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The First 1,000 Days of Life Count: How Micronutrients Impact a Child's Ability to Grow and Learn

August 30, 2016

By Manfred Eggersdorfer and Barbara Troesch

The quality of nutrition during the first 1,000 days - the period between conception and the child’s second birthday – are crucial for health and development along the life cycle. However, malnutrition remains a leading cause of death and illness in young children and those with adequate nutrition are 10 times more likely to overcome common diseases of childhood [1, 2]. Nutrient deficiencies during pregnancy are associated with preterm birth, neural tube defects and low birth weight [3, 4] and such impaired development early in life has far reaching consequences such as lower school attainment and earned wages (in men) as well as increased poverty risk [5]. Moreover, poor nutrition during early life is thought to have long term consequences like coronary heart disease, hypertension and diabetes in the adult years [6]. An important scientific development in this field was Dr. Bruce Ames’ pioneering triage theory, which states that the body prioritizes the use of micronutrients when they are scarce and that priority is given to functions that ensure short-term survival and reproduction at the expense of long-term health [7, 8]. 

The role of multi-vitamins and omega-3s

Novel scientific findings show that women receiving multi-vitamins plus iron and folic acid have reduced risk for stillbirth [9], and emerging evidence suggests that maternal multi-micronutrient supplementation may lead to healthier gestation and reduce the risk of preterm birth and low birth weight particularly in low income countries [10]. Research continues to highlight the important role that omega-3 fatty acids play for both mother and baby [11, 12, 13]. Docosahexaenoic acid (DHA) in particular has been shown to support a healthy pregnancy [11, 12]. It is also recognized to be important for optimal foetal and infant growth; with an important role in brain, eye and nervous system development and function. An expert group reviewing more recent scientific evidence reported the possible beneficial effects of DHA on later child visual and cognitive and emotional development. Moreover that “The LC-PUFA supply and fish intake in pregnancy and infancy seem to positively affect the development of immune responses involved in allergic reactions, and reduce the risk of allergic diseases (asthma and eczema) [13].

Healthy diet, healthy mother, healthy child

Even though a varied, nutrient dense diet can provide most nutrients in the amounts needed during pregnancy, a large majority of the population does not meet dietary recommendations. While a significant number of adults in the U.S. did not consume the recommended amounts of nutrient-rich foods, they tended to consume too much of the foods that should rather be avoided such as solid fats, sugars and alcoholic beverages [14]. Poor dietary choices seem to be a global problem as a recent study reported low intakes of fruits and vegetables for 58% to 88% adults across all geographic clusters [15].Consequently, micronutrient deficiencies during pregnancy are still a global public health concern. For example, the estimated global prevalence of prenatal iron deficiency is 15–20% [16]. Vitamin A deficiency affects an estimated 15% of pregnant women in low-income countries, while in 8% it is severe enough to cause to night blindness [17]. Iodine deficiency ranges from 17% in Oceania to 40% in Africa [1]. A review of diets among pregnant women in high-income countries found intakes of folate, iron and vitamin D to be below recommended intakes [18]. A significant number of pregnant women do not reach recommendations for DHA and the addition of supplements to the diet increases the likelihood of adequate intakes [19].

In conclusion, healthcare professionals should recommend three simple steps to healthy nutrition during pregnancy: adopting a balanced diet, consuming fortified foods and supplementing the diet with minerals, vitamins and omega-3 fatty acids.

 

References

1.            Black, R.E., et al., Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet, 2008. 371(9608): p. 243-260.

2.            Black, R.E., et al., Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 2013. 382(9890): p. 427-51.

3.            West, K.P., Jr., et al., Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial. JAMA, 2014. 312(24): p. 2649-58.

4.            Elmadfa, I. and A.L. Meyer, Vitamins for the First 1000 Days: Preparing for Life. International Journal for Vitamin and Nutrition Research, 2012. 82(5): p. 342-347.

5.            Hoddinott, J., et al., Adult consequences of growth failure in early childhood. The American Journal of Clinical Nutrition, 2013. 98(5): p. 1170-1178.

6.            WHO Regional Office for Europe, Good maternal nutrition- the best start in life, W.H. Organization, Editor. 2016, World Health Organization: Denmark.

7.            Ames, B.N., Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proceedings of the National Academy of Sciences, 2006. 103(47): p. 17589-17594.

8.            Ames, B.N., Optimal micronutrients delay mitochondrial decay and age-associated diseases. Mechanisms of Ageing and Development, 2010. 131(7-8): p. 473-479.

9.            Balogun, O.O., et al., Vitamin supplementation for preventing miscarriage. Cochrane Database Syst Rev, 2016(5): p. CD004073.

10.          Haider, B.A. and Z.A. Bhutta, Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database of Systematic Reviews, 2015(11).

11.          Kar S, Wong M, Rogozinska E, Thangaratinam S. Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies. Eur J Obstet Gynecol Reprod Biol. 2016  thatee K2A22 do;198:40-6. doi: 10.1016/j.ejogrb.2015.11.033. Epub 2015 Nov 30. PMID: 26773247.

12.          Keenan K, Hipwell A, McAloon R, Hoffmann A, Mohanty A, Magee K, The effect of prenatal docosahexaenoic acid supplementation on infant outcomes in African American women living in low-income environments: A randomized, controlled trial. Psychoneuroendocrinology. 2016 Sep;71:170-5. doi: 10.1016/j.psyneuen.2016.05.023. Epub 2016 May 25.

13.          Koletzko B1, Boey CC, Campoy C, Carlson SE, Chang N, Guillermo-Tuazon MA, Joshi S, Prell C, Quak SH, Sjarif DR, Su Y, Supapannachart S, Yamashiro Y, Osendarp SJ Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an early nutrition academy workshop. Ann Nutr Metab. 2014;65(1):49-80. doi: 10.1159/000365767. Epub 2014 Sep 16.

14.          Krebs-Smith, S.M., et al., Americans Do Not Meet Federal Dietary Recommendations. The Journal of Nutrition, 2010. 140(10): p. 1832-1838.

15.          Murphy, M.M., et al., Global assessment of select phytonutrient intakes by level of fruit and vegetable consumption. British Journal of Nutrition, 2014. FirstView: p. 1-15.

16.          Gernand, A.D., et al., Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat Rev Endocrinol, 2016. advance online publication.

17.          World Health Organization, Global prevalence of vitamin A deficiency in populations at risk 1995–2005, in WHO Global Database on Vitamin A Deficiency. 2009: Geneva.

18.          Blumfield, M.L., et al., Micronutrient intakes during pregnancy in developed countries: Systematic Review and Meta-Analysis. Nutrition Reviews, 2013. 71(2): p. 118-132.

19.          Jia, X., et al., Women who take n-3 long-chain polyunsaturated fatty acid supplements during pregnancy and lactation meet the recommended intake. Appl Physiol Nutr Metab, 2015: p. 1-8.