Shaking Old Paradigms: Future
Opportunities for the Development
of Food Products that Promote
Health in Children
Deborah O’Connor PhD RD
Professor, University of Toronto
Senior Associate Scientist, The Hospital for Sick Children
Considerations in Evaluating the
Opportunities in Children
1. What are the most pressing health issues?
2. Can a new food product, or adaptation of an
existing product, help address this issue?
3. Is it feasible to develop this product?
4. Translation of idea from bench to widespread
use.
What I Heard From the “Community”:
Top 5 Calls
1. Weight Control: Programs, sample menus,
“magic foods”
2. Picky Eaters: What can I put in this kid’s
lunch?
3. Vitamin and Mineral Supplements
4. Management of Food Allergy and Food
Sensitivities
5. Are “Organic” Foods Better?
Weight Management in Children:
Magnitude of the Problem in Canada
Janssen I. Can J Diabetes 37:90-96, 2013
Eating Habits of Canadian Children
and Youth
Average Daily Calorie
Consumption
% of Kcal by Food Group
Age
(yrs)
1972
2004
2004
Avg Kcal Avg Kcal 95% CI
5-11
2,300
2,041
2,0052,076
Males:
12-19
3,251
2,806
2,7362,877
Females: 2,243
12-19
2,047
2,0022,092
Garriguet D. Health Reports 18(2):17-32, 2007.
Eating Habits of Canadian Children
and Youth
% Below Recommended # Servings
Vegetables and Fruit
% Below Recommended # Servings
Milk Products
Garriguet D. Health Reports 18(2):17-32, 2007.
Foods and Drinks Accounting for Most
Calories from “Other Foods” (4 yrs +)
Food/Drink
% Kcal from “Other Foods”
Soft drinks
11.3
Salad dressing
9.4
Sugars, syrups, preserves
8.7
Beer
8.2
Fruit drinks
6.1
Vegetable oil, animal fat,
shortening
5.8
Margarine
5.3
Chocolate bars
4.8
Potato chips
4.7
Butter
3.9
Garriguet D. Health Reports 18(2):17-32, 2007.
Snacks
% of Kcal from Between Meal
Consumption
Age
(yrs)
% Kcal
4-8
27
Males:
9-13
26
% Distribution of Kcal from Between
Meal Consumption, by Food Group (4
years +)
Females: 26
9-13
Males:
14-18
30
Females: 28
14-18
Garriguet D. Health Reports 18(2):17-32, 2007.
What I Heard From the “Community”:
Top 5 Calls
1. Weight Control: Programs, sample menus,
“magic foods”
2. Picky Eaters: What can I put in this kid’s
lunch?
3. Vitamin and Mineral Supplements
4. Management of Food Allergy and Food
Intolerance
5. Are “Organic” Foods Better?
The Picky Eater
1.
25-35% of toddlers and preschoolers described as picky eaters.
2.
Most grow appropriately but are at higher risk of being
underweight.
3.
Frequently cited as a cause of conflict in the family.
4.
Canadian Pediatric Association states no role for specialty
formulas. Suggests a vitamin or mineral supplements if diet is
questionable.
5.
CPS and others recommend small portions be provided and meals
and snacks be of high nutrient density. No juice at snack-time.
6.
Lunches a source of much parental concern—in a recent Canadian
study home lunches were of lower quality than those purchased
at school.
Leung AKC et al. Paediatr Child Health 17(8): 455-457, 2012; Dubois L et
al. International J Behavioral Nutrition Physical
Activity 4:9, 2007; Taylor JP eta al Public Health Nutr 15(12):2259-2264,
2012.
What I Heard From the “Community”:
Top 5 Calls
1. Weight Control: Programs, sample menus,
“magic foods”
2. Picky Eaters: What can I put in this kid’s
lunch?
3. Vitamin and Mineral Supplements
4. Management of Food Allergy and Food
Sensitivities
5. Are “Organic” Foods Better?
Vitamins and/or Minerals
Supplements
Group
Any Vitamin
or Mineral
Multivitamin/
Mineral
Vitamin
A
Vitamin
C
Vitamin
D
1-3
38
35
35
36
35
4-8
45
42
41
44
41
9-13
33
25
24
31
24
Males
23
15
14
21
15
Females
29
17
16
24
17
Children
Adolescents
14-18
Shakur YA et al. J Nutr 142(3):534-540, 2012
Minerals Supplements
Group
Multivitamin/
Mineral
Calcium
Phosphorus
Magnesium
Iron
Zinc
Children
1-3
38
21
16
2
20
2
4-8
45
28
21
3
24
2
9-13
33
16
12
4
15
3
Males
23
14
10
9
11
8
Females
29
15
8
11
14
9
Adolescents
14-18
Shakur YA et al. J Nutr 142(3):534-540, 2012
Prevalence of Nutrient Inadequacy
Children 1-13 years
• Use of supplements reduced prevalence of
inadequacy of vitamin D (1-3), calcium (4-13
years).
Youth 14-18
• Use of supplements reduced prevalence of
inadequacy of vitamin D and calcium (females
only).
Shakur YA et al. J Nutr 142(3):534-540, 2012
What I Heard From the “Community”:
Top 5 Calls
1. Weight Control: Programs, sample menus,
“magic foods”
2. Picky Eaters: What can I put in this kid’s
lunch?
3. Vitamin and Mineral Supplements
4. Management of Food Allergy and Food
Sensitivities
5. Are “Organic” Foods Better?
Management of Food Allergy and
Other Food Sensitivities
1. Allergy most common in infants and young
children (6-8% in children <3 years of age)
2. Frequently associated with atopic dermatitis,
asthma
3. Most common allergies are to: milk, egg and
nuts
4. Non-celiac Gluten Sensitivity
Management of Food Allergy and
Other Food Sensitivities
Where Novel Food Products Could
Help Families
1. Nutrient Dense Food in snack-sized portions—low
kcal, low sodium, no trans fat.
2. Foods that address the milk product and vegetable
and fruit gap—excellent sources of fibre.
3. Targeted supplementation—multivitamin
supplements don’t make a lot of sense for most
healthy children.
4. Movement away from beverages (formulas, energydrinks), sugary products targeted for children and
movement toward “whole foods” that are convenient
for parents and kids want to eat.
5. Availability of food products for those with food
allergies and other food sensitivities—clearly labeled.
Food Products Designed for Feeding Sick
and Vulnerable Infants Children and Youth
1. Number of children that could potentially use a
product fewer than number of adult patients
who could benefit from a comparable product.
2. However, …the impact of the product on health
is tremendous…often life-saving.
–
–
–
–
Metabolic formulas (available)
Engineering human milk for clinical indications (work in
progress)
Probiotics (work in progress)
Novel lipid-based approaches for the treatment of intestinalfailure associated liver disease
3. Issues of “powders” in the hospital
environment.
An Exclusive Human Milk Diet for
Very Low Birth Weight Infants
Necrotizing Enterocolitis
Symptoms may include:
poor feeding tolerance
delayed gastric emptying
abdominal distension
emesis
bloody stools
Advanced cases may show fluid in the peritoneal
cavity, peritonitis, or shock.
Is There An Advantage of an Exclusive
Human Milk Diet for NEC Prevention?
• Infants fed mothers’ own milk randomized to:
1. HM100
2. HM40
3. BOV
Pasteurized donor milk + “human” milk fortifier
Preterm formula + “bovine” milk fortifier
*Sullivan et al Journal of Pediatrics 2010;156:562-7.
Is There An Advantage of an Exclusive
Human Milk Diet for NEC Prevention?
• Mothers’ own milk
comprised ~ 70% of
feedings
• > 50% in NEC
• Reduction in surgical NEC
*Sullivan et al Journal of Pediatrics 2010;156:562-7.
Probiotics
Probiotics for the Prevention of NEC:
Mortality Outcome
*AlFaleh K et al. Evid.-Based Child Health 7:6:1807-1854, 2012
Novel Lipid-Based Approaches to
Pediatric Intestinal FailureAssociated Liver Disease
Novel Lipid-Based Approaches to
Pediatric Intestinal Failure-Associated
Liver Disease (IFALD)
Fatty Acid
Intralipid
Omegaven
%fatty acids
Palmitic
10
2.5-10
Stearic
3.5
0.5-2.0
Oleic
26
6-13
Linoleic
50
1-7
a-linolenic
9
<2
ARA
0
1-4
EPA
0
12.8-28.2
DHA
0
14.4-30.9
N-6/n-3
5.5/1
1/6.8
Clinical Experience with Novel
Therapies in Children with IFALD
• Dramatic reductions in the
number of children:
– With hyperbilirubinemia
– Requiring transplant
– Significant reduction of
morbidity
*Diamond IR et al. Arch Pediatr Adolesc Med 166(5):473-478, 2012
Conclusions
1. Many health issues with children that could
be impacted by availability of new and
adapted food products.
2. In terms of which products to develop for
children when?
-
Need to consider size of target population
Potential magnitude of the effect on health outcome
Feasibility in terms of product development, cost etc
Strategy to Promote Longer-term Health
Needs Goes Beyond Patching up a Poor
Diet
Vitamin C
folate
calcium
vitamin A
iron
Omega-3
fatty acid