Issue 003

November 2012

nutrinews
Because Healthy Babies are Happy Babies
Dear Doctor.. It is well known that feeding during the rst years of life determines later growth and development of a child. Toddlers have specic nutritional needs, and cannot be considered as small adults1 Unfortunately with the large body of evidence and guidance on the nutritional needs, requirements and feeding of infants, the toddler years have been less of a focus. That is why this month's issue focuses on key nutrients for toddlers (Iron,Vitamin D and Prebiotics)
In this Issue: Toddler Nutrition Section
Role of Vitamin D and Prebiotics in strengthening toddler immune system.............. 1 Sources of Vitamin D and Prebiotics............................. 1 Nutrition and Development ....... 2 Countdown to 2015.................... 2 Research in Toddler Nutrition.... 3 Abstracts on advances in toddler nutrition........................ 3

Vitamin D and Prebiotics support toddler immunity

A common deciency seen in toddlers, and especially those of ethnic minority including Africans, is Vitamin D. It is best known for its importance in bone mineralization, but it has a number of other functions in the body such as playing an important role in the maintenance of organ systems, regulating calcium and phosphorus levels in the blood, supporting immunity and preventing hypocalcemic tetany. It also promotes soft tissue calcication in the absence of Vitamin K, or with drugs (particularly blood thinners) that interfere with Vitamin K metabolism. Note: Darkly pigmented skin requires longer sunlight exposure than light skin to maximize vitamin D formation. it's only found in certain foods which include liver, egg yolk, oily sh, fortied cereal, milk, butter or fortied margarine though not all toddlers enjoy these foods. Exposure to the sun, especially in the morning, or in the evening, for approximately 20 minutes will also help. Despite the importance of the sun for vitamin D synthesis, it is prudent to limit exposure of skin to sunlight2. The American Academy of Dermatology advises that photoprotective measures be taken, including the use of sunscreen, whenever one is exposed to the sun3. Vitamin D's critical role in immune function was aided by the discovery of vitamin D receptors (VDRs) on the immune system's macrophage and dendritic cells in the past 15 years4. Once triggered by vitamin D, macrophage cells are capable of releasing antibacterial

peptides (parts of protein) like cathelicidin, and these antibacterial proteins play a critical role in the immune system's prevention of infection. Of special interest in this area has been infection by Mycobacterium tuberculosis (responsible for tuberculosis) and Mycobacterium leprae (responsible for leprosy). Vitamin D deciency has emerged as a clear risk factor for these diseases

Prebiotics Vitamin D

working

with

Dietary sources of Vitamin D

The challenge is to ensure the toddler gets enough vitamin D, as

Prebiotics, like Vitamin D, also play a critical role in the immune system4. They have been shown to create a bidogenic effect. Prebiotics are food for good bacteria in the gut. Once a toddler ingests prebiotics, they selectively feed the good bacteria. The good bacteria secrete acids which inhibit pathogens from thriving in the gut. Pg 1

Because Healthy Babies are Happy Babies

Bruzzese et al5, in a study, demonstrate how prebiotics prevent

intestinal and extra-intestinal infections.

Countdown to 2015
Danone has developed useful tools that can assist in the achievement of Millennium Development Goal 4. Some of them are displayed below. 1. A Breastfeeding booklet that was displayed in issue no.002 in the Breastfeeding Newsletter. 2. An infant Nutrition leaet in Amharic to educate mothers on the importance of proper infant nutrition.

The current preventive measures against infections of the intestinal or respiratory tract are based on vaccination against most frequent agents yet functional nutrition in early infancy could also contribute to the preventive measures .

Source of prebiotics
Prebiotics are found naturally in breastmilk6 and in fruits, vegetables, whole grains and legumes such as wheat, banana, beans, lentils and yorghut that play a crucial role in complementary feeding. Bebejunior as well growing-up milk for toddlers ensures that the nutritional requirements for a toddler are adequately met. It contains the right amount of iron to support brain development as well as the right protein content for growth and development. It especially contains Vitamin D and prebiotics for their key role in improving and strengthening the immune system as well as the various benets they offer to a toddler's nutritional status.

Nutritional Leaet 3. Toddler Iron booklet Danone has developed this booklet to assist in reducing the morbidity and mortality rates due to iron deciency anemia.

Breastfeeding Booklet Bebejunior

You can get access to these documents by contacting our local Medical Supervisor: Yonas Zemichael through mobile:+251911621288 Pg 2

Because Healthy Babies are Happy Babies

Further Reading
1. Nutrient intakes of children aged 1 - 2 years as a function of milk consumption, cows milk or growing-up milk. Ghisol et al.7 Results: Total energy and macronutrient intakes were similar in the two groups except protein intake of Group CM (cows milk), which was much higher than the Recommended Daily Allowance and signicantly higher than in Group GUM. A high percentage of children of Group CM had intake of linoleic acid (51 %) and -linolenic acid (84 %) below the lower limit of the Adequate Intake, and intake of Fe (59 %) vitamin C (49 %) and alimentary vitamin D (100 %) less than the Estimated Average Requirement. Signicant differences were observed in the proportions of children with a risk of dietary inadequacy between the two groups for all the mentioned nutrients (P < 0.001). In Group GUM, this imbalance was only observed for vitamin D. Intake of foods other than milk and dairy products could not account for these discrepancies. Conclusions: Consumption of CM (250 ml/d) References

entails the risk of insufciency in -linolenic acid, Fe, vitamin C and vitamin D. Use of GUM (250 ml/d) signicantly reduces the risk of insufciencies in the mentioned nutrients. 2. Vitamin D and the immune system: role in protection against bacterial infection. Bikle DD4 Summary: Both adaptive and innate immune processes are two edged: benecial and harmful. Although suppression of adaptive immunity may be benecial in a number of self-destructive diseases, such suppression may predispose to infection. Enhancement of innate immunity is clearly benecial in diseases like tuberculosis, but potentiation of pro-inammatory processes can increase tissue destruction as in bone loss in periodontal disease. The balance, however, favors adequate vitamin D nutrition in host defense against infection.

1. Koletzko B(ed.) Kinder- und Jugendmedizin, Berlin, Springer, 13th ed. 2007 2. Wolpowitz D, Gilchrest BA. The vitamin D questions: how much do you need and how should you get it? J Am Acad Dermatol 2006;54:301-17. [PubMed abstract] 3. American Academy of Dermatology. Position statement on vitamin D. November 1, 2008 4. Bikle DD et al: Vitamin D and the immune system: role in protection against bacterial infection. Curr Opin Nephrol Hypertens. 2008 Jul; 17(4):348-52 for full document 5. Bruzzese E, et al: a formula containing galacto-and fructo-oligosaccharides prevents intestinal and extra-intestinal infections: an observational study. Clin Nutr. 2009 Apr;28(2):156-61. E pub 2009 Feb 23 6. Newburd DS.Oligosaccharides in human milk and bacterial colonisation. JPediatr Gastroenterol Nutr 2000;30:62-7 7. 2.Jacques Ghisol, Marc Fantino, Dominique Turck, Genevive Potier de Courcy and Michel Vidailhet.Nutrient intakes of children aged 12 years as a function of milk consumption, cow's milk or growing-up milk. Public Health Nutrition, Available on CJO2012 doi:10.1017/S1368980012002893

Breastfeeding is best for babies and provides many benets

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DANONE BABY NUTRITION,

ENGLISH SPEAKING AFRICA, P. O. Box 1826 00621, Nairobi, Kenya. Tel: +254 20444 2143/5/6

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