Shaking Old Paradigms:  Future Opportunities for the Development of Food Products that Promote Health in Children

Deborah O’Connor PhD RDProfessor, University of Toronto

Senior Associate Scientist, The Hospital for Sick Children

Considerations in Evaluating the Opportunities in Children

1. What are the most pressing health issues?2. Can a new food product, or adaptation of an

existing product, help address this issue?3. Is it feasible to develop this product?4. Translation of idea from bench to widespread

use.

What I Heard From the “Community”: Top 5 Calls

1. Weight Control: Programs, sample menus, “magic foods”

2. Picky Eaters: What can I put in this kid’s lunch?

3. Vitamin and Mineral Supplements4. Management of Food Allergy and Food

Sensitivities5. Are “Organic” Foods Better?

Weight Management in Children: Magnitude of the Problem in Canada

Janssen I. Can J Diabetes 37:90-96, 2013

Eating Habits of Canadian Children and Youth

Average Daily Calorie ConsumptionAge (yrs)

1972Avg Kcal

2004Avg Kcal

200495% CI

5-11 2,300 2,041 2,005-2,076

Males: 12-19

3,251 2,806 2,736-2,877

Females:12-19

2,243 2,047 2,002-2,092

% of Kcal by Food Group

Garriguet D. Health Reports 18(2):17-32, 2007.

Eating Habits of Canadian Children and Youth

Garriguet D. Health Reports 18(2):17-32, 2007.

% Below Recommended # Servings Vegetables and Fruit

% Below Recommended # ServingsMilk Products

Foods and Drinks Accounting for Most Calories from “Other Foods” (4 yrs +)

Garriguet D. Health Reports 18(2):17-32, 2007.

Food/Drink % Kcal from “Other Foods”

Soft drinks 11.3

Salad dressing 9.4

Sugars, syrups, preserves 8.7

Beer 8.2

Fruit drinks 6.1

Vegetable oil, animal fat, shortening

5.8

Margarine 5.3

Chocolate bars 4.8

Potato chips 4.7

Butter 3.9

Snacks% of Kcal from Between Meal Consumption

Age (yrs)

% Kcal

4-8 27

Males: 9-13

26

Females:9-13

26

Males:14-18

30

Females:14-18

28

% Distribution of Kcal from Between Meal Consumption, by Food Group (4 years +)

Garriguet D. Health Reports 18(2):17-32, 2007.

What I Heard From the “Community”: Top 5 Calls

1. Weight Control: Programs, sample menus, “magic foods”

2. Picky Eaters: What can I put in this kid’s lunch?

3. Vitamin and Mineral Supplements4. Management of Food Allergy and Food

Intolerance5. Are “Organic” Foods Better?

The Picky Eater

1. 25-35% of toddlers and preschoolers described as picky eaters.

2. Most grow appropriately but are at higher risk of being underweight.

3. Frequently cited as a cause of conflict in the family.

4. Canadian Pediatric Association states no role for specialty formulas. Suggests a vitamin or mineral supplements if diet is questionable.

5. CPS and others recommend small portions be provided and meals and snacks be of high nutrient density. No juice at snack-time.

6. Lunches a source of much parental concern—in a recent Canadian study home lunches were of lower quality than those purchased at school. Leung AKC et al. Paediatr Child Health 17(8): 455-457, 2012; Dubois L et

al. International J Behavioral Nutrition Physical Activity 4:9, 2007; Taylor JP eta al Public Health Nutr 15(12):2259-2264, 2012.

What I Heard From the “Community”: Top 5 Calls

1. Weight Control: Programs, sample menus, “magic foods”

2. Picky Eaters: What can I put in this kid’s lunch?

3. Vitamin and Mineral Supplements4. Management of Food Allergy and Food

Sensitivities5. Are “Organic” Foods Better?

Vitamins and/or Minerals Supplements

Shakur YA et al. J Nutr 142(3):534-540, 2012

Group Any Vitamin or Mineral

Multivitamin/Mineral

VitaminA

Vitamin C

VitaminD

Children

1-3 38 35 35 36 35

4-8 45 42 41 44 41

9-13 33 25 24 31 24

Adolescents14-18

Males 23 15 14 21 15

Females 29 17 16 24 17

Minerals Supplements

Shakur YA et al. J Nutr 142(3):534-540, 2012

Group Multivitamin/Mineral

Calcium Phosphorus Magnesium Iron Zinc

Children

1-3 38 21 16 2 20 2

4-8 45 28 21 3 24 2

9-13 33 16 12 4 15 3

Adolescents14-18

Males 23 14 10 9 11 8

Females 29 15 8 11 14 9

Prevalence of Nutrient Inadequacy

Children 1-13 years• Use of supplements reduced prevalence of

inadequacy of vitamin D (1-3), calcium (4-13 years).

Youth 14-18• Use of supplements reduced prevalence of

inadequacy of vitamin D and calcium (females only).

Shakur YA et al. J Nutr 142(3):534-540, 2012

What I Heard From the “Community”: Top 5 Calls

1. Weight Control: Programs, sample menus, “magic foods”

2. Picky Eaters: What can I put in this kid’s lunch?

3. Vitamin and Mineral Supplements4. Management of Food Allergy and Food

Sensitivities5. Are “Organic” Foods Better?

Management of Food Allergy and Other Food Sensitivities

1. Allergy most common in infants and young children (6-8% in children <3 years of age)

2. Frequently associated with atopic dermatitis, asthma

3. Most common allergies are to: milk, egg and nuts

4. Non-celiac Gluten Sensitivity

Management of Food Allergy and Other Food Sensitivities

Where Novel Food Products Could Help Families

1. Nutrient Dense Food in snack-sized portions—low kcal, low sodium, no trans fat.

2. Foods that address the milk product and vegetable and fruit gap—excellent sources of fibre.

3. Targeted supplementation—multivitamin supplements don’t make a lot of sense for most healthy children.

4. Movement away from beverages (formulas, energy-drinks), sugary products targeted for children and movement toward “whole foods” that are convenient for parents and kids want to eat.

5. Availability of food products for those with food allergies and other food sensitivities—clearly labeled.

Food Products Designed for Feeding Sick and Vulnerable Infants Children and Youth

1. Number of children that could potentially use a product fewer than number of adult patients who could benefit from a comparable product.

2. However, …the impact of the product on health is tremendous…often life-saving.

– Metabolic formulas (available)– Engineering human milk for clinical indications (work in

progress)– Probiotics (work in progress) – Novel lipid-based approaches for the treatment of intestinal-

failure associated liver disease

3. Issues of “powders” in the hospital environment.

An Exclusive Human Milk Diet for Very Low Birth Weight Infants

Necrotizing EnterocolitisSymptoms may include:poor feeding tolerance delayed gastric emptying abdominal distension emesis bloody stoolsAdvanced cases may show fluid in the peritoneal

cavity, peritonitis, or shock.

Is There An Advantage of an Exclusive Human Milk Diet for NEC Prevention?

• Infants fed mothers’ own milk randomized to:

1. HM1002. HM40

3. BOV

*Sullivan et al Journal of Pediatrics 2010;156:562-7.

Pasteurized donor milk + “human” milk fortifier

Preterm formula + “bovine” milk fortifier

Is There An Advantage of an Exclusive Human Milk Diet for NEC Prevention?

• Mothers’ own milk comprised ~ 70% of feedings

• > 50% in NEC • Reduction in surgical NEC

*Sullivan et al Journal of Pediatrics 2010;156:562-7.

Probiotics

Probiotics for the Prevention of NEC: Mortality Outcome

*AlFaleh K et al. Evid.-Based Child Health 7:6:1807-1854, 2012

Novel Lipid-Based Approaches to Pediatric Intestinal Failure-

Associated Liver Disease

Novel Lipid-Based Approaches to Pediatric Intestinal Failure-Associated Liver Disease (IFALD)

Clinical Experience with Novel Therapies in Children with IFALD

• Dramatic reductions in the number of children:– With hyperbilirubinemia– Requiring transplant– Significant reduction of

morbidity

*Diamond IR et al. Arch Pediatr Adolesc Med 166(5):473-478, 2012

Fatty Acid Intralipid Omegaven

%fatty acids

Palmitic 10 2.5-10

Stearic 3.5 0.5-2.0

Oleic 26 6-13

Linoleic 50 1-7

a-linolenic 9 <2

ARA 0 1-4

EPA 0 12.8-28.2

DHA 0 14.4-30.9

N-6/n-3 5.5/1 1/6.8

Conclusions

1. Many health issues with children that could be impacted by availability of new and adapted food products.

2. In terms of which products to develop for children when?

- Need to consider size of target population- Potential magnitude of the effect on health outcome- Feasibility in terms of product development, cost etc

Strategy to Promote Longer-term Health Needs Goes Beyond Patching up a Poor Diet

folate

Vitamin C

iron

calciumvitamin A

Omega-3 fatty acid