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.