1000 DAYS INTRODUCTION The first 1000 days….. A critical window of opportunity to impact on...
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1000 DAYS INTRODUCTION The first 1000 days….. A critical window of opportunity to impact on lifelong health The first 1000 days A critical window of opportunity
1000 DAYS INTRODUCTION 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
Slide 2
1000 DAYS INTRODUCTION The first 1000 days refers to the period
from the moment of conception to when a child is aged 24
months
Slide 3
1000 DAYS INTRODUCTION The first 1000 days: a period of rapid
growth and development BreastfeedingPregnancyWeaning Toddler
Slide 4
1000 DAYS INTRODUCTION Why the first 1000 days are so
important
Slide 5
1000 DAYS INTRODUCTION 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
Slide 6
1000 DAYS INTRODUCTION 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 10 Age
(years) Adult Teenagers Between -9m and 2 years something special
happens WHO Growth Standards, 2006
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1000 DAYS INTRODUCTION And a time of significant development
Cognitive development Immune maturation Digestive system Metabolic
organs Body composition
Slide 8
1000 DAYS INTRODUCTION With an impact on later life health
CRITICAL WINDOW OF OPPORTUNITY Birth -9 months Weaning Adults
Healthy Adults Optimal Growth Altered growth Disease
Slide 9
1000 DAYS INTRODUCTION 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
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1000 DAYS INTRODUCTION Early nutrition leads to Beeing
different Queen bees feed on nutrient-rich royal jelly longer than
worker bees
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1000 DAYS INTRODUCTION Pregnancy
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1000 DAYS INTRODUCTION The development of the foetus in the 3
trimesters Blastocyst implantation embryo development, placenta
formation, organ formation Foetus practising breathing and
movement, organ development Body and organ growth Rapid increase
body fat (week 1 12)(week 13 27) (week 28 40) 1 st 2 nd 3 rd
Slide 13
1000 DAYS INTRODUCTION 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
Slide 14
1000 DAYS INTRODUCTION 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 D
Slide 15
1000 DAYS INTRODUCTION Breastfeeding
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1000 DAYS INTRODUCTION 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
Slide 17
1000 DAYS INTRODUCTION 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** *Ballard, 2013, **Stuebe, 2009,
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1000 DAYS INTRODUCTION 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) *ESPGHAN, 2009, **Kelishadi et al, 2014,
Slide 19
1000 DAYS INTRODUCTION 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
Slide 20
1000 DAYS INTRODUCTION 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
Slide 21
1000 DAYS INTRODUCTION 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
Slide 22
1000 DAYS INTRODUCTION Four baby miracles after birth Physical
growth Cognitive development Immune maturation Digestive
maturation
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1000 DAYS INTRODUCTION 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
Neonate25 years
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1000 DAYS INTRODUCTION Four baby miracles, all supported by
nutrition Immune maturation It takes 2 years to develop the bodys
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
Slide 25
1000 DAYS INTRODUCTION Weaning
Slide 26
1000 DAYS INTRODUCTION 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
Slide 27
1000 DAYS INTRODUCTION BACKGROUND INFORMATION Development of
healthy eating habits 1 Mennella, JA et al (2001) 2 Sullivan &
Birch (1994) ; 3 Scaglioni S et al. (2011). STARTS IN THE WOMB AND
CONTINUES IN THE EARLY YEARS Solid foods exposure 2 Fluid sensory
experience 1 Social environment 3 Food preferences and behavior
Flavor, taste Appearance, taste, textureMother-child
interaction.
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1000 DAYS INTRODUCTION Development of healthy eating habits
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 SOME FACTS
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1000 DAYS INTRODUCTION Toddlers
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1000 DAYS INTRODUCTION 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. WHO Growth Standards, 2006
115 105 95 85 75 65 55 45 35 123 cm Age (years) 15% height increase
22 20 18 16 14 12 6 0 123 97% kg Age (years) 3% 10 8 4 2 25% weight
increase HeightWeight
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1000 DAYS INTRODUCTION 5x smaller 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)
Slide 32
1000 DAYS INTRODUCTION Nutritional needs in toddlers 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. SOME FACTS
Slide 33
1000 DAYS INTRODUCTION 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
Slide 34
1000 DAYS INTRODUCTION Conclusions
Slide 35
1000 DAYS INTRODUCTION 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!