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World Diabetes Day

Early nutrition and the rise in diabetes

Munich, 11/09/2012

The incidence of Type-2 diabetes continues to rise, especially among young people. Nutritional factors play a significant role in promoting development of the disease. LMU’s Berthold Koletzko is exploring ways to combat the epidemic.

Photo: Monika Leon /
Photo: Monika Leon /

Too much weight, too little physical exercise and an energy-rich diet: These three elements, in combination with genetic predisposition and other factors, interact to produce the metabolic disease known as Type 2 diabetes. In effect, adding the typical Western diet to an unfortunate genetic constitution can overwhelm the body’s ability to utilize its primary fuel, glucose. The result is a chronically elevated concentration of glucose in the blood, and the long-term consequences can be devastating. They include an increased risk for strokes, heart attacks, kidney failure and blindness.

According to the World Health Organization (WHO) more than 346 million people worldwide suffer from Type-2 diabetes – and the number continues to rise inexorably. Furthermore, many people remain oblivious to the risk of developing the disease and are unaware of its grave repercussions. To help change this, the WHO has designated the 14th of November as World Diabetes Day. Under the motto “Protect our Future“, the focus this year is on the prevention of diabetes, particularly in children and adolescents, who are increasingly falling victim to the illness.

Prenatal programming
Moreover, these younger age groups may be susceptible to the disease even before the appearance of puppy fat. “Of course, eating habits and diet during childhood play a significant role,” says LMU diabetes expert Berthold Koletzko. “But the basis for one’s future health is laid down before birth. Whether or not one develops diabetes or some other lifestyle disease can depend, among other things, on the effects of maternal nutrients, trace elements and stress hormones on the developing foetus.”

Recent research has uncovered the basic mechanisms responsible for the impact of maternal physiology on the child’s future health. However, the detailed interactions involved are poorly understood, largely because decades may intervene between proximate cause and ultimate effect. In addition, it is difficult for doctors and other health professionals to keep up with the latest findings in the wide-ranging field of nutrition research. A new project, called the “Early Nutrition eAcademy" (ENeA), attempts to remedy this situation by offering a guide to this field of research.

Nutritional guidelines online
The ENeA is an English-language internet platform that was developed under Koletzko’s supervision, with financial support from the EU, and went online this year. Its basic aim is to keep health professionals up to date on advances in research on early nutrition, and explain their practical implications. The site highlights the latest results, presenting them in the form of audio and video files. Simulations of counseling sessions illustrate how new findings can be translated into everyday practice. Active links provide access to the original literature, and these are regularly updated and extended.

Diverse aspects of early nutrition are grouped into CME (continuing medical education)-accredited modules, each made up of several teaching units. The first of these modules is now online. This deals with breast-feeding, and it underlines what is perhaps the best established insight into early nutrition: mother’s milk is the best food for babies, and breast-feeding has a positive long-term effect on both the child’s and the mother’s state of health – and it helps reduce the child’s risk of developing type 2 diabetes later in life.

Breastfeeding decreases risk
“ENeA’s goal is to enhance cooperation between providers of healthcare in the field of early nutrition,” says Koletzko. “They should do more to encourage breast-feeding and dissuade mothers from weaning their children too soon.” Koletzko hopes that informed professionals can effectively act as multipliers, enabling the latest information to reach more and more women. ENeA has been online for four months now, and 2000 participants in over 70 countries have already registered as users.

Modules on other topics are planned. The next one, on Nutrition and Lifestyle during Pregnancy, is scheduled to appear this month. This will consider issues such as pregnancy-associated illnesses. These include gestational diabetes, in which symptoms of diabetes become manifest specifically in pregnant women. “The condition itself may disappear,” says Koletzko. “It is, however, correlated with an increased risk of developing Type-2 diabetes later on. This applies primarily to the mother, but unfortunately it also holds for the child.”

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