1. 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, 13.2.2003 Hanna Nohynek, 2005

2. Ashorn 08/2007 Cow Milk Intake and Human Growth

3. Ashorn 08/2007 Height increments in rural Malawi, LCSS 1995-2000, n = 767, Maleta et al

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

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

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

7. Ashorn 08/2007

9. The Boyd Orr study, Scotland Orr, Lancet, 1928

10. Ashorn 08/2007 7-13 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

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

12. 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 –520 7-8 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

13. Ashorn 08/2007 Other studies China –757 girls, age 10-12 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

14. Ashorn 08/2007

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

16. Ashorn 08/2007

18. 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, 1997 24 8-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

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

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

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

22. 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

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

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

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

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

27. Ashorn 08/2007

28. Height accumulation Maleta et al., Arch Dis Child 2003

29. Ashorn 08/2007 Bottle vs breast feeding Unicef, 1990

30. Ashorn 08/2007

31. LCSS 268.1

32. Ashorn 08/2007

33. 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)

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

35. Ashorn 08/2007

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

37. Ashorn 08/2007 The ultimate aim Nigerian Times