How scared are we?

1. Sporadically anxious Worried sick Stockpiling food Unperturbed Paralysed with terror Mildly concerned Distinctly jumpy How scared are we? The Guardian, 13.2.2003 Moving to Finland Hanna Nohynek, 2005

2. Cow Milk Intake and Human Growth

3. Height increments in rural Malawi, LCSS 1995-2000, n = 767, Maleta et al

4. Height accumulation in rural MalawiMaleta et al., Arch Dis Child 2003

5. Prevalence of malnutritionMaleta et al., Pediatr Perinat Epid 2003 WHO, 1997

6. LCNI-3 trial, MalawiPhuka et al., submitted, n=182

9. The Boyd Orr study, ScotlandOrr, Lancet, 1928

10. The Bundi Children, New GuineaLampl et al., Ann Hum Biol, 1978 • 7-13 year old, stunted children (n = 86, mean height 114 cm, weight 20 kg) • 8 months intervention (random allocation) • Normal diet (roots and potatoes, 5440 kJ, 11 g protein / day) • Added skimmed milk powder (10 g protein / day, 5 days per week) • Added skimmed milk powder (20 g protein / day, 5 days per week)

11. Milk and growth or bone maturationLampl et al., Ann Hum Biol, 1978

12. Other studies • Alabama, 1945 • 82 kids, 1-10 / 4-15 years, 4 / 8 vs 0 dl milk / d • 1.23 cm lenght gain difference in 20 months • Paired allocation, Dreizen et al., Growth, 1950 • Britain • 520 7-8 year olds, ”disadvantaged” • randomised, 1.9 vs 0 dl / d • 0.3 cm lenght gain difference in 21.5 months (130 g weight) • Baker at al., J Epid Comm Health, 1980

13. Other studies • China • 757 girls, age 10-12 years, 3.3 vs 0 dl milk / d • 0.7 cm lenght gain difference in 24 months • Cluster randomised (6), Du et al., Br J Nutr, 2004 • A number of indeterminate or negative results from the North • In some trials, benefit if initially low HAZ • Many ecological and observational studies document an association between milk intake and height or linear growth • Possibility for confounding

15. IGF-1 and linear growth • IGF-1 is affected by GH • GH-deficient children do not grow

18. Cow milk intake and IGF-1 • Intervention studies few, 2 child studies • 12-y girls, 5.5 dl milk / d, 18 months • Minor association to IGF-1 at 18 months, p<0.05 if adjustments, energy confounder • Randomisewd, Cadogan et al., BMJ, 1997 • 24 8-y boys, 1.5 l milk vs same protein in meat, 7 days • Increased concentration of IGF-1 and IGF-1 / s-IGFBP-3 • Hoppe at al., Eur J Clin Nutr, 2004

19. Denmark, high milk protein doseHoppe at al., Eur J Clin Nutr, 2004 IGF-1 Insulin Milk Meat Milk Meat

20. Milk vs meat and bone metabolismBudek at al., Eur J Clin Nutr, 2007

21. Milk vs meat and bone metabolismBudek at al., Eur J Clin Nutr, 2007

22. Additional information • Observational study, 2.5 y kids, Denmark • Direct association between milk intake and serum IGF-1 concentration and lenght • Big effect: 2  6 dl milk intake increase vs 30% increase in IGF-1 • Hoppe at al., Am J Clin Nutr, 2004 • Some negative and positive results both from adults and children (few studies) • Vegans vs vegetarians and meat-eaters

23. Milk intake, height and serum IGF-1Hoppe et al., Am J Clin Nutr

24. ICP modelKarlberg, Stat Med, 1987

25. IC spurtXu et al., Ped Res, 2002

26. IC spurtand attained heightXu et al., Ped Res, 2002

28. Height accumulationMaleta et al., Arch Dis Child 2003

29. Bottle vs breast feeding Unicef, 1990

31. LCSS 268.1

33. 5.50 – 6.49 –month old infants in Lungwena and Malindi villages (n = appr. 1000) Interview, medical examination, growth measurements (Weight-for-height, WHM) ST-DI group (standard treatm, delayed intervention) (Maize-soy flour 71 g / day between 18 and 30 mo) Randomise into 4 groups 210 infants per group FSm group: milk-powder containing fortified spread 750 g / 2 weeks (54 g / day) between 6 and 18 mo No consent / other criteria Exclude/ refer WHM<80% or oedema Exclude+refer FSs group: soy-protein containing fortified spread 750 g / 2 weeks (54 g / day) between 6 and 18 mo Defined inclusion and exlusion criteria Signed informed consent Enroll at least 840 children LP group (control 2): Maize-soy flour 1000 g / 2 weeks (71 g / day) between 6 and 18 mo

34. The 1st International RTUF conference in Malawi, 2003

36. Three pigs from the same litter reared on different diets McCance & Widdowson, Proc Roy Soc Lond 1974

37. Nigerian Times The ultimate aim