First 1,000 days

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The first 1,000 days describes the period from conception to 24 months of age in child development. This is considered a "critical period" in which sufficient nutrition and environmental factors have life-long effects on a child's overall health. While adequate nutrition can be exceptionally beneficial during this critical period, inadequate nutrition may also be detrimental to the child. This is because children establish many of their lifetime epigenetic characteristics in their first 1,000 days. [1] Medical and public health interventions early on in child development during the first 1,000 days may have higher rates of success compared to those achieved outside of this period. [2]

Contents

Adequate nutrition during the first 1,000 days can have a direct and indirect influence on both short and long term health outcomes. [3] There are various risk factors in the first 1,000 days which, if present, are predictors of later obesity. [4] [5] [6] Stunted growth may be remedied (catch-up growth) by attainment of proper nutritional status. This is especially important in adolescent girls, where it may break a cycle of inter-generational underdevelopment. [7]

As a period of rapid growth and development, the first 1,000 days of life are foundational to child development and vulnerabilities to future non-communicable diseases such as cardiovascular or metabolic diseases. [8]

Microbiota

The first 1,000 days of the human microbiome starting from time of conception until 2 years old is a critical time period for growth and development, including nutrients and microbiota. Proper nutrition is an essential to support healthy life; lack of nutrition may have a lifelong negative impact to the child's development. [3] During this time frame of early childhood growth, there are many immune and developmental pathways that are dependent on environmental factors such as nutrients; malnutrition can disrupt growth and development leading to obesity or malnutrition. [9]

During pregnancy, the key microbiota are maternal microbiota and fetal microbiota. [9] Microbiota from the mother is essential for the child's growth even before birth. Pre-birth microbial exposure, either excessive or lack of, can impact growth and development negatively and have long-term effect. For this reason, the mother's nutritional intake becomes important for the child both before birth and after birth.

The first 6 months after birth is characterized mainly by external exposure to microbiota. For instance, different feeding practices leads to different outcomes; breastfeeding and commercial milk will have different essential nutrients and microbiota. [10] Antibiotics may have an effect on the gut microbiota; antibiotic exposure before birth may disrupt the gut microbiota permanently and disrupt the gut functions. [11]

Transitioning into childhood, food intake after 6 months will be changed from milk to complementary foods; this is a critical period for children to get adequate nutrition necessary for growth. [3] From this period, environmental factors start to impact the children more. In underserved communities where families may face food insecurities or poor living conditions, the risk of undernutrition and negative affect to microbial pathway may increase. Cases of undernutrition may be treated by gut microbiota targeted interventions in combination with nutrition; this will restore the lack/loss of microbiota the child has faced during their childhood and promote healthy growth. [9]

Breastfeeding and vaginal birth forms the infant's microbiota which can protect against allergies from developing. [12] However, not everyone can safely give vaginal birth or provide breastmilk due to different circumstances; for infants in these situations, it may be important to look out for specific ingredients such as probiotics in certain infant formulas to makeup for those microbiota.

Epigenetics

Nutrition

Both maternal and early-childhood nutrition influence epigenetic changes, which then inform immunologic and metabolic outcomes throughout development and into later life. [13] Present in human milk are HMOs, bioactive components which aid in immune function and regulation, and miRNA-containing exosomes. HMOs can be fermented into short-chain fatty acids, which play important roles in modulating the microbiome and in T cell differentiation, and may positively correlate with methylation levels. [13] [14] miRNA found in milk-derived exosomes may increase immune tolerance.

Metabolic disease, and particularly type 2 diabetes mellitus and insulin resistance, is strongly associated with malnutrition. Both parental undernutrition and overnutrition predispose a child to developing these conditions. [15] Under these circumstances, differential methylation of adipose tissue genes and miRNA upregulation in adipose tissue and the pancreas may occur. [16]

Stress exposure

Exposure to emotional, physical, and environmental stressors significantly affect the developing brain, which may later manifest in negative mental- and health-related outcomes through the HPA axis' role in stress regulation. [17]

Maternal depression, anxiety, and stress may be associated with increased rates of mental disorders, including schizophrenia, depression, anxiety, ADHD, and autism in the child. Smoking in pregnancy is associated with differential methylation of genes implicated in brain development, central nervous system disorders, asthma, and various cancers. [18] Stress management and smoking cessation in the birthing parent provide avenues for reducing this risk. [17]

Babies born prematurely are often separated from the birthing parent and sequestered in neonatal intensive care units, where they may require additional care and procedures. [19] Stress caused to the infant during this process is associated with epigenetic modifications relating to behavioral issues and stress regulation, notably hypermethylation of the SLC6A4 gene. [1]

Other forms of childhood adversity, which include abuse or neglect, similarly impact a child's development through differential epigenetic programming and stress response dysregulation. In addition to adverse effects on mental health, children who experience these events often exhibit dampened immune responses. [20]

Nutrition and development

Sufficient overall nutrition within the first 1,000 days is vital to healthy neurological and physical growth. This includes, but is not limited to adequate amounts of macronutrients, micronutrients, as well as essential vitamins. The concept of adequate nutrition applies to both the carrying mother as well as the child. [21] Carrying mothers have an increased physiological demand due to their unique circumstance of pregnancy. Their bodies immediately undergo huge changes which require additional nutritional needs. It is also important that mothers sustain adequate nutrition post delivery. This is not just for their own health but the health of their child as breastfeeding is a way that newborns obtain vital macronutrients, micronutrients, and vitamins. There are some macronutrients, micronutrients, and vitamins that may be better obtained and retained if acquired through breastfeeding which is why it is crucial that mothers maintain adequate nutrition post delivery. [22] Key macronutrients include proteins and long-chain polyunsaturated fatty acids (LC-PUFA), while some key micronutrients include choline, [23] iron, [24] zinc, iodine, [25] calcium, and magnesium. [26] Essential vitamins are also vital for growth and development. [27] This includes: Vitamin A, which is key for fetal development, organogenesis, limb formation, immune functions, mucosal integrity and body symmetry. A lack of vitamin A can lead to xerophthalmia, night blindness, and anemia. Vitamin D: which is essential for bone development while a deficiency in Vitamin D can lead to the development of rickets disease. Folate/folic acid: which prevents neural tube defects (NTDs). Children who do not receive adequate nutrition in the first 1,000 days can suffer short and long term health consequences. [28] Some of these consequences can be mitigated if identified and addressed early, however they may become harder to rectify as more time passes. [29] For the most part macronutrients, micronutrients, and essential vitamins can and should be obtained through a healthy and well balanced diet. However sometimes this may not be feasible for either the carrying mother or child. In these cases supplementation may be recommended or required. Overall, adequate nutrition within the first 1,000 days is a responsibility shared by caregivers (e.g. parents), as well as providers (e.g. pediatricians, social workers, dieticians).

Childhood obesity

Since the first 1,000 days of life span both intra- and extrauterine development, dietary requirements can be separated into three distinct phases of dietary development: prenatal, breast or formula feeding, and complementary diet. [30]

Prenatal

Maternal factors such as Type I diabetes, pre-pregnancy weight, gestational diabetes, and gestational weight gain are all risk factors for childhood obesity. While this relationship between maternal factors and development of childhood obesity is not completely understood, it is theorized that altered intrauterine conditions due to elevated nutrient exposure affect fetal development such that the child is programmed to be at higher risk. Interventions to manage maternal pre-existing conditions, as well as gestational complications, such as maintaining health blood sugar levels and blood pressures may help to reduce this risk. [30]

Breast/Formula feeding

Population studies have shown that breast feeding has a long-term benefit of preventing obesity in the future. [31] Formula-fed children tend to follow an "accelerated growth curve" compared to breast-fed children who develop along a slower growth curve because they tend to have higher levels of Insulin-like Growth Factor (IGF)-1. [32] This difference in levels of IGF-1 may be due to differences in nutrient compositions of breast milk and formula milk. This phase of dietary development is also highly dependent on the dietary behaviors of the mother.

Complementary diet

The final stage of dietary development is the longest of the three stages, spanning from months 6-24 and presents the most potential for developing risks for obesity. This is partially due to the fact that the complementary diet comprises the largest fraction of dietary development, but particularly because transitioning from liquid to solid foods presents a challenge of its own. More recent research has been expanding on the role of epigenetics and microbiota during the first 1,000 days in the development of childhood obesity. [33]

Related Research Articles

<span class="mw-page-title-main">Nutrition</span> Provision to cells and organisms to support life

Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficient nutrients causes malnutrition. Nutritional science is the study of nutrition, though it typically emphasizes human nutrition.

A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures, such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted to smaller molecules in the process of releasing energy, such as for carbohydrates, lipids, proteins, and fermentation products, leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

<span class="mw-page-title-main">Human nutrition</span> Provision of essential nutrients necessary to support human life and health

Human nutrition deals with the provision of essential nutrients in food that are necessary to support human life and good health. Poor nutrition is a chronic problem often linked to poverty, food security, or a poor understanding of nutritional requirements. Malnutrition and its consequences are large contributors to deaths, physical deformities, and disabilities worldwide. Good nutrition is necessary for children to grow physically and mentally, and for normal human biological development.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Nutrition and pregnancy</span> Nutrient intake and dietary planning undertaken before, during and after pregnancy

Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception as well as throughout pregnancy and breastfeeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life.

<span class="mw-page-title-main">Stunted growth</span> Reduced growth rate in human development

Stunted growth, also known as stunting or linear growth failure, is defined as impaired growth and development manifested by low height-for-age. It is a primary manifestation of malnutrition and recurrent infections, such as diarrhea and helminthiasis, in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother. The definition of stunting according to the World Health Organization (WHO) is for the "height-for-age" value to be less than two standard deviations of the median of WHO Child Growth Standards. Stunted growth is usually associated with poverty, unsanitary environmental conditions, maternal undernutrition, frequent illness, and/or inappropriate feeding practice and care during early years of life.

<span class="mw-page-title-main">Micronutrient deficiency</span> Medical condition

Micronutrient deficiency is defined as the sustained insufficient supply of vitamins and minerals needed for growth and development, as well as to maintain optimal health. Since some of these compounds are considered essentials, micronutrient deficiencies are often the result of an inadequate intake. However, it can also be associated to poor intestinal absorption, presence of certain chronic illnesses and elevated requirements.

<span class="mw-page-title-main">Vitamin D deficiency</span> Human disorder

Vitamin D deficiency or hypovitaminosis D is a vitamin D level that is below normal. It most commonly occurs in people when they have inadequate exposure to sunlight, particularly sunlight with adequate ultraviolet B rays (UVB). Vitamin D deficiency can also be caused by inadequate nutritional intake of vitamin D; disorders that limit vitamin D absorption; and disorders that impair the conversion of vitamin D to active metabolites, including certain liver, kidney, and hereditary disorders. Deficiency impairs bone mineralization, leading to bone-softening diseases, such as rickets in children. It can also worsen osteomalacia and osteoporosis in adults, increasing the risk of bone fractures. Muscle weakness is also a common symptom of vitamin D deficiency, further increasing the risk of fall and bone fractures in adults. Vitamin D deficiency is associated with the development of schizophrenia.

<span class="mw-page-title-main">Prenatal nutrition</span>

Prenatal nutrition addresses nutrient recommendations before and during pregnancy. Nutrition and weight management before and during pregnancy has a profound effect on the development of infants. This is a rather critical time for healthy development since infants rely heavily on maternal stores and nutrient for optimal growth and health outcome later in life.

Relatively speaking, the brain consumes an immense amount of energy in comparison to the rest of the body. The mechanisms involved in the transfer of energy from foods to neurons are likely to be fundamental to the control of brain function. Human bodily processes, including the brain, all require both macronutrients, as well as micronutrients.

Developmental Origins of Health and Disease is an approach to medical research factors that can lead to the development of human diseases during early life development. These factors include the role of prenatal and perinatal exposure to environmental factors, such as undernutrition, stress, environmental chemical, etc. This approach includes an emphasis on epigenetic causes of adult chronic non-communicable diseases. As well as physical human disease, the psychopathology of the foetus can also be predicted by epigenetic factors.

Nutrition psychology (NP) is the psychological study of the relationship between dietary intake and different aspects of psychological health. It is an applied field that uses an interdisciplinary approach to examine the influence of diet on mental health. Nutrition psychology seeks to understand the relationship between nutritional behavior and mental health/well-being NP is a sub-field of psychology and more specifically of health psychology. It may be applied to numerous different fields including: psychology, dietetics, nutrition, and marketing. NP is a fairly new field with a brief history that has already started to contribute information and knowledge to psychology. There are two main areas of controversy within nutrition psychology. The first area of controversy is that the topic can be viewed in two different ways. It can be viewed as nutrition affecting psychological functions, or psychological choices and behavior influencing nutrition and health. The second controversy is the defining of what is "healthy" or "normal" as related to nutrition.

Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.

<span class="mw-page-title-main">Environmental enteropathy</span> Disorder of chronic intestinal inflammation

Environmental enteropathy is an acquired small intestinal disorder characterized by gut inflammation, reduced absorptive surface area in small intestine, and disruption of intestinal barrier function. EE is most common amongst children living in low-resource settings. Acute symptoms are typically minimal or absent. EE can lead to malnutrition, anemia, stunted growth, impaired brain development, and impaired response to oral vaccinations.

<span class="mw-page-title-main">Undernutrition in children</span> Medical condition affecting children

Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.

<span class="mw-page-title-main">Vegetarian and vegan dog diet</span> Adequate meat-free or animal-free nutrition

As in the human practice of veganism, vegan dog foods are those formulated with the exclusion of ingredients that contain or were processed with any part of an animal, or any animal byproduct. Vegan dog food may incorporate the use of fruits, vegetables, cereals, legumes including soya, nuts, vegetable oils, as well as any other non-animal based foods.

<span class="mw-page-title-main">Human milk microbiome</span> Community of microorganisms in human milk

The human milk microbiota, also known as human milk probiotics (HMP), refers to the microbiota (community of microorganisms) residing in the human mammary glands and breast milk. Human breast milk has been traditionally assumed to be sterile, but more recently both microbial culture and culture-independent techniques have confirmed that human milk contains diverse communities of bacteria which are distinct from other microbial communities inhabiting the human body.

Nutritional immunology is a field of immunology that focuses on studying the influence of nutrition on the immune system and its protective functions. Part of nutritional immunology involves studying the possible effects of diet on the prevention and management on developing autoimmune diseases, chronic diseases, allergy, cancer and infectious diseases. Other related topics of nutritional immunology are: malnutrition, malabsorption and nutritional metabolic disorders including the determination of their immune products.

<span class="mw-page-title-main">Child development in India</span>

Child development in India is the Indian experience of biological, psychological, and emotional changes which children experience as they grow into adults. Child development has a significant influence on personal health and, at a national level, the health of people in India.

Nutritional epigenetics is a science that studies the effects of nutrition on gene expression and chromatin accessibility. It is a subcategory of nutritional genomics that focuses on the effects of bioactive food components on epigenetic events.

References

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  30. 1 2 Mameli, Chiara; Mazzantini, Sara; Zuccotti, Gian (2016). "Nutrition in the First 1000 Days: The Origin of Childhood Obesity". International Journal of Environmental Research and Public Health. 13 (9): 838. doi: 10.3390/ijerph13090838 . ISSN   1660-4601. PMC   5036671 . PMID   27563917.
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