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Professor Stewart Forsyth

Nutritional Health Inequalities in children: Do they matter?. Professor Stewart Forsyth. Ninewells Hospital and Medical School Dundee, Scotland. Health Inequalities. “ Birth, Poverty and Wealth” . Titmus R 1943 National newspapers “Poor folks’ babies stand less chance”

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Professor Stewart Forsyth

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  1. Nutritional Health Inequalities in children: Do they matter? Professor Stewart Forsyth Ninewells Hospital and Medical SchoolDundee, Scotland

  2. Health Inequalities • “Birth, Poverty and Wealth”. Titmus R 1943 • National newspapers • “Poor folks’ babies stand less chance” • “Babies beware of poor parents”

  3. Cardiovascular Health and Social Class -Trends from Childhood to Adulthood EE/Kg Social Class (Poulton, 2002)

  4. Cardiovascular Health and Social Class - Trends from Childhood to Adulthood EE/Kg Social Class (Poulton, 2002)

  5. Association between children’s experienceof socio-economic disadvantage and adult health • Children who grow up in socially deprived families have poorer cardiovascular health in adulthood • Upward mobility does not mitigate or reverse the adverse effects of childhood socio-economic deprivation on adult health Poulton (2002)

  6. Possible mechanisms • Is it a consequence of social class related differences in parenting practices • Infant Feeding Practice

  7. Breastfeeding at 6-8 weeks by Council Area - 2006

  8. DUNDEE INFANT FEEDING STUDY A prospective observational study1984 - present BMJ 1990; 1993; 1998

  9. Duration of Breast Feeding by Social Class Weeks Social Class of Father

  10. Gastrointestinal Illness (GI) in First Year of Life by Social Class No of GI Illnesses per Infant Social Class of Father

  11. Gastrointestinal Illness by Type of Milk Feed No of GI Illnesses per infant Type of Milk Feed

  12. Research Questions • To what extent does infant feeding practice directly influence childhood health indicators across the social spectrum? • Is breast feeding associated with a reduction in health inequalities during childhood?

  13. Characteristics of Social Class Groups

  14. Childhood Health Indicators • Birth – 12 Months • Gastrointestinal illness • Ear infections • Respiratory illness • Age 7 Years • Blood pressure • Body composition

  15. Effect of Breast Feeding on GI Illness by Social Class GI Illnesses per Infant Type of Milk Feed

  16. Ear Infections in First Year of Life by Social Class No of Ear Infections per Infant Social Class of Father

  17. Effect of Breast Feeding on Ear Infections by Social Class Ear infections per Infant Type of Milk Feed

  18. Respiratory Illnesses (RI) in First Year of Life by Social Class No of RI Illnesses per Infant Social Class of Father

  19. Effect of Breast Feeding on Respiratory Infections by Social Class Respiratory infections per Infant Type of Milk Feed

  20. Birth – 12 months • Across each of the social class categories, breast feeding significantly reduces gastrointestinal, ear and respiratory illness • Breast fed children from lower socioeconomic groups had better outcomes than formula fed children from more affluent families

  21. Effect of Breast Feeding on Blood Pressure at age 7 yrs by Social Class Type of Milk Feed

  22. Effect of Breast Feeding on Blood Pressure at age 7 yrs by Social Class Diastolic BP Type of Milk Feed

  23. Percentage body fat - Skinfolds

  24. Introduction of Solid Feeding by Social Class Weeks Social Class of Father

  25. Relation of Solid Feeding to Body Fat at 7 Years and Social Class Body Fat % Timing of Introduction of Solid Foods

  26. Patterns of body fat during childhood Modified from Rolland-Cachera et al, 1984

  27. At Age 7 Years • Breast feeding is associated with lower blood pressure across the social categories • Delayed solid feeding is associated with lower body fat across the social categories.

  28. Daily intake of long chain n-3 fatty acids and LBW, prematurity and IUGR Quantile LBW Preterm IUGR 0 7.1 7.1 8.2 1 3.1 4.1 8.8 2 3.2 3.8 7.2 3 1.8 2.4 5.1 4 2.5 3.5 6.4 5 2.1 2.9 5.3 p <0.001 0.01 0.001 Olsen and Secher, 2002Indices: Percentages

  29. n - 3 fatty acid content and relative DHA concentration of common marine foods n-3 content DHA concentration (g/kg wet weight) (% fatty acid) Mackerel 40 11 Herring 20 4.3 Sardines 20 10 Salmon 12 11 Cod liver 100 9.5 (Olsen et al 1995; Kinsella et al 1990)

  30. Maternal DHA, Oily Fish Intake and Social Class (12-14 weeks gestation) DHA Social Class

  31. Postpartum Depression - Seafood Consumption Predicts Lower Prevalence Rates South Africa (24.5%) 25 Brazil (24.1%) r = - 0.81 p <0.0005 22.5 Germany (20.0%) U. Arab Emirates (18.0%) 20 Australia (18.6%) New Zealand (17.4%) 17.5 Italy (15.0%) 15 Netherlands (14.0%) UK (14.4%) Postpartum depression (EPSD) point prevalence (%) Spain (13.6%) Canada (12.7%) Israel (12.4%) 12.5 Ireland (11.0%) France (11.0%) USA (11.5%) 10 Switzerland (10.2%) Sweden (9.0%) 7.5 Hong Kong (5.5%) Chile (5.5%) 5 Malaysia (3.0%) 2.5 Japan (2.0%) Singapore (0.5%) 0 0 20 40 60 80 100 120 140 160 Apparent Seafood Consumption( lbs/person/year) Hibbeln JR, unpublished, 4/2000

  32. Prevalence of Children with Low Verbal IQ at age 8 years and Mother’s Omega-3 Fatty Acid from Seafood Hibbeln et al, Lancet 2007

  33. Blood pressure (SD) of 6 year old children randomised to a formula in infancy with or without LCPUFA supplement n Systolic Diastolic LCPUFA 65 92.4 57.3 (8.0) (8.3) No LCPUFA 70 94.8 61.0 (9.7) (9.0) Indices: mmHg p<0.01 Forsyth et al, BMJ 2003

  34. Blood pressure (SD) of 6 year old children who were breast fed in infancy or randomised to formula with or without LCPUFA supplement n Systolic Diastolic Breast 79 92.5 57.9 (9.8) (8.1) LCPUFA 65 92.4 57.3 (8.0) (8.3) No LCPUFA 70 94.8 62.0 (9.7) (9.0) Indices: mmHg Forsyth et al, BMJ 2003

  35. Nutrition-Related Health InequalitiesWindows of Opportunity 0 -9 MONTHS PRENATAL 0 – 9 MONTHS POSTNATAL

  36. Inequalities in Health “We have concluded that early childhood is the period of life at which intervention could most hopefully weaken the continuing association between health and class.” The Black Report 1980

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