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SPOTLIGHTS
Meeting nutritional needs for mother and child
A look into how research and development in science can meet the needs of optimal nutrition for mothers and infants.

Ensuring appropriate nutrition is essential for growth of not only an infant, but also maintenance of health for mothers. To enlighten us on why the first 1,000 days of an infant’s life is a unique period of opportunity when the foundations for optimum health and development across the lifespan are established and how research and development (R&D) can help meet the nutritional demands for both mother and child is Peter Van Dael, Senior Vice President at DSM Nutritional Products.

1. What is the significance of optimal nutrition within the first 1,000 days of an infant’s life?

The 1,000 days between conception and a child’s second birthday form a crucial developmental stage in life.

The first nine months in the womb bear witness to tremendous growth, from a single embryotic cell to a foetus weighing up to three kg. The brain registers the fastest growth rate during the third trimester of pregnancy and reaches 85 percent of adult size within the first 1,000 days. It is therefore critically important for children to have optimal levels of key nutrients for brain development, like DHA (Docosahexaenoic acid) and ARA (Arachidonic acid), in this period.

A child’s long-term health has strong links to the nutritional intake in these first 1,000 days. Nutritional intervention in the first two years of life has been reported to be associated with as much as a 10 percent increase in IQ. The risk of developing chronic disease later in life also drastically reduces. Studies have even shown positive economic benefits later in life, such as the increase in earning power by as much as 46 percent in adulthood.1

Optimal early life nutrition is not just a public health imperative but also leads to significant social and economic outcomes as well.

2. How does the nutrition of mothers and mothers-to-be affect early days of an infant’s life?

It is important to ensure that pregnant mothers get adequate nutrition to cover the nutritional needs for foetal growth and development. Given rapid brain development, key nutrients for its growth and development require highest attention. Therefore, it is important to secure an optimum level of DHA, an omega-3 long chain polyunsaturated fatty acid (LCPUFA), which is involved in brain development and cognitive functions. Indeed, DHA has been demonstrated to improve the cognitive and visual outcomes of infants.

In addition, DHA also has a direct impact on reducing the risk of premature birth or low birthweight. Preterm births are on the rise globally, and particularly in Asia where the numbers exceed that of any other continent. Since the gestational age at the moment of delivery is the single most important determinant in infant survival and long-term neurodevelopment, it is crucial for mothers-to-be to understand the importance of their own nutritional needs.

Deficiencies in iron, zinc and vitamin A among children and pregnant women are high in Asia. Anaemia caused by iron deficiency in pregnant mothers correlate with preterm births and low birth weights. The new-born child is then at risk of a reduced store of iron, which could persist for up to a year and lead to the development of iron deficiency anaemia.2

Nutritional deficiencies can be remedied by adequate dietary provisions, fortified foods or dietary supplements. In China, for example, strategies to provide for maternal nutrition are being implemented through education and food fortification. This does require the careful management of different stakeholders however, focusing on maternal nutrition has enormous potential to improve the health of future generations

3. With omega-3 LCPUFA being an essential component in a balanced diet, how does science and innovation help to meet the demands for sufficient consumption?

Demand for early life nutrition is high, and we see increased focus resulting in accelerating growth in APAC. We support mothers and their children in finding the right nutrition solution, and our research efforts support these needs, whether it is by identifying better compounds or by making products more accessible and easier to use.

Growth and development is fast in the first 1000 days, which implies higher nutrient needs, but also fast and high nutrient absorption characteristics. Nutrients that we put into products or provide as supplements also have to be safe. Innovation is about searching for new nutrients or nutrient forms as well as taking the existing nutrients we have and improving their form, making them more bioavailable, stable and incorporable in the solutions we provide.

Breast milk is the gold standard for infant nutrition. Breast milk always contains both DHA and ARA in combination, essential for early life nutrition. Both DHA and ARA are known to support cognitive development. However, as supplementation for babies and infants, we need to be identifying what the most effective sources of LCPUFA are in terms of nutritional functionality as well as product applications.

We also know that young children can be picky eaters, which implies we need to find the best way for them to obtain essential nutrients. Whether this is in powdered form or capsules, additional research will help us diversify the form in which we present these nutrients.

Another important avenue for research is to finetune the ratios of nutrients, so that we can create the right outcomes more efficiently, in terms of targeting eye, immune or brain development. For DHA and ARA, international scientific expert bodies as well as regulatory authorities have established recommendations. In general, both DHA and ARA are considered as optional ingredients, with minimum and upper safe levels defined for both. Their ratio has also been defined – at least at 1:1 and maximum of 1:2 for DHA:ARA ratio.

4. What are the implications of R&D on fortified foods and nutritional supplements on food supply?

In countries where malnutrition is a significant problem, people are often unable to get the nutrition they need through normal dietary intake. This may be because they are unable to access or afford certain types of food as required in a balanced diet. In other cases, certain eating behaviours and preferences predispose populations to certain micronutrient deficiencies.

The idea behind fortifying foods is to promote health outcomes without changing eating behaviour. Moreover, food fortification is one of the most cost-effective interventions to combat malnutrition, a strategy often adopted by global organisations and governments. Further R&D will optimise the delivery of micronutrients in foodstuffs that are already consumed on a regular basis, ensuring cost-effectiveness and the scale of production.

5. How is the outlook in terms of nutritional supplementation R&D in helping consumers meet nutritional demands?

Demand for good nutrition is high in Southeast Asia and it is growing. This is a region where countries have interest in food, nutrition and nutritious diets or dietary choices and further R&D is poised to make a significant impact.

In terms of the number of babies being born, the fastest growth rates are being recorded in underdeveloped or poor regions, and this is the population who are most susceptible to malnutrition.3 A third of infants and children aged 24 months to six years in Indonesia have poor nutritional status. In Laos, 44 per cent of children under five years of age are classified as stunted. This figure is 33 percent for the Philippines and 25 percent for Vietnam.4

Yet, micronutrient deficiencies that cause this level of stunting are avoidable.

Nutritional supplementation is one of the most effective ways of ensuring the needs of these vulnerable populations are met. Accessibility, affordability and availability are key factors to this success. More research is required to understand profiles and specific dietary needs, to identify and test different modes by which nutrients can be delivered, and to find more cost-effective ways of producing the most important nutrients at scale.

In Thailand, the government has partnered with academics over the last 30 years to tackle malnutrition, and this is reflected by a significantly lower proportion of stunting (10 percent). When adequately supported and guided by clear policy objectives, R&D is an immensely powerful driving force in improving the overall health and well-being of young children.

6. What are future plans for scientific research in relation to boosting health and nutrition of infants and mothers?

A key priority is to invest in emerging areas of research and innovation, while keeping focused on key nutrients critical during the first 1,000 days of life, such as LCPUFAs.

One of the emerging areas of research DSM is investing in are human milk oligosaccharides and probiotics. Human milk oligosaccharides (HMO) are the third most abundant nutrient class in breast milk after lactose and lipids. They are reported, among others to support the development of the infant’s gut microbiota, stimulation of the immune response and protection against viral and bacterial infections.

Probiotics are attracting significant attention and resources, with ongoing research efforts to determine their effectiveness in promoting infant well-being. This is in response to younger children being more susceptible to gastrointestinal infections, and the fact that diarrheal disease is one of the top five causes of death in children younger than five.

For the APAC region specifically, a region that accounts for more than half the world’s population, probiotics can also play a role in helping to combat infections that occur as a result of malnutrition. This is an area that does need to be further explored, with more evidence on the therapeutic effects required.

References

  1. Zulfiqar A. Bhutta, Richard L. Guerrant, Charles A. Nelson Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape (2017) Pediatrics, 139 (Supplement 1) S12-S22; DOI: 10.1542/peds.2016-2828D
  2. Abu-Ouf, N. M., & Jan, M. M. (2015). The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi medical journal, 36(2), 146–149. doi:10.15537/smj.2015.2.10289
  3. Indonesia to boost family planning as babies born every year almost equals Singapore's population (2015), Retrieved from: https://www.straitstimes.com/asia/se-asia/indonesia-to-boost-family-planning-as-babies-born-every-year-almost-equals-singapores
  4. Prevalence of stunting height for age (percentage of children under 5), Retrieved from: https://data.worldbank.org/indicator/SH.STA.STNT.ZS

Peter Van Dael, Senior Vice President at DSM Nutritional Products

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APBN Editorial Calendar 2019
January:
Taiwan Medical tourism
February:
Marijuana as medicine — Legal marijuana will open up scientific research
March:
Driven by curiosity
April:
Career developments for researchers
May:
What's cracking — Antibodies in ostrich eggs
June:
Clinical trials — What's in a name?
July:
Traditional Chinese medicine in modern healthcare — Integrating both worlds
August:
Digitalization vs Digitization — Exploring Emerging Trends in Healthcare
September:
Healthy Ageing — How Science is chipping in
October:
Disruptive Urban Farming — Microbes, Plasmids, and Recycling
Editorial calendar is subjected to changes.
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