Glycogen is the primary energy source available to the fetus when hatching; however, upon completion of the hatching process, the poult has greatly decreased its glycogen stores (John et al., 1987; John et al., 1988) thereby increasing the need for nutrients. Earlynutrition is also important for the development of the gastrointestinal tract and the enzymes associated with digestion (Uni, 1998). The first wk post-hatch is also a time of major organ growth and development in the poult (Lilburn, 1998). An improvement in the development of the gastrointestinal tract and organ growth will allow for a more efficient uptake of nutrients to be used for muscle development. Noy and Sklan (1999a) found that poults offered nutrients immediately following hatch in a variety of forms exhibited a higher body weight and breast meat yield at market age. Also poults fed immediately post-hatch show a higher level of satellite cell mitotic activity in vitro compared to feed deprived animals (Halevy et al., 2003).
With growing evidence of an increase in the prevalence, food allergy has been emerged as a new public health problem. As treat- ment and management of food allergy remain challenging, more attention has been paid to the importance of prevention of food allergy. Although the exact mechanism of recent epidemic is not fully understood, it is suggested that nutritional exposure in early life may play an important role in food allergy development. The underlying hypothesis is that nutritional status or food exposure in the critical period of fetal development can affect the programming of immune system and modify the risk of immunologic re- actions to foods in postnatal life. We review accumulating epidemiological studies to examine an association between nutritional exposure during pregnancy or early infancy and food allergy development in children. We also discuss recent advances in the studies of the genetic and epigenetic regulation of food allergy and evaluate the role of earlynutrition in food allergy development to provide a new perspective on the prevention of food allergy.
The effect of infantile nutritional levels on adipose tissue cellularity and metabolism was studied in two groups of Sprague-Dawley rats. Caloric intake was varied during the suckling period by manipulating litter size immediately after birth; however, all animals had free access to food after weaning. The epididymal fat pads of animals raised in small litters were heavier than those of their paired siblings raised in large litters. Initially, the differences in pad weight were accounted for primarily by differences in total cell number; however, at 20 wk both cell number and cell size contributed equally. The rate of glucose incorporation into CO 2 and triglyceride during in vitro incubations was the same for both groups if expressed on a per cell basis; therefore total tissue incorporation was greater in animals with more cells. The results support the hypothesis that early nutritional experiences can effect permanent changes in the cell number and size of the epididymal fat depot and that total cell number is important in the total metabolism of this organ. These findings and the fact that extreme human obesity is accompanied by similar alterations in cellularity and
feeding neonatal rat pups on artificially high carbohy- drate milk formula during their suckling period. These pups as adults develop obesity and hyperinsulinemia. It is, thus, feasible that high carbohydrate early in life could have permanent sequelae on growth and glucose regulation. Moreover, it is noteworthy that rodent protein-deficient diets have elevated carbohydrate to maintain isocaloric feeds and, therefore, the effect of a low-protein diet may indeed be to establish a high- carbohydrate diet. 41
Important insights into the role of snRNAs in the programming of metabolic diseases have recently emerged from studies addressing the impact of paternal nutrition. A suboptimal dietary regime in the father, modifies the snRNA profile in mature sperm of humans and mice, making snRNAs excellent candidates for trans-generational epigenetic inheritance of metabolic traits. Mechanisms of inheritance through the paternal line can be studied in absence of the in utero confounding effects. Only recently, an exciting series of papers have proposed that in mice alterations in the sperm miRNA [117-119]*, tRNA fragments [120, 121] and piRNA  profile can induce metabolic and behavioural perturbations in the progeny. Sperm of mice fed a western diet showed an altered piRNAs profile **. Also, bariatric surgery in obese individuals modified the abundance of miRNAs, piRNAs and tRNA fragments in the sperm **, suggesting that diet and metabolic state can interfere with progeny metabolic health through paternally inherited RNA-based mechanisms, and that these mechanisms are likely to be conserved in humans. MiRNA injection in naïve zygotes was able to initiate in the offspring metabolic alterations similar to a high fat diet-induced phenotype , whereas transfer of tRNA fragments isolated from mature sperm into 2-cell embryos induced severe glucose intolerance in 7-week old mice **. Whether maternal diet could modify snRNA expression in the oocyte is unknown. MiRNA function seems to be globally suppressed in the murine female germline ; however, components of the piRNA-pathway have been shown to be active in the bovine, macaque, and human ovaries, as well as in the early embryo . The oocyte contribution to the epigenetic transmission of metabolic diseases is still unexplored and perhaps difficult to assess directly in presence of other modalities of inheritance through the female germline (e.g. mitochondria). Oocytes of obese mice display oxidative stress-induced defects in mitochondrial function, as well as altered methylation levels , which may contribute to the programming of altered metabolic phenotypes post-natally . Recent work suggests that in mice the insulin resistant phenotype is mainly acquired through the maternal line *, but the underlying epigenetic mechanisms are not known.
Our choice of instruments could be subject to further criticisms (Glewwe and Miguel 2008). While the exogeneity of our instruments is clear, at least for the price data, price and household level shocks could conceivably have per- sistent effects on cognitive achievement other than through nutrition through a direct effect on household cognitive investments. In particular, a shock or increases in food prices in one period could crowd out expenditure in edu- cational items in the next period through a reduction in savings or if the household had to sell assets as a result of the event. If this were indeed the case, our instrumentation strategy would be invalid, because our instru- ments would be correlated with unobserved cognitive investments; our IV GMM estimates would merely be quantifying the effect of such a reduction in investments rather than the nutrition effect. However, it should be noted that our core IV GMM sibling-difference model is robust to certain types of persistence. Indeed, if a shock has not only an immediate effect on household nutritional investments but also a permanent effect on household cognitive investments, the within-sibling specification would partly capture this phe- nomenon. That is, to the extent that a shock is permanent, both siblings should be similarly affected by the reduced household wealth –this would be the case for shocks affecting the index child’s critical period, but not that of the sibling (given that we have already measured the index child’s cognitive development at an earlier period).
The decreased age to market of modern-day commercial broiler chicken has increased the importance of nutrition during the early pre and post-hatch period. Currently, little consideration is given to the composition of the breeder hen dietary fat composition and what effect it may have on reproduction or the immune or inflamma- tory response in progeny birds. The chick embryo relies on nutrients deposited by the hen in the egg for sustaining over one-third its life. Early exposure to lipids and essen- tial n-3 or n-6 fatty acid through hatching egg can influence cell membrane fatty acids, the production of in- flammatory mediators and antioxidant status. Lipids act both directly (e.g., by replacing arachidonic acid vs. EPA as an eicosanoid substrate) and indirectly (e.g. , by altering eicosanoid generation, expression of inflammatory pro- teins/genes) and are summarized in Table 3 . It is be- coming increasingly clear that early exposure to lipids and essential fatty acids has metabolic effects due to provision of energy during embryonic growth. The influence of in ovo fatty acid exposure may extend through the entire production phase for broilers. Therefore, feeding the em- bryo or “early diet manipulation” offers a powerful and holistic tool to promote the health of hatchlings in a nat- ural way. The information derived through in ovo feeding will expand our knowledge of earlynutrition, and can lead to dietary strategies that will ameliorate hatchability loss, culls and early chick mortality. Furthermore, considering the uniqueness of hen and the fertile egg where embryo develops outside the host, properly designed experiments in hens fed well-controlled diets can facilitate new and in- novative comparative nutrition research, expanding our knowledge of maternal diet and earlynutrition in other non avian systems.
hildren are the nation‟s most important resource. They hold the potential and set the limits of future development of any country. Children in the earliest years of their lives are of critical importance both to their immediate wellbeing and to their future (UNICEF, 2011). Preschool children constitute 20 per cent of the Indian population. This is a huge human resource which needs to be developed and nurtured for the country to progress. The young children to develop into responsible citizens with correct attitudes towards food and hygienic practices, nutrition and health education (NHE) should be started as early as possible. Nutrition and health education in the formative years of preschool age will help to inculcate correct habits and will aid in instilling right beliefs (Ramesh and Saroj 2003). Research evidence suggests that children are not born with the innate ability to choose a nutritious diet; instead their food habits are learned through experience and education. Basic knowledge of food and normal eating is learned in childhood (Birch, 1999). The nutrition education of preschoolers requires the involvement of the young child‟s primary role models: parents, caregivers andteachers. Socioeconomic status and cultural traditions strongly influence eating habits and therefore health, nutrition status and disease rates (Birch, 1984). Earlynutrition education
Cornell University, Ithaca, NY INTRODUCTION
Discussing the topic of calves and calf management over the last 40 years traditionally involved dry cow management, colostrum, scours, rumen development and early weaning. In the last ten years, the concept of “intensified feeding or accelerated growth” has become a focus of discussion and during that time the concept has been applied to research programs and on farm in various ways. Much of this discussion involves differences in perspectives about how to best manage the nutrition and nutrient intake of the pre-weaned calf. There are teleological arguments for providing a greater supply of nutrients from milk or milk replacer, e.g. what would the dam provide, and there are also arguments for improving the welfare status of the animals by following the same concept (Jasper and Weary, 2002; de Paula Vieira et al., 2008). At the 15 th American Dairy Science Association Discover Conference on Calves (Roanoke, VA) the overwhelming consensus of the participants was that we need to feed calves for a specific rate of daily gain, much higher than the traditional industry standards, and that is a significant change in industry perspective.
Although the analyses of the 305d first lactation milk yield resulted in identifying pre- weaning ADG as a factor affecting first lactation milk yield, another approach was to use the TDM lactation milk yield to evaluate the response. The use of the TDM analyses should be a less biased solution for milk yield. Accordingly, the TDM lactation yields were analyzed by regressing the residuals on pre-weaning ADG and for every kg of ADG pre-weaning, heifers produced 850 kg more milk during their first lactation (P < 0.01) (Table 2.4). To ensure there was no bias in the response due to some genetic component, the milk response identified by the TDM was analyzed with the sire, dam and individual predicted transmitting ability for milk and the relationships were non-significant, implying the increase in milk yield was environmental in nature and equally affected individuals of high and low genetic merit. Since this appears to be an environmental response, calves and cattle on each farm could have different milk yield responses due to nutrition, housing, and other environmental factors. Therefore, analyzing animals on individual farms should demonstrate similar relationships if the effect is consistent, but the magnitude of the response might be different.
Shorter telomeres have been associated with long-term health issues, such as poor lung function, risk of cancer, cog- nitive decline and poor metabolic health [11, 12, 38–40]. Children who have been treated in intensive care suffer from a substantial long-term legacy of that critical illness, charac- terised by a physical and neurocognitive developmental im- pairment, as documented 4–7 years after PICU admission [3, 41]. The shorter telomeres upon PICU admission could suggest that part of this long-term legacy is explained by their risk profile upon admission. However, as the duration of PICU stay and the use of early PN were found to be associated with further telomere shortening, one could hypothesise that the stress of the illness and/or the treat- ments in PICU could add to the long-term legacy. Cur- rently, involvement of accelerated telomere attrition in that long-term legacy has not been investigated. However, the telomere shortening effect of an extended PICU stay and of early PN administration could in theory consume part of the “telomeric reserve” of these children, which could make them prone to chronic conditions such as asthma, recurrent and/or chronic viral infections and neurocognitive impair- ment [11, 39, 42]. Hence, identifying measures to attenuate telomere shortening in PICU could potentially bring about important long-term benefit to the children. As our study suggests an iatrogenic telomere shortening effect of early PN and thus potential long-term harm, while the PEPaNIC study has shown lack of short-term benefit with an actual increased risk of new infection and delayed recovery with early PN , this may further support withholding of early PN in critically ill children. However, the results of an on- going, extensive medical and neurocognitive long-term follow up of the PEPaNIC study cohort are awaited, which will allow investigation of the actual clinical relevance of the observed telomere shortening with longer PICU stays and with the use of early PN, as a biomarker or a mediator of susceptibility to long-term adverse outcomes after paediatric critical illnesses.
In addition to the beneficial effects of enteral nutrition, the ingredients of the nutrients may have beneficial effects too. There are many studies in- vestigating nutrients that include glutamine, argi- nine, probiotic bacteria and fatty acids. In the pres- ent study one group of rats was fed with Impact. Impact is rich in glutamine, which is essential for
We undertook a full economic analysis to assess the cost implications of providing early parenteral nutrition to adult critically ill patients with short-term relative contraindica- tions to early enteral nutrition. Measures of clinical outcomes and health care resource consumption were obtained from a multicenter clinical trial (the Early PN Trial). Costs of care and costs of providing early parenteral nutrition were obtained from the published literature. Large-scale Monte Carlo simulation of a stochastic cost model revealed the pro- vision of early parenteral nutrition might reduce the overall cost of care by US$3,150 per patient (95% CI US$1,314 to US$4,990). These findings were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early parenteral nutrition, including the sensitivity analysis conducted using European cost data.
Seven observational studies (one prospective cohort study, three retrospective cohort studies and four case series) were identified; two studies compared EEN (dif- ferent definitions) vs delayed EN and reported higher rate of early abdominal closure, less fistula formation and lower incidence of ventilator-associated pneumonia in the “early” EN group (Supplement 5, Table 17). The larg- est study comparing EN to no EN in patients with open abdomen after abdominal trauma reported independent associations between EN and ultimate fascial closure and decreased mortality rate in patients without bowel injury, but no difference in a subgroup of patients with bowel injury [ 47 ].
socioemotional development were less clear, primarily due to the small number of studies and differences in the measurement of socioemotional development across differing ages. At least 3 mechanisms may link early stunting to development during early to middle childhood: (1) biological insults that disrupt early brain development, (2) delayed motor skills that may disrupt the exploration associated with cognitive development, and (3) reduced expectations from parents and peers, based on short stature. The long-term consequences of stunting extend beyond childhood into adulthood and include lower height, less schooling, and reduced economic productivity. 14, 15 Studies
ing early EN were obtained from the published literature. A meta-analysis demonstrated that provision of early EN significantly improved patient survival, and a large-scale Monte Carlo simulation of a stochastic cost model revealed early EN significantly reduced the overall costs of care by US$14,462 per patient (95% CI US$5,464 to US$23,699). These findings were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early EN, including the sensitivity analysis conducted using European cost data. The worst-case scenario, assuming a zero effect on ICU stay and duration of mechanical ventila- tion, demonstrated the costs of saving one additional life by providing early EN to all eligible patients were substantially lower than the arbitrary, accepted threshold of $50,000 per additional life-years saved. 23
longitudinal data for children from Zimbabwe, Alderman, Hoddinott, and Kinsey (2002) use civil war and drought periods that affected growth in children below three years to identify the effect of early childhood malnutrition on schooling in a maternal fixed effect model. This identification strategy is based on findings that income shocks, such as drought and flood, in credit constrained circumstances, change consumption, which affects child growth (Hoddinott and Kinsey 2001; Foster 1995). Glewwe, Jacoby, and King (2001) take a similar approach to sibling estimation, using longitudinal data of Filipino children, but their identification strategy uses a rather strong assumption on height changes among older and younger siblings. Alderman et al. (2000) use price data, interacted with parents’ education and child gender, as instruments for child height growth in Pakistan.
Methods/Design: The Pediatric Early versus Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC) study is an investigator-initiated, international, multicenter, randomized controlled trial (RCT) in three tertiary referral pediatric intensive care units (PICUs) in three countries on two continents. This study compares early versus late initiation of PN when EN fails to reach preset caloric targets in critically ill children. In the early-PN (control, standard of care) group, PN comprising glucose, lipids and amino acids is administered within the first days to reach the caloric target. In the late-PN (intervention) group, PN completing EN is only initiated beyond PICU-day 7, when EN fails. For both study groups, an early EN protocol is applied and micronutrients are administered intravenously. The primary assessor-blinded outcome measures are the incidence of new infections during PICU-stay and the duration of intensive care dependency. The sample size (n = 1,440, 720 per arm) was determined in order to detect a 5% absolute reduction in PICU infections, with at least 80% 1-tailed power (70% 2-tailed) and an alpha error rate of 5%. Based on the actual incidence of new PICU infections in the control group, the required sample size was confirmed at the time of an a priori- planned interim-analysis focusing on the incidence of new infections in the control group only.
The driving force behind the choice of intervention is whether there is sufficient evidence that the intervention is efficacious and feasible in achieving our goals regardless of whether it is nutrition specific or nutrition sensitive. In particular, CIFF will not invest significant resources in fighting obesity, or in nutritional interventions unrelated to growth (e.g. vitamin A, iodine, etc.)