Funded under the National Recovery and Resilience Plan (NRRP), Mission 4 Component 2 Investment 1.3, Theme 10.
Published: May 11, 2023
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"Nutrients are the nourishing substances in food that are essential for the growth, development, and maintenance of body functions. Essential means that if a nutrient is absent, aspects of function and human health decline. When nutrient intake does not regularly meet the nutrient needs dictated by the cell activity, the metabolic processes slow down or even stop.”
Wardlow and Insel "Perspectives in Nutrition”, 2004
Beyond the simple act of consuming various meals, eating food always concerns the human body's acquisition of certain nutrients, which, depending on their own properties, contribute differently to both physical and cognitive development.
Being people’s health and well-being significantly influenced by the quality and quantity of nutrient intake, promoting a well-balanced diet which comprises adequate amounts of macronutrients, such as carbohydrates, proteins, and fats, along with sufficient micronutrients, like vitamins and minerals, and proper hydration, is fundamental during the entire course of life and especially during childhood, as it lays the foundation for a healthy lifestyle in adulthood.
The first 1,000 days of life - from conception to 24 months - have been, in fact, recognised as a unique window of opportunities for healthier beginnings and long-term benefits. The Lancet series on “Maternal and Child Undernutrition” in 2008 recognised for the first time the importance of ‘early life nutrition’ for growth and development. Further studies in this regard have indicated that proper nutrition during the earliest period of life, including child-feeding practices like breastfeeding and supplemental feeding and the maternal diet during pregnancy and lactation, plays a critical role in the rapid growth of a child, ensuring optimal chances to develop their full potential. On the contrary, it has been demonstrated that malnutrition occurring during pregnancy and through children’s second birthday irreversibly affects the health and development of a child, with harmful short-term and long-term consequences, of which many associated with a high mortality risk, delayed cognitive development, higher vulnerability to infectious diseases, and reduced adult labour productivity.
According to the most recent publication jointly produced by UNICEF, WHO and the World Bank (2021), in 2020, an estimated 45 million children under the age of five were suffering from wasting, the deadliest form of malnutrition, which increases children’s risk of death by up to 12 times. 149 million children under the age of five had stunted growth and development due to a chronic lack of essential nutrients in their diets, while 39 million were overweight. During the same year, at least 32 million pregnant and breastfeeding women experienced different forms of micronutrient deficiency.
Maternal malnutrition, particularly in the form of underweight and anaemia, can raise the risk of pre-term birth and low birth weight, thus also increasing the danger of neonatal death, stunting and wasting.
The World Health Organization (WHO) estimates that approximately 20 million infants worldwide are born with low birth weight yearly, frequently due to inadequate maternal nutrition. Malnutrition is responsible for more than 45% of deaths among children under the age of five. Neonatal mortality, or deaths occurring during the first month of life, is especially high in low- and middle-income nations where malnutrition is widespread.
Addressing malnutrition in children under the age of five requires a concerted effort from society as a whole, focused on changing dietary habits and lifestyle practices, starting with optimising early-life nutrition throughout gestation and the first two years of life.
Spoke 05 of the OnFoods project for lifelong nutrition.
A nutritionally balanced diet is essential for optimal growth and healthy bodies and minds, particularly during the early years of life.
However, it is crucial not only for individual well-being but also for promoting sustainable development by impacting economic growth, social well-being, and environmental sustainability.
As enshrined in Sustainable Development Goal 2 (‘End hunger, achieve food security and improved nutrition and promote sustainable agriculture’) of the UN 2030 Agenda, due to its unique transformative potential, proper nutrition plays a pivotal role in achieving many other Global Goals.
Investing in safe, adequate, and sustainable nutrition means empowering people, societies and communities while fostering resilience, progress, and prosperity across all nations. For example, a well-nourished population with more chances to access economic opportunities can reduce different poverty levels (SDG 1). Opting for healthier dietary choices can also promote good health and well-being (SDG 3), as both under and over-nutrition are linked to both rural and urban environments (SDG 11). Improved nutrition can further contribute to promoting gender equality (SDG 5) and reducing inequalities (SDG 10). In food production and consumption, nutrition also significantly influences various environment-related targets, including SDGs 6, 7, 9, 12, 13, 14, and 15.
Unhealthy and unsustainable diets, especially during the first 1.000 days of life, can undermine multiple dimensions of human lives, ranging from the primary levels of education to the possibility of shaping individual professional careers, understanding the nutritional status of a country's population may be very useful to identifying and addressing specific dietary deficiencies, as well as educating and raising awareness about the benefits of proper nutrition for health, economic, social, and developmental purposes.
For this reason, Spoke 05 'Lifelong Nutrition', with the slogan "A healthy diet for all”, aims to promote food and nutrition security in Italy through a life-course approach according to the needs of different population groups based on age, gender, and predisposition to the disease.
Starting from mapping the national population's nutritional status and disseminating the healthy and sustainable principles of the Mediterranean Diet, Spoke 05 is intended to facilitate models for healthy nutritional schemes. One of the main activities of the research team focusing on the sustainability of early life nutrition includes the development and validation of algorithms for designing personalised diets for pregnant women and children during the first 1000 days, ensuring long-term efficacy for weight maintenance. The personalised diets will be tailored to individual needs, considering the mother's health status, nutrient requirements, and dietary preferences. This approach will promote healthy nutrition during pregnancy and early childhood, reducing the risk of chronic diseases and improving the overall health of the Italian population.
Work Package 5.3 for innovative models of the Mediterranean Diet sustainable lifelong.
One of the dietary regimens widely regarded as being in line with the principles of a sustainable and healthy lifestyle in Europe is the Mediterranean Diet.
The Mediterranean Diet (MD) has been described as a sustainable dietary model characterised by a low intake of fat and high consumption of vegetable oils, predominantly adopted by residents of Greece and Southern Italy during the 1960s. Extensive research on this diet has revealed that it offers many health benefits for both people and the environment. Its advantages were initially brought to light by Ancel Keys in 1975, who observed a decreased risk of cardiovascular disease among individuals living in the Mediterranean Basin who adhered to this dietary pattern. Since then, further studies have confirmed the positive impact of the diet on various non-communicable diseases (NCDs), particularly cancer, cognitive function, glycaemic control, and cardiovascular and cerebrovascular diseases.
Starting with recognising the Mediterranean Diet as a sustainable promising pattern with both individual and environmental benefits, Work Package 5.3 aims to devise innovative strategies that encourage lifelong adherence to the Mediterranean dietary model. Planned activities under this package include determining critical variables influencing adherence to the Mediterranean Diet in Italy, considering local socio-economic and cultural food-specific drivers, consumer needs and preferences, lifestyle, and nutrition knowledge by targeting children, adolescents, adults, and free-living older adults.
Individual and environmental obstacles inhibiting healthy dietary habits will be further explored in order to develop and promote new, sustainable nutrition models. These models will be shared through various dissemination and communication techniques, with a particular emphasis on ‘family Mediterranean nutrition’, and healthy eating habits in school children and adolescents.
Considering crucial interventions aimed at monitoring and ensuring proper early-life nutrition, in connection with Spoke 04 “Food Quality and Nutrition”, Work Package 5.3 finally intends to provide and validate a customised algorithm for developing personalised diets that optimise blood glucose levels in pregnant women and healthy children during the first 1.000 days and later in life.
The package aims to deliver comprehensive and impactful results, encouraging a healthy and sustainable lifestyle.
The Research Project PERMED “Early nutrition with PERsonalized MEDiterranean diet to decrease long-term chronic diseases burden: the PERMED study”.
Proper nutrition, essential for human survival and growth, is particularly important during childhood, representing for children a period of rapid body and brain development, progress, and activity. The early years of life, namely the first infants’ 1,000
During pregnancy, the provision of well-balanced maternal nutrition is of utmost importance for the health of newborns since inadequate mother’s nutrition can adversely affect the child both in the womb and during childbirth. For instance, insufficient nutrition resulting from maternal underweight and anaemia leads to an increased risk of premature birth and low birth weight. This, in turn, can elevate the chances of neonatal death, stunting, and wasting.
Interventions during pregnancy have the potential to affect the health of offspring positively. Nevertheless, the mechanisms underlying the beneficial effects of early interventions are not yet fully understood. In recent years, Eran Elinav and colleagues have developed an algorithm capable of predicting personalised postprandial glucose responses in healthy adults (Zeevi et al., Cell. 2015; Rein et al., BMC Med. 2022).
The “PERMED” project, namely “Early nutrition with PERsonalized MEDiterranean diet to decrease long-term chronic diseases burden: the PERMED study”, developed within OnFoods’ Spoke 05 and its Work Package 5.3, in addressing the impact of proper nutrition on long-term health and the lifespan, aims to develop personalised Mediterranean algorithm-based diets to help decrease postprandial blood glucose levels in pregnant women and children.
In order to achieve the project’s expected results, the research team involved will undertake a prospective clinical trial to investigate the effects of a standardised Mediterranean diet versus a standardised Western diet on the health of 100 pregnant women and 100 healthy children. The participants will be randomly assigned to one of the two diets. Throughout the trial, they will collect continuous glucose blood monitoring and serial blood tests, stool samples for microbiome analysis, and urine for metabolomics analysis. Additional data will be gathered using a specific app to track anthropometrics, blood pressure, dietary intake, physical activity, and sleep-wake rhythm. These data will be integrated to develop an algorithm, which will be validated in two independent prospective cohorts following the trials.
The project’s objective is to assess the effectiveness of an algorithm in predicting the post-meal glucose response for children and pregnant women on an individualised basis. By creating and validating these algorithms, it is hoped that personalised Mediterranean diet plans can be established to reduce the occurrence of hyperglycaemia and gestational diabetes during pregnancy. Additionally, the use of this model in paediatrics is expected to have an immediate impact on reducing overweight and obesity. In the long term, it is anticipated that there will be a decrease in the incidence of metabolic syndrome and diabetes overall.
"The PERMED study has been developed starting from the assumpt that Universal dietary recommendations may not suit everyone. Our project will allow us to develop a personalized Mediterranean Diet algorithms in pregnant mothers that will be hopefully able to decrease the incidence of gestational diabetes and to have an impact on the onset of overweight and obesity in their inborns at 24 months." Annamaria Staiano
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Referred to
Spoke 05Research projectPERMED
Early nutrition with personalized mediterranean diet to decrease long-term chronic diseases burden
Principal investigators
Annamaria Staiano
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