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Health of the child is a family affair

Pank Jit Sin
06 Jul 2018

A child’s lifetime risk of developing obesity and various noncommunicable diseases begins long before he or she is born, reveals a prominent paediatrician.

Speaking at the 24th Malaysian Dietitian’s Association National Conference, Dr Muhammad Yazid Jalaludin, of the Department of Paediatrics, Universiti Malaya Medical Centre, said foetal programming is affected by the environmental, nutritional and hormonal effects on the developing foetus.

Foetal programming is the hypothesis (Barker hypothesis) that a foetus’ physiological development, such as organ structures and its associated functions, undergo programming during embryonic and foetal development. This, in turn, sets off a series of physiological and metabolic changes that pervade into adult life. A growing body of evidence is pointing to negative adverse health consequences in adult life due to adaptations (both undernutrition and overnutrition) to prenatal and postnatal environments. These adverse outcomes include an increased likelihood of weight gain and obesity; metabolic syndrome; and cardiovascular disease.  [Adv Exp Med Biol 2005;569:69-79]

Yazid alluded to research published in late 2017 by Pietrobelli’s team, which recommended some practices to minimize obesity in the population. [Int J Environ Res Public Health 2017;14(12):1491] Firstly, both parents’ (eating) behaviours are important as the weight of the parents will influence a child’s future weight. In fact, parental obesity is an important predictor of childhood obesity, said Yazid. Children with at least one overweight parent at the age of adiposity rebound (at 5 to 6 years of age, body fat declines to a minimum, a point called adiposity rebound before increasing again into adulthood) have a four- to five-fold greater chance of becoming obese adults. Children equal to or less than 5 years of age have a 13-fold increased risk of obesity if both parents are obese, suggesting genetic influences predominate in childhood weight gain. [Pediatrics 1998;101:462]

Exclusive breastfeeding from birth to 6 months of age is also protective for the baby. Complementary feeding should commence at about 4 to 6 months of age as it is the optimal window to introduce new foods. Yazid said that until 1 year of age, breastmilk or follow-on formula is the recommended feeding source. Cow’s milk should be avoided entirely until after 1 year of age.

Upon commencement of solid foods, fruits and vegetables should be introduced early. According to Yazid, daily variety, diversity in a meal, and repeated exposure to the food (up to eight times) are efficient strategies to increase acceptance of food not initially accepted. Importantly, sugar, salt and sugary fluids should not be added to the diet.

One important point noted by Pietrobelli’s paper was to respect the child’s appetite and to avoid coercive “clean your plate” practices. Most importantly, food should not be used as a reward for good behaviour. [Int J Environ Res Public Health 2017;14(12):1491] Animal protein sources should also be limited in early life to prevent adiposity rebound. However, adequate intake of essential fatty acids should be promoted. Parents, too, have an important role to play in being good examples and should turn off the television and other electronic devices during meals. Finally, preventive interventions that promote physical activity and sufficient sleep times should be put in place. A growing body of evidence links shortage of sleep to increased risk of developing obesity.

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