The First 1000 Days: A Critical Period of Nutritional Opportunity and Vulnerability

Received: 14 April 2020 Accepted: 14 April 2020
DOI: 10.1111/1747-0080.12617
INVITED EDITORIAL
The first 1000 days: A critical period of nutritional

opportunity and vulnerability
The period of life between conception and a child's classes in Perth and found that only three of five women
second birthday, referred to popularly as the first consumed bread daily.8 Similarly, James-McAlpine et al
1000 days, is key to lifelong health and wellbeing.1 It is a assessed the diets of a cohort of pregnant South East
period of rapid growth and neurodevelopment, high Queensland women and found that the daily serves of
nutritional requirements and high sensitivity to program- grain-based food were less than half the recommended
ming effects and, as a consequence, is a time of great vul- intake.22 The implication of both these studies is that the
nerability.2 Failure to provide sufficient kilojoules and dietary intake of both folate and iodine by pregnant
key nutrients during this critical period may result in stu- Australian women is likely to be insufficient.
nting and lifelong deficits in brain function. In addition, As well as being an important period for foetal devel-
child and adult health risks, including obesity, cardiovas- opment, pregnancy is considered an opportune time for
cular, metabolic and endocrine disease, may be promoting healthy nutrition practices to women when
programmed as a result of exposure to an adverse nutri- they are purportedly more motivated to care for their
tional environment during this period.3 own health and that of their offspring. The internet has
Although the most active period of neurological become the most popular source of nutrition information
development occurs in the first 1000 days, parenting and used by Australian adults in general.23 While, tradition-
early education in the preschool years also have an ally, health professionals have been, and remain, the pri-
impact on long-term developmental and health out- mary source of nutrition information for Australian
comes.4 From a dietary perspective, early childhood is a pregnant women, in this issue, Lobo et al report that
period of life when food preferences and eating behav- Australian pregnant women are increasingly searching
iours, which are influenced by parental feeding practices the internet for information on a variety of nutrition
and role modelling, are firmly established. Food prefer- topics relevant to pregnancy.9 It is critical, therefore, that
ences and eating behaviours have been shown to track pregnant women have access to relevant and factual
into later life5 and provide the foundation for either good information from credible online sources. Lobo et al
or poor health in later childhood and adulthood.6 rated the accuracy of 136 websites and found that govern-
This issue of Nutrition & Dietetics includes a collection ment and business/company websites had an encourag-
of original nutrition research that spans these critical first ingly high degree of accuracy, whereas the websites of
1000 days of life and beyond. In addition to papers community groups had a lower degree of accuracy, and
related to pregnancy,7-10 infancy11-13 and the preschool personal blogs were a source of largely inaccurate infor-
years,14 there are papers related to schoolchildren,15 ado- mation.9 Given the importance of iodine in pregnancy,
lescents16 and young adults.17,18 surprisingly few women (11.8%) searched the internet for
Folate and iodine both play crucial roles in foetal neu- information on this nutrient. Of greater concern is the
rodevelopment7 but are often lacking in the diets of preg- finding that just under half of the women surveyed in
nant women. Consequently, routine supplementation in 2018 were unsure if they had received information on
pregnancy of both of these nutrients is recommended.19 iodine, suggesting that iodine supplementation recom-
However, adherence to these supplementation recom- mendations are not being effectively communicated to
mendations by pregnant women in Australia is far from this target audience, let alone adhered to.
universal,20 and therefore, many pregnant women rely, at Not only does breastfeeding provide optimal nutrition
least in part, on dietary intake to meet their increased to infants, it is also beneficially associated with a range of
needs for these nutrients. In Australia, mandatory fortifi- short- and long-term health outcomes.24 Parizkova et al
cation of breads with iodine and folate was introduced in investigated the association between breastfeeding dura-
2009 in an effort to increase population dietary intake of tion and infant disease in a cross-sectional study of 2304
these nutrients.21 Sherriff et al investigated the dietary Czech mothers.11 Their findings are generally consistent
iodine intake of pregnant women attending antenatal with the current literature,24 including that children fully
Nutrition & Dietetics. 2020;77:295–297. wileyonlinelibrary.com/journal/ndi © 2020 Dietitians Association of Australia 295
296 SCOTT
breastfed to 6 months of age had a significantly lower risk RE FER EN CES

of having been prescribed antibiotics for an upper respi- 1. Moore T, Arefadib N, Deery A, West S. The First Thousand Days:
ratory tract infection than infants who were partially an Evidence Paper. Centre for Community Child Health, Mur-
breastfed or formula fed at 6 months. This is consistent doch Children's Research Institute: Parkville, Victoria; 2017.
with the evidence that breastfeeding reduces the severity 2. Martorell R. Improved nutrition in the first 1000 days and adult
human capital and health. Am J Hum Biol. 2017;29:e22952.
of respiratory illnesses in infants.25 This finding is also of
3. Kwon EJ, Kim YJ. What is fetal programming?: A lifetime
importance given the disruptive effect that antibiotics health is under the control of in utero health. Obstet Gynecol
have on the developing infant's gut microbiota, which Sci. 2017;60:506-519.
may have long-term metabolic consequences.26 4. Doyle O. The First 2,000 Days and Child Skills: Evidence from a
The consequences of poor nutrition in the first Randomized Experiment of Home Visiting. In Working Paper
1000 days are felt particularly in vulnerable populations. Series, No 17/15. Dublin: University College Dublin, UCD Cen-
Leonard et al have previously highlighted an alarming tre for Economic Research; 2017.
rate of anaemia amongst pregnant Aboriginal and Torres 5. Nicklaus S, Boggio V, Chabanet C, Issanchou S. A prospective
study of food variety seeking in childhood, adolescence and
Strait Islander women in Far North Queensland.27 Iron
early adult life. Appetite. 2005;44:289-297.
deficiency anaemia in early childhood is common world- 6. Schwartz C, Scholtens PA, Lalanne A, Weenen H, Nicklaus S.
wide and can have a detrimental effect on growth and Development of healthy eating habits early in life. Review of
neurodevelopment. Young children are particularly vul- recent evidence and selected guidelines. Appetite. 2011;57:
nerable because of their rapidly developing brain, and 796-807.
iron deficiency in early childhood can have lifelong con- 7. Schwarzenberg SJ, Georgieff MK. Advocacy for improving
sequences.28 In this issue, Leonard et al14 report on the nutrition in the first 1000 days to support childhood develop-
ment and adult health. Pediatrics. 2018;141:e20173716.
association of early childhood anaemia and developmen-
8. Sherriff J, Hine T, Begley A, et al. Iodine-containing food prac-
tal outcomes at school age among Aboriginal and Torres
tices of Western Australian pregnant women and ethnicity: an
Strait Islander children of remote Far North Queensland. observational study. Nutr Diet. 2020;77:344-350.
They show, in this study, that children who experienced 9. Lobo S, Lucas CJ, Herbert JS, et al. Nutrition information in
anaemia between 6 and 24 months of age had double the pregnancy: where do women seek advice and has this changed
risk of adverse developmental outcomes at school age. over time? Nutr Diet. 2020;77:382-391.
Several papers in this issue provide further evidence 10. Chmurzynska A, Seremak-Mrozikiewicz A, Malinowska A,
of the importance of adequate and timely nutrition in the et al. Associations between folate and choline intake, homocys-
teine metabolism, and genetic polymorphism of MTHFR,
first 1000 days and the need for this to be communicated
BHMT, and PEMT in healthy pregnant polish women. Nutr
effectively to new mothers and mothers to be. While Diet. 2020;77:368-372.
pregnancy is seen as a critical window of opportunity for 11. Parizkova P, Dankova N, Früuhauf P, Jireckova J, Zeman J,
promoting healthy eating to women, food choices of Magner M. Associations between breastfeeding rates and infant
pregnant women appear to be driven primarily by sen- disease—a survey of 2338 Czech children. Nutr Diet. 2020;77:
sory and not health motives,22 as is the case in the gen- 310-314.
eral population. In particular, the iodine intake of 12. Swanepoel L, Henderson J, Maher J. Mothers' experiences with
pregnant women continues to be of concern, with dietary complementary feeding: conventional and baby-led
approaches. Nutr Diet. 2020;77:373-381.
intakes likely to be insufficient, and the importance of
13. Cormack B, Oliver C, Farrent S, et al. Neonatal dietitian
iodine in pregnancy is seemingly ineffectively communi- resourcing and roles in New Zealand and Australia: a survey of
cated to this target group. There is a need for nutritionists current practice. Nutr Diet. 2020;77:392-399.
and dietitians, along with other health professionals, to 14. Leonard D, Buettner P, Thompson F, Makrides M,
continually advocate for public policies and deliver pro- McDermott R. Early childhood anaemia more than doubles the
grams that ensure the provision of optimal nutrition and risk of developmental vulnerability at school-age among
promotion of healthy eating during this critical period. aboriginal and Torres Strait Islander children of remote Far
North Queensland: findings of a retrospective cohort study.
Nutr Diet. 2020;77:298-309.
CONFLICT OF INTEREST
15. Mehranfar S, Jalilpiran Y, Surkan PJ, Azadbakht L. Association
The author has no conflict of interest to declare. between protein-rich dietary patterns and anthropometric mea-
surements among children aged 6 years. Nutr Diet. 2020;77:
Jane A. Scott PhD FDAA 359-367.
16. Isgin-Atici K, Kanbur N, Akgül S, Buyuktuncer Z. Diet quality
Professor of Public Health Nutrition, Associate Editor, in adolescents with premenstrual syndrome: a cross-sectional
Nutrition and Dietetics, School of Public Health, Curtin study. Nutr Diet. 2020;77:351-358.
17. Whatnall MC, Patterson AJ, Chiu S, Oldmeadow C,
University, Perth, Western Australia, Australia
Hutchesson MJ. Determinants of eating behaviours in
Email: jane.scott@curtin.edu.au
SCOTT 297
Australian university students: a cross-sectional analysis. Nutr 25. Horta BL, Victora CG. Short-Term Effects of Breastfeeding: a Sys-
Diet. 2020;77:331-343. tematic Review on the Benefits of Breastfeeding on Diarrhoea and
18. Teasdale SB, Burrows TL, Hayes T, et al. Dietary intake, food Pneumonia Mortality. Geneva: World Health Organization; 2013.
addiction and nutrition knowledge in young people with men- 26. Gibson MK, Crofts TS, Dantas G. Antibiotics and the develop-
tal illness. Nutr Diet. 2020;77:315-322. ing infant gut microbiota and resistome. Curr Opin Microbiol.
19. National Health and Medical Research Council: Australian 2015;27:51-56.
Dietary Guidelines Canberra: National Health and Medical 27. Leonard D, Buttner P, Thompson F, Makrides M, McDermott R.
Research Council; 2013. Anaemia in pregnancy among aboriginal and Torres Strait
20. El-mani S, Charlton KE, Flood VM, Mullan J. Limited knowl- islander women of far North Queensland: a retrospective cohort
edge about folic acid and iodine nutrition in pregnant women study. Nutr Diet. 2018;75:457-467.
reflected in supplementation practices. Nutr Diet. 2014;71: 28. Eussen S, Alles M, Uijterschout L, Brus F, van der Horst-
236-244. Graat J. Iron intake and status of children aged 6-36 months in
21. Folic acid & iodine fortification [https://www.aihw.gov.au/ Europe: a systematic review. Ann Nutr Metab. 2015;66:80-92.
reports/food-nutrition/folic-acid-iodine-fortification/contents/
summary]
22. James-McAlpine JM, Vincze LJ, Vanderlelie JJ, Perkins AV.
Influence of dietary intake and decision-making during preg- How to cite this article: Scott JA. The first
nancy on birth outcomes. Nutr Diet. 2020;77:323-330. 1000 days: A critical period of nutritional
23. Pollard CM, Pulker CE, Meng X, Kerr DA, Scott JA. Who uses opportunity and vulnerability. Nutrition & Dietetics.
the internet as a source of nutrition and dietary information? 2020;77:295–297. https://doi.org/10.
An Australian Population Perspective. J Med Internet Res. 2015;
1111/1747-0080.12617
17:e209.
24. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st
century: epidemiology, mechanisms, and lifelong effect. The
Lancet. 2016;387:475-490.

The First 1000 Days: A Critical Period of Nutritional Opportunity and Vulnerability

Uploaded by

Copyright:

Available Formats

The First 1000 Days: A Critical Period of Nutritional Opportunity and Vulnerability

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The First 1000 Days: A Critical Period of Nutritional Opportunity and Vulnerability

Uploaded by

Copyright:

Available Formats

Received: 14 April 2020 Accepted: 14 April 2020

The first 1000 days: A critical period of nutritional

breastfed to 6 months of age had a significantly lower risk RE FER EN CES

You might also like