Obesity
LETTER TO THE EDITOR
Playing with Food: The Fetal Programming of Food Preferences Patrıcia Pelufo Silveira TO THE EDITOR: While investigating the long-term impact of intrauterine growth restriction (IUGR) among a contemporary cohort of over 500 U.S. children, Crume et al. described the important finding that, despite a healthy childhood BMI and no differences in growth trajectory beyond 12 months of age, IUGR children have increased central adiposity and early indicators of insulin resistance when compared to those not exposed (1), providing further evidence to the fetal programming hypothesis.
tive influences. However, the finding of an association between fetal adversity and the programming of food preferences is of great interest, when it is well-established that poor fetal growth is associated with an increased risk for type II diabetes, cardiovascular diseases, and metabolic syndrome in adulthood. The chronic, persistent alteration in food preferences in individuals exposed to fetal adversity possibly contributes to the development of these diseases, what could be seen as another facet of the well-known “thrifty phenotype” described by Barker and Hales in 1992, the “thrifty eating.”
However, their manuscript also demonstrates that while total daily calories did not differ between the groups, IUGR children reported a higher average percent energy intake from fat compared to the unexposed. This finding is nicely in agreement with an emerging body of evidence showing that IUGR is associated with the development of a specific feeding behavior and preferences through the life-course (2-5). In other words, IUGR children do not simply and rationally choose what to eat, but their decisions about feeding seem to be influenced by neurobiological processes set during fetal life (2).
And what can be done? Identifying vulnerable populations in infancy may be an important action. Pediatricians should be careful enough to consider the children’s prenatal history when evaluating their growth patterns and their deviances. In addition, researchers show that the sensory environment in which the fetus lives changes as a function of the food choices of the mother as dietary flavors are transmitted and flavor the amniotic fluid. Similarly, breast milk contains molecules derived from the mother’s diet. Therefore, the pregnant/nursing woman’s diet may also be involved in the programming of the offspring’s feeding behavior, and early (even prenatal) counseling about healthy food choices and exercising should be highly reinforced, using a family-based approach.
Food preferences and dietary behaviors are established during childhood, being the result of a complex mixture of genetic, environmental, psychosocial, cultural, and cogni-
However, it remains to be proven that these interventions are effective in altering the children’s eating behavior and choices, and protect their health in the long-term. The
www.obesityjournal.org
scientific evidence supporting these propositions justifies investments in prevention research and programs to support families and communities in nurturing healthy children, which will have the potential to offer future healthier fetal environments to the next generations. C 2014 The Obesity Society V
References 1. Crume TL, Scherzinger A, Stamm E, McDuffie R, Bischoff KJ, Hamman RF, Dabelea D. The long-term impact of intrauterine growth restriction in a diverse US cohort of children: The EPOCH study. Obesity (Silver Spring) 2014;22:608–615. 2. Ayres C, Agranonik M, Portella AK, Filion F, Johnston CC, Silveira PP. Intrauterine growth restriction and the fetal programming of the hedonic response to sweet taste in newborn infants. Int J Pediatr 2012;2012:657379. 3. Silveira PP, Agranonik M, Faras H, Portella AK, Meaney MJ, Levitan RD. Maternal Adversity, Vulnerability and Neurodevelopment Study Team. Preliminary evidence for an impulsivity-based thrifty eating phenotype. Pediatr Res 2012;71: 293-298. 4. Barbieri MA, Portella AK, Silveira PP, Bettiol H, Agranonik M, Silva AA, et al. Severe intrauterine growth restriction is associated with higher spontaneous carbohydrate intake in young women. Pediatr Res 2009;65:215-220. 5. Per€al€a MM, M€annist€ o S, Kaartinen NE, Kajantie E, Osmond C, Barker DJ, et al. Body size at birth is associated with food and nutrient intake in adulthood. PLoS One 2012;7:e46139.
Faculdade de Medicina, Universidade Federal do Rio Grande do Sul,Ramiro Barcelos, 2350, Largo Eduardo Zaccaro, Faraco 90035-903,Porto Alegre,Rio Grande do Sul, Brazil. Correspondence: Patrıcia Silveira ([email protected]) doi: 10.1002/oby.20729
Obesity | VOLUME 00 | NUMBER 00 | MONTH 2014
1
LETTER TO THE EDITOR
Playing with Food: The Fetal Programming of Food Preferences Patrıcia Pelufo Silveira TO THE EDITOR: While investigating the long-term impact of intrauterine growth restriction (IUGR) among a contemporary cohort of over 500 U.S. children, Crume et al. described the important finding that, despite a healthy childhood BMI and no differences in growth trajectory beyond 12 months of age, IUGR children have increased central adiposity and early indicators of insulin resistance when compared to those not exposed (1), providing further evidence to the fetal programming hypothesis.
tive influences. However, the finding of an association between fetal adversity and the programming of food preferences is of great interest, when it is well-established that poor fetal growth is associated with an increased risk for type II diabetes, cardiovascular diseases, and metabolic syndrome in adulthood. The chronic, persistent alteration in food preferences in individuals exposed to fetal adversity possibly contributes to the development of these diseases, what could be seen as another facet of the well-known “thrifty phenotype” described by Barker and Hales in 1992, the “thrifty eating.”
However, their manuscript also demonstrates that while total daily calories did not differ between the groups, IUGR children reported a higher average percent energy intake from fat compared to the unexposed. This finding is nicely in agreement with an emerging body of evidence showing that IUGR is associated with the development of a specific feeding behavior and preferences through the life-course (2-5). In other words, IUGR children do not simply and rationally choose what to eat, but their decisions about feeding seem to be influenced by neurobiological processes set during fetal life (2).
And what can be done? Identifying vulnerable populations in infancy may be an important action. Pediatricians should be careful enough to consider the children’s prenatal history when evaluating their growth patterns and their deviances. In addition, researchers show that the sensory environment in which the fetus lives changes as a function of the food choices of the mother as dietary flavors are transmitted and flavor the amniotic fluid. Similarly, breast milk contains molecules derived from the mother’s diet. Therefore, the pregnant/nursing woman’s diet may also be involved in the programming of the offspring’s feeding behavior, and early (even prenatal) counseling about healthy food choices and exercising should be highly reinforced, using a family-based approach.
Food preferences and dietary behaviors are established during childhood, being the result of a complex mixture of genetic, environmental, psychosocial, cultural, and cogni-
However, it remains to be proven that these interventions are effective in altering the children’s eating behavior and choices, and protect their health in the long-term. The
www.obesityjournal.org
scientific evidence supporting these propositions justifies investments in prevention research and programs to support families and communities in nurturing healthy children, which will have the potential to offer future healthier fetal environments to the next generations. C 2014 The Obesity Society V
References 1. Crume TL, Scherzinger A, Stamm E, McDuffie R, Bischoff KJ, Hamman RF, Dabelea D. The long-term impact of intrauterine growth restriction in a diverse US cohort of children: The EPOCH study. Obesity (Silver Spring) 2014;22:608–615. 2. Ayres C, Agranonik M, Portella AK, Filion F, Johnston CC, Silveira PP. Intrauterine growth restriction and the fetal programming of the hedonic response to sweet taste in newborn infants. Int J Pediatr 2012;2012:657379. 3. Silveira PP, Agranonik M, Faras H, Portella AK, Meaney MJ, Levitan RD. Maternal Adversity, Vulnerability and Neurodevelopment Study Team. Preliminary evidence for an impulsivity-based thrifty eating phenotype. Pediatr Res 2012;71: 293-298. 4. Barbieri MA, Portella AK, Silveira PP, Bettiol H, Agranonik M, Silva AA, et al. Severe intrauterine growth restriction is associated with higher spontaneous carbohydrate intake in young women. Pediatr Res 2009;65:215-220. 5. Per€al€a MM, M€annist€ o S, Kaartinen NE, Kajantie E, Osmond C, Barker DJ, et al. Body size at birth is associated with food and nutrient intake in adulthood. PLoS One 2012;7:e46139.
Faculdade de Medicina, Universidade Federal do Rio Grande do Sul,Ramiro Barcelos, 2350, Largo Eduardo Zaccaro, Faraco 90035-903,Porto Alegre,Rio Grande do Sul, Brazil. Correspondence: Patrıcia Silveira ([email protected]) doi: 10.1002/oby.20729
Obesity | VOLUME 00 | NUMBER 00 | MONTH 2014
1
