NUTRITION

INVITED SPEAKERS

NSSA Invited Speaker - Dr Michael Müller
Michael Müller has a background in biochemistry and gene regulation. He is full professor and has the chair of Nutrition, Metabolism and Genomics in the Division of Human Nutrition at Wageningen University/The Netherlands. He is editorial board member of the European Journal of Nutrition, Molecular Cancer Therapeutics and World Journal of Gastroenterology. He is director of the Netherlands Nutrigenomics Consortium (NGI/TIFN) and board member of the Network of Excellence Nutrigenomics (European Community Kp6).

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ADSA Invited Speaker - Dr Janice Joneja
Janice is a researcher, educator, author, and clinical counsellor with thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. Dr. Joneja holds a Ph.D. in medical microbiology and immunology and is a registered dietitian (RD).

Talk Descriptions:

Dietary Management of Pediatric Food Allergy: Where are we now?

The focus of prevention and management of pediatric food allergy has changed significantly in recent years.  Whereas previously emphasis was placed on avoidance of potentially allergenic foods to prevent allergic sensitization, now exposure of the infant to foods at the optimum time to induce oral tolerance is the most important goal in feeding the potentially allergic infant.  Furthermore, judicious exposure to allergenic foods is being increasingly employed as a method of resolving existing food allergies.  Strategies to implement these procedures in food allergy practice, based on current research, are discussed.

Food Allergy and Food Intolerance: Differences in Mechanisms, Diagnosis and Dietary Management

-    The physiological mechanisms responsible for food allergy and food intolerances differ significantly: Food allergy involves a response of the immune system; food intolerances are reactions that are not immunologically-mediated and typically involve metabolic anomalies, particularly enzyme deficiencies.

-    Accurate identification of the food components responsible for adverse reactions is greatly hampered by the lack of definitive laboratory tests to identify them. Elimination and challenge is the only method available for precise identification of reactive foods.

-    Whatever the mechanism responsible for the reaction, in all cases of food sensitivity, effective management depends on avoidance of the offending food or food component; in the case of anaphylactic reactions to food, correct identification, and avoidance of the allergenic food is critical to survival.

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Dr Donald J. McNamara

Choline, the newest official member of the B vitamin family, had its Adequate Intake levels (AIs) established for the first time by the National Academy of Sciences in 1998. This recommendation is based on the fact that choline is essential for normal functioning of all cells and evidence that endogenous biosynthesis cannot fully meet optimal choline needs. Choline is an essential nutrient needed for the structural integrity and signaling functions of cell membranes; cholinergic neurotransmission; muscle function; lipid transport from liver; and as a major source of methyl groups in the diet. When deprived of dietary choline, most men and postmenopausal women developed signs of organ dysfunction (fatty liver or muscle damage). Studies have shown that choline is critical during fetal development, when it influences stem cell proliferation and apoptosis, thereby altering brain and spinal cord structure and function and influencing risk for neural tube defects and lifelong memory function.

Recent studies have shown that choline intake is related to inflammatory status. People whose diets supplied the highest average intake of choline (found in egg yolk and soybeans), and its metabolite betaine (found naturally in vegetables such as beets and spinach), have levels of inflammatory markers at least 20% lower than subjects with the lowest average intakes. Choline intake has also been shown to be inversely related to blood levels of homocysteine, a risk factor for heart disease. The latest research has shown that higher choline intakes are related to a reduced breast cancer risk.

While research has clearly shown the importance of dietary choline in health promotion and disease prevention, it has also shown that less than 10% of the population achieves the recommended Adequate Intake (AI) for choline, including only one out of ten pregnant women when choline plays a critical role in fetal brain development and reduced neural tube defect risk. The data indicate that adding an egg a day to the diet (a readily available and acceptable source of choline) improves choline intake from 1 in 10 to over half achieving recommended AI.

An unintended consequence of recommendations to limit dietary cholesterol, which have now been shown to have negligible effect on heart disease risk, is the concurrent reduction in a major source of dietary choline resulting in inadequate choline intake in the population. As countries drop dietary cholesterol recommendations there is a clear need to recommend egg intake to address these choline  inadequacy.

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Prof Barrie Margetts

I am Professor of Public Health Nutrition, in the School of Medicine, University of Southampton, UK; and visiting Professor North West University, South Africa.  I am president of the World Public Health Nutrition Association.

Talk descriptions:

Turning Policy into Action: the critical role of developing capacity in the workforce

Progress on achieving Millennium Development Goals, particularly in Sub Saharan Africa has been too slow; maternal mortality is still nearly 100 times higher in Arica than Northern Europe.  Many of the high burden countries are in Africa, and increasingly there is a double burden of overweight and underweight (together as malnutrition).  In South Africa HIV is still too high.  The Landscape Analyses conducted by WHO in a number of high burden countries shows that there are many partners and stakeholders involved in nutrition policies and programmes, but that there is little coordination of the implementation of programmes.  Decentralisation has often lead to inconsistencies between national and provincial polices and programme implementation. A lot of data are collected in high burden countries, but they are not used effectively to feedback and inform local programmes and activities about progress.  Another critical issue highlighted is the lack of capacity in nutrition at all levels, particularly among nurses and community health workers who are primarily responsible for delivering nutrition programmes.  Most countries have nutrition training but few provide training in public health nutrition; where skilled nutrition staff exist they are often located in the urban areas and are often outside government.  University training in nutrition does not map well against the needs of the workforce.

Maternal Nutrition, early child growth and risk of chronic disease in later life.

Maternal nutrition and nutrition in the first two years of life are critical to the short term survival of the child, as well as affecting longer term risk of chronic disease in later life.  Work from South Africa shows that girls that were stunted in early life are ore likely to be relatively fat, for the same BMI, when they reach puberty. This increases their risk of metabolic syndrome.

Attention is shifting from interventions during pregnancy to improve maternal and infant outcomes to interventions before pregnancy using a food based approach. This report will outline the pre-pregnancy food based intervention being undertaken in Mumbai slums.

Food Allergy and Food Intolerance: Differences in Mechanisms, Diagnosis and Dietary Management

¨     The physiological mechanisms responsible for food allergy and food intolerances differ significantly: Food allergy involves a response of the immune system; food intolerances are reactions that are not immunologically-mediated and typically involve metabolic anomalies, particularly enzyme deficiencies.

¨     Accurate identification of the food components responsible for adverse reactions is greatly hampered by the lack of definitive laboratory tests to identify them. Elimination and challenge is the only method available for precise identification of reactive foods.

¨     Whatever the mechanism responsible for the reaction, in all cases of food sensitivity, effective management depends on avoidance of the offending food or food component; in the case of anaphylactic reactions to food, correct identification, and avoidance of the allergenic food is critical to survival.