessecond messenger cascades and isubiquitous in all forms of life, playing akey role in regulating biological processes.

As an energy source: ATP is a universalcurrency of energy in biological systems.

Taurine is an organic acid. It is also a majorconstituent of bile (works breaking downfats) and can be found in lower amounts inthe tissues of many animals includinghumans.

Taurine has also been implicated in a widearray of other physiological phenomenaincluding inhibitory neurotransmission,long-term potientation in the stria-tum/hippocampus, membrane stabilization,feedback inhibition, adipose tissue regula-tion, calcium homeostasis and recovery fromosmotic shock.

Dietary Supplements

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Choline CarnitineInositolDietary Supplements

A type of sugar which is a basic part of cellmembranes, and is important in nerve, brain,and muscle function, where it plays animportant role as the structural basis for anumber of secondary messengers ineukaryotic cells. Inositol is being studied inthe prevention of cancer and fat reduction.

Dietary Supplements

Choline is an organic compound, classifiedas a water-soluble essential nutrient andusually grouped within the Vitamin Bcomplex. This natural amine is found in thelipids that make up cell membranes and inthe neurotransmitter acetylcholine.

Acetylcholine plays a role in variouscognition systems within the brain.Memory, intelligence and mood aremediated at least in part by acetylcholinemetabolism in the brain.

Choline and its metabolites are needed forthree main physiological purposes: structuralintegrity and signaling roles for cellmembranes, cholinergic neurotransmission(acetylcholine synthesis), and as a majorsource for methyl groups via its metabolite,Trimethylglycine (betaine).

Dietary Supplements

Carnitine is a compound biosynthesized fromthe amino acids lysine and methionine. Inliving cells, it is required for the transport offatty acids from the cytosol into themitochondria during the breakdown of lipids(or fats) for the generation of metabolicenergy.

In animals, carnitine is biosynthesizedprimarily in the liver and kidneys from theamino acids lysine or methionine. VitaminC is essential to the synthesis of carnitine.During growth the requirement of carnitinemight exceed its natural production, so ithas to be supplemented.

It is related in the maintenance anddevelopment of bones and brain.

3.2 NT&HT STRATEGY

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NT&HT Strategy

What is NT&HT?NT&HT strategic objectivesWhy developing a strategy?NT&HT Roadbook: Strategy implementation

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3.2

What is NT&HT? NT&HT Strategic objectives

The knowledge increase in a lot of scientificfields during the last years, and especiallyabout epidemiologic evidences, is helpingto clarify the diet role in prevention of chronicdiseases.

Research is helping to clarify some of thecomponents of the diet that increase the riskfor developing chronic diseases, and theactions that should be implemented tominimize their impact in the health andfuture development of the baby.

NT&HT Strategy

HERO is striving to offer the best possiblecomplementary nutrition for baby, andhas developed a global evolution of itsproducts to a better nutritional aim.

Nutrition Today Health Tomorrow is a globalnutritional strategy that includes, amongothers, new development of Infant Foodproducts.

Nutrition Today & Health Tomorrow(NT&HT) is the HERO response to newtrends in infant nutrition, and wants tointegrate all those researches to developproducts which offer to the baby anadequate nutrition today, providing themost adequate nutrition and minimizingthe risk for chronic diseases in adult- orchildhood.

Its main objective is obtaining productsthat, considered in a whole diet, couldhelp in the prevention of future outcomeof chronic diseases, mainly obesity andmetabolic syndrome. Contributions toimprovement of healthy developmentconditions and concern about increasingallergies incidence are also pivotal partsof this Global Strategy aimed to offerthe best possible Infant Food productsto a modern society that is facing newhealth challenges.

This strategy implements a constantupdating policy affecting all the Heroproducts, and will integrate all thosediscoveries which make the productcomposition more suitable for the mostadequate nutrition for the baby; this updatesfind their origin in scientific researches.

The implementation of this strategy is a mustfor every company in the Hero Group,affecting all the products commercializedin the Infant Nutrition range.

NT&HT Strategy

NT&HT strategy has several objectives, whichare listed as follows:

Offer the most adequate nutrition tothe baby, providing the appropriateamounts of nutrients needed, minimizingthe risk for chronic diseases in adult- orchildhood.

Adequate the product composition toreach the best nutrition possible for thebaby fulfilling legislation requirements.

Integrate all the present scientificknowledge about infant nutrition andbodily physiology to offer the mostadequate product for each stage of theinfant growth.

Integrate any future scientific discoverythat will be proven to offer a valuableimprovement for infant healthy growth.

Contribute with a nutritional andscientific strength in each of the Heroproducts, becoming a reference brand ininfant nutrition.

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3. NTHT STRATEGY

Why developing a strategy?NT&HT Strategy

During latter year, obesity prevalence hasbeen increased, with alarming rates aroundthe world and affecting to people of all ages.

It has a special prevalence in childhood (5-12 years of age), in which prevalence is upto 25% (depending on each country) andthe increasing rate is over the adulthood.

Childhood obesity is related with diet;during latter years diet composition hasbeen modified increasing the risk to developchild obesity:

High-dense energetic intakes.

High fat intake with special prevalence ofsaturated fats.

High meat intake.

High salt intake.

High sugar and sweetened foods andbeverages intake.

Low fibre intake.

Low vitamin intake.

Fatty children have an increased risk todevelop chronic diseases, reducing theirlife expectancy.

Cardiovascular diseases: several risk factorsare associated with children obesity, suchas blood pressure (hypertension), adverseblood profiles, hyperinsulinemia…

Diabetes mellitus.

Some other complications: childhoodobesity is associated with risks to developasthma, structure and functionality ofmotor system, caries…

Psychological consequences: overweightand obesity are associated with low self-esteem, depression, bulimia, and ownbody rejection. Parents' attitude is a keyactor in children facing the problem.

The highest risk for childhood obesity isthe possibility of the obesity lasting inadulthood.

Childhood obesity is a decisive factor forthe obesity in adulthood, and the risk forobesity is increased along with thechildren age, fat percentage and familyhistory.

Early nutrition is a preventive issueagainst obesity. As well as the consequen-ces of the infant nutrition in growth, bodycomposition, health and wellness, anincreasing number of scientific investigationshave shown advices about amount andquality of nutrient intake during childhood.It has been shown that these nutrient advicesare key factors in long-term organ develo-pment and functionality, health and risk fordiseases, even the cognitive capacity infollowing years. This has been named earlynutrition.

Some of the conclusions related with weightgain and increasing risks for chronic diseasesare the following:

Excessive protein intake in childhoodis related with weight gain and bodyfat percentage in following stages ofinfant development.

A high sodium intake increases the riskfor cardiovascular and circulatory diseasesbecause it increases the blood pressure.

A high fat intake, specially saturated,increases the risk for cardiovasculardisease, and obesity because it increasesthe cholesterol and triglycerides bloodlevel. Unsaturated fats reduce those levels.

High sugar intake promotes theobesity development and tooth decay(caries).

An adequate fibre intake may havea preventive role for constipation andsome cancer types.

All those discoveries and advices havepromoted to modify the dietary intakes forinfant nutrition, providing enough amountsof each nutrient to ensure the nutritionalneeds in each stage of the infant growth,limited to minimize disease and undernutri-tion risk.

That is a key factor to be considered ininfant nutrition.

All those factors are integrated in theNT&HT strategy, developed by Hero as itsresponse to the obesity epidemic and all thenew discoveries in infant nutrition andphysiology, shaping the roadbook toimplement.

NTHT Roadbook: Strategyimplementation

NT&HT Strategy

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NT&HT Strategy states the following keypoints to improve the suitability of ourproducts:

Breast milk is the best offer, becauseof its qualities and benefits for the baby.

Adequate Energy balance. Productshave to offer an adequate energy balanceto prevent obesity, undernutrition andother diseases.

Covering nutrient requirements. Eachproduct must provide enough amounts ofeach nutrient to avoid both nutritionaldeficiencies and excesses, helping babiesgrow and learn healthy. Implementationof products with an aim to improve theiradjustment to present recommendationsabout nutritional requirements, consideringpresent legal requirements, is arecommended action within the NT&HTstrategy.

Excessive Early protein intake13 isconsidered as an obesity development riskfactor. Protein content of Infant Food mustbe adjusted to requirements, because ofthe association of high intakes withincreased risk of obesity. Reduction ofprotein contents of infant food products,within the admitted ranges and consideringthe established requirements, is arecommended action within the NT&HTstrategy.

Essential Fatty Acids (EFA)13 shall beincluded in the product composition,because they are essential dietary nutrientsrequired for optimal growth anddevelopment, particularly of the brain andretina. LA and ALA are substrates for theendogenous synthesis of LC-PUFAs. Designof baby food with adequate vegetable oilsin order to get balanced fatty acid profile,including essential fatty acids, isrecommended within the NT&HT strategy.

Long-chain Poly Unsaturated FattyAcid (LC-PUFAs)13:During early development, LCPUFA supplyis largely dependent on dietary intake ofARA and DHA because of the immaturityof enzymatic systems to metabolize LAand ALA, so its supplementation shallpromote the development of visual andpsychomotor systems. Presence of LCPsin the design of selected infant foodproducts fits within the NT&HT strategy.

Balanced fatty acid profile13 is desired.Balanced contents of saturated. Monoun-saturated and polyunsaturated fatty acidshave beneficial nutritional effects and arekey factors in the nutritional preventionof the future outcome of chronic diseaseslike obesity.

Reduction of Single sugar contents13

to adequate levels prevents the develop-ment of insulin resistance, and adiposetissue formation. Also, low single sugarcontent prevents caries and sugary lifestylehabits. Reduction of simple sugars con-centrations to adequate levels in InfantFood products is a recommended actionwithin the NT&HT strategy.

Optimization of the carbohydrateassimilation13. Digestibility of starch inInfant Cereals may be a factor to beconsidered in healthy products. Reductionof glycemic peaks and effects of promotionof friendly microbiota are presently understudy and can show interesting benefitsto infant feeding. Resistant starch mayplay an interesting role in this effect.Beneficial effects due to optimization ofcarbohydrate assimilation both onadequate management of glycaemic peaksand prebiotic effects are recommendedwithin the NT&HT strategy.

Mineral, Vitamin and micronutrientssupplementation to support the correctgrowth and development of the baby.Most updated guidelines and recommen-dations about this supplementation willbe applied.

Prebiotic and probiotics. Prebiotics andprobiotics are ingredients that modulateintestinal microbiota and are presently thesubject of an increasing scientific interestas functional ingredients related to welfare.Infant Nutrition is also an area of interestfor pre- and probiotics. Microbiota modu-lation has beneficial effects related toimportant aspects:

Inhibition of pathogen bacteriadevelopment.

Stimulation of immune system.

Mineral absorption.

More recently, microbiota is under study asa possible indicator of future overweight inchildren; this opens the door to potentialrelations between obesity and pre- andprobiotics uses. Adequate uses of Prebioticsand Probiotics are recommended actionswithin the NT&HT strategy.

Allergen Management: Between 4 and6% of children have documented foodallergy and this disease has increasedduring the latter years. Several studies arerelating the control of exposure to foodallergens with improvement in infant healthstatus. International Organizations likeESPGHAN and AAP have publishedstatements about this topic. Several mainactions could be proposed with regardsto allergy.

13See early nutrition section.

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Adequate order of introduction ofallergenic ingredients in complementaryfood.

Use of partially hydrolyzed formulae forinfants with a documented hereditaryatopy risk.

Use of special ingredients with lessallergenic potential.

Control of unwanted allergen cross-contamination in products.

Al l act ions intended to adequatemanagement of allergen exposure due toinfant food products are recommended withinthe NT&HT strategy.

Scientific investigations are constantlyprogressing in baby physiology andfeeding, increasing the knowledge toimprove baby feeding, making it each timemore suitable for the child. New researchadvances that could reinforce this strategywill be incorporated.

All those new developments whichhave a scientifically demonstratedaction to support growth anddevelopment of infants fit withinNT&HT strategy principles and shall beconsidered in the product compositions.

Presently, Hero Nutrition Institute is doingResearch about several compounds thatmight result in significant improvements.Research and new development of productsunder the NT&HT strategy has to be awareof advances on new bioactive compoundsthat could play beneficial roles in InfantNutrition.

This NT&HT strategy is implemented for allthe products having a compositionconsistent with the best nutritionalobjective ever, integrating all the newlyproven scientific discoveries in the productportfolio to cover all the nutritional needsand reducing at the same time the riskfor chronic diseases.

Nutrition Today & Health Tomorrow isa global strategy that positions the Heroportfolio as high quality products,compromised with baby health now andin future stages, supplying a balancedfeeding that make the baby grow anddevelop (physically and cognitively) in ahealthy state.

3.3 NT&HT COMMUNICATION

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3.3NT&HT Advantages

Two different targetsto communicate

Structure in the NT&HTCommunication

Positioning concepts

Strategic concepts

Improved compositions

3.3.1

3.3.2

3.3.3

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3.3.1 NT&HT AdvantagesNT&HT is the response of Hero against the market trends, and this is precisely the competitiveadvantage versus the competitors.

Nutrition today & Health Tomorrow strategy works against the obesity trend in children preventingthe subsequent chronic diseases development.

This strategy makes Hero progress to a best nutritional environment, much more suitable for thebaby in each stage of development.

NTHT Communication3.3

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Several strategic key points must be highlighted, and so are listed as follows:

Breast milk is stated as the best offer for baby feeding.

It has been stated a Strategic Nutritional Aim that, depending on the scientific knowledge about physical and nutritional development in the baby,will be the optimum for each stage.

The Strategic Preventive Aim is stated within chronic diseases related to the baby feeding, supported by the early nutrition discoveries.

The Hero Quality Aim wants to be the utmost, being supported by the appropriate quality controls in each stage of production, ensuring theabsence of contaminations in the products, and an adequate labeling as legislated.

This is a live-on strategy, growing and expanding along with the understanding of the needs and body physiology in babies. Thenutritional, preventive and quality aims want to be constantly improved, implementing all that techniques and compounds that origin in provedscientific investigations, fulfill legislation procedures, and offer a valuable improvement for infant healthy growth.

This is a global strategy that is implementing in all the brands and products in Hero portfolio.

The key issue in this NT&HT strategy is the Active Contribution of the Hero Baby products to the healthy development and growth of thebaby. The improvement of the nutritive profile of each product wants to reach the most suitable nutritional aim for the baby in each stage ofdevelopment, fulfilling the utmost quality and preventive requirements.

3. NTHT STRATEGY

NT&HT strategy is being communicated to two different targets:Caregiver communication is different from Medical communicationbecause of the characteristics of each target:

Medical Communication is the communication relating to, orconcerned with physicians or the practice of medicine(doctors, nurses, nutritionist…).

Caregiver is defined as an adult who cares for an infant or child,and may be parental-related or not.

3.3.3 Structure in the NT&HTCommunication

The Nutrition Today & Health tomorrow communication is divided inthree main groups depending on the role each concept plays withinthe strategy:

Positioning concepts: help to focus on the seriousness of thesituation and the factors that may influence the obesity prevalence.

Strategic Concepts: Communicate what is the NT&HT strategy andhighlights the key issues and advantages of this strategic plan.

Improved compositions: All the changes in the compositions thatare consequence of the NT&HT strategy implementation to improvethe products.

3.3.2 Two different targets to communicate

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Positioning conceptsStructure in the NTHT Communication

CONCEPT: Overweight and obesity have become epidemic.14, 15

Obesity has become an epidemic. It is a disease that has serious consequences in adulthood and begins in childhood.

The WHO14 (World Health Organization) estimates that up to 1.6 billion people are overweight, and more than400.000 people are obese.

The last estimation indicates that up to 22 million of children less of 5 years are overweight, and a high percentageare obese; but the most concerning issue is the incremental trend that is observed in obesity and chronic diseasedevelopment during childhood

At present, overweight and obesity affect up to 22 million of childrenaround the world.

14World Health Organization (WHO), Fact sheet nº 311 (Sept 2006): Obesity and overweight.15WHO, Technical Report Series, number 916 (2003): Diet, Nutrition and the prevention of chronic diseases.

Positioning concepts

3. NTHT STRATEGY

CONCEPT: Overweight and obesity are risk factors for chronic diseases.16

Prevalence of Obesity and Chronic diseases (hypertension, diabetes mellitus, cancer, caries, obesity…) is increased.Main contributors are sedentary lifestyles, excessive intakes of energy, saturated fats, cholesterol, and sodium, andlow fruit, vegetables and fiber consumption.

Obesity is a risk factor in latter development of chronic diseases, so this is the key reason to act against obesitydevelopment in childhood.

Obesity epidemic increases on with the same trend, some diseases obesity-related, like blindness, diabetes mellitus(type 2), coronary heart disease, stroke and kidney disease might become usual diseases during childhood.

This affects fatty or unfatty children fed with unhealthy diets.

Overweight and obesity promote chronic disease development(diabetes mellitus, hypertension, heart disease…).

Unhealthy diets promote obesity and may produce chronic disease development.

16World Health organization (WHO, 2007): The challenge of obesity in the WHO European region and the strategies of response.

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Positioning conceptsStructure in the NTHT Communication

CONCEPT: Dietary intakes are critical determinants for body weight.13

Total energy intake must exceed the energy expenditure during a long time to make the person become obese.

The energy intake from food is metabolized to be used in maintenance, energetic or development (tissue formation)tasks, and an excess will be stored increasing the adipose tissue, causing the baby to be overweight.

It is recommended to balance the energy intake from foods and the energy expenditure to prevent obesity development.

Energy unbalance determinates the obesity development

Excessive feeding causes overweight

13Slyper AH (2004).The Pediatric Obesity Epidemic: Causes and Controversies. J Clin endocrine Metab, Jun; 89 (6): 2540-2547

3. NTHT STRATEGY

CONCEPT: Lifestyle habits beginning during infancy shape the healthprofile of the baby during his/her whole life.17

Several lifestyle habits (excessive intake of salt, sugar or meat) suppose a risk for health; slight modifications in thathabits and attitudes may reduce the risk for suffering chronic diseases during adulthood.

During early childhood the baby establishes the nourishing habits, so it’s important that when solid foods are beingincluded in the baby’s diet, textures and tastes vary to make the baby get used to different tastes.

I.e., some evidences have shown that a high sugar intake during early infancy make the baby get used to palatabilityof those sugary foods. This may be a factor to make the baby reject foods with less palatability during latter stages,and this may be a risk for an adequate growth and development because a high sugar intake or salt intake increaserisks for chronic diseases.

High sugar or salt intakes during early life make the child adopt unhealthylifestyle habits that may increase disease risk.

During the infancy new tastes, textures and smells are discovered,shaping the feeding habits of the baby during adulthood.

17Spanish Food Security and Nutrition Agency (AESAN). Spanish Minister for Health and Consumtion, 2005: Strategy for the nutrition,physical activity and prevention of the obesity.

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Positioning conceptsStructure in the NTHT Communication

CONCEPT: Nutritional needs in the baby change during each stage of life.

The nutritional requirements the baby demands to complete the growth and development adequately vary in eachstage of the early life of the baby:

Birth to 4-6 months: Breastfeeding exclusively or infant food. Immaturity of the digestive system and absence of teethcauses that the food must be a liquid and highly digestible formula.

4-6 months to 12 months: Breastfeeding and follow-on formula. Chewing appears and digestive system is matureenough to tolerate and manage a gradual introduction of solid foods, with new textures and tastes.

More than 12 months of age: baby feeding is progressively adapted to the family foods.

Hero implements NT&HT strategy to supply foods that cover all the nutritional needs of the baby in each stage ofdevelopment, promoting a better growth and development of the baby

Each stage in baby development has particular nutritional requirements.

Baby feeding has to be adapted along with his/her development

3. NTHT STRATEGY

CONCEPT: Unadequate feeding increases risks for unhealthy state

Early life is a fragile stage in baby development.

Carefully planned nutrition must provide an energy balance and a nutrient balance that compensates the cost of thephysical activity, contributing to the normal development and allowing the tissue formation in a good state of health.

Excess intake of macronutrients can lead to obesity and related disorders; excess intake of micronutrients can be toxic.

Also, the balance of various types of nutrients can influence the development of disorders. Lack of nutrients can resultin deficiency syndromes or other disorders (Undernutrition).

Unbalanced diet may increase the risk of suffering obesity, chronic diseasesand other disorders.

Adequate nutrition reduces the risk for disease development.

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Strategic conceptsStructure in the NTHT Communication

CONCEPT: Breast milk is the best offer

Breast milk is stated as the nutrition of choice.

Multiple advantages for the child: nutritional and cognitive improvement; protection against infections and allergies.

Advantages for the mother:reduced fertility during lactation; more rapid return to normal prepartum condition;protection against osteoporosis, obesity, and ovarian and premenopausal breast cancers.

Exclusive breastfeeding (or infant formula feeding) is recommended to be the ideal nutrition and sufficient to supportoptimal growth and development for approximately the first 4 to 6 months after birth.

Furthermore, it is recommended that breastfeeding continue for at least 12 months, and thereafter for as long asmutually desired, although after 1 year, breastfeeding should complement a full diet of solid foods and fluids.

Breast milk is the nutrition of choice.

3. NTHT STRATEGY

CONCEPT: Scientific-based products.

Little by little, investigations increase our knowledge in baby nutrition.

Hero wants to use that knowledge to offer the utmost appropriate products for each development stageof the baby

All the new proven scientific discoveries in infant nutrition and physiology are integrated in Hero products,ensuring the highest quality and suitability to the baby feeding.

We grow step-by-step with the child to offer the most suitable food in each stage of development.

Nutritionist-developed products for each age of development.

Scientifically-supported baby products.

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Strategic conceptsStructure in the NTHT Communication

CONCEPT: Fulfills recommendations

Hero has developed its products considering all the guidelines provided by pediatrician associations and usual foodstandards.

Some of these guidelines are stated by:

The American Association of Pediatrics (AAP),

European Union (EU),

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN),

Codex Alimentarius (standard provided by the World Health Organization, WHO).

Our products fulfill correctly all the guidelines provided by these organisms.

Hero products fulfill the most exhaustive recommendations for infant nutrition (Codex, AAP, ESPGHAN, EU).

Fulfills recommendations from Infant Nutrition Experts

3. NTHT STRATEGY

CONCEPT: Products adapted to each stage of development

Each stage in baby’s development and growth has its own specific requirements, varying along with the baby growth.

Hero implements NTHT strategy to supply foods that cover all the nutritional needs of the baby in each stage ofdevelopment, promoting a better growth and development of the baby.

Products suitable for a specific stage can be consumed in the next stages.

Each stage of development requires its Hero product range.

Fulfills all the nutritional requirements of the baby in that stage.

Progressing step by step with your baby.

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CONCEPT: Allergen management.

Exclusive breastfeeding is recommended as the hallmark for food allergy prevention to at least 12 months of age.

Fulfills the recommendations about introduction of solid food (introduction of potentially allergenic foods: cerealswith or without gluten, egg, milk, fish…).

Exhaustive quality controls to prevent cross-contaminations of the products during production.

Specific products developed to be offered to those babies with an allergy or food intolerance for cow milk, gluten…

Adequate labelling in the products.

Exhaustive quality control to prevent cross-contaminations.

Fulfills the recommendations for the introduction of solid foods.

Strategic concepts

3. NTHT STRATEGY

CONCEPT: No colouring or preservative

Baby feeding must be done with high-quality and secure foods.

High quality ingredients for a high quality products.

No preservatives nor colourings added:

Heat treatment and vaccuum-packaging keep food safe preventing contaminations.The cooking processes keep natural properties of the products unaltered.

Hero ensures the security of babies through exigent cross-contamination controls and using of hypoallergenicingredients.

100% natural products.

No colouring nor preservatives added.

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Strategic conceptsStructure in the NTHT Communication

CONCEPT: balanced nutrition promoting health.

Hero Baby products are defined covering all the nutritional needs for the baby in each stage of development.

Suitable energy and nutrient intakes promoting a balanced nutrition for an adequate growth and development ofthe baby.

Appropriate nutrient content preventing excessive weight gain and increase of chronic disease developing risk (Earlynutrition).

Fulfills recommendations.

Adequate energetic balance.

Fulfills all the requirements of the baby in each stage of development.

Balanced feeding that promotes a healthy growth and development of the baby.

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3. NTHT STRATEGY

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CONCEPT: High protein intake promotes obesity5

The early protein intake hypothesis postulates that high protein intakes during the first months of life increase therisk of obesity and other diseases:

May induce insulin-related responses triggering the preadipocyte differentiation and adipose tissue formation.

Reduces Calcium availability, increasing calcium urine excretion, and may cause lose of bone density and promoteosteoporosis.

Increases Renal Solute Load; the newborn baby has limited renal capacity to deal with a high solute load and atthe same time conserve fluids, and a high increase of the solute load may cause dehydration.

Animal, and in particular dairy protein intake might be responsible for this association.

Suitable protein content helps in prevention of obesity.

5Günther AL, Remer T, Kroke A, Buyken AE (2007). Early protein intake and later obesity risk: which protein sources at whichtime points throughout infancy and childhood are important for body mass

Reducing protein content prevents obesity promotion.

Low protein content prevents insulin response that increases the obesity risk.

Reduced protein content maintains Renal Solute Load balanced and fulfills babyrequirements for adequate growth and development.

Improved compositions

CONCEPT: Long-Chain Polyunsaturated Fatty Acid (LC-PUFAs)supplementation.8

Supplemented because during early infancy the baby can’t synthetize DHA (Docosahexanoic Acid) and AA (ArachidonicAcid) from essential fatty acids.

Estimulate the neuronal development (brain and nervous system), adequate retina development and modulatesthe immune response.

Studies have shown that increased consumption of n - 6 PUFAs, in association with a high LA/LNA ratio, may favourthe continuous development of adipose tissue.

DHA and AA must be supplemented in infant foods, but levels shall be controlled to prevent an excessivew6 intake that could lead to obesity or other complications.

Appropriate AA supplementation prevents adipose tissue development.

Long-Chain Polyunsaturated fatty Acids (AA, DHA) that improve the adequatedevelopment and maturation of Central Nervous System and Retina.

DHA and AA supplementation improves cognitive and visual development.

8G. Ailhaud and P. Guesnet (2004): Fatty acid composition of fats is an early determinant of childhood obesity: a short reviewand an opinion, obesity reviews (2004) 5, 21-26

3. NTHT STRATEGY

DHA and AA supplementation aids in mental and visual development.

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Improved compositionsStructure in the NTHT Communication

CONCEPT: Essential Fatty Acid (EFA) supplementation

Dietary fat are recommended to provide Linoleic Acid (LA) and Alpha-Linolenic Acid (ALA) to cover the requirements.

Long-chain polyunsaturated fatty acids (LC-PUFAs, like DHA and AA) are synthetized from ALA and LA, and bothlinoleic and linolenic acid use the same enzyme ( 6-desaturase), so LA/LNA ratio downregulates the conversion inw3 or w6 LC-PUFAs.

High EFA intakes diminish the LC-PUFAs synthesis (needed for the maturation of retina and nervous system), so itmust be controlled.

Low intakes, specially during first stages of life, may stop growth and development.

Supplies substrate for DHA and ARA synthesis, ensuring an adequate growthand development.

Adequate Essential Fatty Acid profile to cover baby requirements.

Essential Fatty Acid helps to a healthy brain development.

CONCEPT: Balanced Fatty Acid Profile

A balanced fatty acid profile shall be used, defined as:

Low saturated fat and high mono and polyunsaturated fats contents.Diets high in saturated fat have been linked to chronic disease, specifically, coronary heart disease, because it raisesLDL cholesterol.

Low trans fats contents.Trans fats are worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL. Theyalso fire inflammation, an overactivity of the immune system that has been implicated in heart disease, stroke,diabetes, and other chronic conditions. Even small amounts of trans fat in the diet can have harmful health effects.

Balanced fatty acid profile with low saturated and high polyunsaturated fats.

Trans fats minimization (below recommendations) is a must.

Balanced fatty acid profile prevents disease and covers requirements

Healthy fat profile that ensures the utmost development.

3. NTHT STRATEGY

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Improved compositionsStructure in the NTHT Communication

CONCEPT: Single sugar contents are reduced.13

Dietary carbohydrates are broken down in glucose and other monosaccharides, increasing the glucose levels inbloodstream.

Excessive single sugars consumption increase insulin secretion inducing a less favorable body fat profile with adiposetissue formation and weight gain, increasing the risk for obesity and diabetes complications.

Also, sugar can promote unhealthy eating habits in the baby and tooth decay development

Excessive sugar consumption induces a less favorable body fat profile.

Reduced single sugar formula prevents adipose tissue formation and reducesthe subsequent risk for obesity and diabetes development.

Lower single sugar content prevents tooth decay and unhealthy weight gain.

13Slyper AH (2004).The Pediatric Obesity Epidemic: Causes and Controversies. J Clin endocrine Metab, Jun; 89 (6): 2540-2547

CONCEPT: CH assimilation has been optimized.9

Efficient digestion has been shown to be critical for babies, since pancreatic amylotic activity does not fully developeduntil 18 mo of age.

Infant cereal processing includes heat and enzymatic treatment (•-amilase hydrolisis) to increase the digestibility ofstarch, but extended hydrolization increases glucose and energy availability, producing increased glycemicpeaks and insulin resistance, promoting weightgain.

Partially hydrolized formulas slows the metabolization of starch, reducing the insulin resistance andweightgain.

Also, undigestible starch is fermented by friendly microbiota , and metabolites from fermentation contributeto maintenance on colon health, and have beneficial effects on glucose and lipid metabolism. (prebiotic effect).

Partially hydrolized carbohydrates prevent high glycemic peaks and weight gain,and promote colonic prebiotic effect.

Extended hydrolized carbohydrates promote insulin resistance and obesitydevelopment.

Optimized carbohydrate assimilation prevents insulin resistance and subsequentweight gain.

Optimized formula assimilation and digestive enhanced function.

9Bernal MJ, Periago MJ, Ros G (2002) Effects of Processing on Dextrin,Total Starch, Dietary Fiber and Starch Digestibility in InfantCereals, J Food Science 67(3):1249-1254

3. NTHT STRATEGY

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Improved compositionsStructure in the NTHT Communication

CONCEPT: Prebiotic and Probiotic supplementation.

Prebiotic supplementation (FOS and GOS) has soluble dietary-like properties (reduces faecal pH, increases the water-holding capacity of stool and faecal weight and decreases gastrointestinal transit time), and modulate intestinalmicrobiota.

Probiotic supplementation (Bifidobacterium infantis, Lactobacillus casei rhamnosus), enhances the intestinal microbiota,maintaining an adequate digestive function in the baby:

Improves the lactose digestion, and reduces diarrhea.

Estimulates the immune system, reduces the pathogenic bacteria proliferation and bacterial enzymes.

Diminishes LDL-cholesterol.

Adequate prebiotic content enhances friendly microbiota.

Probiotic supplementation to improve digestive function in the baby.

Probiotic and prebiotic supplementation contributes to a correct digestive system functionand enhances the immune system.

Probiotic and Prebiotic supplementation improves digestion of the formula

CONCEPT: Novel Bioactive compounds.

Scientific knowledge progresses with investigations about child nutrition and physiollogy.

Any improvement in child nutrition, based in proven scientific investigations, may be included in our compositionsdealing our unique objective: make our product more suitable for the baby.

NT&HT is an strategy that is alive, and makes the products change evolving and acquiring those improvements thatwill make the product the utmost for the child.

New ideas arising from the scientific & marketing community should enrich the strategy and suggest new action linesfor the future.

Scientifically proven benefits of novel bioactive compounds.

New compounds to enhance the baby’s growth and development.

3. NTHT STRATEGY

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4. REFERENCES

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NUTRITION TODAYHEALTH TOMORROW

1 CODEX STAN 72 (1981) - Codex standard for infant formula and formulas for special medical purposes intended for infants.

2 CODEX STAN 156 (1987) - Codex standard for follow-up formula.

3 CODEX STAN 074 (1981) - Codex standard for processed cereal-based foods for infants and young children.

4 CODEX STAN 73 (1981) - Codex standard for canned baby foods.

5 Günther AL, Remer T, Kroke A, Buyken AE (2007). Early protein intake and later obesity risk: which protein sources at which time points throughoutinfancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nut, Dec; 86 (6): 1765-72.

6 Günther LBA,Buyken AE and Kroke A (2007) Protein intake during the period of complementary feeding and early childhood and the associationwith body mass index and percentage body fat at 7 y of age. Am J Clin Nutr, June; 85 (6): 1626-1633.

7 T. A. Demmers , P. J. H. Jones , Y. Wang , S. Krug , J. E. Heubi School of Dietetics and Human Nutrition, McGill University, Ste. Anne de Bellevue,Canada, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.

8 G. Ailhaud and P. Guesnet (2004): Fatty acid composition of fats is an early determinant of childhood obesity: a short review and an opinion, obesityreviews (2004) 5, 21-26.

9 Bernal MJ, Periago MJ, Ros G (2002) Effects of Processing on Dextrin, Total Starch, Dietary Fiber and Starch Digestibility in Infant Cereals, J FoodScience 67(3):1249-1254.

10 Fukushima Y, Kawata Y, Hara H, Terada A, Mitsuoka T (1998). Effect of a probiotic formula on intestinal immunoglobulin A production in healthychildren, Int J Food Microbiol. Jun 30; 42 (1-2): 39-44.

11 Scholz-Ahrens KE, Ade P, Marten B, Weber P, Timm W, Açil Y, Glüer CC, Schrezenmeir J (2007). Prebiotics, Probiotics, and Symbiotic Affect MineralAbsorption, Bone Mineral Content, and Bone Structure. J. Nutr, March; 137 : 838S-846S.

12 Collins MD, Gibson GR (1999). Probiotics, prebiotics, and synbiotics: approaches for modulating the microbial ecology of the gut. Am J Clin Nutr,May; 69 (5):1052S-1057S.

13 Slyper AH (2004).The Pediatric Obesity Epidemic: Causes and Controversies. J Clin endocrine Metab, Jun; 89 (6): 2540-2547.

14 World Health Organization (WHO), Fact sheet nº 311 (Sept 2006): Obesity and overweight.

15 WHO, Technical Report Series, number 916 (2003): Diet, Nutrition and the prevention of chronic diseases.

16 World Health organization (WHO, 2007): The challenge of obesity in the WHO European region and the strategies of response.

17 Spanish Food Security and Nutrition Agency (AESAN), Spanish Minister for Health and Consumption, 2005: Strategy for the nutrition, physical activityand prevention of the obesity.

4. REFERENCES

NUTRITION TODAY & HEALTH TOMORROW