As mammals, breastfeeding has always been fundamental practice for survival and development. Through years the value of this practice changed a lot following cultural values and society development. During stone age, breastfeeding was the only optional. No breastfeeding at that period was equal to death (1). For Egyptians and Hebrews, children were considered a “divine gift”. Hebrews and Egyptians sought wet nurses to guarantee the survival of children separated from their mothers (2). When wet nurses were not available cow milk was given (1). Walking from Hippocrate to Soranus and Galenus arriving to Avicenna a concept was developed: “characteristics of the nursing mother influence the health of the baby”. Avicenna for the first time said that breastfed is the most appropriate food for growth and development (1). Aristotle was the first that discussed milk properties and he underlined that the healthiest milk for children is the one with the lowest quantity of curds (1). In term of solid food introduction Hippocrates was quite specific. He indicated that solid food should be introduced as soon as children cut their first teeth, while Soranus suggested for weaning the period around 18–24 months and Galen even 3 years (1).
During the 17th and the 18th century two concepts were quite clear, the role of colostrum in the prevention of gastrointestinal infection and high survival rate of children breastfed versus children fed by animal milk (3), and to hire wet nurses became a common practice. During the Industrial Revolution, families moved to cities and due to monetary power, no wet nurses were available and breastfeeding decrease once again. Mothers had no time to breastfeed and the use of animal milk increased with subsequent increasing level of malnutrition and alternative foods were introduced even within the first week with tragic results and almost 100% mortality (4). Several alternatives were proposed, firstly diluted animal milk also with sugar and cream addiction, and condensed milk was discovered. In 1867 the first commercial infant formula from J. Von Liebig was developed with flour, malt and potassium bicarbonate mixed with pre-heated milk and in 1874 the first artificial formula milk for feeding infants was developed by Nestlè (5). Although the very high price of this new formula made it inaccessibly for the majority of population. The prevalence of breastfeeding reached its low point in 1972, only 22% of newborn infant in USA were breastfeed (6), then the rate gradually increase, 34% in 1975 and 59.7% in 1985. Actually due to the baby Friendly Hopsital Initiative launched by WHO and UNICEF in 1991 a support for breast feeding is strong and in a long run (6).
It is quite clear how fundamental is human milk and breastfeeding per se. Specifically, human milk has immunological and nutritional properties and it is considered the best available option which guarantees an adequate growth and an optimal development of a child. Differences in term of mediators and hormones have been shown between infants who were breastfed and ones who were not. A key point is represented by unmeasurable environmental and psycho-affective factors. So, it may be simplistic to consider human milk only as a nutrient; since it encompasses much more (7).
Complimentary foods are necessary for both nutritional and developmental reasons, and are important stages in the transition from milk feeding to family foods (8). The complimentary feeding period is one of rapid growth and development when infants are susceptible to nutrient deficiencies and excess, and during which there are marked changes in the diet with exposure to new foods, tastes, and feeding experiences (8).
Timing of introduction is crucial and is fundamental related to physiological and neurological maturation and four to six months of age is the optimal window to introduce complimentary feeding (9). Renal and gastrointestinal functions are sufficiently mature to metabolize complimentary food in this specific period of time (9). An early introduction of solid food (< 4 months of age) may result in an increase in childhood Body Mass Index (BMI) (10), while iron status of healthy infants could be altered by an earlier introduction of complimentary foods leading to alteration of infant iron stores (11). Among other issues, it is crucial to establish preferences of fruit and vegetables when infants are “learning to eat” (8). Fruit and vegetables are important sources of a wide range of vital micronutrients, and increased consumption of these foods can reduce the risks of a number of chronic diseases, including cardiovascular diseases (10, 12).
Complementary foods must embrace all food categories with an emphasis on vegetables and fruits. Daily variety, diversity in a meal, and repeated exposure up to eight times are efficient strategies to increase acceptance to foods not initially accepted (9, 13). Promoting healthy foods as part of usual meals during complementary feeding is important, as eating habits learned in childhood are likely to continue through life (9). There is no need to add sugar or salt to foods and sugar sweetened beverages. According with Faith et al, fruit juice intake was positively related with adiposity gain (14). Parental use of food as a reward leads to children’s diminished ability to regulate intake, which then leads to increased emotional over eating (15). A high-protein intake in early childhood may increase the levels of insulin-releasing amino acids with may stimulate insulin and insulin-like growth factor secretion that could be related to obesity risk later in life (16). Also fundamental is an adequate fat intake. Early life stages can be seen as critical periods for fat cell development and adipose tissue growth in humans, thus the intake of adequate fat-containing essential fatty acids should be promoted (9, 17). We need to keep in mind that fat confer a greater energy density to the food for which, for equal volume ingested, the amount of available energy is greater (17). Also the lipid component of the diet is more quickly converted and stored in the form of body fat, with a minimum conversion energy cost compared to proteins or carbohydrates.
We could conclude that we need to know whether there are optimum times during the life span when experience promotes healthy food consumption for a healthy life, and conversely, when deprivation of such foods has the greatest consequences on health for generation to come (18).
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- Eckhardt KW, Hendershot GE. Analysis of the reversal in breast feeding trends in the early 1970s. Public Health Rep 1984, 99:410–15.
- Pecoraro L, Agostoni C, Pepaj O, Pietrobelli A. Behind human milk and breastfeeding: not only food. Int J Food Sci Nutr. 2018, 69(6):641–646.
- Fewtrell M, Bonsky J, Campoy C, et al. Complementary feeding. A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition ESPGHAN) Committee on Nutrition. JPGN 2017, 64:119–132.
- Pietrobelli A, Agosti M; MeNu Group. Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. Int J Environ Res Public Health. 2017, 14(12).
- Pearce J. Taylor MA, Langley-Evans SC. Timing of the introduction of complimentary feeding and risk od childhood obesity: a systematic review. Int J Obes 2013, 37:477–85.
- Quasem W, Fenton T, Friel J. Age of introduction of first complimentary feeding for infants: a systematic review. BMC Pediatr 2015, 15:107.
- Canani RB, Costanzo MD, Leone L, Bedogni G, Brambilla P, Cianfarani S, Nobili V, Pietrobelli A, Agostoni C. Epigenetic mechanisms elicited by nutrition in early life. Nutr Res Rev. 2011, 24(2):198–205.
- Johnson CM, Henderson MS, Tripicchio G, Rozin P, Heo M, Pietrobelli A, Berkowitz RI, Keller KL, Faith MS Observed parent-child feeding dynamics in relation to child body mass index and adiposity. Pediatr Obes. 2018, 13(4):222–231.
- Faith MS, Dennison BA, Edmunds LS, Stratton HH. Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction. Pediatrics. 2006, 118(5):2066–75.
- Faith MS, Rose E, Matz PE, Pietrobelli A, Epstein LH. Co-twin control designs for testing behavioral economic theories of child nutrition: methodological note. Int J Obes 2006, 30(10):1501–5.
- Luque V, Closa-Monasterolo R, Escribano J, Ferrè N. Early programming by protein intake: the effect of protein on adiposity development and the growth and functionality of vital organs. Nutr Metab Insights 2015, 8:49–56.
- Rudolph MC, Young BE, Lemas DJ, Palmer CE, Hernandez TL, Barbour LA, Friedman JE, Krebs NF, MacLean PS. Early infant adipose deposition is positively associated with the n‑6 to n‑3 fatty acid ratio in human milk independent of maternal BMI. Int J Obes 2017, 41(4):510–517.
- Larquè E, Labayen I, Flodmark C‑E, Lissau I, Czernin S, Moreno LA, Pietrobelli a, Widhalm K. From conception to infancy – early risk factors for childhood obesity. Nature Rev Endocrinol 2019, 15(8):456–478.
Thomas Zoller1, Maria Clemente1, Luca Pecoraro1, Angelo Pietrobelli1,2
1Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, Verona University Medical School, Verona, Italy
2Pennington Biomedical Research Center, Baton Rouge, LA, USA.
Prof. Angelo Pietrobelli, MD, Pediatric Unit, Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, P.le A. Stefani, 1, 37139 Verona, Italy; E‑mail: email@example.com
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