By Sheela Sinharoy

ASN’s Scientific Sessions & Annual Meeting began on Saturday morning with a minisymposium on Nutrition and Cognitive and Neurological Outcomes. Researchers presented studies looking at a range of outcomes across the life course, from infants to the elderly.

Focusing on infants and preschool aged children, Sylvia Fernandez-Rao of the National Institute of Nutrition in India shared results from a randomized trial in India, in which participants received one of four interventions: micronutrient powders (MNPs), an early learning intervention, a combination of MNP + early learning, or neither. The results showed small improvements in some categories of development from both the MNP and early learning intervention but no evidence of additive effects.

Karim Bougma of McGill University presented results of a randomized trial of salt iodization in Ethiopia. The study enrolled children up to age five and distributed iodized salt in intervention communities. They found a significant difference between intervention and control areas in several measures of child development and also in maternal depression symptoms. This was true despite a significant increase in consumption of iodized salt in control areas as well as variable quality of salt iodization.

Moving on to older children, Beth Prado of UC-Davis presented results from a study that re-enrolled children ages 9-12 years whose mothers had received multiple micronutrient (MMN) supplementation while pregnant. They found that maternal MMN supplementation had small but significant positive effects on cognitive domains that were still measurable up to 12 years later. They additionally found that the cognitive benefits of MMN varied based on the mother’s nutritional status.

Looking at young adults, Susan Emmett of Johns Hopkins University spoke about nutrition and hearing loss. She used data from the Nepal Nutrition Intervention Project, a randomized trial of preschool vitamin A supplementation that began in 1989. The project followed children and collected data every four months, including about any ear discharge in the previous week. Among children who had at least one episode of ear discharge, vitamin A supplementation was associated with a 42% risk reduction of young adult hearing loss.

Usha Ramakrishnan of Emory University also presented data on adults, specifically mothers. She described a randomized trial in Viet Nam, in which women received weekly pre-conceptional supplements of folic acid, iron-folic acid, or multiple micronutrients. The outcome of interest was maternal depression, but researchers found very few symptoms of postpartum depression, and there was no difference between treatment groups.

Finally, Alex Brito of UC-Davis spoke about a randomized trial of vitamin B12 in Chile, which measured neurophysiological outcomes among adults ages 70-79 years. The researchers found significant improvements in nerve conduction velocity with B12 intake but no improvements in other neurophysiological outcomes.

The minisymposium reflected just some of the diversity of interventions and outcomes within the very broad topic of nutrition and cognitive and neurological outcomes. It made clear that, as with many topics at EB 2015, this area is rich with future research opportunities, and there is still much to learn.

By Marion L. Roche, PhD, Micronutrient Initiative

An estimated 42% of pregnant women are anemic. Anaemia in pregnancy is associated with increased mortality for mothers and infants, low birth weight in infants and increased risk of premature delivery. Iron Folic Acid (IFA) supplementation is recommended where anaemia is a public health concern. Many in the global nutrition research community have been anxiously awaiting the JiVitA-3 Randomized Trial in Bangladesh. This study has been looking at the comparative effectiveness of iron folic acid (IFA) supplements vs. multiple micronutrient supplements for pregnant women and one month postpartum.

This recent research in Bangladesh, which shows potential to reduce preterm births and low birth weight, holds promise for contributing to global reductions in neonatal mortality, although reductions in infant mortality were not found to be significant in this study. Low birth weight puts infants at risk of neonatal mortality and developmental consequences later in life. The risks of neonatal deaths for preemies and the critical importance of addressing preterm births has gained increasing recognition through the “Born too Soon” Global Action Report.

These results are exciting and will be balanced with the costs of transitioning from IFA to multiple micronutrients as countries decide how, when, and if to transition to “multis.” For many countries, the multiple micronutrients will be an added cost, and will come with substantial implications for procurement and supply management. They will also be a new product for many of the physicians, nurses, health workers and family members that have a role of supporting and encouraging pregnant women, and most importantly for pregnant women themselves.

Multiple micronutrient supplements will only have benefits if pregnant women have access to the supplements, receive them early enough in pregnancy to consume the recommended dose, and be supported, motivated and encouraged to consume the supplements daily. Global experiences with IFA supplementation would suggest that adherence has been one of the greatest challenges to behaviour change. Supporting adherence requires a reliable supply, encouraging counseling for pregnant women and improving a women’s access to IFA and related ante natal care services.

Nepal’s national iron intensification project is an example of a project that, for over eight years, was able to increase iron coverage from 23% to 80% and increase adherence of 90 tablets from 6% to 56%. This was largely achieved through the integration of a community based delivery system of female community health volunteers (FCHVs) who delivered the IFA supplements to women in their community and also encouraged them and restocked their IFA supply when needed. The FCHVs also received participatory training and provided practical advice on how to support and encourage women. Additional strategies will be needed to further increase adherence and maintain the motivation of the FCHVs.

As the global nutrition community reflects on the implications of the evidence from this new study, they will also be looking to learn from IFA programs and the successes and challenges. Whether IFA or multis are selected as part of the strategy for anemia reduction and improving maternal and newborn health, innovative approaches and replication of best practices and promising strategies for increasing adherence and coverage are needed to reduce maternal anaemia and benefit infants.

By Corrie Whisner, PhD

I recently ran across an interesting article in the PLOS ONE journal entitled, “Holsteins Favor Heifers, Not Bulls: Biased Milk Production Programmed during Pregnancy as a Function of Fetal Sex” by Katie Hinde and colleagues at Harvard and Kansas State Universities. After the passing of International Women’s Day on March 8 and recently finishing the book Lean In by Sheryl Sandberg, I felt inspired to share Hinde’s findings and highlight the scientific side of “girl power!”

In this large retrospective analysis of dairy cow lactation records, researchers found that Holsteins produced 1.6% more milk for female versus male offspring. More interesting, is the finding that fetal sex of first-time mothers influenced milk production in subsequent pregnancies.  The advantage of having a female fetus during the first pregnancy carried over to the second pregnancy, resulting in greater milk production across both lactations regardless of whether the second fetus was male or female. The benefit of having a heifer during the first pregnancy was further documented when cows giving birth to a male in their first pregnancy showed significant increases in milk production if their second pregnancy was a female. This increase was evident when comparing data to milk production in dairy cows that gave birth to two consecutive male offspring; however, the milk production of male-female sequence mothers, did not increase to the level of female-first mothers.

According to Hinde, biologists have been interested in studying how mothers differentially allocate resources to male versus female fetuses during pregnancy. To date, little work has been done to investigate sex-biases in milk production which make this article very exciting! Reading this article definitely reminded me of the Barker Hypothesis and the earlier publication Boys Live Dangerously in the Womb, which both provide evidence for fetal programming in humans and suggest that male and female fetuses respond differently in utero to maternal cues.

Maternal milk is an ever-evolving elixir which fuels important changes throughout early development, so it isn’t hard to believe that milk production might differ between species. After reading this article I amazed to learn that mothers may allocate resources, such as milk, to the offspring sex that will receive maximal benefit. A current belief is that males from species with male-male competitive mating rituals will receive a greater investment across gestation and lactation from their mothers. Additionally, Rhesus monkeys have been found to produce energetically-dense milk, higher in fat, for their male offspring; however, female offspring received a greater milk volume which made up for the lack in energetic-density.

As research continues in this area, I wonder if we will start seeing different types of baby formula for boys and girls. Only time will tell…and to that, I say, “Let’s get MOO-ving, so we have more to talk about soon!”

References
1.    Katie Hinde, Abigail J. Carpenter, John S. Clay, Barry J. Bradford. Holsteins Favor Heifers, Not Bulls: Biased Milk Production Programmed during Pregnancy as a Function of Fetal Sex. PLoS ONE, 2014; 9 (2): e86169 DOI:10.1371/journal.pone.0086169
2.    Trivers RL, Willard DE (1973) Natural selection of parental ability to vary the sex ratio of offspring. Science 179(4068): 90–92. doi: 10.1126/science.179.4068.90
3.    Hinde K (2007) First-time macaque mothers bias milk composition in favor of sons. Curr Biol 17(22): R958–R959. doi: 10.1016/j.cub.2007.09.029
4.    Hinde K (2009) Richer milk for sons but more milk for daughters: Sex-biased investment during lactation varies with maternal life history in rhesus macaques. Am J Hum Biol 21(4): 512–519. doi: 10.1002/ajhb.20917

By Sarah Ohlhorst, ASN Director of Government Relations

The White House recently issued a proclamation declaring September as National Childhood Obesity Awareness Month. ASN has served as a national partner of National Childhood Obesity Awareness since 2010, along with other organizations including America on the Move, American College of Sports Medicine, and HealthCorps. In July, the American Society for Nutrition (ASN) endorsed a resolution introduced by Representatives Marcia Fudge (D-OH) and Kay Granger (R-TX) re-designating the month of September as Childhood Obesity Awareness Month. Educational efforts and events are taking place throughout the entire month of September to bring national attention to the issue of childhood obesity. For example, Nickelodeon is planning a September 24 Worldwide Day of Play– a “blackout” day with zero television programming!

Obesity rates worldwide have doubled in the last three decades, according to a number of articles recently published in The Lancet as part of an obesity series. Globally, an estimated 170 million children under the age of 18 are overweight or obese. In some countries, this includes more than 25% of all children. In the U.S., approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. Being overweight or obese as a child increases the risk of developing additional diseases such as heart disease, hypertension, and type 2 diabetes and increases the likelihood of becoming an overweight or obese adult. The hospital costs associated with childhood obesity alone were estimated at $237.6 million in 2005.

ASN supports research to elucidate the etiology of childhood obesity, which is a multifactorial epidemic affecting the majority of Americans. Through translational research, ASN members are working to understand how obesity develops and negatively impacts the health of individuals. With this basic knowledge, they are developing and evaluating strategies to prevent obesity in individuals, to aid and maintain weight loss, and to identify and advocate for environmental and policy changes that best support a healthy weight in the U.S. population.

“ASN has increased our focus on the issue of obesity as its impact becomes more and more widespread, including establishing an Obesity Working Group with members who are leading obesity researchers to develop an obesity platform” said ASN Executive Officer John Courtney, PhD. “It is vital that NIH and USDA receive the funding they need so our scientists can continue their research into childhood obesity, it causes, and how to lessen its negative impact.”

Do your part to support National Childhood Obesity Month – help encourage healthy behaviors like regular exercise and good nutrition in your own city or state this month and throughout the year!

By: Jovana K.

Over the past decade the use of low fat milk has become more prominent than the use of whole milk because there is substantial scientific evidence that consumption of foods high in fat causes weight gain and increases the risk of heart disease and cancer. However, there is some controversy over whether processed low-fat pasteurized milk can meet the needs of developing offspring and whether it should be consumed during pregnancy and development.

Milk Consumption During Pregnancy

Human brain development involves increased incorporation of long-chain polyunsaturated fatty acids (LCPUFA) in brain phospholipids. From the third trimester through to second year of postnatal life LCPUFA (i.e. docosahexaenoic acid (DHA) and arachidonic acid (AA)) are actively incorporated into the developing brain. The proportion of DHA and AA that the infant has reflects the presence of these fatty acids in the maternal diet. Dietary sources of LCPUFA include fish, fish oil and DHA fortified dairy including milk.

Naturally, cow’s milk does not provide a rich source of DHA however in North America whole milk and partially skimmed milk (2%) are fortified with DHA by adding DHA rich feed additive to cattle’s diet. Skim milk or low fat milk (1%) cannot be fortified with DHA because DHA is contained in the milk fat. The DHA-fortified milk products may allow mothers who do not eat large quantities of fish to obtain the levels of DHA that their baby needs for brain and central nervous system development.

Milk Consumption During Postnatal Development

The American Academy of Paediatrics recommends that toddlers drink whole milk because fatty acids are helpful for brain and bone development. However, some doctors recommend low fat or skim milk to overweight or obese children. Whether low fat or skim milk protects children from weight gain is under debate.

According to a cohort study of 12,829 US children aged 9 to 14 years, weight gain is associated with excess calorie intake and consumption of low fat or skim milk, but is not associated with drinking whole milk products. This finding although surprising is consistent with some animal findings. Pigs fed reduced-fat milk gain weight easily while pigs fed whole milk stay lean. Male rats fed whole milk had significantly lower concentrations of plasma triglycerides, very low-density lipoproteins and apolipoprotein B than rats fed low fat milk. The effects of whole milk on lipid profile and body composition are not well understood, but the process of removing fat from milk may in part be responsible for some of the observed effects.

Milk is an emulsion of butterfat globules and water-based fluid. Butterfat contains unique nutrients that support thyroid function and help the body develop muscle rather than fat. The butterfat properties of whole milk are different from that of low fat or skim milk, which may help to explain the effects of whole milk on body composition. Future studies should explore the mechanism by which whole milk may protect infants from gaining weight.