Objectives My overall objective is to improve long-term health through infant nutrition. My current research is directed at the following interlinked themes: identifying biomarkers of later metabolic health, developing randomised controlled trials of nutritional interventions using routine clinical data, and involving parents in research design.
Research to date A potential mechanism linking early nutrition and later health is through altered lipid metabolism, manifesting as aberrant adipose tissue and ectopic lipid deposition. To investigate this potential biomarker of later metabolic health I established a cohort of healthy full-term infants and examined the influence of breast and formula feeding on adiposity. I employed whole body magnetic resonance (MR) imaging and in vivo spectroscopy. I described longitudinal changes in adipose tissue and intrahepatocellular lipid (IHCL) to age two months. I showed that deposition occurs predominantly within subcutaneous adipose tissue compartments and unexpectedly, that IHCL increases in healthy infants with increasing postnatal age. This challenges the accepted view that hepatic lipid deposition is pathological and led me to posit a novel hypothesis, that IHCL in early infancy represents a readily mobilisable energy store (Gale et al., 2014b). I found no differences in adiposity between feeding groups, however in a systematic review and meta-analysis of published studies I identified a statistically significant and clinically relevant association between method of infant feeding and fat mass (Gale et al., 2012a). I published a protocol for infant MR scanning without sedation (Gale et al., 2013), and developed a robust approach to adjust infant adiposity for body size (Gale et al., 2014a).
Current research My ongoing work, funded by the Academy of Medical Sciences, involves utilising routinely recorded clinical data for neonatal research. I demonstrated the value and robustness of such data in examining the impact of health services re-organisation (Gale et al., 2012b); building upon this I am contributing to the development of a neonatal randomised registry trial (all outcome data are extracted from electronic health records) of a nutritional intervention. A central aspect of this is parent involvement; I am a steering group member of the NIHR/James Lind Alliance Priority Setting Partnership for preterm birth and have ongoing qualitative research in this area.
Future research Early life nutrition offers potential to improve life-long health. My aims over the next 5–10 years are to establish a platform for multi-centre neonatal nutrition randomised registry trials and to use trial cohorts to validate biomarkers of later metabolic health.
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