A critical window of opportunity to impact on lifelong health The first 1000 days A critical window of opportunity to impact on lifelong health The first 1000 days….. A critical window of opportunity to impact on lifelong health

The first 1000 days refers to the period from the moment of conception to when a child is aged 24 months

The first 1000 days: a period of rapid growth and development Breastfeeding Pregnancy Weaning Toddler

Why the first 1000 days are so important

The significance of the first 1000 days What you do, eat or experience during the first 1000 days has lifelong consequences for your health. * McMullen, 2009

Between -9m and 2 years something special happens A time of rapid growth Speed of growth 22 20 18 16 14 12 10 8 6 4 gram per day -9 months to 2 years Age (years) Adult Teenagers Between -9m and 2 years something special happens WHO Growth Standards, 2006

And a time of significant development Cognitive development Immune maturation Digestive system Metabolic organs Body composition

With an impact on later life health critical window of opportunity Birth -9 months Weaning Adults Healthy Adults Optimal Growth Altered growth Disease

The environment has much more impact on your health in later life than your genes It has been estimated that at most 20% of lifelong health can be explained by inherited genes. This means that at least 80% of disease risk in later life is due to the environment, including nutrition and life style. Gluckman, 2013

Early nutrition leads to ‘Beeing’ different Queen bees feed on nutrient-rich royal jelly longer than worker bees

PREGNANCY Pregnancy

The development of the foetus in the 3 trimesters 2nd TRIMESTER 3rd TRIMESTER (week 1 – 12) (week 13– 27) (week 28 – 40) PREGNANCY Blastocyst implantation embryo development, placenta formation, organ formation Foetus practising ‘breathing’ and movement, organ development Body and organ growth Rapid increase body fat

The key challenges of nutrition during pregnancy Nutritional status of a woman before becoming pregnant: determines early embryo and placenta development The body weight of the mother at conception: being underweight or overweight mother puts a pregnancy at risk, and adversely affects later disease risk for the child Nutritional requirements: are increased in pregnancy, particularly for some vitamins and minerals Total food intake: Mothers do not need to ‘eat for two’, but rather need to ‘think for two’ – the quality of the diet is key PREGNANCY

Nutritional requirements during pregnancy Women should have a supplement of folic acid prior to pregnancy and in the first trimester, to prevent neural tube defects such as spina bifida Many women of reproductive age have poor vitamin D status, so a supplement of vitamin D is recommended in many countries Iron, iodine and omega 3 fats (also known as DHA) needs are increased. It may be difficult to meet these needs even by eating a healthy diet Experts have suggested a specific level of omega 3 (DHA) that pregnant women should have daily The above nutrients are of particular importance across the globe with additional nutrient gaps being apparent in different regions e.g. vitamins A, B1, B2 and calcium in Asia PREGNANCY D

Breastfeeding BREASTFEEDING

Breastfeeding is the best way to feed a child Breastfeeding is how nature intended a newborn infant to be fed, and is therefore undisputedly the best way to feed an infant. The WHO and UNICEF recommend that a newborn child is exclusively breastfed for the first six months after birth, with breastfeeding continuing along with appropriate complementary foods up to 2 years of age BREASTFEEDING

Breastfeeding has benefits for the mother Breastfeeding decreases the risk of: breast & ovarian cancer type II diabetes cardiovascular disease* Breastfeeding plays a central role in mobilising fat stores accumulated during pregnancy thus helping a mother return to her pre-pregnancy weight Breastfeeding “resets” maternal metabolism, thereby reducing maternal risk for metabolic disease. So when a woman does not breastfeed, adverse metabolic changes persist for longer, thus increasing her disease risk** BREASTFEEDING *Ballard, 2013, **Stuebe, 2009,

Breastfeeding has benefits for the child Short term benefits protection against gastrointestinal and respiratory infection and allergy* Longer term benefits associated with lower incidences of obesity, diabetes lower levels of cholesterol and blood pressure higher performance in intelligence tests** (not all studies have demonstrated these benefits conclusively it depends on sample size, timings of end point measurement) BREASTFEEDING *ESPGHAN, 2009, **Kelishadi et al, 2014,

Human milk has a unique composition Nutritive components Functional components Immunological compounds e.g.: sIgA, Lactoferrin etc. Long chain poly-unsaturated fatty acids Hormones and growth factors Human Milk OligoSaccharides: HMOS Beneficial bacteria 53-61 g/l 30-50 g/l 10-12 g/l 8-10 g/l BREASTFEEDING

Maternal nutrition and breastfeeding Nutritional requirements are increased even more in breastfeeding women than in pregnant women Women are able to produce milk with adequate protein, fat, carbohydrate and most minerals - even when their supply of these nutrients are limited Vitamin A, B1, B2, B12, D, iodine and omega 3 (DHA) levels in breast milk are linked to dietary intake in the mother BREASTFEEDING

Maternal nutrition and breastfeeding Fat is the most highly variable macronutrient of human milk and maternal diet will influence the quality (not the quantity) of fat in breast milk Low levels of DHA in breast milk has been associated with low intakes in the maternal diet It is important that all breastfeeding women or infants have a supplement of vitamin D DHA BREASTFEEDING

Four baby miracles after birth BREASTFEEDING Physical growth Cognitive development Immune maturation Digestive maturation

Four baby miracles, all supported by nutrition Physical growth 1 cell at conception to 500 trillion cells at 3 years Triple birth weight in the first year of life Growth more in the first three years of life than ever Cognitive development 80% of adult brain mass achieved by 3 years 3x increase in brain weight in first three years 900 words learnt by 3 years BREASTFEEDING Neonate 25 years

Four baby miracles, all supported by nutrition Immune maturation It takes 2 years to develop the body’s most potent immune organ – the gut barrier Early life colonisation of the gut with bacteria is crucial for its development; it is influenced by the mode of delivery of the baby, and by nutrition Digestive system An infant is born with an immature gut. Its digestive and absorptive capacity must develop in the early years BREASTFEEDING

Weaning WEANING

Reasons to start complementary feeding Two key reasons to start complementary feeding: Breastfeeding alone is insufficient to meet the increased nutritional requirements in the rapidly developing child It is important that a child is introduced to solid food with new tastes and textures to develop healthy eating habits WEANING

Development of healthy eating habits… starts in the womb and continues in the early years Food preferences and behavior Fluid sensory experience1 Solid foods exposure2 Social environment3 WEANING Flavor, taste… Appearance, taste, texture… Mother-child interaction…. 1Mennella, JA et al (2001) 2Sullivan & Birch (1994) ; 3Scaglioni S et al. (2011).

Development of healthy eating habits Some facts Fruits tend to be better accepted than vegetables, due to the innate liking for sweet tastes Variety and repetition is an effective strategy to increase vegetable linking Children who have a delayed introduction to textures have been shown to be more ‘fussy eaters’ Healthy eating habits formed early in life track into childhood and beyond WEANING

Toddlers TODDLER

Toddlers gain >15% in height and >25% in weight in just one year This would be like a 70kg adult putting on 17 kg of weight in one year. Height Weight 115 105 95 85 75 65 55 45 35 1 2 3 cm Age (years) 15% height increase 22 20 18 16 14 12 6 1 2 3 97% kg Age (years) 3% 10 8 4 25% weight increase TODDLER WHO Growth Standards, 2006

Young children have specific nutritional needs They need up to 7 times more nutrients than an adult (per kg body weight) Therefore, with every spoon, a child has to eat significantly more nutrients than an adult 5.5 x more Iron 4 x more Calcium 3 x more Essential Fatty Acids Per Kg Body weight (compared to adults) 5x smaller TODDLER

Nutritional needs in toddlers Some facts Toddlers have specific nutritional needs that may not be met by adult diets They require up to 4-7 times the amount of some nutrients per kg compared to an adult. Feeding a toddler can be challenging for parents. ‘Neophobia’ (the fear of new foods) may occur from 18 months of age, and a toddler may be a ‘ fussy eater’. TODDLER

Reality of nutritional intake in toddlers Iron is one of the most important nutrients during this period, to support brain growth and cognitive development. Inadequate iron intakes and poor iron status is the most common nutritional issue seen in this age across the globe Toddlers in many developed countries are eating: too much protein - which may lead to an increased risk of obesity too much salt - which may cause raised blood pressure too much saturated fat - which may cause heart disease later in life too much sugar - linked to the development of dental caries and childhood obesity not enough vitamin D TODDLER

Conclusions

Conclusions The first 1000 days offer a unique window of opportunity to build long-term health. The right nutrition during this critical period really matters. The rapid growth and development during pregnancy, breastfeeding, weaning and toddlerhood leads to specific nutritional requirements during each of these stages. Therefore, it is crucial to ensure every mother and child have access to optimal nutrition during the first 1000 days!