ashorn 08/2007 how scared are we? moving to finland stockpiling food paralysed with terror worried...
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Ashorn 08/2007
How scared are we?
Moving to Finland
Stockpilingfood
Paralysedwith terror
Worried sick
Distinctly jumpy
Sporadicallyanxious
Mildlyconcerned
Unperturbed
The Guardian, 13.2.2003
Hanna Nohynek, 2005
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Cow Milk Intake and Human Growth
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Height increments in rural Malawi, LCSS 1995-2000, n = 767, Maleta et al
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
0 3 6 9 12 15 18 21 24 27 30 33 36
Age (months)
Me
an
inc
rem
en
t / m
on
th (
cm
) Lungwena
WHO
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Height accumulation in rural MalawiMaleta et al., Arch Dis Child 2003
40
50
60
70
80
90
100
110
0 3 6 9 12 15 18 21 24 27 30 33 36
Age (months)
He
igh
t (c
m)
LungwenaWHO
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Prevalence of malnutritionMaleta et al., Pediatr Perinat Epid 2003
PREVALENCE
0
10
20
30
40
50
0 3 6 9 12 15 18 21 24 27 30 33 36
Age (months)
Pre
vale
nce
%
WAZ <-2.0WAZ <-3.0WAZ <-4.0
0
20
40
60
80
100
0 3 6 9 12 15 18 21 24 27 30 33 36
Age (months)
Pre
vale
nce
%
HAZ <-2.0HAZ <-3.0HAZ <-4.0
0.0
2.0
4.0
6.0
8.0
0 3 6 9 12 15 18 21 24 27 30 33 36
Age (months)
Pre
vale
nce
%
WHZ <-2.0WHZ <-3.0
WHO, 1997
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LCNI-3 trial, MalawiPhuka et al., submitted, n=182
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The Boyd Orr study, ScotlandOrr, Lancet, 1928
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7-13 year old, stunted children (n = 86, mean height 114 cm, weight 20 kg)
8 months intervention (random allocation)– Normal diet (roots and potatoes, 5440 kJ, 11 g
protein / day)– Added skimmed milk powder (10 g protein / day, 5
days per week)– Added skimmed milk powder (20 g protein / day, 5
days per week)
The Bundi Children, New GuineaLampl et al., Ann Hum Biol, 1978
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Milk and growth or bone maturationLampl et al., Ann Hum Biol, 1978
Height increment
00,5
11,5
22,5
33,5
4
Control Milk 10 g Milk 20 g
Incr
emen
t (c
m)
Weight increment
0
0,5
1
1,5
2
2,5
3
3,5
Control Milk 10 g Milk 20 g
Incr
emen
t (k
g)
Bone maturity increment
0
5
10
15
20
25
30
Control Milk 10 g Milk 20 g
Incr
emen
t
HAZ change
-1,5
-1
-0,5
0
0,5
1
Control Milk 10 g Milk 20 g
HA
Z c
han
ge
(Z s
core
un
its)
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Other studies Alabama, 1945
– 82 kids, 1-10 / 4-15 years, 4 / 8 vs 0 dl milk / d– 1.23 cm lenght gain difference in 20 months– Paired allocation, Dreizen et al., Growth, 1950
Britain– 520 7-8 year olds, ”disadvantaged”– randomised, 1.9 vs 0 dl / d– 0.3 cm lenght gain difference in 21.5 months
(130 g weight)– Baker at al., J Epid Comm Health, 1980
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Other studies China
– 757 girls, age 10-12 years, 3.3 vs 0 dl milk / d– 0.7 cm lenght gain difference in 24 months– Cluster randomised (6), Du et al., Br J Nutr, 2004
A number of indeterminate or negative results from the North– In some trials, benefit if initially low HAZ
Many ecological and observational studies document an association between milk intake and height or linear growth– Possibility for confounding
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IGF-1 and linear growth
IGF-1 is affected by GH GH-deficient children do not grow
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Cow milk intake and IGF-1
Intervention studies few, 2 child studies 12-y girls, 5.5 dl milk / d, 18 months
– Minor association to IGF-1 at 18 months, p<0.05 if adjustments, energy confounder
– Randomisewd, Cadogan et al., BMJ, 1997 24 8-y boys, 1.5 l milk vs same protein in
meat, 7 days– Increased concentration of IGF-1 and IGF-1 / s-
IGFBP-3– Hoppe at al., Eur J Clin Nutr, 2004
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Denmark, high milk protein doseHoppe at al., Eur J Clin Nutr, 2004
IGF-1 Insulin
Milk MilkMeat Meat
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Milk vs meat and bone metabolismBudek at al., Eur J Clin Nutr, 2007
Energy intake
7,5
8
8,5
9
9,5
10
10,5
Milk Meat
MJ
/ d
ay
Start
End
Protein intake
0
20
40
60
80
100
120
140
Milk Meat
g /
day
Start
End
Calcium intake
0
0,5
1
1,5
2
2,5
3
3,5
Milk Meat
g /
day
Start
End
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Milk vs meat and bone metabolismBudek at al., Eur J Clin Nutr, 2007
S-ostecocalcin concentration
0
10
20
30
40
50
60
Milk Meat
ng
/ m
l
Start
End
S-bone specific AFOS concentration
120
125
130
135
140
145
Milk Meat
U /
l
Start
End
S-CTX (type I collagen) concentration
0
0,5
1
1,5
2
2,5
Milk Meat
ng
/ m
l
Start
End
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Additional information
Observational study, 2.5 y kids, Denmark– Direct association between milk intake and serum
IGF-1 concentration and lenght– Big effect: 2 6 dl milk intake increase vs 30%
increase in IGF-1– Hoppe at al., Am J Clin Nutr, 2004
Some negative and positive results both from adults and children (few studies)
Vegans vs vegetarians and meat-eaters
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Milk intake, height and serum IGF-1
Hoppe et al., Am J Clin Nutr
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ICP modelKarlberg, Stat Med, 1987
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IC spurtXu et al., Ped Res, 2002
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IC spurtand attained
heightXu et al., Ped Res, 2002
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Height accumulationMaleta et al., Arch Dis Child 2003
40
50
60
70
80
90
100
110
0 3 6 9 12 15 18 21 24 27 30 33 36
Age (months)
He
igh
t (c
m)
LungwenaWHO
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Bottle vs breast feeding
Unicef, 1990
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LCSS 268.1
3579
11
1315171921
0 6 12 18 24 30 36 42 48 54 60Age (months)
Wei
gh
t (k
g)
40
50
60
70
80
90
100
110
0 6 12 18 24 30 36 42 48 54 60Age (months)
Hei
gh
t (c
m)
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Randomiseinto 4 groups
210 infants per group
5.50 – 6.49 –month old infants in Lungwena and Malindi villages (n = appr. 1000)
Interview, medical examination, growth measurements (Weight-for-height, WHM)
No consent / other criteria
Exclude/ refer
WHM<80% oroedema
Exclude+refer
Defined inclusion and exlusion criteriaSigned informed consent
Enroll at least 840 childrenLP group (control 2): Maize-soy flour
1000 g / 2 weeks (71 g / day) between 6 and 18 mo
FSm group: milk-powder containing fortified spread750 g / 2 weeks (54 g / day) between 6 and 18 mo
FSs group: soy-protein containing fortified spread750 g / 2 weeks (54 g / day) between 6 and 18 mo
ST-DI group (standard treatm, delayed intervention) (Maize-soy flour 71 g / day between 18 and 30 mo)
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The 1st International RTUF conference in Malawi, 2003
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Three pigs from the same litter reared on different diets
McCance & Widdowson, Proc Roy Soc Lond 1974
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The ultimate aim
Nigerian Times