Nestle Nutrition workshop series. Paediatric programme最新文献

{"title":"Regional case studies--Africa.","authors":"Andrew M Prentice","doi":"10.1159/000209971","DOIUrl":"https://doi.org/10.1159/000209971","url":null,"abstract":"Africa is the final continent to be affected by the nutrition transition and, as elsewhere, is characterized by the paradoxical coexistence of malnutrition and obesity. Several features of the obesity epidemic in Africa mirror those in other emerging nations: it penetrates the richer nations and urban areas first with a strong urban- rural gradient; initially it affects the wealthy, but later there is a demographic switch as obesity becomes a condition more associated with poverty, and it shares many of the same drivers related to the increasing affordability of highly refined oils and carbohydrates, and a move away from subsistence farm work and towards sedentary lifestyles. Africa also has some characteristics of the obesity epidemic that stand out from other regions such as: (1) excepting some areas of the Pacific, Africa is probably the only region in which obesity (especially among women) is viewed culturally as a positive and desirable trait, leading to major gender differences in obesity rates in many countries; (2) most of Africa has very low rates of obesity in children, and to date African obesity is mostly an adult syndrome; (3) Africans seem genetically prone to higher rates of diabetes and hypertension in association with obesity than Caucasians, but seem to be relatively protected from dislipidemias; (4) the case-specific deaths and disabilities from diabetes and hypertension in Africa are very high due to the paucity of health services and the strain that the 'double burden' of disease places on health systems.","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"63 ","pages":"33-41; discussion 41-6, 259-68"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000209971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28093898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innate and adaptive immune pathways to tolerance.","authors":"Catherine A Thornton,&nbsp;Gareth Morgan","doi":"10.1159/000235782","DOIUrl":"https://doi.org/10.1159/000235782","url":null,"abstract":"<p><p>There is a vast scientific literature on the innate and adaptive immune responses that contribute to the development of tolerance with growing appreciation that innate and adaptive immunity do not function independently of each other. Innate immune pathways of current interest are those involving pattern recognition receptors, such as Toll-like receptors, particularly their expression by epithelial cells and dendritic cells at mucosal surfaces. The study of adaptive immune pathways has traditionally focused on specific IgA and the development of effector T-cell populations: the Th1/Th2 paradigm has evolved to encompass Th17 cells. Recent years have seen a dramatic resurgence in the investigation of regulatory T-cell populations that can modify a broad range of immunological activities. Dendritic cells play a key role in linking innate and adaptive immunity. The microenvironment of the dendritic cell at the time of antigen encounter modulates co-stimulatory molecule expression and cytokine production which orchestrate antigen-specific activity by T cells, especially the development of different effector T-cell populations (Th1/Th2/Th17) or regulatory T cells. Cascades of cytokines/chemokines play central roles in many types of immune responses. These include: (i) TGF-beta; (ii) IL-10, and (iii) thymic stromal lymphopoietin (TSLP). Current paradigms of immunity and tolerance in relation to the development of allergy relate to the interplay between innate and immunoregulatory mechanisms.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"64 ","pages":"45-57; discussion 57-61, 251-7"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235782","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28364423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and regulation of immune responses to food antigens in pre- and postnatal life.","authors":"Harald Renz,&nbsp;Petra Ina Pfefferle,&nbsp;René Teich,&nbsp;Holger Garn","doi":"10.1159/000235788","DOIUrl":"https://doi.org/10.1159/000235788","url":null,"abstract":"<p><p>Food antigens are harmless environmental components. The physiological response is the development of clinical and immunological tolerance. It is now well appreciated that tolerance development is the result of active immunoregulation and depends on a close interaction between the innate and adaptive immune system resulting in the development of tolerance-mediating T-cell responses. Programming of the immune system, particularly with regard to tolerance development, already starts before birth and stays under close control of the maternal immune system. Therefore, the pre-and postnatal period represents an important 'window of opportunity' for immunoprogramming. Underlying mechanisms include maternal cell transmission, antibody transfer, transfer of mediates/cytokines, and transmission of antigens and allergens. Immunoprogramming is fostered and augmented in the context of microbial components. Recently, several microbes have been identified which possess the capacity of immunoprogramming early in life. Epigenetic regulation represents an important novel mechanism in this regard. This concept opens new avenues for the development of preventive strategies to avoid inappropriate immune responses against food antigens.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"64 ","pages":"139-51; discussion 151-5, 251-7"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28366039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of dietary immunomodulatory factors in the development of immune tolerance.","authors":"Susan L Prescott","doi":"10.1159/000235791","DOIUrl":"https://doi.org/10.1159/000235791","url":null,"abstract":"<p><p>The development of oral tolerance occurs during critical early stages of immune development. Rising rates of food allergy and other immune-mediated food reactions are an indication that oral tolerance is highly susceptible to environmental change. There is growing evidence that this many not be due food allergens per se, but rather to changing exposure to other key immunomodulatory exposures in this critical period. Successful tolerance appears to depend on many concurrent environmental influences during the period of first allergen encounter, including favorable gut colonization, and the presence of key immunomodulatory factors in breast milk and the infant diet. This review explores the potential effects of early dietary and nutritional factors in tolerogenic immune processes that are normally initiated during initial food allergen encounter.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"64 ","pages":"185-94; discussion 194-200, 251-7"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28366042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial-host interaction: tolerance versus allergy. The 64th Nestle Nutrition Institute Workshop. Foreword.","authors":"Ferdinand Haschke,&nbsp;Petra Klassen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"64 ","pages":"IX-X"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28499616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity, hepatic metabolism and disease.","authors":"John M Edmison,&nbsp;Satish C Kalhan,&nbsp;Arthur J McCullough","doi":"10.1159/000209980","DOIUrl":"https://doi.org/10.1159/000209980","url":null,"abstract":"<p><p>Nonalcoholic steatohepatitis (NASH), which is the most severe histological form of nonalcoholic fatty liver disease, is emerging as the most common clinically important form of liver disease in developed countries. Although its prevalence is 3% in the general population, this increases to 20-40% in obese patients. Since NASH is associated with obesity, its prevalence has been predicted to increase along with the growing epidemic of obesity and type 2 diabetes mellitus. The importance of this observation comes from the fact that NASH is a progressive fibrotic disease in which cirrhosis and liver-related death occur in 25 and 10% in these patients, respectively, over a 10-year period. This is of particular concern given the increasing recognition of NASH in the developing world. Treatment consists of treating obesity and its comorbidities: diabetes and hyperlipidemia. Nascent studies suggest that a number of pharmacological therapies may be effective, but all remain unproven at present. Histological and laboratory improvement occurs with a 10% decrease in bodyweight. Bariatric surgery is indicated in selected patients. A greater understanding of the pathophysiological progression of NASH in obese patients must be obtained in order to develop more focused and improved therapy.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"63 ","pages":"163-72; discussion 172-6, 259-68"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000209980","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28093770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-based approaches to address childhood undernutrition and obesity in developing countries.","authors":"Prakash Shetty","doi":"10.1159/000209984","DOIUrl":"https://doi.org/10.1159/000209984","url":null,"abstract":"<p><p>Community-based approaches have been the mainstay of interventions to address the problem of child malnutrition in developing societies. Many programs have been in operation in several countries for decades and originated largely as social welfare, food security and poverty eradication programs. Increasingly conceptual frameworks to guide this activity have been developed as our understanding of the complex nature of the determinants of undernutrition improves. Alongside this evolution, is the accumulation of evidence on the types of interventions in the community that are effective, practical and sustainable. The changing environment is probably determining the altering scenario of child nutrition in developing societies, with rapid developmental transition and urbanization being responsible for the emerging problems of obesity and other metabolic disorders that are largely the result of the now well-recognized linkages between child undernutrition and early onset adult chronic diseases. This dramatic change is contributing to the double burden of malnutrition in developing countries. Community interventions hence need to be integrated and joined up to reduce both aspects of malnutrition in societies. The evidence that community-based nutrition interventions can have a positive impact on pregnancy outcomes and child undernutrition needs to be evaluated to enable programs to prioritize and incorporate the interventions that work in the community. Programs that are operational and successful also need to be evaluated and disseminated in order to enable countries to generate their own programs tailored to tackling the changing nutritional problems of the children in their society.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"63 ","pages":"227-54; discussion 254-7, 259-68"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000209984","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28093774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of epigenetics in mediating environmental effects on phenotype.","authors":"Daniel K Morgan,&nbsp;Emma Whitelaw","doi":"10.1159/000209976","DOIUrl":"https://doi.org/10.1159/000209976","url":null,"abstract":"<p><p>Epigenetics is being suggested as a possible interface between the genetic and environmental factors that together give rise to phenotype. In mice there exists a group of genes, known as metastable epialleles, which are sensitive to environmental influences, such as diet, and undergo molecular changes that, once established, remain for the life of the individual. These modifications are epigenetic and in some cases they survive across generations, that is, through meiosis. This is termed transgenerational epigenetic inheritance. These findings have led to the idea that similar processes might occur in humans. Although it is clear that the lifestyle of one generation can significantly influence the health of the next generation in humans, in the absence of supporting molecular data it is hard to justify the notion that this is the result of transgenerational epigenetic inheritance. What is required first is to ascertain whether genes of this type, that is genes that are sensitive to the epigenetic state, even exist in humans.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"63 ","pages":"109-17; discussion 117-9, 259-68"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000209976","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28093903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of low birthweight.","authors":"Dewan S Alam","doi":"10.1159/000209983","DOIUrl":"https://doi.org/10.1159/000209983","url":null,"abstract":"<p><p>Globally an estimated 20 million infants are born with low birthweight (LBW), of those over 18 million are born in developing countries. These LBW infants are at a disproportionately higher risk of mortality, morbidity, poor growth, impaired psychomotor and cognitive development as immediate outcomes, and are also disadvantaged as adults due to their greater susceptibility to type 2 diabetes, hypertension and coronary heart disease. Maternal malnutrition prior to and during pregnancy manifested by low bodyweight, short stature, inadequate energy intake during pregnancy and coexisting micronutrient deficiency are considered major determinants in developing countries where the burden is too high. LBW is a multifactorial outcome and its prevention requires a lifecycle approach and interventions must be continued for several generations. So far, most interventions are targeted during pregnancy primarily due to the increased nutritional demand and aggravations of already existing inadequacy in most women. Several individually successful interventions during pregnancy include balanced protein energy supplementation, several single micro-nutrients or more recently a mix of multiple micronutrients. Nutrition education has been successful in increasing the dietary intake of pregnant women but has had no effect on LBW. The challenge is to identify a community-specific intervention package. Current evidence supports intervention during pregnancy with increased dietary intakes including promotions of foods rich in micronutrients and micronutrient supplementation, preferably with a multiple micronutrient mix. Simultaneously a culturally appropriate educational component is required to address misconceptions about diet during pregnancy and childbirth including support for healthy pregnancy with promotion of antenatal and perinatal care services. While further research is needed to identify more efficacious interventions, an urgent public health priority would be to select and implement an optimal mix of interventions to avert the immediate adverse consequences of LBW and to prevent the impending epidemic of type 2 diabetes, hypertension and coronary heart disease which are negatively associated with LBW.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"63 ","pages":"209-21; discussion 221-5, 259-68"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000209983","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28093773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional case studies--India.","authors":"K Srinath Reddy","doi":"10.1159/000209969","DOIUrl":"https://doi.org/10.1159/000209969","url":null,"abstract":"<p><p>As a proportion of all deaths in India, cardiovascular disease (CVD) will be the largest cause of disability and death, by the year 2020. At the present stage of India's health transition, an estimated 53% of deaths and 44% of disability-adjusted life-years lost are contributed to chronic diseases. India also has the largest number of people with diabetes in the world, with an estimated 19.3 million in 1995 and projected 57.2 million in 2025. The prevalence of hypertension has been reported to range from 20 to 40% in urban adults and 12-17% among rural adults. The number of people with hypertension is expected to increase from 118.2 million in 2000 to 213.5 million in 2025, with nearly equal numbers of men and women. Over the coming decade, until 2015, CVD and diabetes will contribute to a cumulative loss of USD237 billion for the Indian economy. Much of this enormous burden is already evident in urban as well as semi-urban and slum dwellings across India, where increasing lifespan and rapid acquisition of adverse lifestyles related to the demographic transition contribute to the rising prevalence of CVDs and its risk factors such as obesity, hypertension, and type 2 diabetes. The underlying determinants are sociobehavioral factors such as smoking, physical inactivity, improper diet and stress. The changes in diet and physical activity have resulted largely from the epidemiological transition that is underway in most low income countries including India. The main driving forces of these epidemiological shifts are the globalized world, rapid and uneven urbanization, demographic shifts and inter- and intra-country migrations--all of which result in alterations in dietary practices and decreased physical activity. While these changes are global, India has several unique features. The transitions in India are uneven with several states in India still battling the ill effects of undernutrition and infectious diseases, while in other states with better indices of development, chronic diseases including diabetes are emerging as a major area of concern. Regional and urban-rural differences in the occurrence of CVD are the hallmark. All these differences result in a differing prevalence of CVD and its risk factors. Therefore while studying nutrition and physical activity shifts in India, the marked heterogeneity and secular changes in dietary and physical activity practices should be taken into account. This principle should also apply to strategies, policies and nutrition and physical activity guidelines so that they take the regional differences into account.</p>","PeriodicalId":87412,"journal":{"name":"Nestle Nutrition workshop series. Paediatric programme","volume":"63 ","pages":"15-24; discussion 41-6, 259-68"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000209969","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28169660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}