Ashorn 08/2007 How scared are we? Moving to Finland Stockpiling food Paralysed with terror Worried sick Distinctly jumpy Sporadically anxious Mildly concerned Unperturbed The Guardian, Hanna Nohynek, 2005

Ashorn 08/2007 Cow Milk Intake and Human Growth

Ashorn 08/2007 Height increments in rural Malawi, LCSS , n = 767, Maleta et al

Ashorn 08/2007 Height accumulation in rural Malawi Maleta et al., Arch Dis Child 2003

Ashorn 08/2007 Prevalence of malnutrition Maleta et al., Pediatr Perinat Epid 2003 WHO, 1997

Ashorn 08/2007 LCNI-3 trial, Malawi Phuka et al., submitted, n=182

Ashorn 08/2007

The Boyd Orr study, Scotland Orr, Lancet, 1928

Ashorn 08/ year old, stunted children (n = 86, mean height 114 cm, weight 20 kg) 8 months intervention (random allocation) –Normal diet (roots and potatoes, 5440 kJ, 11 g protein / day) –Added skimmed milk powder (10 g protein / day, 5 days per week) –Added skimmed milk powder (20 g protein / day, 5 days per week) The Bundi Children, New Guinea Lampl et al., Ann Hum Biol, 1978

Ashorn 08/2007 Milk and growth or bone maturation Lampl et al., Ann Hum Biol, 1978

Ashorn 08/2007 Other studies Alabama, 1945 –82 kids, 1-10 / 4-15 years, 4 / 8 vs 0 dl milk / d –1.23 cm lenght gain difference in 20 months –Paired allocation, Dreizen et al., Growth, 1950 Britain – year olds, ”disadvantaged” –randomised, 1.9 vs 0 dl / d –0.3 cm lenght gain difference in 21.5 months (130 g weight) –Baker at al., J Epid Comm Health, 1980

Ashorn 08/2007 Other studies China –757 girls, age years, 3.3 vs 0 dl milk / d –0.7 cm lenght gain difference in 24 months –Cluster randomised (6), Du et al., Br J Nutr, 2004 A number of indeterminate or negative results from the North –In some trials, benefit if initially low HAZ Many ecological and observational studies document an association between milk intake and height or linear growth –Possibility for confounding

Ashorn 08/2007

IGF-1 and linear growth IGF-1 is affected by GH GH-deficient children do not grow

Ashorn 08/2007

Cow milk intake and IGF-1 Intervention studies few, 2 child studies 12-y girls, 5.5 dl milk / d, 18 months –Minor association to IGF-1 at 18 months, p<0.05 if adjustments, energy confounder –Randomisewd, Cadogan et al., BMJ, y boys, 1.5 l milk vs same protein in meat, 7 days –Increased concentration of IGF-1 and IGF-1 / s- IGFBP-3 –Hoppe at al., Eur J Clin Nutr, 2004

Ashorn 08/2007 Denmark, high milk protein dose Hoppe at al., Eur J Clin Nutr, 2004 IGF-1 Insulin Milk Meat

Ashorn 08/2007 Milk vs meat and bone metabolism Budek at al., Eur J Clin Nutr, 2007

Ashorn 08/2007 Milk vs meat and bone metabolism Budek at al., Eur J Clin Nutr, 2007

Ashorn 08/2007 Additional information Observational study, 2.5 y kids, Denmark –Direct association between milk intake and serum IGF-1 concentration and lenght –Big effect: 2  6 dl milk intake increase vs 30% increase in IGF-1 –Hoppe at al., Am J Clin Nutr, 2004 Some negative and positive results both from adults and children (few studies) Vegans vs vegetarians and meat-eaters

Ashorn 08/2007 Milk intake, height and serum IGF-1 Hoppe et al., Am J Clin Nutr

Ashorn 08/2007 ICP model Karlberg, Stat Med, 1987

Ashorn 08/2007 IC spurt Xu et al., Ped Res, 2002

Ashorn 08/2007 IC spurt and attained height Xu et al., Ped Res, 2002

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Height accumulation Maleta et al., Arch Dis Child 2003

Ashorn 08/2007 Bottle vs breast feeding Unicef, 1990

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LCSS 268.1

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Randomise into 4 groups 210 infants per group 5.50 – 6.49 –month old infants in Lungwena and Malindi villages (n = appr. 1000) Interview, medical examination, growth measurements (Weight-for-height, WHM) No consent / other criteria Exclude/ refer WHM<80% or oedema Exclude+refer Defined inclusion and exlusion criteria Signed informed consent Enroll at least 840 children LP group (control 2): Maize-soy flour 1000 g / 2 weeks (71 g / day) between 6 and 18 mo FSm group: milk-powder containing fortified spread 750 g / 2 weeks (54 g / day) between 6 and 18 mo FSs group: soy-protein containing fortified spread 750 g / 2 weeks (54 g / day) between 6 and 18 mo ST-DI group (standard treatm, delayed intervention) (Maize-soy flour 71 g / day between 18 and 30 mo)

Ashorn 08/2007 The 1 st International RTUF conference in Malawi, 2003

Ashorn 08/2007

Three pigs from the same litter reared on different diets McCance & Widdowson, Proc Roy Soc Lond 1974

Ashorn 08/2007 The ultimate aim Nigerian Times