Avoiding sugar protects infants from deadly diseases

While maternal and infant mortality rates in Sri Lanka are one of the lowest in South Asia, malnutrition, diabetes, heart diseases and other chronic ailments are on the rise.

One of the main reasons is the high consumption of sugar starting from an early age, resulting in childhood obesity and children getting diabetes early in life and a host of adult chronic diseases lowering their quality of life and shortening their life span.

No mother wants to put her child’s life at risk of such dreaded diseases that affect their future lives. The answer is simple. Exclusive breast feeding for the first six months, and thereafter, a sensible controlled complementary schedule when baby is ready to start feeding food. The Sunday Observer spoke to Consultant Neonatologist, University Unit De Soyza Hospital for women , and Senior Lecturer, Department of Paediatrics, University of Colombo, and Internationally Board Certified Lactation Consultant, Dr Nishani Lucas for guidelines on how new born children up to the age of one year and even beyond should be fed to give them a healthy start in life.

As she says, “Give your child a well balanced diet with minimum sugar intake. Combine that with regular physical activity where even toddlers are encouraged to be active. And you will find that you hold the key to the cornerstone of good health.”

Excerpts of the interview…

Q. The Health Ministry has declared June as National Nutrition Month. Your comments?

A. The aim of having a National Nutrition Month is to make an attitudinal change within the people to upgrade their nutritional standards.

It focuses on helping people to make correct food choices, as well as developing good eating and exercising habits.

Q. We have had National Nutrition days, weeks, and months before. So what is new in this year’s priority focus?

A. All these would have sensitized people to different issues with regard to obtaining better nutrition. Changing lifestyles is not easy but needs to start with attitudinal change.

The theme for 2017 is “Taste without sugar”. High sugar consumption leads to overweight and obesity and these in turn contribute to cardiovascular diseases, cancer, diabetes, chronic kidney disease, musculoskeletal conditions, psychological problems, reduction in productivity, poor quality of life and shortened life span.

Sugar is a taste we acquire after birth. This is one of the main reasons why sugar is withheld from complementary feeding in infants, so that the child is prevented from acquiring the taste for sugar from the very early days.

Q. How do you define ‘Nutrition’? Why is it so important for us?

A. Nutrition is nourishment or energy that is obtained from food consumed. Good nutrition by means of an adequate, well balanced diet combined with regular physical activity, is a cornerstone of good health.

In contrast poor nutrition leads to reduced immunity, increased susceptibility to disease, reduced productivity as well as impaired physical and mental development.

Q. At what stage of our lives does nutrition begin? Before we are born or later? If it is while we are still in our mother’s womb, how does the fetus get its nutrition? Explain in detail.

A. Nutrition starts before we are born at the time of conception. The fetus gets its nutrition from the placenta, which depends on both maternal and placental factors, which interact in complex ways.

It is influenced by maternal metabolism, maternal adaptation to pregnancy and pathologies which affect placental development.

The first 1,000 days of life are characterized by rapid rates of neuronal proliferation (cell numbers), growth and differentiation (complexity), myelination, and synaptogenesis (connectivity).

Thus, this time period harbours the greatest opportunity to provide optimal nutrition to ensure normal development and also the time of greatest brain vulnerability to any nutrient deficit.

The intrauterine nutrition alters the fetal genome. This is known as “fetal programming” which has led to the recent theory of “fetal origins of adult disease.”

This implies that alterations in fetal nutrition and endocrine status result in developmental adaptations that permanently change the structure, physiology, and metabolism of the offspring, thereby predisposing individuals to metabolic, endocrine, and cardiovascular diseases in adult life.

Animal studies show that both maternal under nutrition and over nutrition reduce placental-fetal blood flow and stunt fetal growth.

Q. During the 9 months of pregnancy, at what stage does the fetus need to get the maximum nutrition for optimal benefits?

A. The fetus needs to get optimum nutrition during all stages of the pregnancy in order achieve optimum growth as it has different requirements at different stages.

Q. What if the mother is unable to give adequate nutrition to her unborn baby, due to various reasons like teen pregnancy, poverty causing malnutrition and other complications? Are there interventions in place by the Health Ministry to build her nutrition levels before delivery?

A. The Ministry of Health provides all Sri Lankan mothers antenatal care at the field level which includes calcium, iron and folic acid supplementation, screening for medical conditions such as hepatitis B, syphilis, pregnancy induced hypertension, diabetes, anemia and treatment of these conditions in order to eliminate / minimize the effects on the fetus.

Fetal growth is monitored throughout the pregnancy by clinical examination as well as, ultrasound scans where necessary.

Q. For how long should a mother exclusively breast feed her baby to give her child a good start in life?

A. A mother should exclusively breast feed her child for a minimum of 4 months but preferably 6 months. Breast milk alone is sufficient to meet the all nutritional requirements of the baby until the baby completes 6 months of age.

If a mother is required to return to work after 84 days or if the baby shows growth faltering at 4 months, complementary feeds could be introduced at the end of 4 months instead of at the end of 6 months.

Q. . What are the special benefits of human breast milk?

A. Breast milk is specie specific. Humans have the highest amount of lactose in their milk to optimize rapid brain growth which happens during the first 1,000 days of life. Therefore, breast fed babies have an IQ 7-10 points higher than babies fed animal milk.

Breast milk contains neutrophils, macrophages, immunoglobulins, lactoferrin, lactalbumin, oligosaccharides, lysozymes and many more immune mediators and is responsible for reduction in respiratory infection up to 70%, diarrhoeal infection up to 64%, ear infections up to 50%, necrotising enterocolitis up to 58% and sudden infant death up to 38% in the first 2 years of life. It also reduces hay fever, eczema and asthma by 9%. Breast feeding reduces maloccusion by 68% as well as the risk of acute lymphoblastic leukemia and acute myelolastic leukemia by 1.2 and 1.3 fold respectively. Breast feeding reduces adult onset of obesity by 26%, type 1 diabetes by 39% and type 2 diabetes by 27% via early programming. It also reduces breast cancer by 39% and ovarian cancer by 26%.

Q. During the period where the baby is exclusively breast fed do you recommend any other liquid like water or orange juice?

A. No, absolutely not. The baby gets all the liquid it requires from the breast milk. The baby has a small stomach, if it is filled with watery, less nutritious substance like water and juice, there is no room for nutrient rich breast milk. Breast milk provides complete nutrition until the baby is six months old.

Introduction of sugar with various juices, is also detrimental to the health of the infant. Also, by introducing various substance through various utensils, the baby is exposed to the unnecessary risk of diarrhoea.

Q. Some mothers complain their breasts are too small and cannot produce enough milk , while others are afraid of giving the first milk ( colostrum ) for superstitious reasons and just extract it and throw it away, even though it is the most important part of the new milk produced by the mother. Your comments?

A. All women have the capacity to make milk for their babies. Breast size has got nothing to do with milk production. The size of the breast is determined by the fat content, not by the functional units that produce milk.

The reason why some women do not produce enough milk is because their breast feeding technique is wrong, and thereby, the milk that is produced in the breast is not emptied by the baby. This results in feed back going to the brain saying that the breast is not emptied and there’s no need of refilling.

These mums can get help with correcting their feeding technique at the Lactation Management Centres attached to the state hospitals that provide maternity care services.

The first milk, also called colostrum is very rich in immunoglobulin and offers a large protection to the baby from many noxious agents, even half a drop is precious to the baby. The parents have to take the lead and ensure that their baby is given the best nutrition and ensure that colostrum is surely fed to their baby.

Q. When should a mother start breast feeding her baby?

A. A mother should start feeding her baby soon after birth, as soon as the baby displays hunger cues (looking around, putting tongue out, licking around etc).

This should happen within the first hour of birth. The baby should be delivered on to the abdomen, dried and then placed at the breast for the first breast feed, provided the baby is breathing well. Weighing, cleaning etc should all happen after the baby has completed his/her first breast feed. 

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