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so good afternoon today i'm talking to about thirty now
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oh infant and child nutrition with cognitive development and also educational outcomes
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so to begin with i'll give you the background the background
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to the west australian pregnancy cope or or brain study
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and then talk about breastfeeding early diet and actually patterns
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and their impact on development cognition and educational outcomes
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so from thirty four weeks of gestation to to use
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the peaks enos development and brain growth occur
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the grey matter grows into seven to eleven years and white matter
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grows beyond twenty years in specific areas associated with cognition
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my life issue in parts of the brain control higher function continue into adolescence
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stop cortical structures that are important in
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cognition grow into light adolescent
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and that analysis come from that the size of the
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hippocampus car lights memory performance in children and adolescents
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cognition means attention memories thinking learning visual in
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some matters sensory perception and these
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have been associated with educational achievement measured by literacy and numerous e.
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nutrition in its relationship to the brain provide
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precursors to new row transmitter is
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it has a role in your uh transmitter re uptake i'm
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italian metabolism overall him reset to say this is
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structural components of brain cells mining she
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anderson nazis and actually genetic alterations
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we know that micro nutrient supplement haitian cognitive development study such
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a mixed results that malnourished children have horror cognitive outcomes
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that breakfast is beneficial for cognition and that breastfeeding
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has also been shown beneficial for cognitive development
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we also know that carbohydrate reach the logo i see make food for breakfast
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provides a continuous supply of glucose is
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facilitating better problems with performance
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and children who have breakfast you better uh in their educational outcomes
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and high i. q. and data memory performance at four years in it
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has been shown in children who could seem to hire amount
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a fruit vegetables and to prepare the home during infancy
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um between six and twelve months of age
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so our um hypotheses is that it is plausible that nutrition
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has an impact on child development cognition and educational outcomes
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and these hypotheses sensitive all from studies of looking at breast feeding
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and fatty acids effects on development and mental health
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to look at this question are these questions we've used
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data from the west australian pregnancy or cohort
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study what's to strengthen pregnancy outboard study or the reins study is known as it's no
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this study i'm recruited nearly three thousand we mean between sixteen and
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twenty weeks of gestation nineteen eighty nine to nineteen ninety two
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there were nearly three thousand babies that have been followed up
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ages one two three five eight ten fourteen seventeen
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twenty twenty two and we now conducting the twenty six
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you follow along with the thirty you follow planned
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this is just a a schematic uh the fee node to pick and
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by and by all the biological data collection over the years which
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really shows that for anti natal fruit mm um
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adult life is thousands of variables collected
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so to look uh i'm diet we've used three main methods first
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it from feeding in the first three years of life
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then diets scores that early i'm eating assessment score
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and then dart free patterns in adolescence
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to begin with or talk to about breast feeding in
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cognitive development and this was um studies done
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in a home early two thousand two thousand and three published in two thousand and three
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effective feeding on imprint development whispers discussed more
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than i'm half a century ago
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where breastfed babies were reported to have better quite
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cognitive outcomes in childhood them formula fed babies
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therefore neck not breastfeeding maybe every skip or
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cognitive development although this is controversial
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the aim was to examine the association between the duration of for
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breast and cognitive outcomes that were measured sixty nine years later
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taking into account a wide range of perry nato social and family matters
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predominant breastfeeding was measured as the n. h.
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that um ah the milk was introduce
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so the age that milk at the breast milk was introduced
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so there were um yeah before groups for this analysis is never breastfed
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fully press fit for less than four months fully breastfed from four to six
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months and then for the price paid for more than six months
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social social and demographic factors medical obstetrics histories
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from each parent that were collected at enrolment including mothers and fathers
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and these were collected during pregnancy and follow what's throughout childhood
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and they involve structured interviews and clinical examinations
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and we've had a response rate of more than seventy five per cent lot
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of effort has gone into the study to increase the response right
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and these are um just the perry nato covariance the
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social curve air it's what just in the analysis
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the outcome data at six and i years of
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age included keyboard body picture um vocabulary test
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and the performance plot design i use of h.
00:06:59
and these were measured by registered psychologists and more age adjusted school
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words and this is uh one of the girls and study
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we use chi square test analysis of variance multiple and logistic regression
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and just just to briefly show that um
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besides your actions with breast the mm was that the older
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the mother she breastfed longer to hire her education
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um she pressed that longer a less parental smoking and also um
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presence of older siblings were associated with longer duration of breastfeeding
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now this is in an adjusted analysis he verbal like you
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was significantly increase if the baby was pulling press right for more than six months
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and the performance of test scores will also increase the press pleading was
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um for longer than six months and then in adjusted analyses
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adjusting for all those factors there that are men mentioned
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the results will still significant with about four
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i. q. points higher for babies who were breastfed for more than six months
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and then when we looked at uh the for for rebels
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of maternal education with maternal education three being the highest
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they were breastfed for longer um the scores were higher in every group
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and that was the same for the block design test so the longer
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the baby was pressed paid a higher with the school words
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the straits of this study is that it's a perspective birth
00:09:05
row works actually pregnancy car or apologies for that
00:09:09
it's a perspective pregnancy cohort study and it's representative of the general population
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preterm babies and children with non english speaking mothers were excluded
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breastfeeding was measured prospectively so it was measured at one two and three
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years and the cognitive outcomes measured five and six and i years
00:09:33
and we corrected for interactions and harry no social and family
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code very it's and there was adequate statistical power available
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so just to summarise this first study after adjustment for covariance
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the remainder significant association between iteration the breast milk feeding
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and verbal i. q. although the performance up
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test this weekend weekend following adjustment
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and the highest maternal education level at the most
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positive effect on i. q. m. plot designed
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scores in those fully breastfed for more than six
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months compared to lower maternal education levels
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and the results continued fruity ten use of h.
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from this analysis there was a clear dose response between the duration of
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for breastfeeding and verbal like you at six years and ten years
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and we speculated that it was that by a law suit components in this in
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the mail oak in human male such as hormones growth factors side kinds
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colony stimulating factors the specific nutrients such as fatty acids
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that may account for the observed difference it's
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so i was very surprised actually to see that there was very little
00:11:08
literature on the impact of breastfeeding on child development and early development
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so i hypothesis was just breastfeeding have an impact on child development
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and for this analysis we've looked at breast feeding categorise for
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less than four months compared to four more months
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again we use the west australian pregnancy cohort
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study eng clinical assessments and test
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for child development using in front monitoring questionnaire ages one to win three
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and this in turn monitoring questionnaire now known is ages and stages questionnaire
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is a brief assessment designed to identify children
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did we should receive more intensive evaluation
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but it s. s. gross motor skills fine
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motor skills adaptability sensibility in communication
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and interestingly that babies that were breastfed for all four more
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months compared to less than four months was it hard
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um it was significantly higher for for those
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um domains listed down the side
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up to three years of age and then when we
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adjusted in the multi no meal logistic regression analyses
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for the risk of having an abnormal score for any
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of those domains of the infirm on front questionnaire
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by looking at breast fed compare less than four months compared to press
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paid for for more mountains there's significantly increase risk of having
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two or more atypical schools are fine
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motor adaptability some stability and communication
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and that was published in two thousand and eleven and
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that also was adjusted all these factors listed here
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so we thought well perhaps this breastfeeding have
00:13:21
an impact on the educational achievement
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and
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now we've looked at breast feeding in a lot of different ways because it was collected
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is a continuous variable we can make up points any and any time point
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and for this analysis we've looked at a full breath paid
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for less than six compared to sixty more mountains
00:13:46
because at that because we now um recognise
00:13:51
the w. h. o. recommendations for exclusive
00:13:54
breastfeeding up to six months and beyond for this um analysis we've combined
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education um this is the west australian literacy and numerous e. assessment
00:14:10
was linked with the reins study i'm breastfeeding we've also link
00:14:15
with the early diets chords which are showing you shortly
00:14:20
and this was done through the data link each branch in the department of health so
00:14:27
the early in front fading guide it was collecting completely separately from
00:14:32
the literacy in numerous e. assessment conducted i use later
00:14:38
and that um the just the scores for mass reading writing and spelling
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um what you can see here is that for both ways
00:14:54
that if a probable i was breastfed for six months or more there's scores
00:15:02
compared to girls the boring the boy scores are significantly
00:15:07
higher for every one of those educational outcomes
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we speculate back would be um hormonal out differences or arm
00:15:22
breast milk see that being a source of essential fatty acids stimulation from the mother
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i'm breastfeeding reflecting secure attachment but we don't know
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why boy he said um have um
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a more beneficial response to breastfeeding than girls
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in the right study with then going on to look at all i it in
00:15:47
the early years and to begin with all jewish talking through town we created
00:15:53
the early eating assessment we call they eat
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score dire directory quality score for toddlers
00:16:03
this is because usually i'm analysis is focused on
00:16:07
either breast feeding is a single action or
00:16:11
single macro or micro nutrient this limitations with
00:16:15
looking at single nutrients from different groups
00:16:20
we wanted to take an overall diet quality and passions approach um
00:16:28
but there's the very few directory quality scores created for young children and
00:16:34
it's very limited evidence on early childhood diet and its impact on
00:16:41
um educational outcomes
00:16:46
so to begin with a hop that hypothesis was that i
00:16:50
first socio demographic factors searches lower part parental education
00:16:56
maternal smoking and lower socioeconomic status will be associates associated with
00:17:02
lower dark three scores that's just um makes sense
00:17:11
um nutritional data was collected i i just wanted to win three
00:17:15
from a twenty four hour recall i'm reporting by the mother
00:17:21
i'm sure record that typing quantity of food drink each meal time
00:17:26
um it was semi quantitative because the mother completed the twenty four a
00:17:32
recall but unfortunately the quality over three
00:17:35
thousand babies with not um
00:17:40
oh really ferried across the study so we only have semi wanted to try to data
00:17:47
where we can say um it's been eating occasion for example the mother wrote banana
00:17:53
we don't know if it was half or a quarter or a whole banana but it was an even occasion of a banana
00:18:00
and then we had the socio demographic data from the question years
00:18:04
and physical examinations throughout the first three years of life
00:18:10
and conducted the basic unit area multi very linear regression
00:18:17
so to develop this school or
00:18:21
and usually we we from the twenty four hour ah we all
00:18:26
two thousand two hundred sixty two individual fruit were
00:18:29
reported on the twenty four hour a recall
00:18:33
we've collapse those into law hundred groups and down to twenty groups
00:18:39
and then sat on my two groups which are listed here
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and this is to to make sense of the the enormous amount of nutrition data
00:18:52
each component was graded from zero to ten so tight they have
00:18:57
total scored seventy overall whereas if that where if they had
00:19:03
um how right out that the test um um the most um recommended
00:19:09
amount absurd that whole grains them and get a score ten
00:19:14
if they had um snap friends that would have a score of zero and so on
00:19:25
so that really is just shows how we created the school or so
00:19:34
gets or out of seven t.
00:19:40
um this is the numbers of children that responded that the
00:19:45
parents who responded to the twenty four hour are recall
00:19:50
so well nearly fifteen hundred we had um data from fifteen
00:19:56
hundred children um over the how how three years
00:20:02
and the parents who responded or more likely to be older married have fewer children
00:20:09
more educated more socio economically advantaged i breastfed for longer
00:20:14
and they would nonsmokers this is common sense
00:20:19
it was interesting to know start with that um
00:20:25
these are the histograms for this or news one two and three and that
00:20:34
out of seven c. d.'s with the means school wars so as you
00:20:39
can see the die qualities actually reduced over the three years
00:20:45
the mothers very it's conscious that one year and then the child gets um
00:20:52
introduced other finishing birthday parties and siblings and friends
00:20:59
so the tower the total score was slightly higher in curls
00:21:03
at your to vegetables had higher scores at age two
00:21:08
but surprisingly girls also cuts the higher scores of of eating snack foods
00:21:16
and that's um over the three years so more on
00:21:21
health me and means that the the scores
00:21:28
and this is shows over the three years that
00:21:33
uh i'm healthy score decrease the towel school or
00:21:37
decreased over the first three years of life
00:21:43
and the thing it's so snack foods all the first three
00:21:47
years it's not for me it's and so does increased
00:21:52
me for vegetable vegetables decrease but whole grains day every
00:22:00
decreased over the first three years of life
00:22:05
and factories independently associated with the score is as i mentioned is that um
00:22:12
hi i'm out there with higher education longer
00:22:15
breast feeding and married mother um
00:22:19
words associated with having higher scores and other to having other children
00:22:25
having a mother who had a depression smoked
00:22:32
had higher be yeah mine also of pardons beer might were associated with
00:22:37
lower died for scores in the first three years of lie
00:22:42
that's just summarising that are so just to summarise the
00:22:49
die quality or the first three years of life
00:22:52
really deteriorated they were consuming less healthy people get more unhealthy from
00:23:01
so what we went on out to look at was the
00:23:04
um this school or the cognitive development and educational outcomes
00:23:10
overall name of creating the score was to look at
00:23:14
the relationships between between the diet for intake
00:23:17
uh one two and three years in cognitive development
00:23:20
later right ten years in in the cohort
00:23:25
a hypothesis was having a high a healthier diet quality during
00:23:31
those very sensitive early years when brain development is occurring
00:23:36
results in higher verbal and nonverbal cobbler to
00:23:40
the bill ability at ten years
00:23:44
again we use the west australian pregnancy cohort never followed up to ten years
00:23:50
and early diet score which i've just described to you
00:23:56
sorry bout this okay ah
00:24:00
um again we've looked at the peabody picture
00:24:03
vocabulary test this was measured uncompleted at
00:24:08
five in ten years and it was normalised to mean of one hundred
00:24:15
and then the non verbal ability measured as they are right that
00:24:19
is colour progressive matrix chest which was a measure of reasoning
00:24:26
so what does test means um but ah the child out of
00:24:32
the east he which one would speech into that box
00:24:40
these covariance work on included in the measure it in
00:24:44
the models to would just for our breast feeding
00:24:48
frequency of reading to the child because we know we we actually
00:24:52
measured if the parent read to the child every night
00:24:57
um others mental health and socio demographic factors
00:25:02
and used um descriptive statistics again including regression
00:25:09
um what we showed is that um the higher the to
00:25:12
high quality at your one that verbal outcome um that
00:25:18
we're all i. q. or keeping the t. which significantly increased
00:25:25
um if they die quality was higher so higher
00:25:29
diet quality the better with the i. q.
00:25:34
um and it's skis me a similar result
00:25:41
for the nonverbal now come at ten years of age
00:25:47
and it's all those those results we it's not you
00:25:51
it's really striking although each shows that while um
00:25:57
hi i thought that i hired by all that he the greater was the
00:26:02
i. q. score and the same for the colour progressive mitre sees
00:26:11
so the mechanism that is involved is the bright that could be involved is the brain
00:26:16
reaches eighty percent if it's adult why during the first two years of life
00:26:21
this is due to relatively fast growth and a higher nutritional sensitivity
00:26:27
and it's interesting that the findings were only in the first year of life
00:26:32
di di quality in in the first your line had
00:26:35
the greatest impact on according to how comes
00:26:41
the difference in the timing of the growth in different parts instructions of the brain
00:26:46
and the verbal and nonverbal intelligence may
00:26:49
have different developing developmental mechanisms
00:26:53
some parts of the brain implements more strongly by environmental factors
00:26:58
such as diet whereas others maybe more genetically determined
00:27:06
this is a perspective longer to them study of a large number of children
00:27:12
peter diet data was measured from the very early years
00:27:16
and we could just for wide range of covariance from
00:27:21
before birth because maternal be a mime paternal be mine
00:27:25
were measured before pregnancy and impact on cognitive development
00:27:32
try to try to what based on the twenty four hour recall it may not be
00:27:37
entirely representative of the typical diet but it
00:27:41
and it was semi quantitative in nature
00:27:44
but we are very grateful it was collected because being
00:27:48
a medical study nutrition guide was not routinely collected
00:27:54
so just to conclude this aspect of the study die in one year
00:28:00
all children might influence verbal and nonverbal
00:28:03
cognitive ability over the long term
00:28:08
and we think this is a significant finding because this is a period it of early line
00:28:14
wait in front di is transformed to an adult type diet and food choices by
00:28:20
the parents not only give a lifelong healthy eating habit to the child
00:28:25
but my also determine their long term developmental potential
00:28:32
with then gone on to look at the this early diets school or
00:28:37
with the academic outcomes ages ten twelve years of
00:28:41
age and that's the was just really
00:28:44
near seen numerous score so we've looked at
00:28:47
early dawn right with the educational outcomes
00:28:53
offices is it early di is associated with charles cognitive performance
00:28:58
and the cobbler two performances the predictor for academic achievement
00:29:03
and that is why we hypothesise that direction early years might
00:29:08
influence academic performance during and childhood and into adolescence
00:29:16
that a game reviews early downright score and
00:29:20
multi variable regression and again um
00:29:28
in fact here so the diet for h. one
00:29:33
um the higher the diet score the higher were the results from mouse reading
00:29:40
writing and spelling and this is in a multi variable um analysis
00:29:48
interestingly though he starts school or i i threw a ninety three
00:29:55
was not really having any impact is the die in the very early years
00:30:02
and then i'm looking at a results act twelve years of age again
00:30:09
die at the already years with significant the associated with
00:30:14
increased scores for mass reading writing and spelling
00:30:21
i won't go through this but just just to say that the effects
00:30:25
size was that for the whole for the same rules the um
00:30:32
offers percentile compared to the um ninety nine percentile
00:30:37
first of all here you can see that for percent of or
00:30:42
three hundred and sixty to ninety nine percentile is four hundred twenty
00:30:48
seven it's that was quite a big difference between a discourse
00:30:57
now just to know what we are looking at an overall diet
00:31:01
school or the directory condom but we want you to know
00:31:05
one of the components of the diet that was having its impact
00:31:10
interestingly one year of age the more fruit
00:31:16
and the more dairy and in fact dairy with significant at all three yeah it is
00:31:22
the more jerry the child was happening in the first three years of life
00:31:27
the better with their educational outcomes at twelve years of age
00:31:36
so i'm just to summarise this um part of your analysis that higher die
00:31:42
its course during the early years were associated with significantly higher academic scores
00:31:48
ages ten and twelve uh increase their in fruit
00:31:52
consumption was associated with significantly higher school words
00:31:57
ages ten and twelve years and that parent should be encouraged
00:32:01
to provide good quality diets for the toddlers during that
00:32:05
important and sensitive period of brain development in the first
00:32:10
year it first and second third use of life
00:32:17
finally we've looked at directory patterns and died free
00:32:22
patterns were mentioned from a fruit frequency questionnaire
00:32:27
where we've looked at frequency it can function in
00:32:29
relation to withstand exercise this was completed by
00:32:34
usually the mother or the father pat primary caregiver when the chocolates fourteen years of age
00:32:40
and also it seventeen would continue to collect directory
00:32:44
into my data from fourteen years of age
00:32:50
there were two hundred twelve fruit arm that would link to
00:32:54
extensive data bases to provide intake some forty three groups
00:32:59
it provided in information for two major directory patterns
00:33:05
this is the fifty one or fifty one nutrient is able
00:33:09
group which into um forty thirty eight three groups
00:33:15
and amazingly i know this is very small into
00:33:19
how or data which fell into very logical
00:33:23
passions and it could be because there were
00:33:26
fourteen year old australian adolescents that um
00:33:32
seem to have high there are healthy or western tie
00:33:36
dye main thing really if the fruit loaded on
00:33:41
well i've point three or more um they were included in the pattern
00:33:47
some of these shows the western diet for heartburn with high intake white rooms
00:33:54
i'm confectionery bread maybe refined grains process me it's
00:34:00
she it's um french fries soft drinks cakes
00:34:05
this gets um and so long
00:34:08
and healthy diet free pattern which with high in
00:34:13
yeah we're red vegetables leafy green vegetables or
00:34:17
vegetables fruit legumes whole grains and fish
00:34:25
that's seventeen years i should in the study it was conducted a cox
00:34:29
state cognitive tests and nice majored
00:34:34
a range of cognitive abilities
00:34:37
um there was six tasks for the detection to cost
00:34:42
identification task on one card learning task i won't
00:34:47
go through the details of those tasks
00:34:51
um continue was paired association learning task uh my is learning test
00:34:57
and a mains approach from man's learning delight really cold yes
00:35:07
and amazingly
00:35:11
um the early diet was associated with that
00:35:16
the west adele i'm sorry this is a little bit
00:35:19
and celtic yeah i'll i'll i it's throat
00:35:25
quite consistent results in the second column this is the western die
00:35:30
and the top score is a healthy diet having a higher
00:35:36
uh entitle western don't actually pattern was significantly associated with
00:35:43
although it's um out on this year is the lower thing on uh
00:35:51
this is a higher or a western diet is is um this um the
00:35:57
o. c. l. test means having a lower score is a better result
00:36:06
no lower score means a worse result it but that was
00:36:11
logical findings and so ah to adjustment me um
00:36:19
it text s. energy earmarked test to the
00:36:22
deck test was the detections tech task
00:36:26
and a lower score meant better performance and then the g. earmark chess
00:36:33
yeah also lower score meant to better performance so after adjustment for a
00:36:39
whole range of factors there the western diet we showing is significantly
00:36:45
um increase risk having for results on
00:36:49
this cock state um tasks
00:36:53
and that was published in the journal of child
00:36:55
psychology and psychiatry in two thousand and fourteen
00:37:01
are we then looked at those directory patterns at age fourteen and
00:37:07
their educational outcomes again and showed
00:37:12
that having higher western diet
00:37:19
showed no results
00:37:22
for mass reading writing spelling wasn't assessed at that particular
00:37:27
time point but it was consistent that um
00:37:33
hi western directed pattern was associated with pour educational outcomes
00:37:40
interestingly the healthy diet food pattern was not
00:37:45
consistently shown i'm having higher arm
00:37:49
or better better educational outcomes which you what what you would expect
00:37:54
but the western diet was associated with lower um educational now comes
00:38:09
and that was published last well in in two thousand and fifteen
00:38:16
so just very briefly to conclude
00:38:21
the shorter generation oppress fading for direct
00:38:25
in early childhood and into adolescents
00:38:29
here's to have an impact on cognitive development and educational outcomes
00:38:35
thank you i'd like to say thank you to the nestle nutrition institute for driving me to comment show you
00:38:42
these results to a national health and medical research council
00:38:46
and too early nutrition number talk let's go for
00:38:51
i'm being involved with already nutrition over the
00:38:54
past five news to you in collaboration

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Conference program

Nutrition advocacy in action: the politics of sugar vs. fat
Marion Nestle, New York University, USA
28 Sept. 2017 · 9:27 a.m.
Fat and carbohydrate recommendations - Have they changed?
Barbara Schneeman, University of California, Davis, USA
28 Sept. 2017 · 10:14 a.m.
Promoting equitable health and wellbeing around the globe
Nancy Brown, American Heart Association, Dallas, USA
28 Sept. 2017 · 11:30 a.m.
Gut hormones and nutrition
Sir Stephen Bloom, Imperial College London, England
28 Sept. 2017 · 1:38 p.m.
Nutrition, metabolic health, cancer and NCDs
Elio Riboli, Imperial College London, England
28 Sept. 2017 · 2:27 p.m.
Infant and child nutrition and cognitive development
Wendy Oddy, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
28 Sept. 2017 · 3:51 p.m.
Microbes, metabolism and autoimmunity
Ramnik Xavier, Massachusetts General Hospital, Boston, USA
29 Sept. 2017 · 9:06 a.m.
Lipid metabolism in high fructose fed humans
Luc Tappy, University of Lausanne, Switzerland
29 Sept. 2017 · 10:03 a.m.
Food, health and disease: The evidence and reporting the evidence
Dennis Bier, Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
29 Sept. 2017 · 11:11 a.m.
Deeper down the rabbit hole of data, analysis, and inference errors and suggestions for digging back out
David Allison, Indiana University School of Public Health, Bloomington, USA
29 Sept. 2017 · 1 p.m.
Neural circuits of food intake - is it all about calories?
Harvey Grill, University of Pennsylvania, Philadelphia, USA
29 Sept. 2017 · 1:55 p.m.

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