Koletzko B, Aggett P J, Bindels J G, Bung P, Ferré P, Gil A, Lentze M J, Roberfroid M, Strobel S
Kinderpoliklinik, Klinikum Innenstadt der Ludwig-Maximilians-Universität, München, Germany.
Br J Nutr. 1998 Aug;80 Suppl 1:S5-45. doi: 10.1079/bjn19980104.
Few other aspects of food supply and metabolism are of greater biological importance than the feeding of mothers during pregnancy and lactation, and of their infants and young children. Nutritional factors during early development not only have short-term effects on growth, body composition and body functions but also exert long-term effects on health, disease and mortality risks in adulthood, as well as development of neural functions and behaviour, a phenomenon called 'metabolic programming'. The interaction of nutrients and gene expression may form the basis of many of these programming effects and needs to be investigated in more detail. The relation between availability of food ingredients and cell and tissue differentiation and its possible uses for promoting health and development requires further exploration. The course of pregnancy, childbirth and lactation as well as human milk composition and the short- and long-term outcome of the child are influenced by the intake of foods and particularly micronutrients, e.g. polyunsaturated fatty acids, Fe, Zn and I. Folic acid supplementation from before conception through the first weeks of pregnancy can markedly reduce the occurrence of severe embryonic malformations; other potential benefits of modulating nutrient supply on maternal and child health should be further evaluated. The evaluation of dietary effects on child growth requires epidemiological and field studies as well as evaluation of specific cell and tissue growth. Novel substrates, growth factors and conditionally essential nutrients (e.g. growth factors, amino acids, polyunsaturated fatty acids) may be potentially useful as ingredients in functional foods and need to be assessed carefully. Intestinal growth, maturation, and adaptation as well as long-term function may be influenced by food ingredients such as oligosaccharides, gangliosides, high-molecular-mass glycoproteins, bile salt-activated lipase, pre- and probiotics. There are indications for some beneficial effects of functional foods on the developing immune response, for example induced by antioxidant vitamins, trace elements, fatty acids, arginine, nucleotides, and altered antigen contents in infant foods. Peak bone mass at the end of adolescence can be increased by dietary means, which is expected to be of long-term importance for the prevention of osteoporosis at older ages. Future studies should be directed to the combined effects of Ca and other constituents of growing bone, such as P, Mg and Zn, as well as vitamins D and K, and the trace elements F and B. Pregnancy and the first postnatal months are critical time periods for the growth and development of the human nervous system, processes for which adequate substrate supplies are essential. Early diet seems to have long-term effects on sensory and cognitive abilities as well as behaviour. The potential beneficial effects of a balanced supply of nutrients such as I, Fe, Zn and polyunsaturated fatty acids should be further evaluated. Possible long-term effects of early exposure to tastes and flavours on later food choice preferences may have a major impact on public health and need to be further elucidated. The use of biotechnology and recombinant techniques may offer the opportunity to include various bioactive substances in special dietary products, such as human milk proteins, peptides, growth factors, which may have beneficial physiological effects, particularly in infancy and early childhood.
在食物供应和新陈代谢的其他方面中,几乎没有比孕期和哺乳期母亲以及婴幼儿的喂养更具生物学重要性的了。早期发育过程中的营养因素不仅对生长、身体组成和身体功能有短期影响,而且对成年后的健康、疾病和死亡风险以及神经功能和行为的发育也有长期影响——这一现象被称为“代谢编程”。营养素与基因表达之间的相互作用可能构成许多此类编程效应的基础,需要更详细地加以研究。食物成分的可获得性与细胞和组织分化之间的关系及其在促进健康和发育方面的可能用途需要进一步探索。孕期、分娩和哺乳期的过程以及母乳成分和儿童的短期和长期结局受到食物尤其是微量营养素(如多不饱和脂肪酸、铁、锌和碘)摄入的影响。从受孕前到怀孕的头几周补充叶酸可显著降低严重胚胎畸形的发生率;调节营养供应对母婴健康的其他潜在益处应进一步评估。评估饮食对儿童生长的影响需要进行流行病学和现场研究以及对特定细胞和组织生长的评估。新型底物、生长因子和条件必需营养素(如生长因子、氨基酸、多不饱和脂肪酸)可能作为功能性食品的成分具有潜在用途,需要仔细评估。肠道的生长、成熟和适应以及长期功能可能受到低聚糖、神经节苷脂、高分子量糖蛋白、胆汁盐激活脂肪酶、益生元和益生菌等食物成分的影响。有迹象表明功能性食品对发育中的免疫反应具有一些有益作用,例如由抗氧化维生素、微量元素、脂肪酸、精氨酸、核苷酸以及婴儿食品中改变的抗原含量所诱导产生的作用。青春期结束时的峰值骨量可通过饮食手段增加,这有望对预防老年骨质疏松症具有长期重要意义。未来的研究应针对钙和生长骨骼的其他成分(如磷、镁和锌)以及维生素D和K以及微量元素氟和硼的综合作用。孕期和产后的头几个月是人类神经系统生长和发育的关键时期,而充足的底物供应对这些过程至关重要。早期饮食似乎对感官和认知能力以及行为有长期影响。碘、铁、锌和多不饱和脂肪酸等营养素均衡供应的潜在有益作用应进一步评估。早期接触口味和风味对后期食物选择偏好的可能长期影响可能对公众健康产生重大影响,需要进一步阐明。生物技术和重组技术的应用可能提供机会,将各种生物活性物质纳入特殊膳食产品中,如人乳蛋白、肽、生长因子,这些物质可能具有有益的生理作用,尤其是在婴儿期和幼儿期。