Maternal Nutrition and Digestive Issues in Paediatric Age Group

On 10^th and 11^th March 2018 the FrieslandCampina Institute organised a scientific meeting in collaboration with the Obstetrical and Gynaecological Society of Malaysia (OGSM) in Kuala Lumpur (Malaysia). Various scientific experts shared scientific insights in the field of maternal nutrition and digestive issues in the paediatric age.

After the opening ceremony, Associate Professor Dr Hamid Jan Bin Jan Mohamed dived into the effects of low glycaemic index diets on gestational weight gain and diabetes in adults. Dr Hamid explained that high glycaemic index (GI) foods are absorbed quickly, which results in a feeling of emptiness within shorter time after food intake. Examples of low GI (≤55) foods are: skimmed milk, basmati rice, vegetables, lentils, pasta, wholegrain bread, while examples of high GI (≥70) foods are: white bread, jasmine rice, pumpkin and processed foods like biscuits and cakes. A randomised controlled cross-over non-blinded study performed by Kaur et al., (2015) in 11 young Chinese adults shows that a low GI breakfast and afternoon snack was capable of attenuating 24-h blood glucose profiles, minimising glycaemic excursions and reducing food intake in healthy males.

Monitoring maternal health

According to the WHO global status report on noncommunicable diseases 2010, Malaysia has the highest prevalence of obesity in the ASEAN region with close to 18% of adult females and 10% of adult males suffering from obesity. Dr Hamid shared that a high pre-pregnancy body mass index is a contributing factor to obese infants. In a pregnancy cohort study among 153 parents in Malaysia (Zalbahar et al., 2016), a significant association was found between maternal BMI and infant growth and body composition through the first 12 months of life. This association was independent of parental socio-economic status, but could be partly explained by maternal lifestyle factors such as diet and physical activity during pregnancy. Dr Hamid Jan Bin Jan Mohamed highlighted that findings from this study emphasise the importance of monitoring maternal weight status, particularly before and during pregnancy and early life of offspring among Malaysians.

Intervention

Dr Hamid was involved in Malaysian Ministry of Health. The 6-month intervention project consisted of three arms, namely a meal replacement group combined with exercise, a portion size reduction group combined with exercise and a control group. Low GI foods were provided for the meal replacement group. Results show that the meal replacement group had the greatest improvement in weight loss (-3.04 kg), BMI (-4.33 kg/m²) and waist circumference (-4.33 cm).

In terms of the benefit of a low GI diet in patients with gestational diabetes mellitus (GDM), there are studies showing that a low GI diet was associated with less frequent insulin use and lower birth weight than control diets (Viana et al., 2014). Also an intervention of low GI diet in early pregnancy is having a positive influence on gestational weight gain (McGowan et al., 2013). Furthermore, choosing low-GI foods instead of conventional or high-GI foods has a small (HbA(1c): -0.43% points) but clinically useful effect on glycaemic control in patients with diabetes (Brand-Miller and Hayne 2003). The practice of low GI in the daily diet should be encouraged among women at high risk of gestational weight gain and gestational diabetes, according to Dr Hamid Jan Bin Jan Mohamed.

Gastro-intestinal issues in infants and young children

Children can cry for many reasons, like discomfort, pain and hunger. However, when crying iswith no apparent reason, then it may be a concern and the underlying reason must be investigated. Infant colic e.g. is defined by the rule of three: crying for more than 3 hours a day, on more than 3 days per week for a minimum duration of 3 weeks. It is known that infants cry increasingly more as they grow. Medical professionals can anticipate and educate parents and explain the natural history of crying and reassure them that crying, when there is no underlying medical problem, will eventfully stop. Using the PURPLE acronym, developed by Ronald Barr, is a practical tool to inform and educate parents.

Prof. Lee Way Seah shared useful and practical information in a clinical setting on the evaluation and treatment of common gastro-intestinal (GI) issues in infancy and childhood, including infantile colic, gastro-oesophageal reflux disease (GERD), recurrent abdominal pain and constipation.

Pregnancy nutrition and childhood development

Dr Premitha shared that not all foetal outcomes are inherited from genes. There are genes and hereditary factors, whilst the environmental variables will also have an impact, including early childhood experiences and social relationships. Exogenous factors, like maternal health, placenta function, stress, maternal lifestyle and nutrition can affect the genetic expression of the DNA of the foetus. The “Foetal programming” hypothesis, published by Barker, assumes that the health of the foetus and infant – determined by the mother’s nutrition and the baby’s exposure to various factors after birth – determines the pathologies of later life. A study in England that used data of babies born during 1907-1924 (Barker et al., 1993), found an unexpected link between low birth weight and heart health during middle age. Also Dutch Famine studies, which use data from the ”Famine winter” during World War II, show that offspring born during famine, experience more medical problems (Ravellit et al., 1976; Ravelli et al., 1998) during adulthood. These data show that maternal conditions during pregnancy are a window of opportunity for health later in life. A healthy lifestyle and balanced diet are important during pregnancy. An overview of the most important nutrients before and during pregnancy and lactation is shown in the picture below.

Screening and diagnosis of gestational diabetes

Prof. Dato Zainul presented the update on screening for GDM risk factors, both in the traditional way and as a continuous process. The current method for diagnosis of GDM is a Modified Oral Glucose Tolerance Test (MOGTT). Screening and diagnosis of DM in pregnancy and treatment is effective, not only in preventing adverse maternal and perinatal health outcomes, but also in preventing diabetes in both mother and child later in life. Lastly, he also shared his view that doctors must always use their clinical judgement as a primary guide to decide whether the diabetes is well controlled or otherwise and not just rely fully on the results of clinical investigations.

Programme