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<p>Foreword xv</p> <p>Terms of Reference xvi</p> <p>Task Force Membership xvii</p> <p><b>1 Introduction to Early Life and Later Disease 1</b><br /> <i>Dr Siân Robinson</i></p> <p>1.1 Environmental influences on development 1</p> <p>1.2 Links between early life and adult disease 3</p> <p>1.3 Biological mechanisms 7</p> <p>1.4 Nutrition of mothers and children 8</p> <p>1.5 Nutrition of young women today 11</p> <p>1.6 Key points 11</p> <p>1.7 Key references 12</p> <p><b>2 Normal Growth and Development 13</b><br /> <i>Professor J. Harry McArdle, Dr Laura A. Wyness and Dr Lorraine Gambling</i></p> <p>2.1 Introduction 13</p> <p>2.2 Prenatal development 13</p> <p>2.3 Embryo development 16</p> <p>2.4 Fetal development 16</p> <p>2.5 Fetal development overview 18</p> <p>2.6 Birthweight 22</p> <p>2.7 Postnatal growth and development 24</p> <p>2.8 Growth monitoring (growth charts) 24</p> <p>2.9 Secular growth trends 25</p> <p>2.10 Canalisation, catch-up and catch-down growth 25</p> <p>2.11 Key points 26</p> <p>2.12 Recommendations for future research 27</p> <p>2.13 Key references 27</p> <p><b>3 Maternal Nutrition and Infant Feeding: Current Practice and Recommendations 28</b><br /> <i>Dr Alison M. Lennox, Professor Judith L. Buttriss and Helena J. Gibson-Moore</i></p> <p>3.1 Introduction 28</p> <p>3.2 Characteristics of pregnant women in the UK 28</p> <p>3.3 Current practice and recommendations: pre-pregnancy 32</p> <p>3.4 Current practice and recommendations: during pregnancy 35</p> <p>3.5 Current practice and recommendations: lactation 41</p> <p>3.6 Infant feeding: issues relating to evidence base 42</p> <p>3.7 Current practice and recommendations: breastfeeding 43</p> <p>3.8 Current practice and recommendations: formula feeding 50</p> <p>3.9 Current practice and recommendations: weaning/complementary feeding 53</p> <p>3.10 Allergy 67</p> <p>3.11 Conclusions 68</p> <p>3.12 Key points 69</p> <p>3.13 Recommendations for future research 70</p> <p>3.14 Key references 70</p> <p>Appendix 3.1: Historical perspective on breastfeeding and artificial feeding 71</p> <p>Breastfeeding 71</p> <p>Artificial infant formula 73</p> <p><b>4 Mechanisms and Pathways of Critical Windows of Development 75</b><br /> <i>Professor Harry J. McArdle and Dr Lorraine Gambling</i></p> <p>4.1 Introduction 75</p> <p>4.2 Embryo stages 75</p> <p>4.3 Development of placenta 75</p> <p>4.4 Nutritional programming: the effect of nutrition on fetal development 77</p> <p>4.5 Potential mechanisms of nutritional programming 80</p> <p>4.6 Conclusions 84</p> <p>4.7 Key points 85</p> <p>4.8 Recommendations for future research 85</p> <p>4.9 Key references 85</p> <p><b>5 Perinatal Effects of Sex Hormones in Programming of Susceptibility to Disease 86</b><br /> <i>Professor Richard M. Sharpe</i></p> <p>5.1 Introduction 86</p> <p>5.2 Timing of masculinisation and its body-wide effects 86</p> <p>5.3 Disorders of masculinisation 87</p> <p>5.4 Male–female differences in disease risk: the potential role of perinatal androgens 88</p> <p>5.5 Fetal growth, susceptibility to intrauterine growth restriction and its long-term consequences, including timing of puberty 88</p> <p>5.6 Growth hormone–insulin-like growth factor-I axis 90</p> <p>5.7 Brain and behavioural effects 90</p> <p>5.8 Sex differences in eating disorders, neuronal mechanisms and adipose tissue distribution 90</p> <p>5.9 Cardiovascular disease/hypertension 92</p> <p>5.10 Kidney disease/hypertension 92</p> <p>5.11 The immune system 93</p> <p>5.12 Lung development and disease risk 93</p> <p>5.13 Effects of maternal diet/obesity and infant feeding choices 93</p> <p>5.14 ‘Fetal programming’ and epigenetic mechanisms 95</p> <p>5.15 Conclusions 95</p> <p>5.16 Key points 95</p> <p>5.17 Recommendations for future research 96</p> <p>5.18 Key references 96</p> <p><b>6 Neurological Development 97</b><br /> <i>Professor Julian G. Mercer</i></p> <p>6.1 Introduction 97</p> <p>6.2 The developing brain 99</p> <p>6.3 Brain energy balance circuits and peripheral feedback signals 101</p> <p>6.4 Nutritional influences on the developing brain 106</p> <p>6.5 Programming mechanisms 110</p> <p>6.6 Nutritional interventions 112</p> <p>6.7 Conclusions 113</p> <p>6.8 Key points 114</p> <p>6.9 Recommendations for future research 115</p> <p>6.10 Key references 115</p> <p><b>7 Establishing of Gut Microbiota and Bacterial Colonisation of the Gut in Early Life 116</b><br /> <i>Dr Anne L. McCartney</i></p> <p>7.1 Introduction 116</p> <p>7.2 Acquisition of the gut microbiota 117</p> <p>7.3 Factors affecting the infant gut microbiota (acquisition and development) 118</p> <p>7.4 The gut microbiota of exclusively milk-fed infants 120</p> <p>7.5 The effects of weaning on the infant gut microbiota 123</p> <p>7.6 Potential long-term effects: implications for obesity 128</p> <p>7.7 Conclusions 128</p> <p>7.8 Key points 128</p> <p>7.9 Recommendations for future research 129</p> <p>7.10 Key references 129</p> <p><b>8 Nutrition and Development: Obesity 130</b><br /> <i>Professor Lucilla Poston</i></p> <p>8.1 Introduction 130</p> <p>8.2 Inadequate in utero nutrition: a risk factor for obesity in later life? 130</p> <p>8.3 Breastfeeding and risk of obesity in later life 132</p> <p>8.4 Maternal diabetes and obesity: early life determinants of offspring obesity? 132</p> <p>8.5 Interventions to reduce offspring obesity? 135</p> <p>8.6 Interventions in pregnant diabetic women 136</p> <p>8.7 Interventions in obese pregnant women 137</p> <p>8.8 Mechanisms underlying the early life origins of obesity; role of animal studies 138</p> <p>8.9 A central role for disturbance in pathways of appetite regulation 139</p> <p>8.10 Conclusions 141</p> <p>8.11 Key points 141</p> <p>8.12 Recommendations for future research 142</p> <p>8.13 Key references 142</p> <p><b>9 Nutrition and Development: Type 2 Diabetes 143</b><br /> <i>Dr Susan E. Ozanne</i></p> <p>9.1 Introduction 143</p> <p>9.2 Relationships between birthweight and type 2 diabetes 144</p> <p>9.3 Postnatal growth 144</p> <p>9.4 Evidence for the role of early nutrition in humans influencing type 2 diabetes risk 145</p> <p>9.5 Evidence for the role of early nutrition in animal models influencing type 2 diabetes risk 145</p> <p>9.6 Conclusions 148</p> <p>9.7 Key points 148</p> <p>9.8 Recommendations for future research 149</p> <p>9.9 Key references 149</p> <p><b>10 Nutrition and Development: Cardiovascular Disease 150</b><br /> <i>Dr Paul D. Taylor and Professor Thomas A. B. Sanders</i></p> <p>10.1 Introduction 150</p> <p>10.2 Evidence-based on clinical endpoints 151</p> <p>10.3 Postnatal growth 152</p> <p>10.4 Programming of atherosclerosis 153</p> <p>10.5 Programming of blood pressure 157</p> <p>10.6 Animal models of nutritional manipulation in early life 158</p> <p>10.7 Conclusions 162</p> <p>10.8 Key points 162</p> <p>10.9 Recommendations for future research 162</p> <p>10.10 Key references 163</p> <p><b>11 Nutrition and Development: Cancer 164</b><br /> <i>Professor Paul Haggarty and Professor Steven Darryll Heys</i></p> <p>11.1 Cancer incidence and trends 164</p> <p>11.2 Cancer biology 165</p> <p>11.3 Evidence linking early nutrition to cancer 166</p> <p>11.4 Possible mechanisms linking early nutrition to cancer risk 168</p> <p>11.5 Conclusions 174</p> <p>11.6 Key points 175</p> <p>11.7 Recommendations for future research 175</p> <p>11.8 Key references 176</p> <p><b>12 Nutrition and Development: Bone Health 177</b><br /> <i>Dr Vicki Quincey, Professor Elaine Dennison, Professor Cyrus Cooper and Dr Nicholas C. Harvey</i></p> <p>12.1 Early life origins of osteoporosis 177</p> <p>12.2 Maternal nutrition in pregnancy 180</p> <p>12.3 Postnatal calcium and vitamin D nutrition 184</p> <p>12.4 Calcium and vitamin D nutrition in older children 186</p> <p>12.5 Vitamin D: problems with defi ning normality 186</p> <p>12.6 Physical activity and bone health in childhood 188</p> <p>12.7 Conclusions 189</p> <p>12.8 Key points 189</p> <p>12.9 Recommendations for future research 190</p> <p>12.10 Key references 190</p> <p><b>13 Nutrition and Development: Asthma and Allergic Disease 191</b><br /> <i>Professor Graham S. Devereux and Dr Nanda Prabhu</i></p> <p>13.1 Introduction 191</p> <p>13.2 Pathogenesis 191</p> <p>13.3 Increasing prevalence of asthma and allergic disease 193</p> <p>13.4 Impact of asthma and allergic disease 193</p> <p>13.5 Importance of antenatal and early life influences on asthma and allergic disease 194</p> <p>13.6 Maternal dietary food allergen intake during pregnancy and breastfeeding 195</p> <p>13.7 Breastfeeding and childhood atopic dermatitis and asthma 198</p> <p>13.8 Infant dietary food allergen intake 198</p> <p>13.9 Early life nutrient intake 199</p> <p>13.10 Obesity and childhood asthma and allergic disease 203</p> <p>13.11 Conclusions 203</p> <p>13.12 Key points 204</p> <p>13.13 Recommendations for future research 204</p> <p>13.14 Key references 205</p> <p><b>14 Nutrition and Development: Early Nutrition, Mental Development and Mental Ageing 206</b><br /> <i>Professor Marcus Richards, Dr Alan Dangour and Professor Ricardo Uauy</i></p> <p>14.1 The importance of mental development and ageing 206</p> <p>14.2 Maternal diet during pregnancy 207</p> <p>14.3 Breastfeeding 209</p> <p>14.4 Post-weaning diet 212</p> <p>14.5 Conclusions 213</p> <p>14.6 Key points 214</p> <p>14.7 Recommendations for future research 215</p> <p>14.8 Key references 215</p> <p><b>15 Putting the Science into Practice: Public Health Implications 216</b><br /> <i>Professor Judith L. Buttriss, Sara A. Stanner and Professor Thomas A. B. Sanders</i></p> <p>15.1 Introduction 216</p> <p>15.2 Summary of the Task Force’s fi ndings for various chronic conditions 218</p> <p>15.3 Diet and lifestyle themes relevant to pregnancy and early life 228</p> <p>15.4 Diet and lifestyle themes relevant to early feeding and weaning 240</p> <p>15.5 Vulnerable groups 242</p> <p>15.6 Diet and lifestyle recommendations 245</p> <p>15.7 Role of health professionals 247</p> <p>15.8 Recommendations 250</p> <p>15.9 Key points 254</p> <p>15.10 Key references 255</p> <p><b>16 Conclusions of the Task Force 256</b></p> <p>16.1 Chapter 1 257</p> <p>16.2 Chapter 2 257</p> <p>16.3 Chapter 3 258</p> <p>16.4 Chapter 4 258</p> <p>16.5 Chapter 5 259</p> <p>16.6 Chapter 6 259</p> <p>16.7 Chapter 7 260</p> <p>16.8 Chapter 8 260</p> <p>16.9 Chapter 9 260</p> <p>16.10 Chapter 10 261</p> <p>16.11 Chapter 11 261</p> <p>16.12 Chapter 12 261</p> <p>16.13 Chapter 13 262</p> <p>16.14 Chapter 14 262</p> <p>16.15 Chapter 15 263</p> <p><b>17 Recommendations of the Task Force 265</b></p> <p>17.1 Priorities for future research on current practice in relation to early life development 265</p> <p>17.2 Priorities for future research on mechanisms and pathways of early life development 265</p> <p>17.3 Priorities for future research: specifi c diseases 267</p> <p>17.4 Recommendations to key stakeholders 268</p> <p><b>18 Nutrition and Development: Answers to Common Questions 273</b></p> <p>18.1 Nutrition and development 273</p> <p>18.2 Developmental programming hypotheses 273</p> <p>18.3 Normal growth 273</p> <p>18.4 How development occurs and factors that can affect it 274</p> <p>18.5 Infl uences of perinatal sex hormone exposure on programming of disease susceptibility 275</p> <p>18.6 Cognitive and neurological development 276</p> <p>18.7 Infl uences of gut microbiota on programming of disease susceptibility 276</p> <p>18.8 Obesity 277</p> <p>18.9 Diabetes 278</p> <p>18.10 Cardiovascular disease 278</p> <p>18.11 Cancer 279</p> <p>18.12 Bone health 280</p> <p>18.13 Allergic diseases and asthma 281</p> <p>18.14 Mental health and cognitive behaviour 282</p> <p>18.15 Dietary and lifestyle advice for early life 282</p> <p>18.16 Policies relating to early life nutrition and development 286</p> <p>Glossary 287</p> <p>References 294</p> <p>Index 342</p>

<p><strong>The British Nutrition Foundation</strong> is a registered charity. It promotes the wellbeing of society through the impartial interpretation and effective dissemination of scientifically based knowledge and advice on the relationship between diet, physical activity and health.

<p>This Task Force report reviews the evidence that the seeds of many adult diseases are sown in utero and in infancy. The report, written by experts in the field, summarises current knowledge in this area. It illustrates how early life nutrition can bring about changes in organ development and function, thus programming risk of disease in adult life. It also considers what might be done in early life to reduce the burden of future ill health.</p> <p><i>Nutrition and Development: Short- and Long-Term Consequences for Health</i> includes chapters on the history of this topic area, normal growth and development, and current recommendations and practice in relation to nutrition and diet in early life. Chapters exploring the possible mechanisms and pathways of critical windows for development cover the effects of diet and nutrition in early life on organ and skeletal development, the role of sex hormones in programming disease susceptibility, the establishment of gastrointestinal microbiota, and the impact of early life nutrition on cognitive and neurological development.</p> <p>This new report:</p> <ul> <li>describes how development occurs and explores how changes in the fetal and postnatal environment, such as over- or under-nutrition, can result in permanent alterations in function;</li> <li>explains how diet and nutrition in early life can affect risk of adult disease, with specific chapters on allergic disease and asthma, bone health, cancer, cardiovascular disease, cognitive function, diabetes and obesity;</li> <li>includes a summary of the key points, as well as recommendations in each chapter to help fill the gaps in our knowledge;</li> <li>provides an overview of the main messages in a practical question and answer format suitable for lay readers.</li> </ul> <p><i>Nutrition and Development</i> is an important information resource for those involved in research and teaching in the health sciences sector and will also be of use to those involved in making decisions about health policy. It will be of interest to a broad range of health professionals, the food industry and those who write and broadcast about the effects of food on health.</p>

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