Good nutrition is important at every stage of life, but never more so than during the first 1000 days – from conception to around the second birthday. The ‘Early Life Nutrition Coalition’ defines nutrition during the early years of life as “nutritional exposures prior to conception and during pregnancy, infancy and early childhood. These exposures can leave an imprint on the foetus and young child that results in increased risks for disease in later life.”
Early life nutrition has been shown to strongly influence foetal growth and development (1) as well as the risk of metabolic and allergic disease in childhood and adult life (2-4). Optimal nutrition during the same period may set up long standing wellbeing.
This is also the period when a child’s gut microbiota is established (5-7). In infants, the intestinal microbiota development is distinguished by rapid and large changes in microbial abundance, diversity and composition. This is influenced by medical, cultural and environmental factors such as mode of delivery, diet, family environment and disease (8). The intestinal microbiota is involved in various vital functions, including barrier function, metabolic reactions, trophic effects and maturation of the innate and adaptive immune responses (8) and exerts lifelong impacts on health.
Dr Joanna McMillan explains a little about the importance of The First 1000 Days.
Prior to conception, the nutrition status and wellbeing of both parents is important. The Early Life Coalition highlights that maternal obesity and a woman’s health before conception has a significant impact on pregnancy outcomes and may have a lifelong impact on her child’s health. Increasing paternal body mass index is also linked to impaired embryo and foetal development, and reduced pregnancy rates and pregnancy loss.
Iodine and folate supplementation are required pre-conception. For folic acid, the recommended supplementation dose during the pre-conception period is at least 400 micrograms/day. Folate supplementation should be continued for at least one month before and three months after conception, in addition to consuming folate from a varied diet (9). Where there is an increased risk of Neural Tube Defects (NTD) (e.g. in women who are obese, those using anticonvulsant medication, those with existing type 2 diabetes, those with a previous history of a child with NTD or a family history of NTD), 5 mg/day folic acid is recommended (10).
For iodine, the recommended supplementation dose during the pre-conception period is 150 micrograms/day. Iodine supplementation should continue for the duration of pregnancy and during lactation. Women with diagnosed pre-existing thyroid conditions require individual medical advice before taking their iodine supplements (10).
For other key dietary intake recommendations, the Australian Dietary Guidelines provide sensible advice for women and families to follow, to achieve healthy dietary patterns.
The impact of a mother’s nutrition status on her baby’s long term health continues during pregnancy. According to the Early Life Coalition, maternal obesity, excessive gestational weight gain, diabetes and stress during pregnancy all increase the risk of obesity in the offspring. Recommended weight gain during pregnancy, depending on pre-pregnancy body mass index, is shown in Table 1 (10,11).
|Pre-pregnancy body mass index||Recommended total weight gain|
|Less than 18.5 kg/m2||12.5 to 18 kg|
|18.5 to 24.9 kg/m2||11.5 to 16 kg|
|25 to 29.9 kg/m2||7 to 11.5 kg|
|More than 30 kg/m2||5 to 9 kg|
Iodine and folate supplementation should continue during pregnancy (10). Other key maternal nutrients noted by The Coalition include Vitamins A, C, D and E and the minerals selenium and zinc, plus long chain polyunsaturated fatty acids and Prebiotics & Probiotics, as these have been linked to multiple health outcomes in the offspring including asthma, allergic disease and obesity. The consumption of appropriate levels of other vitamins and minerals, including all B Group vitamins, iron, calcium and zinc via a range of foods, as recommended in The Australian Dietary Guidelines during pregnancy is essential.
In terms of Prebiotics and Probiotics, emerging evidence shows Prebiotics during pregnancy may protect against allergy in the offspring. Prebiotics are naturally occurring dietary fibre compounds found in food like barley, legumes, firm green bananas, sorghum and some other whole grains, which act as food for the gut microbiota (however, not all fibres have prebiotic properties). Alterations to the gut microbiota of the mother can change the microbiota of the infant (10). Probiotics during pregnancy have also been shown to have metabolic and immune system benefits (1, 10,12).
Exclusive breastfeeding is recommended up until around 6 months of age. The NHMRC (2012) Infant Feeding Guidelines highlight that breast milk contains numerous biologically active components, and has the ideal composition to promote optimal growth and development in infants (13). To support the energy and nutrient requirements of breastfeeding, lactating mothers are encouraged to eat a health and varied, as described in The Australian Dietary Guidelines during lactation.
If babies are not breast fed, the only safe alternative is infant formula and healthcare professionals are well placed to provide families with all the information and support they need to prepare, store and use feeds correctly (13).
The Early Life Coalition paper also states that “a high intake of protein during infancy has been linked to obesity in childhood” and that “While the optimal upper limit of dietary protein intake has not been firmly established, a systematic review found that a higher protein intake in infancy and early childhood (i.e. 15–20% of energy intake) was associated with increased growth and an increased risk of being overweight in later childhood” (10).
When solid food is introduced to an infant at around 6 months of age, iron rich solids should be introduced first and breast milk or infant formula remains the main source of nutrition, up until around 12 months of age. Infants are physiologically and developmentally ready for new foods, textures and modes of feeding and need more nutrients than can be provided by breast milk or infant formula alone. Delaying the introduction of solid foods beyond this age may increase the risk of developing allergic syndromes (13).
The NHMRC Infant Feeding Guidelines advise that by 12 months of age, a variety of nutritious foods from the five food groups is recommended, as described in the Australian Dietary Guidelines (13). Healthy eating in the second year of life builds on nutrition and eating practices established during infancy. It provides the energy and nutrients needed for growth and development, develops a sense of taste and an acceptance and enjoyment of different family foods, and instils attitudes and practices that can form the basis for lifelong health-promoting eating patterns (13).
A wide range of solid foods from the five food groups should be introduced during this rapid time of growth, with an emphasis on iron-rich foods (13). It may also assist the child to choose a broader range of foods in later life (10).
The ability to influence lifelong health through early life nutrition presents healthcare professionals with opportunities to assist families achieve optimal outcomes for their children, through readily modifiable lifestyle factors.
The full report by The Early Life Coalition, entitled ‘EARLY LIFE NUTRITION – The opportunity to influence long-term health’, has been generously provided by the Early Life Nutrition Coalition and may be downloaded here.