Ricardo Uauy
University of Chile
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The Lancet | 2013
Robert E. Black; Cesar G. Victora; Susan P Walker; Zulfiqar A. Bhutta; Parul Christian; Mercedes de Onis; Majid Ezzati; Sally Grantham-McGregor; Joanne Katz; Reynaldo Martorell; Ricardo Uauy
Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate--including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding--is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.
The Lancet | 2007
Anthony J. McMichael; John Powles; Colin Butler; Ricardo Uauy
Food provides energy and nutrients, but its acquisition requires energy expenditure. In post-hunter-gatherer societies, extra-somatic energy has greatly expanded and intensified the catching, gathering, and production of food. Modern relations between energy, food, and health are very complex, raising serious, high-level policy challenges. Together with persistent widespread under-nutrition, over-nutrition (and sedentarism) is causing obesity and associated serious health consequences. Worldwide, agricultural activity, especially livestock production, accounts for about a fifth of total greenhouse-gas emissions, thus contributing to climate change and its adverse health consequences, including the threat to food yields in many regions. Particular policy attention should be paid to the health risks posed by the rapid worldwide growth in meat consumption, both by exacerbating climate change and by directly contributing to certain diseases. To prevent increased greenhouse-gas emissions from this production sector, both the average worldwide consumption level of animal products and the intensity of emissions from livestock production must be reduced. An international contraction and convergence strategy offers a feasible route to such a goal. The current global average meat consumption is 100 g per person per day, with about a ten-fold variation between high-consuming and low-consuming populations. 90 g per day is proposed as a working global target, shared more evenly, with not more than 50 g per day coming from red meat from ruminants (ie, cattle, sheep, goats, and other digastric grazers).
Developmental Medicine & Child Neurology | 2000
Eileen E. Birch; Sharon Garfield; Dennis R. Hoffman; Ricardo Uauy; David G. Birch
The effects of dietary docosahexaenoic acid (DHA) supply during infancy on later cognitive development of healthy term infants were evaluated in a randomized clinical trial of infant formula milk supplemented with 0.35% DHA or with 0.36% DHA and 0.72% arachidonic acid (AA), or control formula which provided no DHA or AA. Fifty‐six 18‐month‐old children (26 male, 30 female) who were enrolled in the trial within the first 5 days of life and fed the assigned diet to 17 weeks of age were tested using the Bayley Scales of Infant Development, 2nd edition (BSID‐II) (Bayley 1993) at the Retina Foundation of the Southwest, Dallas, TX. These children had also been assessed at 4 months and 12 months of age for blood fatty‐acid composition, sweep visual evoked potential (VEP) acuity, and forced‐choice preferential looking (FPL) acuity (Birch et al. 1998). Supplementation of infant formula with DHA+AA was associated with a mean increase of 7 points on the Mental Development Index (MDI) of the BSID‐II. Both the cognitive and motor subscales of the MDI showed a significant developmental age advantage for DHA‐ and DHA+AA‐supplemented groups over the control group. While a similar trend was found for the language subscale, it did not reach statistical significance. Neither the Psychomotor Development Index nor the Behavior Rating Scale of the BSID‐II showed significant differences among diet groups, consistent with a specific advantage of DHA supplementation on mental development. Significant correlations between plasma and RBC‐DHA at 4 months of age but not at 12 months of age and MDI at 18 months of age suggest that early dietary supply of DHA was a major dietary determinant of improved performance on the MDI.
Pediatric Research | 1990
Ricardo Uauy; David G. Birch; Eileen E. Birch; Jon E. Tyson; Dennis R. Hoffman
ABSTRACT: Retinal function was assessed by electroretinogram in 32 neonates randomly assigned to formulas of different ω-3 fatty acid content and in 10 infants fed human milk. All neonates had a birth weight of 1000-1500 g and were fed study diets from d 10 to 45 or discharge. Group A received formula containing predominantly 18:2 ω-6. Group B received a balanced mix of 18:2 ω-6 and 18:3 ω- 3. Group C was given a formula containing both essential fatty acids and supplemented with marine oil to provide 22:6 ω-3 content similar to that of human milk. The fatty acid composition of plasma and red blood cell (RBC) lipids were similar for all groups on entry but marked dietinduced differences were found after feeding the study diets. Group C was comparable to the human milk-fed group, but group A had lower 22:6 ω-3 and ω-3 long-chain polyunsaturated fatty acids (LCPUFA) in plasma and RBC membranes. Cone function was not affected by dietary essential fatty acids. Rod electroretinogram thresholds were significantly higher for group A relative to the human milk-fed group and group C and significantly correlated with RBC ω-3 LCPUFA (r = -0.63, p < 0.0001); 44% of the variance could be explained by RBC and plasma ω-3 LCPUFA content. Rod electroretinogram amplitude was significantly lower for group A relative to the human milkfed group and group C and related to plasma 22:6 ω-3 (r = 0.55) and total ω-3 LCPUFA (r = 0.58) (both p < 0.0001); 42% of the variance was explained by plasma ω-3 LCPUFA, the ratio of ω-6/ω-3 LCPUFA in RBC, and gestational age at birth. Our results support an essential role for ω-3 fatty acids in retinal development.
Journal of Perinatal Medicine | 2008
Berthold Koletzko; Eric L. Lien; Carlo Agostoni; Hansjosef Böhles; Cristina Campoy; Irene Cetin; Tamás Decsi; Joachim W. Dudenhausen; Cristophe Dupont; Stewart Forsyth; Irene Hoesli; Wolfgang Holzgreve; Alexandre Lapillonne; Guy Putet; Niels Jørgen Secher; Michael E. Symonds; Hania Szajewska; Peter Willatts; Ricardo Uauy
Abstract This paper reviews current knowledge on the role of the long-chain polyunsaturated fatty acids (LC-PUFA), docosahexaenoic acid (DHA, C22:6n-3) and arachidonic acid (AA, 20:4n-6), in maternal and term infant nutrition as well as infant development. Consensus recommendations and practice guidelines for health-care providers supported by the World Association of Perinatal Medicine, the Early Nutrition Academy, and the Child Health Foundation are provided. The fetus and neonate should receive LC-PUFA in amounts sufficient to support optimal visual and cognitive development. Moreover, the consumption of oils rich in n-3 LC-PUFA during pregnancy reduces the risk for early premature birth. Pregnant and lactating women should aim to achieve an average daily intake of at least 200 mg DHA. For healthy term infants, we recommend and fully endorse breastfeeding, which supplies preformed LC-PUFA, as the preferred method of feeding. When breastfeeding is not possible, we recommend use of an infant formula providing DHA at levels between 0.2 and 0.5 weight percent of total fat, and with the minimum amount of AA equivalent to the contents of DHA. Dietary LC-PUFA supply should continue after the first six months of life, but currently there is not sufficient information for quantitative recommendations.
Pediatric Research | 1998
Eileen E. Birch; Dennis R. Hoffman; Ricardo Uauy; David G. Birch; Claude Prestidge
The need for a dietary supply of docosahexaenoic acid (DHA) and arachidonic aid (AA) in term infants was evaluated in a double-masked randomized clinical trial of the effects of supplementation of term infant formula with DHA (0.35% of total fatty acids) or with DHA (0.36%) and AA(0.72%) on visual acuity development. One hundred and eight healthy term infants were enrolled in the study; 79 were exclusively formula-fed from birth (randomized group) and 29 were exclusively breast-fed (gold standard group). Infants were evaluated at four time points during the first 12 mo of life for blood fatty acid composition, growth, sweep visual evoked potential(VEP) acuity, and forced choice preferential looking acuity. Supplementation of term infant formula with DHA or with DHA and AA during the first 4 mo of life yields clear differences in total red blood cell (RBC) lipid composition. Supplementation of term infant formula with DHA or with DHA and AA also yields better sweep VEP acuity at 6, 17, and 52 wk of age but not at 26 wk of age, when acuity development reaches a plateau. The RBC lipid composition and sweep VEP acuity of supplemented infants was similar to that of human milk-fed infants, whereas the RBC lipid composition and sweep VEP acuity of unsupplemented infants was significantly different from human milk-fed infants. Differences in acuity among diet groups were too subtle to be detected by the forced choice preferential looking protocol. Infants in all diet groups had similar rates of growth and tolerated all diets well. Thus, early dietary intake of preformed DHA and AA appears necessary for optimal development of the brain and eye of the human infant.
The American Journal of Clinical Nutrition | 1998
Ricardo Uauy; Manuel Olivares; Mauricio González
The biochemical basis for the essentiality of copper, the adequacy of the dietary copper supply, factors that condition deficiency, and the special conditions of copper nutriture in early infancy are reviewed. New biochemical and crystallographic evidence define copper as being necessary for structural and catalytic properties of cuproenzymes. Mechanisms responsible for the control of cuproprotein gene expression are not known in mammals; however, studies using yeast as a eukaryote model support the existence of a copper-dependent gene regulatory element. Diets in Western countries provide copper below or in the low range of the estimated safe and adequate daily dietary intake. Copper deficiency is usually the consequence of decreased copper stores at birth, inadequate dietary copper intake, poor absorption, elevated requirements induced by rapid growth, or increased copper losses. The most frequent clinical manifestations of copper deficiency are anemia, neutropenia, and bone abnormalities. Recommendations for dietary copper intake and total copper exposure, including that from potable water, should consider that copper is an essential nutrient with potential toxicity if the load exceeds tolerance. A range of safe intakes should be defined for the general population, including a lower safe intake and an upper safe intake, to prevent deficiency as well as toxicity for most of the population.
Public Health Nutrition | 2004
Chizuru Nishida; Ricardo Uauy; Shiriki Kumanyika; Prakash Shetty
Nutrition Planning, Assessment and EvaluationService, Food and Nutrition Division, FAO, Rome, ItalyThe Joint WHO/FAO Expert Consultation on diet,nutrition and the prevention of chronic diseases tookplace in Geneva from 28 January to 1 February 2002. Theoverall objective of the Consultation was to review andupdate current international recommendations on diet,nutrition and the prevention of chronic diseases byevaluating the latest scientific evidence and lessonslearned from implementing national interventionstrategies to reduce the burden of these diseases. Specificobjectives included:1. Reviewing the changes in the dietary and healthpatternsworldwideandexaminingtheirrelationshiptoemergence of chronic diseases, particularly obesity,type 2 diabetes, hypertension and cardiovasculardiseases, cancer, dental disease, and osteoporosis.2. Reviewing the latest scientific evidence on therelationship between diet, nutrition and chronicdiseases.3. Examining diet, nutrition and health issues from a lifecourse perspective.4. Considering gene/nutrient interactions and theirimplications.5. Formulating recommendations concerning diet andnutrition for the prevention of chronic diseases toassist countries in developing and implementingeffective evidence-based multisectoral policies andstrategies.6. Identifying further research needs.The selection of the expert participants followed standardcriteria, including geographic and sex balance, inconsultation with regional offices. Thirty experts wereidentified,halffromdevelopingcountriesandcountriesineconomic transition where diet-related chronic diseasesare an increasing public health problem. Before beingofficially invited to participate, all were requested todeclare possible conflicts of interest to ensure the qualityand neutrality of each expert’s contributions.Four working groups composed of world-renownedexperts prepared background papers on majordiet-related chronic diseases, such as obesity, type-2diabetes,cardiovasculardiseasesandcancer,thatincludedcurrent trends for each disease, a review of the strengthand weakness of the scientific evidence linking diet anddisease, and its policy implications. Other experts wereresponsible for papers on dental diseases and osteoporo-sis while WHO staff prepared a paper on the life courseapproach and FAO staff prepared a review of the globaland regional food consumption patterns and trends.Each background paper was peer-reviewed; papers weresubmitted, together with comments by peer-reviewers(some 20 in all), to the Expert Consultation as a generalframework for discussion.Report preparationFollowinground-tableconsultationswithnongovernmen-tal organizations and industry associations in April 2002to obtain feedback on the Expert Consultation’s initialdraftreport,thedraftreportwasmadeavailableonWHO’swebsite for review and comment by all interested partiesuntil June 2002.In August 2002, the Consultation’s Chairperson, Vice-Chairperson and rapporteurs met in Geneva with theWHO/FAO secretariat members as well as with severalexpertsonphysicalactivitytoreviewmorethan120setsofcomments from governments of FAO/WHO MemberStates, representatives of the scientific community,nongovernmental organizations, commercial enterprisesandinterestedindividuals.Thesecommentswerelikewiseposted in their entirety on WHO’s website for publicscrutiny. In October 2002, several members of the ExpertConsultationmetwiththeChairpersonandtheWHO/FAOSecretariatto finalize severalpending issues. In December2002, the final draft report was sent to the members of theExpert Consultation for review and final approval. Thereport was then finalized and published in the WHOTechnical Report Series (TRS 916)
Lipids | 2001
Ricardo Uauy; Dennis R. Hoffman; Patricio Peirano; David G. Birch; Eileen E. Birch
Essential fatty acids are structural components of all tissues and are indispensable for cell membrane synthesis; the brain, retina and other neural tissues are particularly rich in long-chain polyunsaturated fatty acids (LC-PUFA). These fatty acids serve as specific precursors for eicosanoids, which regulate numerous cell and organ functions. Recent human studies support the essential nature of n-3 fatty acids in addition to the well-established role of n−6 essential fatty acids in humans, particularly in early life. The main findings are that light sensitivity of retinal rod photoreceptors is significantly reduced in newborns with n−3 fatty acid deficiency, and that docosahexaenoic acid (DHA) significantly enhances visual acuity maturation and cognitive functions. DHA is a conditionally essential nutrient for adequate neurodevelopment in humans. Comprehensive clinical studies have shown that dietary supplementation with marine oil or single-cell oil sources of LC-PUFA results in increased blood levels of DHA and arachidonic acid, as well as an associated improvement in visual function in formula-fed infants matching that of human breast-fed infants. The effect is mediated not only by the known effects on membrane biophysical properties, neurotransmitter content, and the corresponding electrophysiological correlates but also by a modulating gene expression of the developing retina and brain. Intracellular fatty acids or their metabolites regulate transcriptional activation of gene expression during adipocyte differentiation and retinal and nervous system development. Regulation of gene expression by LC-PUFA occurs at the transcriptional level and may be mediated by nuclear transcription factors activated by fatty acids. These nuclear receptors are part of the family of steroid hormone receptors. DHA also has significant effects on photoreceptor membranes and neurotransmitters involved in the signal transduction process; rhodopsin activation, rod and cone development, neuronal dendritic connectivity, and functional maturation of the central nervous system.
The Journal of Pediatrics | 1991
Ricardo Uauy; Avroy A. Fanaroff; Sheldon B. Korones; Elizabeth A. Phillips; Joseph B. Phillips; Linda L. Wright
We studied the occurrence of necrotizing enterocolitis in 2681 very low birth weight infants during an 18-month period to characterize the biodemographic and clinical correlates. Proven necrotizing enterocolitis (Bell stage II and beyond) occurred in 10.1% of study infants; necrotizing enterocolitis was suspected in 17.2% of study infants. Positivity of blood cultures was related to necrotizing enterocolitis staging. The mortality rate increased only for stage III necrotizing enterocolitis (54% died). Logistic regression identified medical center of birth, race, gender, birth weight, maternal hemorrhage, duration of ruptured membranes, and cesarean section as significant risk factors. For one center the odds ratio was 3.7, whereas for another center it was only 0.3. For black boys, the odds ratio was 2.3 relative to nonblack boys; for girls, race did not affect prevalence of necrotizing enterocolitis. Age at onset was related to birth weight and gestational age. Intercenter differences in necrotizing enterocolitis prevalence were related to time required to regain birth weight and other indicators of fluid management. Gram-positive organisms predominated in positive blood cultures for stage I and II necrotizing enterocolitis; enteric bacteria were isolated more frequently in infants with stage III disease. We conclude that necrotizing enterocolitis prevalence varies greatly among centers; this may be related to early clinical practices of neonatal care.