Report of International Conference in Budapest

The International Conference on “Early nutrition programming and health outcomes in later life: obesity and beyond” attracted over 250 scientists from over 30 countries around the world. European scientists were well represented but there were also many from the US, Australia, Japan, the Middle East and Russia. The conference was a satellite of the European Congress on Obesity and so considered in particular the long term programming effects which might contribute to obesity in later life. Basic scientific research, data from epidemiological studies and clinical trial results were all presented during the programme.

Plenary sessions on a number of the broader questions in the field of early nutrition programming allowed the wider issues to be debated and explored. These proved lively and stimulating. Professor George Davey-Smith discussed the challenges facing epidemiological studies of the effects of early life on later disease. He discussed the problem of how to fully take into account confounding effects and set out various ways this could be improved, including looking to see whether the effect was seen with exposure at a critical period only or at all times (more likely to be due to confounding); whether it was also seen with paternal exposure (again, more likely to be due to confounding) or whether there was a marker of exposure that was not confounded that could be used. He also drew attention to the potential offered by Mendelian randomisation for investigating relationships between genetic variants which are not confounded by other factors and outcomes.

Professor David Leon offered a “life course” critique of the early nutrition programming hypothesis which asked why focus on fetal life only, how behavioural risk factors later in life were taken into account and how a more holistic perspective would enable a better understanding of disease risk over a lifetime. This approach integrates social and behavioural factors (the causes of causes) with biological factors. There is a paradox that  new advances in systems biology make it possible to begin to build quantitative models of disease risk pathways but social pathways are always context specific and cannot be generalised from one generation or culture to another.

Professor Alan Lucas gave a challenging and thought-provoking talk on where the evidence on the benefits of breastfeeding stood. He argued that changes in lifestyle over millennia meant that breast milk should not just be assumed to be the ideal milk for babies now but that promotion of breastfeeding should be based on sound evidence of benefit. Randomised controlled trials of breastfeeding are not ethical however and so evidence must be based on trials in pre-term infants randomised to banked breast milk or formula and trials like the PROBIT study which randomised parents to breastfeeding promotion or not. These studies have found good evidence of benefit with breast milk compared to formula milk.

The parallel symposia provided a wealth of informative and interesting talks and discussions. An excellent presentation by Professor John Mathers on epigenetics and their contribution to fetal programming explained this new and exciting area of science to those unfamiliar with it. Epigenetic markings are permanent marks on the gene which alter their expression and lead to different functions. They connect environmental exposure with gene expression and function. They can be caused by methylation of the DNA or by histone decoration. Epigenomics is the study of epigenetic markings and their consequences.

One of the highlights of the conference was the presentation of the first results from the CHOP study by Professor Berthold Koletzko. This study compared the growth rates of infants who had been fed a high protein infant formula with those who had been fed a low protein formula for their first year of life and found that those on the low protein formula had slower growth rates and by two years, a significantly lower BMI than those on the high protein formula. The low protein formula group’s BMI was closer to that of breast fed infants.

Other symposia on “early nutrition and later cardiovascular risk”, “programming of obesity and metabolic disease” and “causes of adult obesity – origins in early life” explored the role of early nutrition programming on later obesity risk in great depth. The Young Investigators’ Forum, and the abstracts and posters presented at the conference also enabled attendees to get a great look at where this area of science is headed


Professor Philip Smith closed the conference by outlining the priorities for obesity research for the National Institutes of Health in the US. Early nutrition programming and the role of epigenetics in the development of disease susceptibility were among these. How do changes to the epigenome lead to different phenotypes? How can epigenetic modifications which lead to altered gene expression be characterised , and how can systems be developed to find and identify them?

The conference took place in the stunning art nouveau Palace Hotel in the centre of Budapest where the reception and dining areas of the hotel had retained the original 1911 art nouveau styling with decorative stained glass windows and lights. The gala dinner, cruising down the Danube provided another opportunity to appreciate the fine architecture that Budapest has to offer and to discuss more of the tantalising issues of Early Nutrition Programming Project with colleagues.