Detalle del proceso de programación

Due to the rapid growth rate during infancy, fat accounts for about 50% of the total energy intake in human milk and infant formula. Because exclusive breastfeeding is recommended during the first 6 months of life, and because the fat content of infant formula and follow-on formula is regulated (40–55 E% in infant formula and 35–55 E% in follow-on formula) (37), no further recommendations are given for the first 6 months of life. After 6 months of age, this high energy density is reduced with increasing amounts of comple- mentary foods. Thus the fat intake can decline rapidly to around 30 E% at the end of infancy depending on the composition of the complementary food and the extent of partial breastfeeding. It is also common that after the first

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year the proportion of fat increases gradually until 3 years of age to levels common among adults. If the proportion of fat and, therefore, the energy density of the diet becomes too low in the first year or in early childhood this might result in insufficient energy intake because children of this age have limited capability for ingesting more voluminous servings.

According to the EFSA, total fat intake below 25 E% has been associ- ated with low vitamin intakes in some young children (10). The German- Austrian-Swiss recommendation (156) of total fat intake for infants 4 to 11 months of age is 35–45 E%. The US Institute of Medicine has set an adequate intake (AI) for 7–12 month olds to 40 E% (157). Similarly, the EFSA has set an AI at 40 E% for children aged 7–12 months based on AI and consensus reports (10, 158). In the NNR 2012, the intake of total fat for infants between 6 and 11 months of age is recommended to be kept between 30 E% and 45 E%, and this is the same as in the NNR 2004.

Some studies in children indicate that a fat content around or below 30 E% of the total energy is already applicable after the age of 1 year because fat intakes at these levels did not adversely influence children’s growth and neurological development in the Finnish STRIP study (159). The German-Austrian-Swiss 2008 recommendation of total fat intake for children aged 1 to 3 years is 30 E% to 40 E% (156) and similarly the US Institute of Medicine set an acceptable macronutrient distribution range (AMDR) for the proportion of fat to 30–40 E% for children 1 to 3 years of age (157). The EFSA set the recommended intake for the same age group (1–3 years old) to 35–40 E% (10).

In NNR 2012, the intake of total fat for children from 12 to 23 months of age is recommended to be kept between 30 E% and 40 E%. From the age of 2 years, the recommendation of total fat intake is the same as for older children and adults in NNR 2012.

The quality of dietary fat is also important in infancy and childhood. From the age of 12 months, the intake of SFA should be less than 10 E%. The intake of TFA both from dairy fat and partially hydrogenated, industri- ally produced fats should be kept as low as possible. Partial breastfeeding is recommended from 6 months and throughout the child’s first year, and can be continued for as long as it suits the mother and the child. Half or more of the energy from human milk is fat. Typical fatty acid composi- tion (wt%) in mature breastmilk is 40–45% SFA, 40–45% MUFA and 13–16% PUFA (160–164) There is, however, no evidence for a higher recommendation of saturated fat intake for 6–11 month old children than the recommendation for older children, i.e. lower than 10 E%.

NORDIC NUTRITION RECOMMENDATIONS 2012

For the intake of cis-PUFA in childhood, no new convincing evidence has emerged for changing the recommendations from NNR 2004. The EFSA’s AI for LA is 4 E% and AI for ALA is 0.5 E%, but the EFSA also adds an AI for DHA of 100 mg/d (10). This is primarily based on cohort studies and a few randomized trials with DHA supplementation to the foetus or young infants that indicate a positive effect on visual acuity, cognitive function and attention, maturity of sleep patterns, spontaneous motor activity, and immunity.

In the NNR 2012, it is recommended that the total intake of cis-PUFA for children 6–23 months of age should constitute 5–10 E% and that this should include at least 1 E% from n-3 fatty acids, including DHA, as in NNR 2004. However, the optimum ratio of n-6 to n-3 fatty acids is not known.

References

1. Helldán A, Kosonen M, Tapanainen H. The National FINDIET 2012 Survey. (In Finnish, summary, figures and tables in English) Helsinki: National Institute For Health and Welfare2013 Report No.: 16/2013. 2. Thorgeirsdottir H, Valgeirsdottir H, Gunnarsdottir I. National dietary survey of the Icelandic nutrition council 2010–2011. Main findings: Directorate of Health, Icelandic Food and Veterinary Authority and Unit for Nutrition Research, University of Iceland2011.

3. Steingrimsdottir L, Thorgeirsdottir H, Ægisdottir S. Dietary Survey of the Diet of Icelanders 1990. 1. Main findings: Icelandic Nutrition Council1990.

4. Totland TH, Kjerpeseth Melnæs B, Lundberg‑Hallén N. En landsomfattende kostholdsundersøkelse blant menn og kvinner i Norge i alderen 18–70 år 2010–11. Oslo: Helsedirektoratet 2012 Report No.: 06/2000.

5. Johansson L, Solvoll K. Norkost 1997. Landsomfattende kostholdsundersøkelse blant menn og kvinner i alderen 16–79 år. Oslo: Statens råd för ernæring og fysisk aktivitet1999 Report No.: 2/1999. 6. Lyh ne N, Christensen T, Velsing Groth M, Fagt S, Biltoft‑Jensen A, Hartkopp H, et al. Danskernes

kostvaner 2000–2002. Hovedresultater (Dietary habits of Danes. Main results): Danmarks Fødevareforskning 2005.

7. Pedersen AN, Fagt S, Velsing Groth M. Danskernes kostvaner 2003–2008. Hovedresultater (Dietary habits of Danes 2003–2008. Main results): DTU Fødevareinstituttet2010.

8. Amcoff E, Edberg A, Enghardt Barbieri H. Riksmaten vuxna 2010–11. Livsmedels‑ och näringsintag bland vuxna i Sverige. Resultat från matvaneundersökningen utförd 2010–11 (Food and nutrient intake in Sweden 2010–11. (In Swedish, summary, figures and tables in English) Uppsala: Livsmedelsverket2012. 9. Becker W, Pearson M. Riksmaten 1997–1998. Kostvanor och näringsintag i Sverige. Metod‑

och resultatrapport (Dietary habits and nutrient intake in Sweden 1997–1998). Uppsala: Livsmedelsverket2002.

10. EFSA. Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010;8:1461.

11. Mozaffarian D. Trans fatty acids – effects on systemic inflammation and endothelial function. Atheroscler Suppl. 2006 May;7(2):29–32.

f

at and fatt

y a

CI

ds

12. Burdge GC, Wootton SA. Conversion of alpha‑linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Br J Nutr. 2002 Oct;88(4):411–20.

13. Fats and fatty acids in human nutrition. Report of an expert consultation. 10–14 November 2008, Geneva. Rome: FAO/WHO Food and Agricultural Organisation of the United Nations 2010 Report No.: 91.

14. Terpstra AH. Effect of conjugated linoleic acid on body composition and plasma lipids in humans: an overview of the literature. Am J Clin Nutr. 2004 Mar;79(3):352–61.

15. Riserus U, Arner P, Brismar K, Vessby B. Treatment with dietary trans10cis12 conjugated linoleic acid causes isomer‑specific insulin resistance in obese men with the metabolic syndrome. Diabetes Care. 2002 Sep;25(9):1516–21.

16. Riserus U, Basu S, Jovinge S, Fredrikson GN, Arnlov J, Vessby B. Supplementation with conjugated linoleic acid causes isomer‑dependent oxidative stress and elevated C‑reactive protein: a potential link to fatty acid‑induced insulin resistance. Circulation. 2002 Oct 8;106(15):1925–9.

17. Schaeffer L, Gohlke H, Muller M, Heid IM, Palmer LJ, Kompauer I, et al. Common genetic variants of the FADS1 FADS2 gene cluster and their reconstructed haplotypes are associated with the fatty acid composition in phospholipids. Hum Mol Genet. 2006 Jun 1;15(11):1745–56.

18. Goyens PL, Spilker ME, Zock PL, Katan MB, Mensink RP. Conversion of alpha‑linolenic acid in humans is influenced by the absolute amounts of alpha‑linolenic acid and linoleic acid in the diet and not by their ratio. Am J Clin Nutr. 2006 Jul;84(1):44–53.

19. Hussein N, Ah‑Sing E, Wilkinson P, Leach C, Griffin BA, Millward DJ. Long‑chain conversion of [13C] linoleic acid and alpha‑linolenic acid in response to marked changes in their dietary intake in men. J Lipid Res. 2005 Feb;46(2):269–80.

20. Liou YA, King DJ, Zibrik D, Innis SM. Decreasing linoleic acid with constant alpha‑linolenic acid in dietary fats increases (n‑3) eicosapentaenoic acid in plasma phospholipids in healthy men. The Journal of nutrition. 2007 Apr;137(4):945–52.

21. Eritsland J. Safety considerations of polyunsaturated fatty acids. The American journal of clinical nutrition. 2000 Jan;71(1 Suppl):197S‑201S.

22. EFSA. Scientific Opinion on the Tolerable Upper Intake Level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA). EFSA Journal 2012;10:2815. 23. Burdge GC, Jones AE, Wootton SA. Eicosapentaenoic and docosapentaenoic acids are the principal

products of alpha‑linolenic acid metabolism in young men*. Br J Nutr. 2002 Oct;88(4):355–63. 24. Gerster H. Can adults adequately convert alpha‑linolenic acid (18:3n‑3) to eicosapentaenoic acid (20:5n‑

3) and docosahexaenoic acid (22:6n‑3)? Int J Vitam Nutr Res. 1998;68(3):159–73. 25. Emken EA, Adlof RO, Gulley RM. Dietary linoleic acid influences desaturation and acylation of

deuterium‑labeled linoleic and linolenic acids in young adult males. Biochim Biophys Acta. 1994 Aug 4;1213(3):277–88.

26. Vermunt SH, Mensink RP, Simonis MM, Hornstra G. Effects of dietary alpha‑linolenic acid on the conversion and oxidation of 13C‑alpha‑linolenic acid. Lipids. 2000 Feb;35(2):137–42.

27. Burdge GC, Finnegan YE, Minihane AM, Williams CM, Wootton SA. Effect of altered dietary n‑3 fatty acid intake upon plasma lipid fatty acid composition, conversion of [13C]alpha‑linolenic acid to longer‑chain fatty acids and partitioning towards beta‑oxidation in older men. Br J Nutr. 2003 Aug;90(2):311–21. 28. Egert S, Lindenmeier M, Harnack K, Krome K, Erbersdobler HF, Wahrburg U, et al. Margarines fortified

with alpha‑linolenic acid, eicosapentaenoic acid, or docosahexaenoic acid alter the fatty acid composition of erythrocytes but do not affect the antioxidant status of healthy adults. The Journal of nutrition. 2012 Sep;142(9):1638–44.

29. Brossard N, Croset M, Pachiaudi C, Riou JP, Tayot JL, Lagarde M. Retroconversion and metabolism of [13C]22:6n‑3 in humans and rats after intake of a single dose of [13C]22:6n‑3‑triacylglycerols. Am J Clin Nutr. 1996 Oct;64(4):577–86.

NORDIC NUTRITION RECOMMENDATIONS 2012

30. Conquer JA, Holub BJ. Dietary docosahexaenoic acid as a source of eicosapentaenoic acid in vegetarians and omnivores. Lipids. 1997 Mar;32(3):341–5.

31. Lauritzen L, Hansen HS, Jorgensen MH, Michaelsen KF. The essentiality of long chain n‑3 fatty acids in relation to development and function of the brain and retina. Prog Lipid Res. 2001 Jan‑ Mar;40(1–2):1–94.

32. Uauy R, Hoffman DR, Mena P, Llanos A, Birch EE. Term infant studies of DHA and ARA supplementation on neurodevelopment: results of randomized controlled trials. The Journal of pediatrics. 2003 Oct;143(4 Suppl):S17–25.

33. Morale SE, Hoffman DR, Castaneda YS, Wheaton DH, Burns RA, Birch EE. Duration of long‑ chain polyunsaturated fatty acids availability in the diet and visual acuity. Early Hum Dev. 2005 Feb;81(2):197–203.

34. Uauy R, Mena P, Wegher B, Nieto S, Salem N, Jr. Long chain polyunsaturated fatty acid formation in neonates: effect of gestational age and intrauterine growth. Pediatr Res. 2000 Jan;47(1):127–35. 35. Koletzko B, Agostoni C, Carlson SE, Clandinin T, Hornstra G, Neuringer M, et al. Long chain

polyunsaturated fatty acids (LC‑PUFA) and perinatal development. Acta Paediatr. 2001 Apr;90(4):460–4. 36. Forsyth JS, Willatts P, Agostoni C, Bissenden J, Casaer P, Boehm G. Long chain polyunsaturated fatty

acid supplementation in infant formula and blood pressure in later childhood: follow up of a randomised controlled trial. BMJ. 2003 May 3;326(7396):953.

37. Commission directive on infant formulae and follow‑on formulae, 2006/141/EC (2006). 38. Velzing‑Aarts FV, van der Klis FR, van der Dijs FP, van Beusekom CM, Landman H, Capello JJ, et al.

Effect of three low‑dose fish oil supplements, administered during pregnancy, on neonatal long‑chain polyunsaturated fatty acid status at birth. Prostaglandins Leukot Essent Fatty Acids. 2001 Jul;65(1):51–7. 39. Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very‑long‑

chain n‑3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics. 2003 Jan;111(1):e39–44.

40. Makrides M, Gibson RA. Long‑chain polyunsaturated fatty acid requirements during pregnancy and lactation. Am J Clin Nutr. 2000 Jan;71(1 Suppl):307S‑11S.

41. Lauritzen L, Jorgensen MH, Hansen HS, Michaelsen KF. Fluctuations in human milk long‑chain PUFA levels in relation to dietary fish intake. Lipids. 2002 Mar;37(3):237–44.

42. Jorgensen MH, Hernell O, Hughes E, Michaelsen KF. Is there a relation between docosahexaenoic acid concentration in mothers’ milk and visual development in term infants? J Pediatr Gastroenterol Nutr. 2001 Mar;32(3):293–6.

43. Sarkkinen E, Korhonen M, Erkkila A, Ebeling T, Uusitupa M. Effect of apolipoprotein E polymorphism on serum lipid response to the separate modification of dietary fat and dietary cholesterol. Am J Clin Nutr. 1998 Dec;68(6):1215–22.

44. Dietary guidelines for Americans 2010. In: USDA., editor.2010.

45. Standards of Medical Care in Diabetes—2012. Diabetes Care. 2012;35(Supplement 1):S11‑S63. 46. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on

cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012 Jul;33(13):1635–701.

47. Valsta LM, Tapanainen H, Sundvall J, Laatikainen T, Mannisto S, Pietinen P, et al. Explaining the 25‑year decline of serum cholesterol by dietary changes and use of lipid‑lowering medication in Finland. Public Health Nutr. 2010 Jun;13(6A):932–8.

48. Hartiala O, Magnussen CG, Kajander S, Knuuti J, Ukkonen H, Saraste A, et al. Adolescence risk factors are predictive of coronary artery calcification at middle age: the cardiovascular risk in young Finns study. J Am Coll Cardiol. 2012 Oct 9;60(15):1364–70.

f

at and fatt

y a

CI

ds

49. Juonala M, Viikari JS, Raitakari OT. Main findings from the prospective Cardiovascular Risk in Young Finns Study. Curr Opin Lipidol. 2013 Feb;24(1):57–64.

50. Schwab U, Lauritzen L, Tholstrup T, Haldorsson T, Riserus U, Uusitupa M, et al. Effect of the amount and type of dietary fat on cardiometabolic risk factors and risk of cardiovascular diseases, type 2 diabetes and cancer: a systematic review. Food & Nutrition Research. In press.

51. Teslovich TM, Musunuru K, Smith AV, Edmondson AC, Stylianou IM, Koseki M, et al. Biological, clinical and population relevance of 95 loci for blood lipids. Nature. 2010 Aug 5;466(7307):707–13. 52. Waterworth DM, Ricketts SL, Song K, Chen L, Zhao JH, Ripatti S, et al. Genetic variants influencing

circulating lipid levels and risk of coronary artery disease. Arterioscler Thromb Vasc Biol. 2010 Nov;30(11):2264–76.

53. Deloukas P, Kanoni S, Willenborg C, Farrall M, Assimes TL, Thompson JR, et al. Large‑scale association analysis identifies new risk loci for coronary artery disease. Nat Genet. 2013 Jan;45(1):25–33. 54. Muller H, Kirkhus B, Pedersen JI. Serum cholesterol predictive equations with special emphasis on trans

and saturated fatty acids. an analysis from designed controlled studies. Lipids. 2001 Aug;36(8):783–91. 55. Sacks FM, Katan M. Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma

lipoproteins and cardiovascular disease. The American journal of medicine. Dec 30;113 Suppl 9B:13S‑ 24S.

56. Vessby B, Uusitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, et al. Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia. 2001 Mar;44(3):312–9.

57. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta‑analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146–55.

58. Bos MB, de Vries JH, Feskens EJ, van Dijk SJ, Hoelen DW, Siebelink E, et al. Effect of a high monounsaturated fatty acids diet and a Mediterranean diet on serum lipids and insulin sensitivity in adults with mild abdominal obesity. Nutr Metab Cardiovasc Dis. 2010 Oct;20(8):591–8.

59. van Dijk SJ, Feskens EJ, Bos MB, Hoelen DW, Heijligenberg R, Bromhaar MG, et al. A saturated fatty acid‑ rich diet induces an obesity‑linked proinflammatory gene expression profile in adipose tissue of subjects at risk of metabolic syndrome. Am J Clin Nutr. 2009 Dec;90(6):1656–64.

60. Summers LK, Fielding BA, Bradshaw HA, Ilic V, Beysen C, Clark ML, et al. Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity. Diabetologia 2002 Mar;45(3):369–77.

61. Smith RD, Kelly CN, Fielding BA, Hauton D, Silva KD, Nydahl MC, et al. Long‑term monounsaturated fatty acid diets reduce platelet aggregation in healthy young subjects. Br J Nutr. 2003

Sep;90(3):597–606.

62. Lefevre M, Champagne CM, Tulley RT, Rood JC, Most MM. Individual variability in cardiovascular disease risk factor responses to low‑fat and low‑saturated‑fat diets in men: body mass index, adiposity, and insulin resistance predict changes in LDL cholesterol. The American journal of clinical nutrition. 2005 Nov;82(5):957–63; quiz 1145–6.

63. Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins. A meta‑analysis of 27 trials. Arterioscler Thromb. 1992 Aug;12(8):911–9.

64. Briel M, Ferreira‑Gonzalez I, You JJ, Karanicolas PJ, Akl EA, Wu P, et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta‑regression analysis. BMJ. 2009;338:b92.

65. Kraus WE, Houmard JA, Duscha BD, Knetzger KJ, Wharton MB, McCartney JS, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002 Nov 7;347(19):1483–92. 66. Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, et al. Effect of aerobic exercise training on

serum levels of high‑density lipoprotein cholesterol: a meta‑analysis. Arch Intern Med. 2007 May 28;167(10):999–1008.

NORDIC NUTRITION RECOMMENDATIONS 2012

67. Tang JL, Armitage JM, Lancaster T, Silagy CA, Fowler GH, Neil HA. Systematic review of dietary intervention trials to lower blood total cholesterol in free‑living subjects. BMJ. 1998 Apr 18;316(7139):1213–20.

68. Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol: quantitative meta‑ analysis of metabolic ward studies. BMJ. 1997 Jan 11;314(7074):112–7.

69. Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr. 2009 May;63 Suppl 2:S22–33.

70. Almendingen K, Jordal O, Kierulf P, Sandstad B, Pedersen JI. Effects of partially hydrogenated fish oil, partially hydrogenated soybean oil, and butter on serum lipoproteins and Lp[a] in men. J Lipid Res. 1995 Jun;36(6):1370–84.

71. Rivellese AA, Maffettone A, Vessby B, Uusitupa M, Hermansen K, Berglund L, et al. Effects of dietary saturated, monounsaturated and n‑3 fatty acids on fasting lipoproteins, LDL size and post‑prandial lipid metabolism in healthy subjects. Atherosclerosis. 2003 Mar;167(1):149–58.

72. Sanders TA, Gleason K, Griffin B, Miller GJ. Influence of an algal triacylglycerol containing

docosahexaenoic acid (22: 6n‑3) and docosapentaenoic acid (22: 5n‑6) on cardiovascular risk factors in healthy men and women. The British journal of nutrition. 2006 Mar;95(3):525–31.

73. Hartweg J, Perera R, Montori V, Dinneen S, Neil HA, Farmer A. Omega‑3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. Cochrane database of systematic reviews (Online). 2008(1):CD003205.

74. Erkkila AT, Schwab US, de Mello VD, Lappalainen T, Mussalo H, Lehto S, et al. Effects of fatty and lean fish intake on blood pressure in subjects with coronary heart disease using multiple medications. Eur J Nutr. 2008 Sep;47(6):319–28.

75. Lovejoy JC, Smith SR, Champagne CM, Most MM, Lefevre M, DeLany JP, et al. Effects of diets enriched in saturated (palmitic), monounsaturated (oleic), or trans (elaidic) fatty acids on insulin sensitivity and substrate oxidation in healthy adults. Diabetes Care. 2002 Aug;25(8):1283–8.

76. Due A, Larsen TM, Hermansen K, Stender S, Holst JJ, Toubro S, et al. Comparison of the effects on insulin resistance and glucose tolerance of 6‑mo high‑monounsaturated‑fat, low‑fat, and control diets. The American journal of clinical nutrition. 2008 Apr;87(4):855–62.

77. Due A, Larsen TM, Mu H, Hermansen K, Stender S, Astrup A. Comparison of 3 ad libitum diets for weight‑

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