NTHT by Candy martinez

NUTRITION TODAY & HEALTH TOMORROW

NUTRITION TODAY HEALTH TOMORROW

Index

HERO INSTITUTE FOR INFANT NUTRITION

INFANT NUTRITION

2.1.

Nutrition Basics

2.1.1. - Nutrition Basics

2.1.2. - Nutrition Process

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

2.2.

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

REFERENCES

INDEX

1. HERO INSTITUTE FOR INFANT NUTRITION 02 / 03

NUTRITION TODAY HEALTH TOMORROW

Hero Institute for Infant Nutrition. Hero Group strives to develop, innovate, and remain dedicated to products of superior quality in order to exceed the consumer's changing and increasing expectations. To achieve these so high objectives, is required a high excellence level in quality, research and development execution processes in the product development, and a total coordination between each R&D department. Due to the geographic dispersion of the R&D departments in the companies of the Hero Group, the Hero Institute for Infant Nutrition has been created to ensure the coordination in all the activities of research, development and new technologies along the Hero Group. This Institute is sited in Alcantarilla (Murcia, Spain), and leads the network of local R&D departments (USA, Turkey, Swiss, Swedenâ&#x20AC;Ś). The Hero Institute for Infant Nutrition is distributed in several laboratories, offices and documentation services. 04 / 05

The laboratories are designed and equipped with the latest technologies available for their specific purpose: Technological Development in Infant Formula, Cereals, Special Products, Instrumental Analysis, Biotechnologyâ&#x20AC;Ś The scientific program of the Hero Group leans on a multidisciplinary, highly skilled work party that works together to make our excellence in product development come true. Collaborations with external knowledge holders are developed in several fields, involving Universities, Hospitals, Public Research Centers, Spin-offs and Technological Institutions to achieve our objectives. Both domestic and external projects on applied research and experimental development carried out ensure the development of the Hero companies in our core categories, serving our demanding consumers worldwide, going forth to achieve our aim: lead the infant nutrition market.

Mission of the Institute The role of the Hero Institute for Infant Nutrition is helping to ensure a healthy life, providing a healthy nutrition, offering products that will contribute to improve the health during all the life. The Hero Institute for Infant Nutrition compromises to develop its activity in several fields: Adapt, when possible, the Hero Group product portfolio to the best valuable composition for infant nutrition. Provide comprehensible information to consumers and healthcare providers about the product portfolio. Provide an adequate education in healthy nutrition. Develop responsible marketing practices according to legislation procedures and guidelines. Promote a healthy lifestyle in all the Hero Group companies. HERO INSTITUTE

2. INFANT NUTRITION 06 / 07

NUTRITION TODAY HEALTH TOMORROW

Infant Nutrition

2.1 Nutrition Basics 2.1.1 Nutrition Basics 2.1.2 Nutrition Process

00 00 00

2.2 Baby feeding 2.2.1 Baby Digestive System 2.2.2 Baby Feeding 2.2.3 Product Definition

00 00 00 00

2.3

Obesity

2.4

Obesity-related diseases 00

2.5

Allergy

INFANT NUTRITION

2.1 NUTRITION BASICS 08 / 09

NUTRITION TODAY HEALTH TOMORROW

2.1.1 Nutrition Basics

2.1 2.1.1

2.1.2

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

Nutrition Basics

Nutrition Basics Energy Macronutrients Protein Fats Carbohydrates Fiber Water Micronutrients Minerals Vitamins

09 10

Nutrition Process

10 11 11 12 12 13 14

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 nutrient balance. Excess intake of macronutrients can lead to obesity and related disorders (Diabetes Mellitus, 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. Lack of nutrients can result in deficiency syndromes or other disorders (Undernutrition). 2. INFANT NUTRITION

Energy Foods provide the body with energy. This energy keeps your heart beating, your brain active, and your muscles working. The energy is measured in calories (Kcal). Calories effectively act as the fuel that powers our bodies and enables us to function, in the same way that the wind moves the vanes of the windill. Balancing energy intake with energy expenditure is necessary for a desirable body weight. Energy expenditure depends on age, sex, weight and metabolic and physical activity. If energy intake exceeds expenditure, weight is gained. Conversely if we use more energy than we consume we use up fat to provide us with more energy. Carbohydrates, fats, and proteins are the nutrients that are sources of energy; fats produce 9 kcal/g (37 kJ/g); proteins and carbohydrates produce 4 kcal/g (17 kJ/g).

Protein

Macronutrients

They are the structural element basic in all the body cells. Every cell in the human body contains protein. It is a major part of the skin, muscles, organs, and glands. Protein is also found in all body fluids, except bile and urine. A protein is a large molecule composed of one or more chains of amino acids (building block of the proteins) in a specific order determined by the base sequence of nucleotides in the DNA coding for the protein.

Biological value (BV) reflects the similarity in amino acid composition of protein to that of animal tissues; thus, BV indicates what percentage of a dietary protein provides essential amino acids for the body and is a estimation of the nutritional quality of the protein: animal proteins (meat, milk, egg...) have good quality and most of vegetable proteins (cereals, mainly) have less quality.

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

A perfect match is egg protein, with a value of 100. Animal proteins in milk and meat have a high BV (~90).

CLASSIFICATION.Amino acids are classified into two groups:

FUNCTION. Proteins are required for several functions:

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

Structural Proteins - provides support for structures and tissues.

Non essential amino acids are made by the body from the essential amino acids or normal breakdown of proteins. TABLE 1. AMINO ACID Essential

Non Essential

Isoleucine Leucine Lysine Methionine Phenylalanine Threonine Thryptophan Valine Histidine (*)

Alanine Arginine Asparagine Aspartic Acid Cysteine Glutamic Acid Glutamine Glycine Proline Serine Tyrosine

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

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The amino acid composition of protein varies widely.

Storage Proteins - store amino acids. Antibodies - specialized proteins involved in immune system. Energetic Function - if the body is not getting enough calories from dietary sources or tissue stores (particularly of fat), protein may be used for energy, obtaining 4 kcal/g. Regulation of cell activity - modulates cell and tissue metabolic processes, and coordinates certain bodily activities. Transport proteins.

Fats

Macronutrients

Fats are compounds formed from chemicals called fatty acids. CLASSIFICATION. Fatty acids are classified in three major types depending on the type of bonds in their molecular structure. Saturated Fatty Acids: These fatty acids are predominant in meats and dairy products and several vegetable oils (palm, coconutâ&#x20AC;Ś). Palmitic and Estearic acids are typical saturated fatty acids. Monounsaturated Fatty Acids: When the presence of monounsaturated fatty acids is high, fat tends usually to be liquid. These fatty acids are abundant in olive oil. Oleic acid is the most important monounsaturated fatty acid. Polyunsaturated fatty acids: Fats high in polyunsaturated fatty are usually liquid and have tendency to oxidation. Fish oils, sunflower and soy oils have high levels of these fatty acids. Essential Fatty Acids (Linoleic and Alpha-Linolenic) are included in this group; essential fatty acids have to be present in the diet because the organism hasn't the ability to synthesize them; they are precursors of long-chain polyunsaturated fatty acids like Arachidonic (ARA) and Docosahexaenoic (DHA) acids, that play important nutritional roles in brain and visual development.

Carbohydrates

Macronutrients

Fatty acids can form compounds from combination of several fatty acids or even other elements:

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

Simple lipids: They include fatty acids and the compounds formed from combination of fatty acids and glycerol (mono-, di- and triglycerides).

They occur naturally in fruits, milk and milk products, vegetables, and are also found in processed and refined sugars (refined sugars provide calories, but lack in vitamins, minerals and fiber).

Complex lipids: they include nitrogen or phosphorous in their composition. Among the complex lipids, important structural types are phosphoglycerides, phosphosphingolipids, and glycolipids. They are key components in cell membranes and play a role transporting lipids in the bloodstream.

FUNCTION. Fats are energetic nutrient (produce 9 kcal/g), but also are required for several functions: Structural elements - form cell membrane and nerve structures. Essential components in several synthesis. Transport functions.

CLASSIFICATION. Carbohydrates are classified as simple or complex. The classification depends on the chemical structure of the particular food source and reflects how quickly the sugar is digested and absorbed. Simple carbohydrates are composed of small molecules, generally monosaccharides or disaccharides, which increase plasma glucose levels rapidly. Monosaccharides include fructose (found in fruits), galactose (found in milk) and others. Disaccharides include lactose (found in dairy), maltose (found in vegetables) and some others. Complex carbohydrates are composed of larger molecules, which are broken down into monosaccharides. Complex carbohydrates increase plasma glucose levels more slowly but for a longer time. Starches and fiber are complex carbohydrates. FUNCTION. The primary function of carbohydrates is to provide energy for the body, especially the brain and the nervous system. The liver breaks down carbohydrates into glucose (blood sugar), which is used for energy by the body.

2. INFANT NUTRITION

Fiber

Macronutrients

Dietary fiber is the portion of food which is not digested nor absorbed into the body, because we don't have the enzymes required to its digestion. This includes plant nonstarch polysaccharides, oligosaccharides, lignin, and some resistant starch. CLASSIFICATION. There are two forms of dietary fiber: soluble and insoluble. Soluble fiber attracts water and turns to gel during digestion. This slows digestion. Soluble fiber is found in oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Soluble fiber has been scientifically proven to lower cholesterol, which can help prevent heart disease. Insoluble fiber is found in foods such as wheat bran, vegetables, and whole grains. It appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. FUNCTION. Dietary fiber adds bulk to the diet. Because it makes you feel full faster, it can be helpful in controlling weight. Fiber aids digestion, helps prevent constipation, and is sometimes used for the treatment of diverticulosis, diabetes and heart disease. Eating a large amount of fiber in a short period of time can cause intestinal gas (flatulence), bloating, and abdominal cramps. This usually goes away once the natural bacteria in the digestive system get used to the increase in fiber in the diet. Adding fiber gradually to the diet, instead of all at one time, can help reduce gas or diarrhea. Too much fiber may interfere with the absorption of minerals such as iron, zinc, magnesium, and calcium. 12 / 13

Water

Macronutrients

Water is the body's principal chemical component, making up, on average, 60 percent of the body weight. Every system in 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 must replenish its water supply by consuming beverages and foods that contain water. Lack of water can lead to dehydration, a condition that occurs when the body doesnĂt have enough water to carry out normal functions.

FUNCTIONS: Moistens tissues such as those in the mouth, eyes and nose. Regulates body temperature. Protects body organs and tissues. Helps prevent constipation. Lubricates joints. Lessens the burden on the kidneys and liver by flushing out waste products. Carries nutrients and oxygen to cells. Helps dissolve minerals and other nutrients to make them accessible to the body.

Minerals

Micronutrients

Minerals are inorganic substances needed by the body in small amounts to help it function properly and stay strong. The body uses minerals for many 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.

TABLE 2. MINERALS MINERAL

ACTIONS

SOURCES

CALCIUM

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

Salmon, sardines, milk, cheese, yogurt, calciumset tofu, Chinese cabbage, kale, broccoli.

COPPER

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

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

FLUOR

Reduce tooth decay, and help maintain bone structure.

Fluoridated water, seafood, tea and gelatin.

IODINE

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

Iodized salt, seafood.

IRON

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

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

MAGNESIUM

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

Meats, seafood, milk, cheese, yogurt, green leafy vegetables, bran cereal, nuts.

PHOSPHOROUS

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

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

POTASIUM

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

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

SODIUM

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

Table salt, milk, beets, and celery, processed meats and fast foods.

ZINC

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

Beef, pork, lamb, peanuts, peanut butter, and legumes.

MANGANESE

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

Nuts, legumes, tea, and whole grains.

SELENIUM

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

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

2. INFANT NUTRITION

Vitamins

Macronutrients

Vitamins are organic substances that your body needs to grow and develop normally. There are 13 vitamins needed by the body, which can usually be 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. TABLE 3. WATER-SOLUBLE VITAMIN WATER-SOLUBLE VITAMIN

ACTION

SOURCE

VITAMIN C

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

All fruits and vegetables.

VITAMIN B1 (Thiamine)

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

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

VITAMIN B2 (riboflavin)

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

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

VITAMIN B3 (Niacin)

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

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

VITAMIN B5 (Panthotenic Acid)

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

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.

VITAMIN B6 (Pyridoxine)

Helps the immune system to produce antibodies. Maintains normal nerve function and forms red blood cells. Helps breaking down proteins.

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

VITAMIN B12 (Cyanocobalamine)

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

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

FOLIC ACID

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

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

BIOTIN

Helps break down proteins and carbohydrates.

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.

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TABLE 4. FAT-SOLUBLE VITAMIN FAT-SOLUBLE VITAMIN

ACTION

SOURCE

VITAMIN A

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

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

VITAMIN D

Promotes absorption and use of calcium and phosphate for healthy bones and teeth.

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

VITAMIN E

Antioxidant protects body tissue from damage caused by free radicals. Formation of red blood cells and helps the body to use vitamin K.

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

VITAMIN K

Blood clotting.

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

2. INFANT NUTRITION

2.1.2 Nutrition Process When we eat foods, they are not in a form that the body can take advantage of them to nourish itself; food and drink must be reduced to small molecules of nutrients before they are absorbed into the blood and carried to cell throughout the body. Digestion is the process by which food and drink are broken down into their smaller parts so that the body can use them. Digestion involves the mixing of food, its movement through the digestive system, and the chemical breakdown of the large molecules of food into smaller molecules. THE PROCESS OF DIGESTION Digestion process begins in the mouth, when we chew and swallow, and is completed in the small intestine, where nutrients are absorbed. The movement of the food through the digestive system ends up when the food is eliminated in the anus. 16 / 17

Image 1. Nutrition process from mouth to the anus.

Image 2. Mouth and stomach.

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. When food arrives to the small intestine, bile is released, mixing with fats in the food; bile acids dissolve fats in water. PANCREAS: secretes the pancreatic juice into duodenum; it contains enzymes 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.

Image 3. Liver, pancreas and small intestine.

All of the nutrients are absorbed through the cells in the intestinal walls, called villi. Waste products after absorption and undigested portions of food, are propelled into large intestine. 2. INFANT NUTRITION

Image 4. Large intestine.

LARGE INTESTINE It concentrates, stores and secretes food wastes. As material passes through the large intestine it becomes progressively drier and more solid 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 large intestine and adjacent to the anus for accumulating the faeces prior to elimination from the body. After the digestion process, nutrients have been metabolized and absorbed, entering the blood stream: Carbohydrates: All the digestible carbohydrates are converted to glucose and other monosaccharides, being transported to bloodstream. Protein: are split up to amino acid, which are absorbed and transported to bloodstream. Fats: Are separated into fatty acids, glycerin or combinations with pancreatic, intestinal juices and bile. They move across the intestinal wall separated, and enter the blood stream combined with a protein that carries them to the heart and all the body.

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TISSUE TRANSPORTATION

TISSUE DIFUSSION

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

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

Nutrients may be taken to: Tissues, to be used in cell metabolism. Liver, to be transformed into more needed nutrients. Adipose tissue, being stored.

These capillaries are the smallest of a body's blood vessel, that enable the interchange of water, oxygen, carbon dioxide and other nutrients and waste chemical substances between blood and surrounding tissues. Cell absorption is the last step in the digestion process; nutrients are absorbed into the cells, and then are digested, transformed and used depending on the needs and type of cell. This is a hormone-controlled process, using substances like insulin to manage the use of the nutrients in the cells. Once inside the cells, the intracellular enzymes transform the nutrients in cellular metabolism substrates.

2. INFANT NUTRITION

2.2 BABY FEEDING 20 / 21

2.2

Baby Feeding

2.2.1

Baby digestive system

2.2.2

Baby feeding

2.2.3

Product definition Infant Formula Follow-on Formula Cereals Baby Foods

26 27 27 28 29

2.2.1 Baby Digestive System

Birth to 3 month

Liquids

Breastfeeding permitted: Rooting reflex, suck-and-swallow mechanism. Gag reflex interfere with the introduction of solid foods. Able to digest simple carbohydrates (lactose, saccharose). Low protein digestion because of low pepsin activity. Absorption of entire proteins from breast milk (immunoglobulin or allergenic proteins). Insufficient fat absorption because pancreatic lipase and bile salts are low. Low renal solute load management.

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4 to10 month

PurĂŠed foods

Head control and back support make possible successful ingestion and swallowing of semisolid foods. Have neuromuscular coordination enought to form food bolus, transfer it to 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.

10 to12 month Smashed& chopped foods Munching reflex, and first teeth appear. Have enought tongue coordination to enable them to swallow thicker boluses of food.

> 12 month

Family foods

Chewing, teeth development. Can swallow thicker boluses of food. Can feed themselves with fingers or using spoons or drinking cups.

Can sit unsupported,and swallow thicker boluses of food.

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, primarily the electrolytes sodium, chloride, potassium and phosphorus, which have been ingested in excess of body needs, and metabolic end-products, of which 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 the synthesis 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.

2. INFANT NUTRITION

2.2.2 Babyfeeding Birth to 3 month

4 to 6 month

7 to 9 month

Breastfeeding is advocated as best for the baby. If breastfeeding is not possible or preferable, baby can be bottled with infant formula.

Extrusion reflex disappears. This is the time when most infants are introduced gradually to solid foods. Baby is still being provided the usual feedings of breast milk, or with follow-on formula.

Baby drools more than usual and chews just about anything.

LIQUIDS

Breastfeeding

Infant Formula

Follow-on Formula Gluten-free cereals

Breastmilk is the nutrition of choice; it has multiple advantages to the child (nutritional and cognitive; protection against infection, allergies, obesity, Crohn’s disease and diabetes) and mother (reduced fertility during lactation; more rapid return to normal prepartum condition; protection against osteoporosis, obesity and ovarian and premenopausal breast cancers). Breastfeeding is recommended exclusively until 6th month and then continue for at least 12 month of age. Before 4 month, solid food is not needed nutritionally and the extrusion reflex, in which the tongue pushes out anything placed in the mouth, makes feeding of solids difficult. INFANT FORMULA (Birth – 6 mo) CEREAL-BASED FOODS (5 – 36 mo)

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FOLLOW-ON FORMULA (6 – 36 mo) CANNED FOODS (5 – 36 mo)

PUREED FOODS

Breastfeeding exclusively

BREASTFEEDING.

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 6 month 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 be identified). The texture of solid foods fed to the infant will vary depending on age and individual 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 the first year, chopped table foods should be the basis of the diet. Adequate nutrients should be provided for normal growth and steady-but not excessive-weight again. The amount should be regulated by the infants appetite, provided that the growth rate is normal.

10 to 12 month

1st year

At 12 month weaning is recommended (transition from breastmilk to other sources of nourishment).

The rate of growth begins to slow down. Mostly babies can feed themselves with fingers, using spoons or drinking from cup. First teeth appears. Follow-on formula is maintained until 36 month. Food texture might include little pieces not pureed (smashed, gratedâ&#x20AC;Ś) so the baby can chew, improving the teeth development.

1 year

MASHED FOODS Breastfeeding

2 years FAMILY FOODS

WEANING

Follow-on Formula

Cereals containing Gluten

Cereals Gluten

Fruit PurĂŠe Vegetables Meat puree, yogur and danies White fish

When the baby is 1 year old, begins a new feeding stage.

Fruit Puree

Gradually, the baby is introduced to more coarse textured foods, so the baby gets used to piecemeal foods.

Meat puree, yogur and danies

Vegetables

White fish Legumes

Legumes Complete egg

2. INFANT NUTRITION

3 2.2.3 Product Definition Several products may be used during the first year of age, as seen in table 5. Table 5. Baby Feeding: Practical Guide

Birth

4-6 months

Breastfeeding exclusively, or Infant Formula (*)

12 months

Breastfeeding or Follow-on 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. 26 / 27

+ 12 months Toddler Formula

Infant Formula

Product Definition

Infant formula 1 means a breast-milk substitute specially manufactured to satisfy, by itself, the nutritional requirements of infants during the first months of life up to the introduction of appropriate complementary feeding. This product is processed by physical means only and so packaged as to prevent spoilage and contamination under all normal conditions of handling, storage and distribution in the country where the product is sold. ESSENTIAL COMPOSITION. Infant formula is a product based on milk of cows or a mixture thereof and/or other ingredients which have been proven to be suitable for infant feeding. The nutritional safety and adequacy of infant formula shall be scientifically demonstrated to support growth and development of infants. All ingredients and food additives shall be gluten-free. ENERGY: Infant formula prepared ready for consumption in accordance to the instructions of the manufacturer shall contain per 100 ml not less than 60 kcal (250 kJ) and not more than 70 kcal (295 kJ) of energy.

Follow-on Formula CARBOHYDRATE: Lactose should be the preferred carbohydrate in formula based in cowâ&#x20AC;&#x2122;s milk protein and hydrolised protein, avoiding additions of sucrose and fructose. VITAMINS: Vitamin A, Vitamin D 3 , Vitamin E, Vitamin K, Thiamine, Riboflavin, Niacin, Vitamin B6 (Pyridoxine), Vitamin B12 (Cyanocobalamin), Pantothenic Acid, Folic Acid, Vitamin C, Biotin. MINERALS: Iron, Calcium, Phosphorous, Magnesium, Sodium, Chloride, Potassium, Manganese, Iodine, Selenium, Copper, Zinc, maintaining a relation between Calcium and Phosphorous shall be between 1:1 and 2:1. OPTIONAL INGREDIENTS: Taurine, Choline, Myoinositol, L-carnitine, Docosahexanoic Acid (DHA), Eicosapentanoic Acid (EPA) and Arachidonic Acid (ARA). CONSISTENCY AND PARTICLE SIZE: free of lumps and of large coarse particles and suitable for adequate feeding of young infants.

Follow-on formula2 means a food intended for use as a liquid part of the weaning diet for the infant from the 6th month on and for young children. Is a food prepared from the milk of cows and/or other constituents of animal and/or plant origin, which have been proved to be suitable for infants from the 6th month on and for young children, processed by physical means only so as to prevent spoilage and contamination under all normal conditions of handling, storage and distribution. When in liquid form, is suitable for use either directly or diluted with water before feeding, as appropriate. In powdered form it requires water for preparation. The product shall be nutritionally adequate to contribute to normal growth and development when used in accordance with its directions for use.

ESSENTIAL COMPOSITION. ENERGY: shall provide not less than 60 kcal (or 250 kJ) and not more than 85 kcal (or 355 kJ). PROTEIN: Protein of nutritional quality equivalent to that of casein or other protein in inverse proportion to its nutritional quality. Essential amino acids may be added to improve protein quality and nutritional value, only in amounts necessary for that purpose.

PROTEIN: The protein used shall be of nutritional equivalent to that of a casein, and must contain an available quantity of each essential and semi-essential amino acid, at least equal to that contained in the reference protein (breast milk). FAT: Lauric and miristic acids, trans fatty acids, erucic acid and phospholipids shall be limited. Linoleic Acid (LA) and -Linolenic Acid (ALA) contents are limited, and must maintain a ratio LA/ALA between 5:1 and 15:1.

Product Definition

1CODEX

STAN 72 (1981) â&#x20AC;&#x201C; Codex standard for infant formula and formulas for special medical purposes intended for infants.

FAT: The content of Lauric and miristic acids, Trans fatty acids, erucic acid and phospholipids shall be limited. Linoleic Acid (LA) and -Linolenic Acid (ALA) contents are limited, and must maintain a ratio LA/ALA between 5:1 and 15:1.

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

2. INFANT NUTRITION

Cereals

Product Definition

CARBOHYDRATES: The product shall contain nutritionally available carbohydrates suitable for the feeding of the older infant and the young child in such quantities as to adjust the product to the energy density in accordance with the requirements.

Processed cereal-based 3 foods are prepared primarily from one or more milled cereals, which should constitute at least 25% of the final mixture on a dry weight basis.

VITAMINS: Vitamin A, Vitamin D 3 , Vitamin E, Vitamin K, Thiamine, Riboflavin, Niacin, Vitamin B6 (Pyridoxine), Vitamin B12 (Cyanocobalamin), Pantothenic Acid, Folic Acid, Vitamin C, Biotin.

Products consisting of cereals which are or have to be prepared for consumption with milk or other appropriate nutritious liquids;

MINERALS: Iron, Calcium, Phosphorous, Magnessium, Sodium, Chloride, Potassium, Manganese, Iodine, Selenium, Copper, Zinc, maintaining a relation between Calcium and Phosphorous shall be between 1:1 and 2:1. OPTIONAL INGREDIENTS: Other nutrients may be added when required to ensure that the product is suitable to form part of a mixed feeding scheme intended for use from the 6th month on. CONSISTENCY AND PARTICLE SIZE: free of lumps and of large, coarse particles.

Four categories are distinguished:

Cereals with an added high protein food which are or have to be prepared for consumption with water or other appropriate protein-free liquid;

CARBOHYDRATES: Sucrose, fructose, glucose, glucose syrup or honey may be added to cereals but limiting the amount of added carbohydrates.

Rusks and biscuits which are to be used either directly or, after pulverization, with the addition of water, milk or other suitable liquids.

FAT: The lipid content, and specially lauric acid and myristic acid, is limited. Shall have a minimum content of linoleic acid.

ESSENTIAL COMPOSITION.

They may also contain legumes (pulses), starchy roots (such as arrow root, yam or cassava) or starchy stems or oil seeds in smaller proportions. The requirements concerning energy and nutrients refer to the product ready for use as marketed or prepared according to the instructions of the manufacturer, unless otherwise specified.

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PROTEIN. The chemical index of the added protein shall be equal to at least 80% of that of the reference protein casein or the Protein Efficiency Ratio (PER) of the protein in the mixture shall be equal to at least 70% of that of the reference protein casein. In all cases, the addition of amino acids is permitted solely for the purpose of improving the nutritional value of the protein mixture, and only in the proportions necessary for that purpose.

Pasta which are to be used after cooking in boiling water or other appropriate liquids;

The four categories listed are prepared primarily from one or more milled cereal products, such as wheat, rice, barley, oats, rye, maize, millet, sorghum and buckwheat.

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

ENERGY DENSITY: The energy density of cereal-based foods should not be less than 3.3 kJ/g (0.8 kcal/g).

VITAMIN: Vitamin B1 (Thiamine), Vitamin D and Vitamin A contents shall be within limits required. MINERAL: Mineral contents shall be limited (sodium) or have minimum amounts (calcium). OPTIONAL INGREDIENTS: Other ingredients suitable for infants who are more than six months of age and for young children can be used.

Baby Foods CONSISTENCY AND PARTICLE SIZE: Processed cereal-based foods should have a texture appropriate for the spoon feeding of infants or young children of the age for which the product is intended. Rusks and biscuits may be used in the dry form so as to permit and encourage chewing or they may be used in a liquid form, by mixing with water or other suitable liquid, that would be similar in consistency to dry cereals.

Product Definition

Baby foods4 are foods intended primarily for use during the normal infant's weaning period and also for the progressive adaptation of infants and children to ordinary food. They may be either in ready-to-eat form or in dry form requiring reconstitution with water only.

Dry baby foods, after reconstitution with water or other suitable liquid, approximate to the consistency and particle size of strained or junior foods.

Baby foods in ready-to-eat form are processed by heat before or after being sealed in their containers, and Baby foods in dry form are processed by physical means, in each case so as to prevent spoilage. ESSENTIAL COMPOSITION. Baby foods may be prepared from any suitable nutritive material that is used, recognized or commonly sold as an article or ingredient of food, including spices. Vitamins and minerals may only be added in accordance with the legislation of the country in which the food is sold. The amounts of sodium derived from the added vitamins and/or minerals shall be limited, even not permitted in fruit products and dessert products based on fruit. CONSISTENCY AND PARTICLE SIZE: Ready-to-eat baby foods are homogeneous or comminuted in the following forms: Strained: food of a fairly uniform, small particle size which does not require and does not encourage chewing before being swallowed. Junior: food that ordinarily contains particles of a size to encourage chewing by infants and children.

4CODEX STAN 73 (1981) â&#x20AC;&#x201C; Codex standard for canned baby foods.

2. INFANT NUTRITION

2.3 OBESITY

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2.3

Obesity

Definition and values

Main causes for obesity

Definition and values

Obesity

Obesity is a complex and multifactorial disease that happens when weight is in ranges that are greater than what is generally considered healthy for a given height. It happens when genetic, diet and lifestyle habits factors cause an energy imbalance between ingested energy and energy expenditure. That imbalance produces a pathologic fat accumulation, increasing mortality, and morbidity. Obesity can also affect infancy and childhood. This is particularly troubling because the extra weight often starts kids on the path to health problems confined to adults, such as diabetes, high blood pressure and high cholesterol. Obesity rates are measured with the Body Mass Index ( BMI = Kg/m2 ), with two main values; people with BMI>25 are considered to be in overweight, and people with BMI over 30 are considered obese.

Main causes for obesity

Obesity

Diet modifications

1.FAMILY HISTORY AND GENETICS.

ENERGY.

Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese. Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat. Children adopt the habits of their parents.

An excess in energy intake can produce an energy imbalance if there is not enough energy consumption (in case of sedentary lifestyle habits).

2.DIET MODIFICATIONS. Diet has changed to a high-dense food, high in fats and sugar but low in vitamin, mineral and other nutrients that cause an energy imbalance that may promote weight gain.

3.LIFESTYLE HABITS. Sedentary lifestyle, with low physical activity and unhealthy eating patterns (snacks, fast foods) increases the obesity risk͘

Added to this situation, children have increased the consumption of high-dense energy foods which provide an excess of energy but a poor intake of nutrients, and an increased food intake, possibly related with the appetite modulation.

FATS. Fats metabolism is highly energetic profitable than carbohydrate and protein metabolism because the low energy required for triglyceride synthesis. When the energy balance is positive, a portion of the dietary fat is deposited directly in the adipose tissue with low energy burn. Saturated fatty acids are mainly stored, and unsaturated fatty acids are mainly metabolized, so unsaturated are the chosen ones for dietary uses. Also, fat doesn’t add bulk to the food, so it doesn’t make people feel full, producing a hyperphagic effect that may produce a weight increase.

CARBOHYDRATES. The present carbohydrate relevance is based in the increase of carbohydrate in children diet, as a consequence of recommendations to reduce fats in diet. Single carbohydrates are broken down in glucose and other monosaccharides, increasing the glucose blood levels and so the energy providing substrate. Complex carbohydrates are composed of big molecules that break down in monosaccharides. 32 / 33

Lifestyle habits Complex carbohydrates increase the glucose blood levels more slowly than single carbohydrates, but the glucose level lasts more time than in single ones.

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

Dietary carbohydrates have changed since last years; in the present time, are being used carbohydrates with a high Glycemic Index: an indicator of the ability of different types of foods that contain carbohydrate to raise the blood glucose levels within 2 hours. Foods containing carbohydrates that break down most quickly during digestion have the highest Glycemic index. Values vary from 100 (higher, glucose) to 1 (lower).

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

Glycemic Index is important because of the consequences of intaking a high Glycemic food: CH breaks down quickly in glucose, increasing blood levels and producing a high release of insulin (hiperinsulinemia), stimulating the glucose absorption and storage in cells.

PROTEINS.

Early protein hypothesis postulates that a high protein intake during the first months of life may increase the risk for obesity. It has been shown that the protein-related risk varies depending on the source; BMI and body fat percentage are more affected by the animal protein than by vegetable ones. Especially high affection is produced by milk or dairy protein.

There are some habits related with food and attitudes that suppose a risk for the health; the modification of those habits could lead to a reduction of risks to develop chronic diseases: Physical Inactivity, high salt, sugar or meat intakes, and eating high-dense energetic foods increase the risk for chronic diseases. Another factor to consider is that during the first years of life the baby adopts lifestyle habits that will form the profiles lasting during the whole life. That is something that concerns nutrition because additions of sugar or salt to the baby food may instill unfavorable habits to the baby; later in time, he or she will prefer foods with high salt or sugar contents, and thus may increase the risk for develop a chronic disease.

In the liver, glucose is metabolized to glucagon (stored in the liver) or lipoproteins that are released to bloodstream. Lipoproteins reach the adipose tissue and there are metabolized to triglycerides that will be stored increasing the adipose tissue mass. Also, a high Glycemic index food promotes hyperphagic, so increases the food intake.

FIBER. High dietary fiber intake has been shown to promote weight loss, maybe because the incomplete digestion and low energy absorption of the fiber. The fiber gives bulk to the food, increasing the chewing and the stomach strain, so it may reduce appetite and reduce the energy 2. INFANT NUTRITION

2.4 OBESITY-RELATED DISEASES 34 / 35

Diabetes

Obesity-related diseases

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

Obesity is a risk factor for late development of chronic diseases. If the present obesity trend is maintained, obesity-related diseases such as diabetes mellitus (type 2 diabetes), blindness, coronary heart disease and kidney disease may become usual diseases of the children. Even those unfat children, excessive saturated fats, sodium intake and others in diets, may predict a high risk to develop chronic diseases.

2.4

Obesity-related diseases

Diabetes

Coronary heart disease and stroke

Hypertension

Metabolic Syndrome

Cancer

Osteoporosis

Caries

Type 2 diabetes is the most common type of diabetes. This form of diabetes is most often associated with old age, obesity, family history of diabetes, previous history of gestational diabetes, and physical inactivity. The disease is more common among certain ethnic populations. More than 85 percent of people with type 2 diabetes are overweight; the cause is still unknown, but it may be related with an insulin resistance: Insulin carries sugar from blood to the cells, where it is used for energy. When a person is insulin resistant, blood sugar cannot be taken up by the cells, resulting in high blood sugar. In addition, the cells that produce insulin must work extra hard to try to keep blood sugar normal. This may cause these cells to gradually fail. Risk for developing type 2 diabetes may be lowered by losing weight and increasing the amount of physical activity, helping to control the blood sugar levels and prevent or delay complications.

2. INFANT NUTRITION

Obesity-related diseases

Coronary heart disease and stroke

Hypertension

Obesity-related diseases

Coronary heart disease means that the heart and circulation (blood flow) are not functioning normally. Often, the arteries have become hardened and narrowed.

Hypertension is sustained elevation of blood pressure (blood pressure is the force of your blood pushing against the walls of your arteries when heart beats).

If you have coronary heart disease, you may suffer from a heart attack, congestive heart failure, sudden cardiac death, angina (chest pain), or abnormal heart rhythm.

Hypertension with no known cause (primary; formerly, essential hypertension) is most common. Hypertension with an identified cause (secondary hypertension) is usually due to a renal disorder. Usually, no symptoms develop unless hypertension is severe or long-standing.

In a heart attack, the flow of blood and oxygen to the heart is disrupted, damaging portions of the heart muscle. During a stroke, blood and oxygen do not flow normally to the brain, possibly causing paralysis or death. People who are overweight are more likely to develop high blood pressure, high levels of triglycerides (blood fats) and LDL cholesterol (a fat-like substance often called “bad cholesterol”), and low levels of HDL cholesterol (“good cholesterol”). These are all risk factors for heart disease and stroke. In addition, excess body fat-especially abdominal fat-may produce substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk. Weight loss may improve blood pressure, triglyceride, and cholesterol levels; improve heart function and blood flow; and decrease inflammation throughout the body.

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As you gain weight, the amount of blood circulating through your body increases. This puts added pressure on your artery walls. In addition, excess weight often is associated with an increase in heart rate and a reduction in the capacity of your blood vessels to transport blood. All of these factors can increase blood pressure. Many other factors can affect blood pressure, including the condition of your kidneys, nervous system, or blood vessels, and the levels 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 high blood pressure, because the body holds extra water to wash the salt from the body; the added water puts stress on your heart and blood vessels, and may cause blood pressure to rise.

Obesity-related diseases

Metabolic Syndrome

The metabolic syndrome is a group of obesity-related risk factors for coronary heart disease and diabetes. A person with metabolic syndrome has approximately twice the risk for coronary heart disease and five times the risk for type 2 diabetes. The metabolic syndrome is strongly linked to obesity, especially abdominal obesity. Other risk factors are physical inactivity, insulin resistance, genetics, and old age. Obesity is a risk factor for the metabolic syndrome because it raises blood pressure and triglycerides, lowers good cholesterol, and contributes to insulin resistance. Excess fat around the abdomen carries even higher risks. It may be possible to prevent the metabolic syndrome with weight management and physical activity. For patients who already have the syndrome, losing weight and being physically active may help prevent or delay the development of diabetes, coronary heart disease, or other complications.

Cancer

Obesity-related diseases

Cancer occurs when cells in one part of the body, grow abnormally or out of control. Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus, and kidney. Overweight is also linked with uterine and postmenopausal breast cancer in women. Gaining weight increases the risk for several of these cancers; fat cells may release hormones that affect cell growth, leading to cancer. Healthy eating and physical activity habits may lower cancer risk. Fruit, vegetables and cereal-based diets seem to prevent some cancer (colon), and diets with a high fat consumption may increase the risk for them.

Osteoporosis

Obesity-related diseases

Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but any bone can be affected. Getting too little calcium over lifetime can increase your risk for osteoporosis; not getting enough vitamin D can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. There is no direct relation between obesity and osteoporosis; it is the low physical activity, not exercising and being inactive, or staying in bed for long periods what can increase the risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Bone is made up of calcium, protein, and other minerals. Getting enough calcium helps protect bones by slowing bone loss. Vitamin D helps your body absorb calcium. Exposure to sunlight causes your body to make vitamin D.

Caries

Obesity-related diseases

Tooth decay is a destruction of the tooth enamel. Caries is often triggered by frequent and prolonged exposure to liquids and solid food containing sugars. Bacteria that live in the mouth thrive on these foods, producing acids that attack tooth enamel. Over a period of time, these acids destroy tooth enamel, resulting in tooth decay. Breast milk by itself is the healthiest food for babiesâ&#x20AC;&#x2122; teeth, day or night. It tends to slow bacterial growth and acid production. However, when breast milk is alternated with sugary foods or drinks, the rate of tooth decay can be faster than with sugar alone. Again, there is no direct relation with obesity, but one of the factors that increase the obesity risk (high sugar intake) can the modulate caries risk, tooÍ&#x2DC;

2. INFANT NUTRITION

2.5 FOOD ALLERGY

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Allergy

2.5

Food Allergy

2.5.1 Food Allergies

Symptoms

Risk factors

Treatment

Gluten

2.5.2 Allergic Response

2.5.3 Food Intolerance

Sugar intolerance

Symptoms

Food Allergies

Symptoms usually begin immediately, seldom more 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 food allergies.

2.5.1 Food Allergies In a true allergy, the immune system mistakenly identifies a specific food or a component of food as a harmful substance. The immune system triggers certain cells to produce immunoglobulin E (IgE) antibodies to fight the culprit food or food component (the allergen). The next time even the smallest amount of that food is eaten, the IgE antibodies sense it and signal the immune system to release histamine and other chemicals into the bloodstream. These chemicals cause a range of allergic signs and symptoms. Histamine is partly responsible for most allergic responses.

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Rarely, the symptoms may begin hours after eating the offending food. If symptoms are developed shortly after eating a specific food, you may have a food allergy. The process of eating and digesting food affects the timing and the location of a reaction. Key symptoms include hives, and wheezing. In severe reactions, may occur low blood pressure and blocked airways. A life-threatening complication is anaphylaxis, a severe, whole-body allergic reaction that happens with airway blockage, cardiac arrest (no effective heartbeat), respiratory arrest (no breathing) and shock, and can result in death.

Risk factors

Food Allergies

Certain factors may increase the risk of developing a food allergy: Family history. If other allergies (asthma, hay fever, eczemaâ&#x20AC;Ś) are common in the family, the person is at increased risk of food allergies. A child who has one parent with an allergy has about 48% chance of developing an allergy. If both parents suffer from allergies, the child has about a 70 percent chance of developing allergy. Age. Infants and toddlers are more likely to suffer from allergy. As the child grows older, the digestive system matures and the body is less likely to absorb food or food components that trigger allergies.

Treatment

Food Allergies

Food allergy is treated by avoiding the foods that trigger the reaction. FOOD ALLERGY PREVENTION IN BABIES. In children, the great majority of food allergies are triggered by certain proteins in eggs, fish, selfish, cowâ&#x20AC;&#x2122;s milk, wheat and soybeans. How the baby is introduced to solids can be an important factor in how the child reacts to foods throughout his life. Starting solids too early can trigger food allergies, eczema and asthma, as can exposing the baby to viruses during the first three months of his or her life. It is well documented that prolonged exclusive breastfeeding results in a lower incidence of food allergies. From birth until somewhere between four and six months of age, babies possess what is often referred to as an "open gut." This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream. This is great for the breastfed baby as it allows beneficial antibodies in breast milk to pass more directly into baby's bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too.

Gluten Baby starts producing these antibodies on his own at around 4-6 months, and gut closure should have occurred by this time also. Once the baby's system has had time to mature, it will be time to introduce solids. The order of introduction of solid foods is the one commented in the baby feeding section (see page 24). When offering a new type of food, baby must always be fed it for several days in a row before starting another new food. This makes it easier to detect food allergies, which can present with diarrhea, vomiting, coughing, hives or a rash. Mixed ingredient foods must not be offered until itâ&#x20AC;&#x2122;s sure that the baby isn't allergic to any of the individual ingredients.

Food Allergies

Gluten is a protein found in various cereal grains (wheat, rye, and also in barley and oat). Celiac sprue is an immunologically mediated disease in genetically susceptible people caused by intolerance to gluten, resulting in mucosal inflammation, which causes malabsorption. Symptoms usually include diarrhea and abdominal discomfort. Diagnosis is by smallbowel biopsies showing characteristic though not specific pathologic changes of villous atrophy that resolve with a strict gluten-free diet. A person with celiac disease may have no symptoms. People without symptoms are still at risk for the complications of celiac disease, including malnutrition. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications. Anemia, delayed growth, and weight loss are signs of malnutrition: The body is just not getting enough nutrients. Malnutrition is a serious problem for children because they need adequate nutrition to develop properly. A gluten-free diet, when followed carefully, helps prevent symptoms of the disease.

During baby's first 4-6 months, while the gut is still "open," antibodies (sIgA) from breast milk coat baby's digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs.

2. INFANT NUTRITION

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

Plasma cells B-UMPHOCYTE produces plasma cells

Antigen stimulates B-UMPHOCYTE Blymphacyte

Antigen

Plasma cells secrete allergen-specific antibody (lgE)

lgE-primed Mast cell

These lgE attach themselves to mast cells (plentiful in Gastrointestinal tract, nose, eyes and lungs).

Antibodies (lgE)

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

Antigen stimulates lgE in the mast cell and get captured by them. Antigen

Image 5. Allergic response

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The lgE primed mast cells release its chemicals

Chemicals

Mast cells with lgE binded to antigens SYMPTOMS APPEAR: Abdominal pain Angioedema Diarrhea Difficulty swallowing Nasal congestion Itching Fainting Shortness of breath Vomiting Stomach cramps Nausea Itchy lips, tongue or throats Swollen lips

The person will suffer the symptoms of the allergy

2 .5.2 Allergic Response

2.5.3 Food Intolerance

Antibodies circulate in the bloodstream and are present in almost all bodily fluids. They help to capture unwanted invaders. People who have allergies have an antibody called Immunoglobulin E, or IgE.

Food intolerance is a digestive system response rather than an immune system response.

When allergens first enter the body of a person predisposed to allergies, a series of reactions occurs and allergen-specific IgE antibodies are produced. Following IgE production, these antibodies travel to cells called mast cells, which are particularly plentiful in the nose, eyes, lungs and gastrointestinal tract. The IgE antibodies attach themselves to the surface of the mast cells and wait for their particular allergen. Each type of IgE has specific “radar” for one type of allergen only. That's why some people are only allergic to cat dander (they only have the IgE antibodies specific to cat dander) and others seem to be allergic to everything (they have many more types of IgE antibodies.) The next time an allergic individual comes into contact with the allergens to which he or she is sensitive, the allergens will be captured by the IgE. This initiates the release of chemical “mediators” such as histamine and other chemicals from the mast cells. These mediators produce the symptoms of an allergic reaction, such as swelling of tissues, sneezing, wheezing, coughing and other reactions. The allergic reaction typically continues: these newly released mediators recruit other inflammatory cells to that site, resulting in additional inflammation. Many symptoms of chronic allergic disease -such as swelling, excessive mucus and hyperresponsiveness to irritating stimuli- are the result of tissue inflammation due to ongoing exposure to allergens. It is not yet fully understood why some substances trigger allergies and others do not, nor why every person does not develop an allergic reaction after exposure to allergens. A family history of allergies is the single most important factor that predisposes a person to develop allergic disease.

It occurs when something in food irritates a person’s digestive system or when a person is unable to properly digest, or break down, the food. Intolerance to lactose, which is found in milk and other dairy products, is the most common food intolerance. Symptoms of food intolerance include nausea, stomach pain, gas, vomiting, heartburn, diarrhea…

Sugar Intolerance

Food Intolerance

Sugars like lactose, saccharose and maltose are broken down to single sugars (glucose) in the small intestine by enzymes produced in intestine cells. That single sugars are absorbed into the bloodstream through the intestine walls. When the body is deficient in one of these enzymes, sugars are not digested and can’t be absorbed, remaining in the small intestine. The high concentration of sugars promotes a great amount of liquids to get into the small intestine, causing diarrhea. Also, that unabsorbed sugars are fermented by the microbiota in the large intestine, causing abdominal bloating, excessive intestinal gas, nausea, and abdominal cramping. Lactose intolerance can begin at different times in life. In Caucasians, it usually starts to affect children older than age 5. In AfricanAmericans, lactose intolerance often occurs as early as age 2. Lactose intolerance is sometimes seen in premature babies. Children who were born at full term generally do not show signs of lactose intolerance until they are at least 3 years old. Removing milk products from the diet usually improves the symptoms. Other sources of calcium should be added to the diet if milk products are removed. Not having milk in the diet can result in a shortage of vitamin D, riboflavin, and protein. Therefore, a milk substitute is needed.

2. INFANT NUTRITION

3. NUTRITION TODAY & HEALTH TOMORROW STRATEGY 44 / 45

NUTRITION TODAY HEALTH TOMORROW

NUTRICION TODAY & HEALTH TOMORROW Strategy

3.1

Early nutrition

3.2

NT&HT Strategy

3.3

NT&HT Communication

3.1 EARLY NUTRITION 46 / 47

NUTRITION TODAY HEALTH TOMORROW

3.1

Early Nutrition

3.1.1

Breastfeeding

3.1.2

Proteins

3.1.3

Fats Reduction of saturated fat Minimization of trans fat Reduction of cholesterol levels Presence of essential fatty acids Supplementation with long-chain polyunsaturated fatty acids

51 51 51 52 52 52

3.1.4

Carbohydrates Optimized carbohydrate assimilation and prebiotic effect Single sugar reduction

54 54 54

3.1.5

Probiotic and Prebiotic Probiotic Prebiotic

55 55 55

3.1.6

Dietary supplements Nucleotides Taurine Inositol Choline Carnitine

56 56 56 57 57 57 3. NTHT STRATEGY

3.1. Early Nutrition It is well recognized that nutritional deficiencies early in life have a direct impact on the health of 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 frequently irreversible. In this context, it is evident that nutrition during childhood has a significant impact on the health of the adult. These effects are related to impaired structure, size and/or function that develop over 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 can alter 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 birth and/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 importance in the manifestation of obesity in later life. Dietary factors during the sensitive period of infancy and early childhood are increasingly recognized as being potentially critical for adult disease and predisposition to obesity.

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Breastfeeding is recommended as the best offer for baby feeding during the first year of life: Its higher nutritional quality, defined as the balance of nutrients provided by breast milk, minerals, and probiotics and Prebiotics providing. Immune specific and unspecific support: Breast milk contains many immune factors which give the infant passive protection against infections.

Furthermore, it is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired, although after 1 year, breastfeeding should complement a full diet of solid foods and fluids. In conclusion, there is convincing evidence that Breastfeeding has positive long term effects on development and health reaching into childhood and, in some cases, into adulthood.

Breastfeeding also modulates the childâ&#x20AC;&#x2122;s own system and it seems that this modulation has long-term effects. The immune modulating effects are likely to influence allergic diseases during childhood. Antigenic exposure minimization.

3.1.1 Breastfeeding Newborn feeding must supply all the metabolic requirements to achieve a correct development and get an adequate maturation of vital organs such as kidneys, liver, brain, etc. Breast milk is the perfect feeding source for babies, because it contains appropriate amounts of carbohydrates, proteins and fats, and also provides digestive enzymes, minerals, vitamins and hormones that are required during first months of development. Breast milk also contains antibodies from the mother that promote the immune system maturation in the baby.

High hygienic qualities; milk goes through breast (its production place) directly to the baby digestive system. Psychological reasons, including higher stimuli for babies. Supports the development and maturation of the digestive tract. Also, breastfeeding has benefits for the mother, such as 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 support optimal growth and development for approximately the first 4 to 6 months after birth.

3. NTHT STRATEGY

3.1.2 Proteins The early protein intake hypothesis5 postulates that high protein intakes during the first months of life increase the risk of obesity. It has been studied whether a critical period of protein intake for later obesity may exist early in childhood, and the relation between protein intake from different sources and body mass index (BMI) and body fat percentage (%BF) at older age. A higher animal protein (especially dairy) intake at 12 month was related to a higher BMI at 7 years, which was not explained by family and maternal characteristics. A similar but weaker tendency was obtained with animal protein intake at 5-6 years. Higher protein intake from vegetable sources at 12 month and 5-6 years was not associated.

Results show that a high protein intake during the period of complementary feeding and the transition to the family diet might be decisive. The mechanism6 behind the early protein hypothesis is thought to be that an increased insulin secretion of insulin and insulin growth factor 1 (IGF-1) triggers the multiplication and differentiation of preadipocytes, and infancy and early childhood may represent a time window when high protein intakes can exert these adverse effects. The results support the hypothesis that the end of the first year of life, when children undergo the transition from breast milk of formula feeding to a diet based on family foods, may be the critical phase with respect to protein intake and subsequent obesity risk. Animal and in particular dairy protein intake might be responsible for this association. Infant formula and follow-on formula shall reduce its protein content to prevent the BMI and %BF increase and reduce the risk for obesity.

5G端nther

AL, Remer T, Kroke A, Buyken AE (2007). Early protein intake and later obesity risk: which protein sources at which time points throughout infancy 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.

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

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3.1.3 Fats Fat is an important part of a healthy diet; during the first months of life. Little kids, especially, need a certain amount of fat in their diets so the brain and nervous system develop correctly. All fats may be included as a part of healthy eating; it's the type of fat that is eaten more or less what matters.

Reduction of saturated fat (balanced fatty acid profile)

Fats

Diets high in saturated fat have been linked to chronic disease, specifically, coronary heart disease, because it raises LDL cholesterol. A balanced fatty acid profile shall be used, with a low insaturated fat content and high in mono and polyunsaturated fats.

Minimization of trans fat

Fats

During food processing some fats are created when liquid oils are converted into solid fats (Hydrogenation). This creates partiallyhydrogenated oils that tend to keep food fresh longer while on grocery shelves. The problem is that these partiallyhydrogenated oils contain trans fats which can also increase low-density lipoprotein LDL-cholesterol and decrease high-density lipoprotein (HDL) cholesterol - risk factors for heart disease. Trans fats are worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL. They also 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.

3. NTHT STRATEGY

Reduction of cholesterol levels

Fats

There is compelling evidence that the atherosclerosis (fatty deposits of plaque in artery walls) or its precursors begins in childhood and progresses slowly into adulthood7. Then it often leads to coronary heart disease. Furthermore, there is evidence that: Elevated cholesterol levels early in life may play a role in the development of atherosclerosis in adults. Eating patterns and genetics affect blood cholesterol levels and coronary heart disease risk. Lowering levels in children and adolescents may be beneficial. Many laboratories, clinical, pathological and epidemiological studies have clearly established that high blood cholesterol levels play a role in developing coronary heart disease in adults. Several studies also have shown that fatty buildups in arteries begin in childhood and are more likely with higher blood cholesterol levels.

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, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, United States

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Presence of essential fatty acids

Fats

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) and other 3 fatty acids (eg, eicosapentaenoic acid, docosahexaenoic acid) are required by the body but can be synthesized from EFAs. 6

Arachidonic Acid (AA)

Eicosapentanoic Acid (EPA)

(linoleic acid)

Docosahexanoic Acid (DHA) Image 6. Essential fatty Acids synthesis.

Both linoleic and linolenic acid use the same enzyme ( 6-desaturase), so LA/LNA ratio downregulates the conversion in 3 or 6 LC-PUFAs. Regarding pregnancy, recent data show the importance of LNA in development, as low intrauterine availability of -linolenic acid (18:3 n6) is related to low birth weight and presumably to low fat mass.

Fats

Supplementation with long-chain polyunsaturated fatty acids

The fetus and newborn infant can convert the parent fatty acids linoleic acid (18:26) and alfa-linolenic acid (18:33) to AA and DHA respectively. But the desaturation enzyme systems in the human fetal liver seem to be immature and unable to supply sufficient LCPUFA to meet the high requirements until 16 weeks after term age. This means that during early development LCPUFA supply is largely dependent on dietary intake of AA and DHA. For the fetus this implies that it is dependent on maternal intake of LCPUFA; the young infant has to rely on LCPUFA supply in milk. Breast milk does contain LCPUFA in levels depending on maternal consumption, but the standard Hero formulas for term infants lack these fatty acids. Studies have shown that EFAs and LCPUFAs levels must be controlled through a fine balance, because of their bodily effects: Some studies show evidences that supports the hypothesis that increased8 consumption of n - 6 PUFAs, in association with a high LA/LNA ratio, may favour the continuous development of adipose tissue during the pregnancy/lactation period and during infancy, which are periods highly sensitive to nutritional stimuli, at a time when physical activity should be rather similar between individuals. This dynamic phase of development may increase the size of precursor pools and may subsequently lead to adult obesity, owing to continuous intake of n - 6 PUFA-enriched diets. Whether prevention appears as a key issue, the fatty acid composition of dietary fats early in life should be reconsidered in a more balanced and rational manner in order to prevent a further increase of childhood obesity among future generations.

Omega 6 series: Several studies have suggested a reduction in Linoleic Acid and Arachidonic Acid intakes, to avoid possible adverse effects due to accretion of ARA and excessive production of its oxygenated derivatives (eicosanoids) which would then compete with those of the n3 series. That is because ARA is very adipogenic and plays in preadipocytes the role of a precursor of prostacyclin; this suggests an adipogenic role of prostacyclin. EPA and DHA inhibit the stimulating effect of ARA in prostacyclin production.

Limiting Linoleic Acid intake to adequate levels, and maintaining a fine balance between LA and LNA intake, will promote an acceptable adipose tissue development. Supplementation in preterm and term infants can induce a better neurodevelopmental outcome at school age.

Omega 3 series: n3 PUFA are essential nutrients owing to the crucial role of its metabolic end-product DHA, especially in regard to the maturation of visual and brain function (they are an integral part of cell membranes throughout the body and affect the function of the cell receptors in these membranes). They also bind to receptors in cells that regulate genetic function. Likely due to these effects, omega-3 fats have been shown to help prevent heart disease and stroke, may help control lupus, eczema, and rheumatoid arthritis, and may play protective roles in cancer and other conditions. In addition, they provide the starting point for making hormones (Prostacyclin, thromboxane, and prostaglandin) that regulate blood clotting, contraction and relaxation of artery walls, and inflammation. Clinical studies using high intakes of LNA have demonstrated that the endogenous conversion of LNA to DHA is strongly limited and insufficient to cover the DHA requirements, so must be supplemented. LC-PUFA (both w3 and w6) and EFAs must be supplemented in infant foods, but levels shall be controlled to prevent an excessive w6 intake that could lead to obesity or other complications.

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, obesity reviews (2004) 5, 21-26 3. NTHT STRATEGY

Carbohydrates

3.1.4 Carbohydrates

Optimized carbohydrate assimilation and prebiotic effect

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

In general, starch cereals are considered highly digestible, but efficient digestion has been shown to be critical for babies, since pancreatic amylotic activity does not fully developed until 18 month of age. This is the reason infant cereal processing includes heat and enzymatic treatment ( -amylase) to increase the digestibility of starch, and glucose and energy availability. Industrial processing9 causes an increase in dextrin and the subsequently modification of starch, which is mainly dextrinized starch in commercial products. The digestibility of the product is higher, but it also produces a high glycemic answer because of its fast release of sugars after hydrolysis. Undigestible starch is fermented by friendly microbiota, and metabolites from fermentation contribute to maintenance on colon health, and have beneficial effects on glucose and lipid metabolism. The product shall contain a mixture of carbohydrates digestible in babies under 18 months preventing high glycemic peaks and promoting prebiotic effect.

Single Sugar Reduction

Carbohydrates

Dietary carbohydrates are broken down in glucose and other monosaccharides, increasing the glucose levels in bloodstream. It has been showed that there is a direct relation between high glycemic index and increase of weight; carbohydrates with a high glycemic index may increase plasma glucose to high levels rapidly. It is hypothesized that, as a result, insulin levels increase, inducing hypoglycemia, adipose tissue formation and hunger, which tends to lead to consumption of excess calories and weight gain. These effects are predicted to result in a less favorable lipid profile and increased risk of obesity, diabetes mellitus, and complications of diabetes if present. Complex carbohydrates (found in whole grains), on the other hand, are broken down more slowly, allowing blood sugar to rise more gradually. Also, sugar can enhance the taste of some foods, making the child get used to tasty foods, rejecting those tastyless foods and taking only those with plenty sugars. That lifestyle habit is predicted to lead to consumption of excessive energy and weight gain. In addition, eating too many sugary foods can also lead to tooth decay. A reduction of single sugars to adequate levels can promote a moderate glycemic response preventing weight gain, tooth decay and adoption of unhealthy lifestyle habits.

9 Bernal

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

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3.1.5 Probiotic and Prebiotic

Probiotic

Probiotic and Prebiotic

Probiotics are "live microorganisms which when administered in adequate amount confer a health benefit on the host" (FAO 2001). 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 several nutrients11.

Prebiotic

Probiotic and Prebiotic

Prebiotics 12 are food ingredients that selectively stimulate the growth and activity of beneficial microorganisms in the colon. Fructo-oligosaccharides (FOS) and Galactooligosaccharides (GOS) are the major prebiotics. They are resistant to digestion in the upper gastrointestinal tract and are, therefore, able to stimulate the growth of Bifidobacterium and Lactobacillus strains farther down in the large intestine. In vivo, they do not support the growth of pathogens, and have shown to increase the absorption of calcium and magnesium and decrease triglycerides.

10Fukushima Y, Kawata Y, Hara H, Terada A, Mitsuoka

T (1998). Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children, Int J Food Microbiol. Jun 30; 42 (1-2): 39-44

11Scholz-Ahrens

KE, Ade P, Marten B, Weber P, Timm W, AĂ§il Y, GlĂźer CC, Schrezenmeir J (2007). Prebiotics, Probiotics, and Symbiotic Affect Mineral Absorption, Bone Mineral Content, and Bone Structure. J. Nutr, March; 137 : 838S-846S

12Collins

MD, Gibson GR (1999). Probiotics, prebiotics, and synbiotics: approaches for modulating the microbial ecology of the gut. Am J Clin Nutr, May; 69 (5):1052S1057S. 3. NTHT STRATEGY

3.1.6 Dietary Supplements A dietary supplement, is a preparation intended to supply nutrients that are missing or are not consumed in sufficient quantity in a person's diet. These elements are added to foods because they can enhance several body functions (brain, visual, nervous) and improve the absorption of other nutrients and tissue and bone development.

Nucleotides

Dietary Supplements

Nucleotides are compounds that play a key role in numerous intracellular biochemical processes. They are synthesized de novo by the body utilizing amino acid precursors or salvaged from degraded nucleic acids and nucleotides. Nucleotides participate in several biochemical processes that are essential to the function of the living body: As nucleic acids: being the monomeric units they carry the genetic code as DNA and RNA. In biosynthesis: for example, UDPgalactose in the synthesis of lactose or UDP-glucose in the process of glycogenesis. As components of co-enzymes: NAD, FAD and coenzyme A. As biological regulators: cyclic AMP initiates second messenger cascades and is ubiquitous in all forms of life, playing a key role in regulating biological processes. As an energy source: ATP is a universal currency of energy in biological systems.

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Taurine

Dietary Supplements

Taurine is an organic acid. It is also a major constituent of bile (works breaking down fats) and can be found in lower amounts in the tissues of many animals including humans. Taurine has also been implicated in a wide array of other physiological phenomena including inhibitory neurotransmission, long-term potientation in the striatum/hippocampus, membrane stabilization, feedback inhibition, adipose tissue regulation, calcium homeostasis and recovery from osmotic shock.

Inositol

Dietary Supplements

A type of sugar which is a basic part of cell membranes, and is important in nerve, brain, and muscle function, where it plays an important role as the structural basis for a number of secondary messengers in eukaryotic cells. Inositol is being studied in the prevention of cancer and fat reduction.

Choline

Dietary Supplements

Choline is an organic compound, classified as a water-soluble essential nutrient and usually grouped within the Vitamin B complex. This natural amine is found in the lipids that make up cell membranes and in the neurotransmitter acetylcholine. Acetylcholine plays a role in various cognition systems within the brain. Memory, intelligence and mood are mediated at least in part by acetylcholine metabolism in the brain. Choline and its metabolites are needed for three main physiological purposes: structural integrity and signaling roles for cell membranes, cholinergic neurotransmission (acetylcholine synthesis), and as a major source for methyl groups via its metabolite, Trimethylglycine (betaine).

Carnitine

Dietary Supplements

Carnitine is a compound biosynthesized from the amino acids lysine and methionine. In living cells, it is required for the transport of fatty acids from the cytosol into the mitochondria during the breakdown of lipids (or fats) for the generation of metabolic energy. In animals, carnitine is biosynthesized primarily in the liver and kidneys from the amino acids lysine or methionine. Vitamin C is essential to the synthesis of carnitine. During growth the requirement of carnitine might exceed its natural production, so it has to be supplemented. It is related in the maintenance and development of bones and brain.

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NUTRITION TODAY HEALTH TOMORROW

3.2

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

60 60 61 62

3. NTHT STRATEGY

What is NT&HT?

NT&HT Strategy

HERO is striving to offer the best possible complementary nutrition for baby, and has developed a global evolution of its products to a better nutritional aim. Nutrition Today Health Tomorrow is a global nutritional strategy that includes, among others, new development of Infant Food products. Nutrition Today & Health Tomorrow (NT&HT) is the HERO response to new trends in infant nutrition, and wants to integrate all those researches to develop products which offer to the baby an adequate nutrition today, providing the most adequate nutrition and minimizing the risk for chronic diseases in adult- or childhood. The knowledge increase in a lot of scientific fields during the last years, and especially about epidemiologic evidences, is helping to clarify the diet role in prevention of chronic diseases. Research is helping to clarify some of the components of the diet that increase the risk for developing chronic diseases, and the actions that should be implemented to minimize their impact in the health and future development of the baby.

Its main objective is obtaining products that, considered in a whole diet, could help in the prevention of future outcome of chronic diseases, mainly obesity and metabolic syndrome. Contributions to improvement of healthy development conditions and concern about increasing allergies incidence are also pivotal parts of this Global Strategy aimed to offer the best possible Infant Food products to a modern society that is facing new health challenges. This strategy implements a constant updating policy affecting all the Hero products, and will integrate all those discoveries which make the product composition more suitable for the most adequate nutrition for the baby; this updates find their origin in scientific researches. The implementation of this strategy is a must for every company in the Hero Group, affecting all the products commercialized in the Infant Nutrition range.

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NT&HT Strategy

NT&HT Strategic objectives

NT&HT strategy has several objectives, which are listed as follows: Offer the most adequate nutrition to the baby, providing the appropriate amounts of nutrients needed, minimizing the risk for chronic diseases in adult- or childhood. Adequate the product composition to reach the best nutrition possible for the baby fulfilling legislation requirements. Integrate all the present scientific knowledge about infant nutrition and bodily physiology to offer the most adequate product for each stage of the infant growth. Integrate any future scientific discovery that will be proven to offer a valuable improvement for infant healthy growth. Contribute with a nutritional and scientific strength in each of the Hero products, becoming a reference brand in infant nutrition.

NT&HT Strategy

Why developing a strategy?

During latter year, obesity prevalence has been increased, with alarming rates around the world and affecting to people of all ages.

The highest risk for childhood obesity is the possibility of the obesity lasting in adulthood.

It has a special prevalence in childhood (512 years of age), in which prevalence is up to 25% (depending on each country) and the increasing rate is over the adulthood.

Childhood obesity is a decisive factor for the obesity in adulthood, and the risk for obesity is increased along with the children age, fat percentage and family history.

Childhood obesity is related with diet; during latter years diet composition has been modified increasing the risk to develop child obesity: High-dense energetic intakes. High fat intake with special prevalence of saturated fats. High meat intake. High salt intake. High sugar and sweetened foods and beverages intake. Low fibre intake. Low vitamin intake. Fatty children have an increased risk to develop chronic diseases, reducing their life expectancy. Cardiovascular diseases: several risk factors are associated with children obesity, such as blood pressure (hypertension), adverse blood profiles, hyperinsulinemiaâ&#x20AC;Ś Diabetes mellitus. Some other complications: childhood obesity is associated with risks to develop asthma, structure and functionality of motor system, cariesâ&#x20AC;Ś Psychological consequences: overweight and obesity are associated with low selfesteem, depression, bulimia, and own body rejection. Parents' attitude is a key actor in children facing the problem.

Early nutrition is a preventive issue against obesity. As well as the consequences of the infant nutrition in growth, body composition, health and wellness, an increasing number of scientific investigations have shown advices about amount and quality of nutrient intake during childhood. It has been shown that these nutrient advices are key factors in long-term organ development and functionality, health and risk for diseases, even the cognitive capacity in following years. This has been named early nutrition.

All those discoveries and advices have promoted to modify the dietary intakes for infant nutrition, providing enough amounts of each nutrient to ensure the nutritional needs in each stage of the infant growth, limited to minimize disease and undernutrition risk. That is a key factor to be considered in infant nutrition. All those factors are integrated in the NT&HT strategy, developed by Hero as its response to the obesity epidemic and all the new discoveries in infant nutrition and physiology, shaping the roadbook to implement.

Some of the conclusions related with weight gain and increasing risks for chronic diseases are the following: Excessive protein intake in childhood is related with weight gain and body fat percentage in following stages of infant development. A high sodium intake increases the risk for cardiovascular and circulatory diseases because it increases the blood pressure. A high fat intake, specially saturated, increases the risk for cardiovascular disease, and obesity because it increases the cholesterol and triglycerides blood level. Unsaturated fats reduce those levels. High sugar intake promotes the obesity development and tooth decay (caries). An adequate fibre intake may have a preventive role for constipation and some cancer types. 3. NTHT STRATEGY

NT&HT Strategy

NTHT Roadbook: Strategy implementation

NT&HT Strategy states the following key points to improve the suitability of our products: Breast milk is the best offer, because of its qualities and benefits for the baby. Adequate Energy balance. Products have to offer an adequate energy balance to prevent obesity, undernutrition and other diseases. Covering nutrient requirements. Each product must provide enough amounts of each nutrient to avoid both nutritional deficiencies and excesses, helping babies grow and learn healthy. Implementation of products with an aim to improve their adjustment to present recommendations about nutritional requirements, considering present legal requirements, is a recommended action within the NT&HT strategy. Excessive Early protein intake 13 is considered as an obesity development risk factor. Protein content of Infant Food must be adjusted to requirements, because of the association of high intakes with increased risk of obesity. Reduction of protein contents of infant food products, within the admitted ranges and considering the established requirements, is a recommended action within the NT&HT strategy. Essential Fatty Acids (EFA)13 shall be included in the product composition, because they are essential dietary nutrients required for optimal growth and development, particularly of the brain and retina. LA and ALA are substrates for the endogenous synthesis of LC-PUFAs. Design of baby food with adequate vegetable oils in order to get balanced fatty acid profile, including essential fatty acids, is recommended within the NT&HT strategy. 62 / 63

Long-chain Poly Unsaturated Fatty Acid (LC-PUFAs)13: During early development, LCPUFA supply is largely dependent on dietary intake of ARA and DHA because of the immaturity of enzymatic systems to metabolize LA and ALA, so its supplementation shall promote the development of visual and psychomotor systems. Presence of LCPs in the design of selected infant food products fits within the NT&HT strategy. Balanced fatty acid profile13 is desired. Balanced contents of saturated. Monounsaturated and polyunsaturated fatty acids have beneficial nutritional effects and are key factors in the nutritional prevention of the future outcome of chronic diseases like obesity. Reduction of Single sugar contents13 to adequate levels prevents the development of insulin resistance, and adipose tissue formation. Also, low single sugar content prevents caries and sugary lifestyle habits. Reduction of simple sugars concentrations to adequate levels in Infant Food products is a recommended action within the NT&HT strategy. Optimization of the carbohydrate assimilation13. Digestibility of starch in Infant Cereals may be a factor to be considered in healthy products. Reduction of glycemic peaks and effects of promotion of friendly microbiota are presently under study and can show interesting benefits to infant feeding. Resistant starch may play an interesting role in this effect. Beneficial effects due to optimization of carbohydrate assimilation both on adequate management of glycaemic peaks and prebiotic effects are recommended within the NT&HT strategy.

Mineral, Vitamin and micronutrients supplementation to support the correct growth and development of the baby. Most updated guidelines and recommendations about this supplementation will be applied. Prebiotic and probiotics. Prebiotics and probiotics are ingredients that modulate intestinal microbiota and are presently the subject of an increasing scientific interest as functional ingredients related to welfare. Infant Nutrition is also an area of interest for pre- and probiotics. Microbiota modulation has beneficial effects related to important aspects: Inhibition of pathogen bacteria development. Stimulation of immune system. Mineral absorption. More recently, microbiota is under study as a possible indicator of future overweight in children; this opens the door to potential relations between obesity and pre- and probiotics uses. Adequate uses of Prebiotics and Probiotics are recommended actions within the NT&HT strategy. Allergen Management: Between 4 and 6% of children have documented food allergy and this disease has increased during the latter years. Several studies are relating the control of exposure to food allergens with improvement in infant health status. International Organizations like ESPGHAN and AAP have published statements about this topic. Several main actions could be proposed with regards to allergy.

13See

early nutrition section.

Adequate order of introduction of allergenic ingredients in complementary food. Use of partially hydrolyzed formulae for infants with a documented hereditary atopy risk. Use of special ingredients with less allergenic potential. Control of unwanted allergen crosscontamination in products. All actions intended to adequate management of allergen exposure due to infant food products are recommended within the NT&HT strategy.

This NT&HT strategy is implemented for all the products having a composition consistent with the best nutritional objective ever, integrating all the newly proven scientific discoveries in the product portfolio to cover all the nutritional needs and reducing at the same time the risk for chronic diseases. Nutrition Today & Health Tomorrow is a global strategy that positions the Hero portfolio as high quality products, compromised with baby health now and in future stages, supplying a balanced feeding that make the baby grow and develop (physically and cognitively) in a healthy state.

Scientific investigations are constantly progressing in baby physiology and feeding, increasing the knowledge to improve baby feeding, making it each time more suitable for the child. New research advances that could reinforce this strategy will be incorporated. All those new developments which have a scientifically demonstrated action to support growth and development of infants fit within NT&HT strategy principles and shall be considered in the product compositions. Presently, Hero Nutrition Institute is doing Research about several compounds that might result in significant improvements. Research and new development of products under the NT&HT strategy has to be aware of advances on new bioactive compounds that could play beneficial roles in Infant Nutrition.

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3.3 NT&HT COMMUNICATION 64 / 65

NUTRITION TODAY HEALTH TOMORROW

3.3.1 NT&HT Advantages NT&HT is the response of Hero against the market trends, and this is precisely the competitive advantage versus the competitors. Nutrition today & Health Tomorrow strategy works against the obesity trend in children preventing the subsequent chronic diseases development. This strategy makes Hero progress to a best nutritional environment, much more suitable for the baby in each stage of development.

3.3

NTHT Communication

3.3.1

NT&HT Advantages

3.3.2

Two different targets to communicate

3.3.3

Structure in the NT&HT Communication

Positioning concepts

Strategic concepts

Improved compositions

3. NTHT STRATEGY

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 the absence 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. The nutritional, preventive and quality aims want to be constantly improved, implementing all that techniques and compounds that origin in proved scientific 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 the baby. The improvement of the nutritive profile of each product wants to reach the most suitable nutritional aim for the baby in each stage of development, fulfilling the utmost quality and preventive requirements.

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3.3.2 Two different targets to communicate

3.3.3 Structure in the NT&HT Communication

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

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

Medical Communication is the communication relating to, or concerned with physicians or the practice of medicine (doctors, nurses, nutritionistâ&#x20AC;Ś).

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

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

Strategic Concepts: Communicate what is the NT&HT strategy and highlights the key issues and advantages of this strategic plan. Improved compositions: All the changes in the compositions that are consequence of the NT&HT strategy implementation to improve the products.

3. NTHT STRATEGY

Structure in the NTHT Communication

Positioning concepts

Positioning concepts 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 than 400.000 people are obese. The last estimation indicates that up to 22 million of children less of 5 years are overweight, and a high percentage are obese; but the most concerning issue is the incremental trend that is observed in obesity and chronic disease development during childhood

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

14 World Health Organization (WHO), Fact sheet nยบ 15WHO, Technical Report Series, number 916 (2003): Diet,

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311 (Sept 2006): Obesity and overweight. Nutrition and the prevention of chronic diseases.

Medical

Medical + Mass

CONCEPT: Overweight and obesity are risk factors for chronic diseases.16 Prevalence of Obesity and Chronic diseases (hypertension, diabetes mellitus, cancer, caries, obesityâ&#x20AC;Ś) is increased. Main contributors are sedentary lifestyles, excessive intakes of energy, saturated fats, cholesterol, and sodium, and low 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 obesity development 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 diseaseâ&#x20AC;Ś). 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.

3. NTHT STRATEGY

Structure in the NTHT Communication

Positioning concepts

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

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

Medical

Medical + Mass

CONCEPT: Lifestyle habits beginning during infancy shape the health profile 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 that habits and attitudes may reduce the risk for suffering chronic diseases during adulthood. During early childhood the baby establishes the nourishing habits, so itâ&#x20AC;&#x2122;s important that when solid foods are being included in the babyâ&#x20AC;&#x2122;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 palatability of 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 increase risks for chronic diseases.

High sugar or salt intakes during early life make the child adopt unhealthy lifestyle 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.

3. NTHT STRATEGY

Structure in the NTHT Communication

Positioning concepts

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 each stage 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 teeth causes 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 mature enough 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 of development, 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

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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 the physical 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 result in deficiency syndromes or other disorders (Undernutrition).

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

Adequate nutrition reduces the risk for disease development.

3. NTHT STRATEGY

Structure in the NTHT Communication

Strategic concepts

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 support optimal 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 as mutually desired, although after 1 year, breastfeeding should complement a full diet of solid foods and fluids.

Breast milk is the nutrition of choice.

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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 stage of 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.

3. NTHT STRATEGY

Structure in the NTHT Communication

Strategic concepts

CONCEPT: Fulfills recommendations Hero has developed its products considering all the guidelines provided by pediatrician associations and usual food standards. 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

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CONCEPT: Products adapted to each stage of development Each stage in babyâ&#x20AC;&#x2122;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 of development, 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.

3. NTHT STRATEGY

Strategic concepts 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: cereals with or without gluten, egg, milk, fishâ&#x20AC;Ś). 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, glutenâ&#x20AC;Ś Adequate labelling in the products.

Exhaustive quality control to prevent cross-contaminations. Fulfills the recommendations for the introduction of solid foods.

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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 hypoallergenic ingredients.

100% natural products. No colouring nor preservatives added.

3. NTHT STRATEGY

Structure in the NTHT Communication

Strategic concepts

Medical

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 of the baby. Appropriate nutrient content preventing excessive weight gain and increase of chronic disease developing risk (Early nutrition). 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

Improved compositions CONCEPT: High protein intake promotes obesity5 The early protein intake hypothesis postulates that high protein intakes during the first months of life increase the risk 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 promote osteoporosis. Increases Renal Solute Load; the newborn baby has limited renal capacity to deal with a high solute load and at the 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.

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 baby requirements for adequate growth and development.

Suitable protein content helps in prevention of obesity.

5G端nther

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

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CONCEPT: Long-Chain Polyunsaturated Fatty Acid (LC-PUFAs) supplementation.8 Supplemented because during early infancy the baby canâ&#x20AC;&#x2122;t synthetize DHA (Docosahexanoic Acid) and AA (Arachidonic Acid) from essential fatty acids. Estimulate the neuronal development (brain and nervous system), adequate retina development and modulates the immune response. Studies have shown that increased consumption of n - 6 PUFAs, in association with a high LA/LNA ratio, may favour the continuous development of adipose tissue. DHA and AA must be supplemented in infant foods, but levels shall be controlled to prevent an excessive w6 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 adequate development and maturation of Central Nervous System and Retina. DHA and AA supplementation improves cognitive and visual development.

DHA and AA supplementation aids in mental and visual development.

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

3. NTHT STRATEGY

Structure in the NTHT Communication

Improved compositions

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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 both linoleic and linolenic acid use the same enzyme ( 6-desaturase), so LA/LNA ratio downregulates the conversion in w3 or w6 LC-PUFAs. High EFA intakes diminish the LC-PUFAs synthesis (needed for the maturation of retina and nervous system), so it must 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 growth and development. Adequate Essential Fatty Acid profile to cover baby requirements.

Essential Fatty Acid helps to a healthy brain development.

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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 raises LDL cholesterol. Low trans fats contents. Trans fats are worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL. They also 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 requirementsÍ&#x2DC;

Healthy fat profile that ensures the utmost development.

3. NTHT STRATEGY

Structure in the NTHT Communication

Improved compositions

CONCEPT: Single sugar contents are reduced.13 Dietary carbohydrates are broken down in glucose and other monosaccharides, increasing the glucose levels in bloodstream. Excessive single sugars consumption increase insulin secretion inducing a less favorable body fat profile with adipose tissue 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 developmentÍ&#x2DC;

Excessive sugar consumption induces a less favorable body fat profile. Reduced single sugar formula prevents adipose tissue formation and reduces the subsequent risk for obesity and diabetes development.

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

13Slyper

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

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CONCEPT: CH assimilation has been optimized.9 Efficient digestion has been shown to be critical for babies, since pancreatic amylotic activity does not fully developed until 18 mo of age. Infant cereal processing includes heat and enzymatic treatment (â&#x20AC;˘-amilase hydrolisis) to increase the digestibility of starch, but extended hydrolization increases glucose and energy availability, producing increased glycemic peaks and insulin resistance, promoting weightgain. Partially hydrolized formulas slows the metabolization of starch, reducing the insulin resistance and weightgain. Also, undigestible starch is fermented by friendly microbiota , and metabolites from fermentation contribute to 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 obesity development. Optimized carbohydrate assimilation prevents insulin resistance and subsequent weight 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 Infant Cereals, J Food Science 67(3):1249-1254

3. NTHT STRATEGY

Structure in the NTHT Communication

Improved compositions

CONCEPT: Prebiotic and Probiotic supplementation. Prebiotic supplementation (FOS and GOS) has soluble dietary-like properties (reduces faecal pH, increases the waterholding capacity of stool and faecal weight and decreases gastrointestinal transit time), and modulate intestinal microbiota. 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 function and enhances the immune system.

Probiotic and Prebiotic supplementation improves digestion of the formula

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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 compositions dealing 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 that will make the product the utmost for the child. New ideas arising from the scientific & marketing community should enrich the strategy and suggest new action lines for the future.

Scientifically proven benefits of novel bioactive compounds. New compounds to enhance the babyâ&#x20AC;&#x2122;s growth and development.

3. NTHT STRATEGY

4. REFERENCES

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

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

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

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

Günther AL, Remer T, Kroke A, Buyken AE (2007). Early protein intake and later obesity risk: which protein sources at which time points throughout infancy 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.

Günther LBA,Buyken AE and Kroke A (2007) Protein intake during the period of complementary feeding and early childhood and the association with 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, obesity reviews (2004) 5, 21-26.

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

Fukushima Y, Kawata Y, Hara H, Terada A, Mitsuoka T (1998). Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children, 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 Mineral Absorption, Bone Mineral Content, and Bone Structure. J. Nutr, March; 137 : 838S-846S.

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.

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

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

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

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 activity and prevention of the obesity. 4. REFERENCES

NUTRITION TODAY & HEALTH TOMORROW