CHALLENGES IN CHILDHOOD NUTRITION
Wan-Yee, Teo
Department of Paediatric Medicine
KK Women’s & Children’s Hospital
In this 21st century, nutrition has become a major component of child health. While many developing countries in Africa and Asia are struggling with malnutrition, childhood nutrition in Singapore and other developed countries has taken on a new facet.
With advances in obstetric and neonatal intensive care, our population of Very Low Birthweight (VLBW) infants is expanding. Nutrition in VLBW infants will play an important role in the “origin” of adult diseases in future years. Overfeeding and obesity is not uncommon in the ex-premies. Cumulative nutritional deficit during early life signals the need for early postnatal catch-up growth. Excessive postnatal growth puts these infants at high risk for adult diseases such as early onset type 2 diabetes and obesity. It is important to follow-up this group of children and titrate our current nutritional recommendations accordingly. An obese child is in fact in a state of malnutrition. A VLBW infant who requires energy and protein for catch up postnatal growth…a stunted child who is overweight with increased blood pressure, diabetes and other problems of obesity such as obstructive sleep apnoea…a mother with low pregnancy weight gain…delivering a baby with low birth weight and the cycle continues…
The problem we will face in the 21st century will be the double burden of malnutrition-obese and stunted mother with a malnourished baby…likewise this will be the problem faced by many other developed countries around the world.
In our local context, a recent study done in our neonatal unit at KKH reviewing the nutritional profile of VLBW infants following introduction of VLBW Nutrition Pathway showed an improved in weight gain in these infants with new feeding policies.*
The general direction of infant nutrition in the future will be to improve the nutrient intake and growth in VLBW infants and to encourage the use of EBM (expressed breast milk) to VLBW infants as it has been shown that the outcome on weight and neurodevelopment (IQ) are better with the use of EBM. Undernutrition during the critical window of the first few weeks of life has important neurodevelopmental sequelae. Long chain polyunsaturated fatty acids play an important role in visual and cognitive development in VLBW infants. VLBW infants with extrauterine growth restriction are at higher risk of later postnatal growth failure and its long term consequences. Some studies have postulated a link between decrease in breastfeeding with the increase incidence of allergic conditions in childhood.
Nutrition bears economic costs because nutrition impacts on cognitive neurodevelopment.
Psychosocial stimulation works hand-in-hand with nutrition to optimize a child’s growth. It has been reported that children who receive psychosocial stimulation grows better, another way of looking at this is that children who are emotionally or socially neglected can have failure to thrive. Provision of psychosocial stimulation follows from our country’s political stability, family stability and being war-free.
*Nutritional Profile of Very Low Birth Weight Infants with New Feeding Policies.
Presented as a poster at 2nd Congress of Asian Society of Paediatric Research, Yokohama, December 8-10 2006
Acknowledgements
I would like to thank Prof Chay OM, Prof Phua KB and Dr VS Rajadurai for their valuable comments.
