I lipidi nella alimentazione del bambino

Carlo AgostoniClinica Pediatrica, Ospedale San Paolo

Università degli Studi di Milano

! I lipidi del latte materno: composizione e significato

- acidi grassi- colesterolo

! Quando la dieta prudente?

ACIDI GRASSI NEL LATTE MATERNO

GRASSI nel latte maternoGRASSI nel latte materno

Grassi % 1g 1m 3m 6m 9m 12m

Saturi 38 39 38 43 42 41Monoinsaturi 45 47 46 42 42 41Polinsaturi 16 13 14 14 15 16

Marangoni F, Agostoni C et al, BJN 2000;84:103

Acidi grassi saturiAcidi grassi saturi

Grassi % 1g 1m 3m 6m 9m 12m

Miristico (14C) 4 5 5 8 9 8Palmitico (16C) 25 25 25 25 24 24Stearico (18C) 7 7 7 8 8 8

Marangoni F, Agostoni C et al, BJN 2000;84:103

Trigliceridi nel latte maternoTrigliceridi nel latte materno

Trigliceride Area %12:0-16:0-16:0 14.616:0-16:0-18:1 11.918:2-18:2-16:0 8.818:0-18:0-18:1 7.318:2-16:0-12:0 6.1

adattato da Dotson et al, Lipids 1992;278:933

Grassi totali

Linoleico

Alfa-linolenico

Arachidonico

Docosaesaenoico

Acidi grassi polinsaturi

Structural differences between BF (+ DHA) e FF (- DHA)in infants dead for cot death

The mean weight percentage of docosahexaenoic acid was significantly greater (p < 0.02) in 5 breast-milk-fed infants (9.7%)than in 5 age-comparable formula-milk-fed infants (7.6%).

Farquharson et al, Lancet 1992; 340:810

Breast-fed infants had a greater proportion of DHA in their erythrocytes and brain cortex relative to those fed formula (P < 0.005) but differences were not observed in retina. Cortex DHA increased in breast-fed (but not formula-fed) infants with age (r2 = 0.72, P < 0.01, n = 15), largely an effect of length of feeding (r2 = 0.62, P < 0.01, n = 35). There was an association between age at death and erythrocyte DHAwith cortex DHA (r2 = 0.50, P < 0.01).

Makrides et al, Am J Clin Nutr 1994;60:189

LCPUFA nelle formule LCPUFA nelle formule

! Effetti positivi o no-effetti a breve termine (mai effetti negativi)

! Segnalazioni di effetti positivi sullo sviluppo a medio termine (18 ms � 4-5 anni)

! Mai riportate associazioni negative con crescita e morbidità

LCPUFA / DHA nel divezzamentoLCPUFA / DHA nel divezzamento

! Differenze di apporto di LCPUFA sono associate ad affetti funzionali anche durante il divezzamento

! L�apporto �efficace� varia tra 100 e 130 mg DHA/die (10-15 mg/kg)

! Gli effetti visivi sembrano associati ai livelli di DHA circolanti, anche indipendentemente dalla supplementazione

LC-PUFA supply: short-term effects from trials in the complementary feeding period

Complementaryfeedingperiod

enriched formulas or eggs in previously

breastfed infants

LC-PUFA in PKU infants

through a specific product

• Visual acuity at 12 months:no direct effects,

visual acuity associated with DHA status

irrespective of the type of diet

• Visual acuity at 12 months:

positive effects from 3 studies

Principali fonti di DHA nel primo anno:possibile ruolo del DHA nel corso del �periodo finestra�

0

200

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600

800

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0 1 2 3 4 5 6 7 8 9 10 11 12tempo (mesi)

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TRATTAMENTO

LATTE MATERNO

TUORLOPESCE

FORMULA ADATTATA

PERIODO FINESTRA:

" aumentano le richieste di DHA

" diminuisce l�apporto di DHA con la dieta

COLESTEROLO NEL LATTE MATERNO

< 1 year

1-16 yrs

>16 yrs

mono vs poly, role of LCP

QUANDO LA DIETA PRUDENTE?

Prudent diet : who, when

Low-fat diet #at a population level: not before 2-3 years of age in target/individual groups: early start (> 6 mos)?

Prevention of obesity#at a population level: from the early type of feeding

Low fat diet > 2Low fat diet > 2--3 yrs of age: why3 yrs of age: why

! The fat content of the diet is an important determinant of the energy density.

! The fat content of diet should be above, and not below, 25% of energy intake.

! A higher level might be necessary if the appetite is poor or if the infant has recurrent infections

ESPGHAN CoN, 2007

PRUDENT DIET # LOW FAT-DIET

in target/individual groups: early start (> 6 mos)?

BACKGROUND: The rate of coronary heart disease (CHD) mortality in eastern Finland has been the highest in the world. The official mortality statistics suggest, however, that is has declined by 60% during the past 20 years.CONCLUSIONS: The decline in CHD mortality rate in Finland appears to be the result of a successful combination of primary and secondary prevention measures and improvements in acute coronary care.

Salomaa V et al Circulation 1996;94:3130-7

-

+1%

-4%

Nuovo concetto di Nuovo concetto di ��dieta prudentedieta prudente��## prevenzione della sindrome metabolicaprevenzione della sindrome metabolica

! Dall�allattamento al seno����! ����..alla prima colazione

prevenendo periodi di rapida accelerazione della crescita

A role for breakfast!

Krause�s Food, Nutrition & Diet Therapy,10th Ed, 2000

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Carlo Agostoni, MDAssociate ProfessorDept. of PediatricsSan Paolo Hospital8 Via A di Rudinì20142 MilanoItalyPhone +39 02 89158665Fax +39 02 89126846mobile phone: +39 348 5807859e-mail: carlo.agostoni@unimi.it, agostoc@tin.it