Epidemiological and experimental studies on the impact of infant nutrition on body weight and metabolism and on psychomotor and cognitive development in children of diabetic mothers

Doctoral thesis German OPEN
Rodekamp, Elke (2010)
  • Publisher: Freie Universität Berlin Universitätsbibliothek, Garystr. 39, 14195 Berlin
  • Subject: 610 Medizin und Gesundheit | 610 Medical sciences; Medicine | infant nutrition | diabetic breast milk | overweight risk | offspring of diabetic mothers | cognitive development | perinatal programming | psychomotor development
    • ddc: ddc:610

Breast feeding offers a number of short- and long-term advantages to mothers and their children. Many population-based studies have shown that, e.g., breast-fed infants are at lower risk of later overweight and associated disturbances than formula-fed infants. Furthermore, numerous studies point to an independent positive influence of breast feeding on psychomotor and cognitive development. Therefore, breast feeding could, as a measure of primary prevention, be of particular importance for offspring of diabetic mothers who are at increased risk of developing overweight and associated disturbances and often present with delayed psychomotor and cognitive development, as compared to children of healthy mothers. However, this has rarely been investigated before. Here, we carried out a two-part epidemiological study as well as a complementary experimental study to characterize consequences of ingesting breast milk from diabetic mothers.<br> In the Kaulsdorf Cohort Study (KCS), a prospective cohort study in children of diabetic mothers, we investigated consequences of ingesting diabetic breast milk (DBM) on later overweight risk and on psychomotor and cognitive development. Childhood overweight risk was increased in children who had ingested more DBM during the early neonatal period (first week of life). Univariate analysis revealed that DBM intake during the late neonatal period (second to fourth week of life) was associated with a doubled risk of overweight in childhood. Adjustment for a number of confounders did not change this effect. However, after adjustment only for the DBM volume ingested during the first neonatal week no independent effect of late neonatal DBM ingestion was observed. Early neonatal DBM ingestion had a dose-dependent positive influence on psychomotor development, but showed a dose-dependent negative impact on an important cognitive parameter, namely on reaching the developmental milestone &#x92;speaking first words&#x92;. <br> Cross-fostering normal pups to diabetic rat dams led to hypothalamic &#x92;malprogramming&#x92; in terms of an acquired neuro-endocrine disposition to hyperphagia, overweight, and diabetogenic disturbances: Despite unchanged peripheral concentrations of glucose, insulin, and leptin, offspring suckled by diabetic dams presented with an up-regulation of orexigenic neuropeptides, i.e., of those stimulating food intake and body weight gain, and with a down-regulation of anorexigenic neuropeptides, i.e., of those inhibiting food intake and body weight gain, in the hypothalamic arcuate nucleus. <br> Taken together, early neonatal ingestion of diabetic breast milk might increase later overweight risk and retard cognitive development in offspring of diabetic mothers. In the cross-fostering model, exposure to maternal diabetes during lactation through intake of diabetic breast milk led to profound structural and functional alterations in hypothalamic nuclei which are decisively involved in the lifelong regulation of food intake, body weight, and metabolism. Further studies on possible positive and negative consequences of infant nutrition with &#x92;diabetic breast milk&#x92; are urgently needed. In general, breast feeding with its long-lasting consequences might be an important paradigm of &#x92;perinatal programming&#x92; of health and disease.
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