how scared are we?

Ashorn 08/2007

How scared are we?

Moving to Finland

Stockpilingfood

Paralysedwith terror

Worried sick

Distinctly jumpy

Sporadicallyanxious

Mildlyconcerned

Unperturbed

The Guardian, 13.2.2003

Hanna Nohynek, 2005

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Cow Milk Intake and Human Growth

Ashorn 08/2007

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

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

0 3 6 9 12 15 18 21 24 27 30 33 36

Age (months)

Me

an

inc

rem

en

t / m

on

th (

cm

) Lungwena

WHO

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

40

50

60

70

80

90

100

110

0 3 6 9 12 15 18 21 24 27 30 33 36

Age (months)

He

igh

t (c

m)

LungwenaWHO

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Prevalence of malnutritionMaleta et al., Pediatr Perinat Epid 2003

PREVALENCE

0

10

20

30

40

50

0 3 6 9 12 15 18 21 24 27 30 33 36

Age (months)

Pre

vale

nce

%

WAZ <-2.0WAZ <-3.0WAZ <-4.0

0

20

40

60

80

100

0 3 6 9 12 15 18 21 24 27 30 33 36

Age (months)

Pre

vale

nce

%

HAZ <-2.0HAZ <-3.0HAZ <-4.0

0.0

2.0

4.0

6.0

8.0

0 3 6 9 12 15 18 21 24 27 30 33 36

Age (months)

Pre

vale

nce

%

WHZ <-2.0WHZ <-3.0

WHO, 1997

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

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The Boyd Orr study, ScotlandOrr, Lancet, 1928

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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)

The Bundi Children, New GuineaLampl et al., Ann Hum Biol, 1978

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

Height increment

00,5

11,5

22,5

33,5

4

Control Milk 10 g Milk 20 g

Incr

emen

t (c

m)

Weight increment

0

0,5

1

1,5

2

2,5

3

3,5

Control Milk 10 g Milk 20 g

Incr

emen

t (k

g)

Bone maturity increment

0

5

10

15

20

25

30

Control Milk 10 g Milk 20 g

Incr

emen

t

HAZ change

-1,5

-1

-0,5

0

0,5

1

Control Milk 10 g Milk 20 g

HA

Z c

han

ge

(Z s

core

un

its)

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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

Ashorn 08/2007

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

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IGF-1 and linear growth

IGF-1 is affected by GH GH-deficient children do not grow

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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

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Denmark, high milk protein doseHoppe at al., Eur J Clin Nutr, 2004

IGF-1 Insulin

Milk MilkMeat Meat

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

Energy intake

7,5

8

8,5

9

9,5

10

10,5

Milk Meat

MJ

/ d

ay

Start

End

Protein intake

0

20

40

60

80

100

120

140

Milk Meat

g /

day

Start

End

Calcium intake

0

0,5

1

1,5

2

2,5

3

3,5

Milk Meat

g /

day

Start

End

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

S-ostecocalcin concentration

0

10

20

30

40

50

60

Milk Meat

ng

/ m

l

Start

End

S-bone specific AFOS concentration

120

125

130

135

140

145

Milk Meat

U /

l

Start

End

S-CTX (type I collagen) concentration

0

0,5

1

1,5

2

2,5

Milk Meat

ng

/ m

l

Start

End

Ashorn 08/2007

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

Ashorn 08/2007

Milk intake, height and serum IGF-1

Hoppe et al., Am J Clin Nutr

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ICP modelKarlberg, Stat Med, 1987

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IC spurtXu et al., Ped Res, 2002

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IC spurtand attained

heightXu et al., Ped Res, 2002

Ashorn 08/2007

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Height accumulationMaleta et al., Arch Dis Child 2003

40

50

60

70

80

90

100

110

0 3 6 9 12 15 18 21 24 27 30 33 36

Age (months)

He

igh

t (c

m)

LungwenaWHO

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Bottle vs breast feeding

Unicef, 1990

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LCSS 268.1

3579

11

1315171921

0 6 12 18 24 30 36 42 48 54 60Age (months)

Wei

gh

t (k

g)

40

50

60

70

80

90

100

110

0 6 12 18 24 30 36 42 48 54 60Age (months)

Hei

gh

t (c

m)

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Randomiseinto 4 groups

210 infants per group

5.50 – 6.49 –month old infants in Lungwena and Malindi villages (n = appr. 1000)

Interview, medical examination, growth measurements (Weight-for-height, WHM)

No consent / other criteria

Exclude/ refer

WHM<80% oroedema

Exclude+refer

Defined inclusion and exlusion criteriaSigned informed consent

Enroll at least 840 childrenLP group (control 2): Maize-soy flour

1000 g / 2 weeks (71 g / day) between 6 and 18 mo

FSm group: milk-powder containing fortified spread750 g / 2 weeks (54 g / day) between 6 and 18 mo

FSs group: soy-protein containing fortified spread750 g / 2 weeks (54 g / day) between 6 and 18 mo

ST-DI group (standard treatm, delayed intervention) (Maize-soy flour 71 g / day between 18 and 30 mo)

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The 1st International RTUF conference in Malawi, 2003

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Three pigs from the same litter reared on different diets

McCance & Widdowson, Proc Roy Soc Lond 1974

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The ultimate aim

Nigerian Times