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QUALE LATTE PER IL TUO BAMBINO . Carlo Agostoni Dipartimento di Scienze Cliniche e di Comunità IRCCS Policlinico Cà Granda Università degli Studi di Milano. Il latte nel divezzamento (e oltre) Quale latte?. Latte materno Formule Latte vaccino. LATTE MATERNO 

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quale latte per il tuo bambino

QUALE LATTE PER IL TUO BAMBINO 

Carlo Agostoni

Dipartimento di Scienze

Cliniche e di Comunità

IRCCS Policlinico CàGranda

Università degli Studi di Milano

il latte nel divezzamento e oltre quale latte
Il latte nel divezzamento (e oltre)Quale latte?
  • Latte materno
  • Formule
  • Latte vaccino
slide3

LATTE MATERNO 

24 mesi e anche oltre se la mamma o il bambino lo desiderano

WHO

igf i at 9 months and number of breastfeedings skot cohort
IGF-I at 9 Months and Number of Breastfeedings SKOT Cohort

In all infants recorded different daily intakes of cow’s milk, infant formula and meat

P=0.0006

n=88

n=46

n=3

n=115

Madsen AL, et al. Growth Hormone IGF Res. 2011;21:199-204.

fasting insulin at 9 months and number of breastfeedings skot cohort
Fasting Insulin at 9 Months and Number of BreastfeedingsSKOT Cohort

P=0.0015

n=88

n=46

n=3

n=115

Madsen AL, et al. Diabet Med. 2010;27:1350-1357.

slide6

Allattamento al seno e prevalenza di sovrappeso e obesità in 9357 bambini di età compresa tra 5 e 6 anni (Von Kries R et al, BMJ 1999; 319:147)

sovrappeso : BMI> 90o percentile per età e sesso

obesità: BMI>97o percentile per età e sesso

slide7
Breastfeeding and prevalence of overweight° in over 15000 adolescents aged 9-14 years. (adapted from Gillmann et al, JAMA 2001:285:2461-67)

°Overweight was BMI>95th percentile for age and sex

slide9

Life expectancy at birth in EU member states has increased by over 6 years between 1980 and 2010. On average across the European Union, life expectancy at birth for the three-year period 2008-10 was 75.3 years for men and 81.7 years for women.

Most European countries have reduced tobacco consumption via public awareness campaigns, advertising bans and increased taxation

Alcohol consumption has also fallen in many European countries.

In the European Union, 52% of the adult population is now overweight and 17% is obese. The obesity rate has doubled since 1990 in many European countries. Obesity tends to be more common among disadvantaged social groups, and especially women

il latte materno
Il latte materno

1.   Basso apporto proteico (< 1 g / 100 ml; latte vaccino 3.5 g/100 ml, formule non meno di 1.2-1.4 g/100 ml)

2. Ottimale rapporto energia/proteine

3. Presenza di numerosi fattori anti-infettivi

3. Grassi e carboidrati con valore funzionale (LCPUFA, oligosaccaridi)

formule quali
Formule : quali
  • Formule standard

fino a 6 o 12 mesi

  • Formule di seguito 

tra 6 e 12 mesi

  • Formule di crescita 

2 e 3 anni

elementi chiave delle formule
Elementi chiave delle formule
  • Proteine (quantità e qualità)
  • Grassi (quantità e qualità  acido linolenico, acido docosaesaenoico)
  • Qualità carboidrati (digeribili/non digeribili)
  • Minerali e micronutrienti (ferro, zinco, calcio, Vitamina D), altri composti “funzionali”
is cows milk harmful for a child s health

Is Cows' Milk Harmful for a Child's Health ?

Key-notelecture - NUTRITION

Carlo Agostoni

Fondazione IRCCS CàGranda

Ospedale Maggiore Policlinico

Universityof Milan, Italy

CHAIR PERSON: Dominique Turck, Lille, France

conclusions cow s milk harmful
Conclusions: Cow’s Milk harmful?
  • Negative effects on iron status up to 9-12 months, then no negative effects if adequately complemented with iron enriched foods
  • Lactose intolerance  easily managed
  • Allergy to WCM proteins may be transient. Atopics may independently be at risk of poor growth
  • A cause-effect relationship with T1D is not established, and the same for ASDs
  • Cow’s milk stimulates IGF-1 and may affect linear growth , but associations with non-communicable diseases is still not convincing
conclusions cow s milk safety
Conclusions: Cow’s Milk Safety
  • From 12 months of life onwards
  • Up to around 500 mL per day
  • 250 mL in lactose intolerants
  • Fat-reduced milks after 24-36 months on individual basis
reports of nutrient intakes in european countries in the 8 24 mos period
Reports of nutrient intakes in European Countries in the 8-24 mos period

Country age(mos) Pg/kg P % Lip% Cho%

Spain 9 4.4 15.7 26.4 58

France 10 4.3 15.6 27.1 57

Italy 12 5.1 19.5 30.5 50

Denmark 12-36 3.3 15 28 57

Rolland-Cachera et al. Acta Paed 1999; 88:365

protein obesity association
Protein/obesity association

Author Prot% Age Observation: P

(obesity, BMI)

Rolland-Cachera 1995 >14.8 2 yrs 8 yrs <0.05

Int J Obes Rel Dis 19:573

Scaglioni 2000 22 1yr 5 yrs <0.05

Int J Obes Rel Dis 24:777

Dorosty 2000 14 18ms Adiposity Rebound NS

Pediatrics 105: 1115

Hoppe 2004 13,F, 14,M 9ms 10yrs NS

Am J Clin Nutr 79:494

Scaglioni 2004 14 1y 8yrs NS

Acta Paediatrica 93:1596

larn 2012 proteine ar e pri
LARN 2012- PROTEINE AR e PRI

Anni kg AR g/d PRI g/d En%*

0.5-0.99 8.6 9 11 --

1-3 13.7 11 14 4M, 3.7F

4-6 20.6 16 19 4.1M, 4.3F

7-10 31.4 25 31 5M, 5.4F

11-14M 49.7 39 48 5.7M

11-14F 50.7 39 48 6.5F

15-17M 66.6 50 62 6.25M

15-17F 55.7 40 50 6.3F

*En%  calcolata come AR (fabbisogno medio) proteine vs

mediana (kcal/die) fabbisogno energetico per LAF

come ridurre le proteine
Come ridurre le proteine ?
  • Latte vaccino 500 mL (o equivalente)  circa 3.5 g/dL 18 g proteine  72 kcal
  • Latte “formula”  1.5 g dL  circa 7.5 g proteine  30 kcal
  • In una dieta giornaliera intorno a 1000 kcal il bambino (con 500 mL di prodotto) passerebbe da circa 45 g proteine (180 kcal, 18% energia) a circa 35 grammi proteine (140 kcal, 14% energia)
influence of protein intake on metabolic endocrine response in infants
Influence of Protein Intake on Metabolic-endocrine Response in Infants

Socha P, et al. Am J Clin Nutr. 2011.

slide27

Energy and nutrientcontent per 100 ml ofdifferent milk basedproducts

foryoungchildren (modifiedfromNutritionCommittee, Germany, 2011)

slide28

Changingproteinrequirements in relation todifferentenergyintakes: example in youngadults

2.9%

Nutrient:energyratiorequirementdependsupon the activitylevelof the individuals in a population

5.3%

6.9%

slide31

LARN

1120

1382

mediana

LARN

1040

1346

REE, resting energy expenditure predicted with the equations of

Henry (2005) using body mass and height.

slide35

FORMULA TYPE AND ENERGY INTAKE kcal/day

Circa 20%

energia in più

dell’AR raccomandato

slide37

Energy costs of fat and protein deposition in the human infant

Am J ClinNutr 1988; 48:951

Total energy requirement for deposition  1.17 kJ/kJ (kcal/kcal) deposited for fat (ie, 1 kJ deposited and 0.17 kJ expended for deposition, and 2.38 kJ/kJ (kcal/kcal) for protein.

The metabolizable-energy requirement for weight gain during infancy was calculated (range, 12.2-25.1 kJ/g, or 2.9-6.0 kcal/g; means, 18.7 kJ/g, or 4.5 kcal/g) from the energy costs of fat and protein deposition and published information on changes in body composition during the first year of life.

slide38

Energy expended by low birth weight infants in the deposition of protein and fat.

Pediatr Res 1997 ;41:584

Using multiple regression analysis of energy expenditure against protein stored, and metabolizable energy, the energy expended in the deposition of protein was calculated to be 5.5 kcal/g +/- 1.1 kcal/g (SE) and the energy cost of fat deposited was 1.6 kcal/g +/- 0.3 kcal/g (SE).

quando introdurre il latte vaccino
Non prima del dodicesimo mese  latte materno fino ad un anno, anche più a lungo

Dopo il 12° mese può essere introdotto il latte vaccino (limitare la quantità?)

Tra il 12° ed il 36° mese una formula di crescita - GUM- può migliorare il bilancio dei nutrienti  effetti funzionali non noti, mancano dati “diretti” su parametri ematici

Quando introdurre il latte vaccino ?

ATTENZIONE al bilancio energetico nel suo complesso 

puo’ vanificare ogni altro tentativo di riequilibrio

qualitativo e quantitativo