News

The American Academy of Pediatrics Advances the Conversation about the First 1000 Days of Life

Nate Matusheski, PhD

February 27, 2018

If you are a regular NUTRI-FACTS reader, you already know the importance of long-chain polyunsaturated fatty acids and other micronutrients, such as iron, iodine and choline, for brain development during the first 1000 days of life. This period represents a critical developmental time between conception and a child’s second birthday. Nutrient deficiencies during pregnancy are associated with a variety of negative outcomes, including preterm birth, neural tube defects and low birth weight (1). Globally, malnutrition is a leading cause of death in young children, and children who receive adequate nutrition are much more likely to overcome childhood diseases (2). However, recent evidence also suggests that inadequate nutrition within this important window of time can hinder neurodevelopment, with possible life-long consequences for brain function, mental development and achievement of intellectual potential (3–6).

In a recent policy statement, the American Academy of Pediatrics (AAP) calls new attention to the importance of key nutrients in supporting brain development in the first 1000 days. In addition to protein and energy, they call out the long-chain polyunsaturated fatty acids arachidonic acid (ARA) and docosahexaenoic acid (DHA), and micronutrients including vitamins A, B6, B12 and K, plus folate, choline, zinc, copper, iodine, iron and selenium as key factors supporting neurodevelopment in this important time period. AAP cites evidence of long-term neurobehavioral damage resulting from iron deficiency (7), reduced performance on IQ tests associated with early iodine deficiency (8,9) and positive effects on intelligence observed 6 years after DHA and ARA supplementation (10).

The objective of AAP’s policy statement is to inform pediatricians of the importance of these key nutrients, support the promotion of healthy nutrition and advocate for the expansion of programs that support early life nutrition in communities to ensure that all children have the best chance for a healthy life.

The AAP makes 10 recommendations for pediatricians and other leaders in child nutrition, in summary:

  1. Be knowledgeable about breastfeeding, and educate and advocate for it
  2. Advocate at the local, state and federal levels to preserve and strengthen nutrition programs with a focus on early life nutrition
  3. Be conversant about food sources that supply critical nutrients necessary for brain development during important times
  4. Advocate for actionable “positive nutrition” messages to provide more prescriptive advice about optimal dietary choices
  5. Focus the attention of existing nutrition programs on improving micro- and macronutrient offerings for infants and young children
  6. Encourage families to take advantage of programs that provide early life nutrition, and advocate for eliminating barriers to these programs
  7. Oppose changes in eligibility or financing structures that would create barriers to such nutrition programs
  8. Anticipate neurodevelopmental concerns in children with early nutrient deficiency
  9. Partner with obstetricians and family physicians to encourage improvements in maternal diet and identify situations that may limit access to crucial micronutrients
  10. Become advocates in the “hunger community,” considering a personal contribution to social action by becoming involved in an organization focused on hunger

Many physicians enter practice with insufficient knowledge of nutrition (11). This new statement by the AAP builds on their existing statements that focus on the importance of early life nutrition, including their policy on breastfeeding (12) and policy on iron supplementation (13). In today’s uncertain healthcare environment in the United States, it’s reassuring that the AAP has increased their focus on early life nutrition as a critical aspect of practice for pediatricians, and raised the importance of access to essential nutrients in the first 1000 days of life to promote lasting health.

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References

  1. Elmadfa I, Meyer AL. Vitamins for the first 1000 days: preparing for life. Int J Vitam Nutr Res Int Z Vitam- Ernahrungsforschung J Int Vitaminol Nutr. 2012;82:342–7.
  2. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, Onis M de, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. 2013;382:427–51.
  3. Morgane PJ, Austin-LaFrance R, Bronzino J, Tonkiss J, Díaz-Cintra S, Cintra L, Kemper T, Galler JR. Prenatal malnutrition and development of the brain. Neurosci Biobehav Rev. 1993;17:91–128.
  4. Grantham-McGregor S. A review of studies of the effect of severe malnutrition on mental development. J Nutr. 1995;125:2233S–2238S.
  5. Pollitt E, Gorman K, L Engle P, Rivera JA, Martorell R. Nutrition in early life and fulfilment of intellectual potential. J Nutr. 1995;125:1111S–1118S.
  6. Georgieff MK, Brunette KE, Tran PV. Early life nutrition and neural plasticity. Dev Psychopathol. 2015;27:411–23.
  7. Georgieff MK. Long-term Brain and Behavioral Consequences of Early Iron Deficiency. Nutr Rev. 2011;69:S43–8.
  8. Bleichrodt N, Born MP. A metaanalysis of research on iodine and its relationship to cognitive development. 1996 [cited 2018 Feb 5]; Available from: https://research.vu.nl/en/publications/a-metaanalysis-of-research-on-iodine-and-its-relationship-to-cogn
  9. Pharoah P, Buttfield IH, Hetzel BS. Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. Int J Epidemiol. 2012;41:589–92.
  10. Colombo J, Carlson SE, Cheatham CL, Shaddy DJ, Kerling EH, Thodosoff JM, Gustafson KM, Brez C. Long-term effects of LCPUFA supplementation on childhood cognitive outcomes1234. Am J Clin Nutr. 2013;98:403–12.
  11. Adams KM, Butsch WS, Kohlmeier M. The state of nutrition education at US medical schools. J Biomed Educ [Internet]. 2015 [cited 2017 Aug 30]; Available from: http://dx.doi.org/10.1155/2015/357627
  12. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129:e827–41.
  13. Baker RD, Greer FR, Nutrition TC on. Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age). Pediatrics. 2010;126:1040–50.