1000 AND BEYOND: Nourishing From Birth to Lifelong Health

Nutritional needs during the first 1000 days to support growth during infancy and toddlerhood: the influence of maternal health

Key Messages

• The first 1000 days of life is important as it is a window of opportunity for maternal and infant nutrition to influence proper growth and development
• Maternal and infant risk factors both are associated with development of obesity and adverse health outcomes in the child
• Maintenance of proper weight, nutrition and prevention of gestational diabetes during pregnancy is important
• Obesity in the child is multifactorial hence prevention through proper nutrition and maintenance of appropriate growth trajectories are crucial

Abstract

The first 1000 days is a crucial period in the life of a child since it is a window of opportunity influencing proper growth and development. This period starts at the time of conception, signifying the very crucial role of maternal health. Studies have shown that maternal over and undernutrition can result in adverse outcomes for the offspring and next generation. The increasing prevalence of obesity in women is now a big concern because higher fat mass is associated with higher risk of adiposity in the infant. Other maternal factors which can affect the health of the child are glucose control, having gestational diabetes (GDM) and the diet. Among the post conception factors which increase the risk of childhood obesity and possibly noncommunicable diseases (NCDs) later in life are birth weight, type of feeding and rapid weight gain. With this, breastfeeding is seen to be ideal and leads to lower growth trajectories. Specifically, the CHOP study showed that infants on higher protein formula had higher risk for obesity compared to those on lower protein formula. A birth weight of more than 4.0 kgs has also been shown to predispose to higher risks of obesity in childhood. After the first year, the feeding practices, environmental factors and the BMI of the child may further influence the development of NCDs later in life. Hence, the period of the first 1000 days is crucial in terms of proper nutrition intervention for the mother and child.

Nutrition during first 2 years of life and the risks of NCDs

Key Messages

• Factors in the first 2 years of life can lead to development of obesity and risk for the development of NCDs
• Protein levels in milk has been identified as a risk factor for obesity and adiposity formation in the child, with breastmilk as having the ideal level resulting in normal growth trajectories
• Lower protein levels of formula compared to conventional levels is associated with lower BMI. Those on higher protein levels have higher BMI and risk for obesity in childhood
• Proper nutrition and maintenance of normal growth trajectories are important to promote health and development in the child

Abstract

Nutrition in the first 2 years of life is very important as this can influence not only growth and development, but may also lead to adverse health outcomes. Obesity and noncommunicable diseases (NCDs) are increasing, posing a question on what factors in the child can influence the development of these diseases later in life. Among the risk factors for obesity in infants and children are the growth trajectories, type of feeding, birth weight, complementary feeding earlier than 4 months of age, feeding portions and practices as well as physical activity. Studies showed that breastfeeding has a protective effect against obesity and babies not fully breastfed for less than 4 months had greater risk for obesity. The high level of protein in milk formulas was identified as a risk factor in the development of a higher BMI in the CHOP study. More so, high protein intakes in early childhood in excess of metabolic requirements can increase IGF1 release triggering high weight gain and induce adipogenesis and thus resulting to long term risk for obesity and associated NCDs. The EPOCH and PROTEUS studies showed that reduced levels of high quality protein (1.7-1.8 g/100 kcal) did not adversely affect the growth and biologic markers at 12 months and even until 2-5 years of age. A study by Ziegler of infants given low protein formula of 1.6 g/100 kcal, which is below the regulatory minimum level of 1.6 g/100 kcal resulted in normal growth. An ongoing SHAPE study showed that infants fed with a formula of 1.85 and then 1.5 g /100 kcal, resulted on growth and body composition at 1 year which is similar to the WHO reference and BF infants. Hence, proper nutrition and avoidance of risk factors in the mother and child are important to prevent the development of obesity and NCDs in later life.