Baby’s First 1,000 Days: The Impact of Nutrition

By Caitlin Berens March 1, 2017

A growing body of research has shown the impact proper nutrition can have on long-term health, starting early on. But can the first 1,000 days really decide a child’s future, or is it a bit more complicated than that?

On any given day, a young child in America is more likely to get sweets or sugar-sweetened beverages than a serving of fruit or a vegetable,” according to a recent report by the 1,000 Days organization.

Let that sink in.

We know that good nutrition is important. Heck, “eat your vegetables” is a mantra ingrained in us since our highchair days (only now it’s the little one in front of us finding it funny to spit them right out). But we’ll have to keep on trying, especially as a growing body of research is making more and more clear the connection between long-term health and good nutrition during pregnancy and throughout infancy and early childhood.

“We’re looking a lot more at obesity and what kids eat [now] because it used to be that we figured oh, they’re just a kid, they’re fine, the chance of diabetes or heart disease or obesity is really, really small, and, you know, when they’re an adult we’re going to worry about that stuff,” says Robin Jacobson, M.D., a pediatrician and clinical assistant professor in the Department of Pediatrics at NYU Langone Medical Center. “But now we’ve found that if kids are eating unhealthy and they’re overweight and obese, they’re more likely to have problems when they’re an adult. So if we deal with all [of] those issues and deal with them eating better and being more healthy as a child, they’re more likely to have a better life and less problems later on in life.”

But is there a particular period in a person’s life when nutrition matters the most?

Yes, according to 1,000 Days. Founded in 2010 and dedicated to “working to ensure a healthy first 1,000 days for mothers and children everywhere,” the group released the aforementioned report last year called “The First 1,000 Days: Nourishing America’s Future.” The report laid out the long-term importance of a child’s—you guessed it—first 1,000 days, which it defines as starting from pregnancy, continuing through infancy, and ending at age 2.

In examining research about vegetable consumption and other habits in the U.S. during this period, the report included some startling facts, including this zinger: “A study that analyzed over a decade of dietary patterns in children from birth to 2 years in the U.S. found that only 40 percent of infants and toddlers regularly eat vegetables. In fact, the most common vegetable eaten by American toddlers, starting as early as age 1, is the French fry.” This could be setting children up for a “lifetime of health problems,” according to the report.

We spoke with local experts to get their opinions on how central these 1,000 days really are and what matters most during this period.

Do the First 1,000 Days Really Decide it All?

There is no question among the experts we contacted that nutrition during pregnancy, infancy, and early childhood matters, both in the short- and long-term. But while some spoke of the real, irreversible implications of a pregnancy with insufficient nutrition, others claimed you can’t pinpoint a specific period where it matters the most and that good nutrition in isolation during the younger years is simply not enough to promise long-term health.

Embracing the 1,000-Day Window

The experts we interviewed suggested focusing on good nutrition and healthy eating habits during pregnancy and in the early stages of children’s lives would not only save money in the long run by preventing costly health problems—it could save lives. The 1,000 Days report even goes as far as to say that providing the right nutrition in these early days can have “a lasting effect on a nation’s health and prosperity.”

Angela Bianco, M.D., associate professor of Obstetrics, Gynecology and Reproductive Science at Icahn School of Medicine at Mount Sinai, explains the shift that has occurred as scientists have learned more about these issues: “There’s more and more research being done about how important the provision of nutrients and diet is during fetal life and its sort of long-term implications on adult life. Twenty or 30 years ago we never really thought that these two sort of separate and distinct periods in our lives influenced each other, but there’s more and more data to suggest that they’re actually very much integrally linked.”

According to Rebekka Levis, M.D., a pediatrician at Maria Fareri Children’s Hospital in Valhalla, it’s important to never lose sight of good nutrition, though there are some critical times where we need it most. “Adequate nutrition is important at all stages of the life cycle, from pre-conception to older adulthood. But I definitely agree that it’s essential during these critical growth periods such as pregnancy and infancy and early childhood, and if nutrient needs are not met during these critical periods, it’s impossible to actually go back later and correct the errors in growth and development that have occurred as a result,” Dr. Levis says.

Caitlin Mattina, R.D., CDN, CDE, an outpatient dietician at Westchester Medical Center, drew the connection between iron and brain development. “Iron deficiency during pregnancy is actually related to lower scores on intelligence, language, motor skills, and attention tests in early childhood. So children aged 4-5 are testing lower in these areas if the mother was iron deficient during pregnancy. So there’s a definite correlation there,” she says.

Iron is certainly not the only thing one should work to incorporate in a nutrient-rich diet, as Mattina warns: “If you’re severely malnourished and underweight, if you’re not eating any fruits and vegetables whatsoever, if you’re not taking a vitamin, if you have iron deficiency anemia, and not enough folic acid, all of these things, you could end up with major complications,” she says.

Seeing Past 1,000 Days

While experts agree with the concept that nutrition in the first 1,000 days can have a lasting impact on long-term health—and none argued that this period of time didn’t matter—many considered the time period simply a good start, and only one piece of a longer-term puzzle.

“I think giving them [babies] access to appropriate nutrients is definitely important first off in infancy, but that in isolation won’t really help. It’s a lifelong process that you’re just kind of setting up,” says Corey Wasserman, M.D., a pediatrician with Weill Cornell Medicine.

Though a lot of development takes place during the first 1,000 days, there’s more to come that one shouldn’t lose sight of: “I think it’s hard to say that there’s one period that matters before all others because infancy all the way through adolescence is a time of brain maturation and physical growth and developmental achievements,” Dr. Wasserman says. “Overall I agree it’s very important starting in infancy to kind of set the stage for a lifetime of healthy eating, but I don’t think you necessarily can put a time limit on when that time runs out.”

Though she notes the impact good nutrition can have during the early stages, Dr. Levis sees nutrition as an ongoing process. “The first 1,000 days are extremely, vitally important, but a healthy diet should be maintained throughout life,” she says.

Advice For the First 1,000 Days and Beyond

Pregnancy: A Nutrient-Rich Diet and Appropriate Weight Gain

According to The First 1,000 Days report, “Nearly half of women [in the U.S.] gain an excessive amount of weight during pregnancy.”

Excessive weight gain can cause issues for both the mother and baby, and so Dr. Bianco provides simple, succinct advice: “Essentially, the higher your BMI is prior to conception, the lower your weight gain should be during pregnancy.” According to the Centers for Disease Control and Prevention, women carrying one child with a pre-pregnancy BMI at a “normal” level (18.5-24.9) should gain 25-35 pounds during pregnancy, while someone who is obese (BMI greater than or equal to 30) should aim for just 11-20 pounds.

Regardless of weight gain, all pregnant women need to pack in the nutrients. “The nutrient needs increase but the calorie needs don’t increase as much, so that can also be a little challenging for patients,” Mattina says, dispelling the common adage that a pregnant woman is “eating for two.”

Calorie needs typically don’t increase in the first trimester, according to Mattina. In the second, women generally require an additional 340 calories per day and in the third trimester an additional 450 calories per day, “like a sandwich and a glass of milk,” she says.

These additional calories can add up quickly, so it’s important to look for nutrient-rich foods to add to your diet, particularly those including iron, zinc, protein, copper, folate, iodine, multiple vitamins, and certain fats.

Newborn to 6 Months: Breast Milk to the Extent Feasible

The report acknowledged the recommendation by the American Academy of Pediatrics that babies be exclusively breast-fed for the first six months, while saying that “the majority of U.S. babies are not breastfed in accordance with AAP and WHO [World Health Organization] recommendations, and 1 in 5 babies in America are never breastfed at all.” The report labeled breast milk as “nature’s superfood,” noting how it helps early brain development and helps protect babies from infection.

The report did acknowledge the absence of support mothers face when it comes to breast-feeding, including a lack of paid time off for new moms in the U.S. And there are other reasons a mother might not breast-feed her child—and that is okay, too, experts say.

“You’re not going to find a doctor who is going to argue with you [about] the benefits of breast-feeding, but I think it’s important to understand that if for whatever reason women don’t want to or can’t [breast-feed] it is not necessarily a neurodevelopmental tragedy for the baby. Babies can grow up happy and healthy on exclusively formula,” Dr. Wasserman says. “So I think the take-home message really would be that breast-feeding is not all or nothing.”

6 Months and Older: Healthy Foods, Eating Habits, and Minding Beverages

As children reach 6 months and beyond, this is a time to provide them with a diverse diet of nutrient-rich foods to both help development and help shape their taste preferences for healthy foods.

To develop healthy habits and eat a well-balanced diet, experts stress the importance of slowing down, putting away the tech, and eating meals as a family. They also encourage parents to have a wide variety of healthy snacks and food available and for parents to lead by example.

“Children learn by observing, so it’s really important for parents to model what a healthy diet and a healthy lifestyle is,” Dr. Levis says. To add an element of fun, make the whole event of having a healthy meal a family activity—kids of all ages can lend a hand in meal planning, shopping, and even cooking. Dr. Levis encourages parents to include even picky toddlers and younger kids in meal preparation and choosing meals. “I really think it helps them become aware of what’s healthy and it gets them excited about trying new things and so I think that’s really important,” she says.

Is your child well past the first 1,000 days? Do you fear you’ve fallen off track? Fortunately, experts say it’s always beneficial to make a change, no matter how old a person is. Though some groundwork may be set in the early stages, “it’s never too late to adopt a healthy, nutritious lifestyle,” Mattina says.

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