This document discusses nutrition over the lifecourse and various topics related to nutrition at different stages of life. It begins with an overview of lifecourse models in nutrition and different dietary assessment methods. It then covers several lifecourse topics in nutrition including breastfeeding, food contaminants, nutrition in children and adolescents, diet and the elderly, diet and cancer, and diet and cardiovascular disease. For each topic, it provides details on recommendations, definitions, causes and consequences, and dietary factors of importance. The document aims to provide a comprehensive overview of nutrition across the entire lifespan.

1. Nutrition
over the
life cycle
Gianluca Tognon
www.gianlucatognon.com

2. The lifecourse
model
 Critical period model
 Critical period influences with later modifiers
of their effects
 Accumulation of risks with correlated results
(one adverse or protective experience brings
to another adverse or protective experience)
 Accumulation of risks with independent and
uncorrelated results

3. Dietary assessment
methods
Food records
Food frequency
questionnaire
24h dietary recall
Diet history

4. LIFECOURSE TOPICS
IN NUTRITION
Breastfeeding
Food contaminants
Children and adolescents
Diet and cancer
Diet and the elderly
Diet and cardiovascular
disease
Go to the conclusions

5. Breastfeeding
 Which are the WHO recommendations
for breastfeeding?
 And for complementary foods/weaning?

6. WHO Recommendations for
breastfeeding
 Exclusive breastfeeding is recommended
up to 6 months of age, with continued
breastfeeding along with appropriate
complementary foods up to two years of
age or beyond
 Breastfeeding should begin within one
hour of birth
 Breastfeeding should be "on demand", as
often as the child wants day and night
 Bottles or pacifiers should be avoided

7. Guidelines for complementary
foods and weaning (WHO)
 Start to give complementary foods at 4-6 months
 7-12 months: continue breast-feeding as often as the
baby wants. Give the child complementary food
regularly, about 3-5 times per day
 Do not give glucose drinks, sodas, and soft drinks,
and avoid giving spicy foods to the baby
 When the baby is already taken to eating, give mixes
of complementary food
 Continue to breast-feed the child up to 2 years and
beyond

8.  breastfeeding should not be decreased
when starting on solids
 food should be given with a spoon or cup,
not in a bottle
 food should be clean, safe and locally
available
 ample time is needed for young children
to learn to eat solid foods

9. Breast milk
substitutes
An international code to regulate the marketing of breastmilk substitutes was adopted in 1981. It calls for:

All formula labels and information to state the benefits
of breastfeeding and the health risks of substitutes

No promotion of breast-milk substitutes

No free samples of substitutes to be given to pregnant
women, mothers or their families

No distribution of free or subsidized substitutes to
health workers or facilities
Back to the questions

10. Children and adolescents
 Malnutrition and undernutrition affect
childhood health in a very serious way.
These two terms are often used
interchangeably, but do they really mean
the same?
 Which are possible causes and
consequences of these conditions?

11. Malnutrition and
Undernutrition
 Malnutrition: A physical condition in which people
experience either nutrition deficiencies
(undernutrition) or an excess of certain nutrients
(overnutrition)
 Undernutrition: The physical condition resulting
from deficiencies in one or several macro- and
micronutrients. It impairs growth, pregnancy,
lactation, physical work, cognitive function, and
disease resistance and recovery

12. Undernutrition
Undernutrition encompasses:
Stunting: low height for age
Wasting: low weight for age
Deficiencies of vitamins and
minerals

14. Causes of undernutrition:
biological & environmental
 Maternal malnutrition before and/or during
pregnancy (underweight newborn)
 Infectious diseases (diarrheal disease,
measles, AIDS, tuberculosis and others)
 Overcrowded and/or unsanitary living
conditions (which increase the likelihood of
infections)
 Agricultural patterns, droughts, floods, wars
and forced migrations

15. Social and economic
causes
 Poverty
 Low/No education
 Inadequate weaning practices (withdrawal of
breastmilk or inadequate nutrient
composition)
 Social problems (child abuse, maternal
deprivation, abandonment of the elderly,
alcoholism, drug addiction)
 Cultural and social practices (food taboos,
food and diet fads)

16. Consequences of chronic
hunger
 Most undernourished people do not starve to death,
they die because their health has been compromised
by dehydration from infections that cause diarrhea
 Undernutrition reduces mental and physical
development in children and makes people susceptible
to potentially fatal infections
 Consequences of unrelieved hunger include stunted
growth, poor learning, extreme weakness, clinical signs
of protein-energy malnutrition (PEM), increased
susceptibility to disease, loss of the ability to stand or
walk, premature death

17. Undernutrition in early life and risk of
obesity and T2D in adulthood
 Disturbed growth due to undernutrition during
fetal life, infancy or childhood results in early
metabolic adaptations
 These adaptations may be beneficial for shortterm survival, but can increase the risk of
chronic diseases, including obesity and T2D in
the long term
 The combination of low birth weight and rapid
childhood growth has been associated with
increased central fat deposition and insuline
resistance

19. Back to the questions

20. Diet and the elderly
What is sarcopenia?
Which dietary factors are
important in its management?

21. Sarcopenia
 Age-related loss of muscle mass, strength
and performance
 The decline in skeletal muscle mass with
aging is attributed to a disruption in the
regulation of skeletal muscle protein turnover
(synthesis/turnover)
 The major factors considered to be involved
include inflammation, hormonal changes,
neurological factors, physical inactivity and
inadequate nutritional intake (vitamin D and
protein intake)

22.  Poor muscle strength is a major public
health concern in older persons
because it predisposes to poorer
function and greater risk of falls,
disability, and death
 Several chronic conditions such as
stroke, diabetes mellitus, arthritis,
coronary heart disease, and chronic
obstructive pulmonary disease seems
to be associated with steeper strength
decline and low handgrip strength

24.  22-year follow-up data
 Determinants of muscular strength
decline:
 physically strenuous work and
becoming physically sedentary
 excess body weight
 smoking
 cardiovascular disease, hypertension,
diabetes mellitus, asthma in midlife
 pronounced weight loss
 chronic bronchitis

25. Dietary proteins
 It has been suggested that 25-30 g of
dietary protein per meal is required to allow
an appropriate stimulation of postprandial
muscle protein synthesis
 Dietary protein intake should be overall
equal to 1.2-1.5 g/kg/day to attenuate
muscle loss compared to the
recommended intake of at least 0.8
g/kg/day
 Dietary protein supplementation might be a
possible strategy

26. Vitamin D

The reduction in endogenous vitamin
D synthesis together with low vitamin
D intakes result in a high prevalence
of vitamin D deficiency among elderly
people

Low vitamin D has been associated
with poor muscle mass and impaired
physical performance in the elderly

The activation of the vitamin D
receptor in skeletal muscle tissue
seems to stimulate muscle protein
synthesis, preventing atrophy

Another mechanism is the regulation
of calcium pumps and therefore,
calcium concentration and muscle
contraction performance
7-Dehydrocholesterol
Back to the questions

27. Food contaminants
 What’s an endocrine disruptor?
 Can you name at least two endocrine
disruptors that can be found in food?
 Why are they interesting issue for life
course epidemiology?

28. Endocrine disruptors
Endocrine disruptors are chemicals that may
interfere with the body’s endocrine system
and produce adverse developmental,
reproductive, neurological, and immune
effects in both humans and wildlife
Dioxins
PCBs
Bisphenol A
Polyflorinated compounds (e.g. teflon)
Brominated flame retardants

29. Old and new
acquaintances

Old acquaintances:
 Dioxins (ED, carcinogenic and teratogenic)
 PCBs (109 congeners, interfere with thyroid hormones,
toxicity evaluated with TEF and TEQ)
 PAHs (combustion products which are carcinogenic
metabolites)

New acquaintances:
 Perfluoroctans (ED and carcinogenic contained in cleaning
products, food containers, cardboard, photographic films,
shampoos, toothpastes, lubricants for bicycles, garden
tools, Teflon, Goretex, pesticides)
 Flame retardants (very common, ED; contain bromine,
many are produce dioxins or by incineration)
 Phenols (ED; contained in plastic products, degreasing
solutions, paints, plastics, pesticides).
 Phthalates (ED, some are carcinogenic, their use is
becoming less frequent, classically in PVC and in the
films)

30. Mother and child
 Endocrine disruptors accumulates in the human
(and animal) body fat tissue over the entire life
 Unfortunately, one of the mechanisms through
which the body eliminates chemicals is
breastfeeding
 However, breastfeeding is discouraged only in
women who have been exposed to chemical
exposure
 Exposure during gestation of certain compounds
(e.g. PCBs) can affect thyroid hormones and
thus, nervous system’s development
Back to the questions

31. Diet and cancer
 Some years ago, the WCRF released an
expert report about diet and cancer. Can
you remember at least some of the
recommendation made by WCRF?
 What do you know about antioxidants?
Are they really so important and why?

35.  The concentration of antioxidants from food
reaches very low levels in the organism
(much lower than glutathione)
 Not all oxidative processes happening
inside the body are necessarily negative

 Bioactive substances in fruit and vegetables
might work through mechanisms other than
protection from oxidation and at low
concentrations: no need to use
supplements and supplemented foods!

36. INCREASED RISK
DECREASED RISK
Oral cavity, pharynx,
larynx
Alcoholic beverages
Non-starchy vegetables and carotenoidrich foods
Esophagus
Alcoholic beverages
Non-starchy vegetables, Fruit, carotenoid
and vitamin C-rich fruit
Stomach
Salt, Salted foods
Non-starchy vegetables, garlic and fruit
Colon-rectus
Red meat, processed meats
Alcoholic drinks (men)
Fiber-rich foods, Milk, Calcium,
Garlic
Alcoholic beverages (women)
Breast
pre-menopause
Alcoholic beverages
Breast
post-menopause
Alcoholic beverages
Prostate
High-calcium diets
Convincing reduction
Probable increase
Licopene and selenium-containing foods
Probable reduction
Convincing increase
Breastfeeding
Modified from: WCRF 2007

37. INCREASED RISK
Arsenic in drinking water, beta-carotene
supplements
Lung
DECREASED RISK
Fruit, carotenoid-rich foods
Aflatoxins
Liver
Alcoholic beverages
PANCREAS
Skin
Folate-rich foods
Arsenic in drinking water
Convincing reduction
Probable reduction
Convincing increase
Probable increase
Back to the questions

38. Diet and cardiovascular
diseases
 Are obese at an increased risk of
mortality compared to normal weight
people?
 What are trans fatty acids? Why they
are dangerous?
 How would you define a ”Mediterranean
diet pattern”?

39. Physiology. The health risk of obesity--better metrics imperative. Science 2013,

40. Trans fatty acids

Natural TFAs constitutes a small portion of
the human diet and mostly come from dairy
products

The intake of TFAs has increased since the
advent of fat hydrogenation (e.g. margarines)

In natural isomers the double bond is
generally at C11 (e.g. vaccenic acid), while in
technologically-produced ones it is generally
between C4 or C10

The most common TFA in partially
hydrogenated vegetable oils is the elaidic
acid (trans-18:1 n9/∆9), a trans isomer of the
oleic acid

41. The Mediterranean
dietary pattern
• One of the most cited examples of
dietary pattern, repeatedly shown to
be positively associated with a good
health
• The first evidence of the beneficial
effects of the Mediterranean diet
came years ago from the Seven
Country Study (Keys, 1980)

42. Mediterranean diet,
health and longevity
The Mediterranean diet was first considered protective
against coronary heart diseases (de Lorgeril et al., 1999)
In other studies, beneficial effects on total mortality
reduction have been discovered (Trichopoulou et al.,
2005)
Two recent literature meta-analyses showed that the
Mediterranean diet is associated with a better health
status overall (Sofi et al., 2008 & 2010)

43.  The general features of this pattern are a
high or moderately high intake of:
 cereals (that in the past were largely unrefined)
 olive oil (or in general higher unsaturated than
saturated fat intake)
 fruit, vegetables and legumes
 nuts and seeds
 fish
 alcoholic beverages, but mostly red wine,
generally during meals
And a low or moderately low intake of
 dairy products
 meat and meat products
Back to the questions
High
intakes
Low
intakes
Mediterrean diet score

44. Final considerations

45. Thank you!
Gianluca Tognon
www.gianlucatognon.com