‘Feeding’ brain development: Key
nutrients essential during first 1,000 days
The brains
of normal children develop in a complex process involving changes in the number
and organization of brain cells in a specified sequence. The most active period
of neurologic development occurs in the first 1,000 days of life. This period,
beginning at conception and ending at the start of the third postnatal year, is
a time of tremendous opportunity for neurodevelopment — and a time of great vulnerability.
In a new
policy statement, the Academy emphasizes the importance of the nutritional
environment of the fetus, infant and toddler and the effect it has on whether
brain growth and differentiation proceed normally. The policy, Advocacy for Improving
Nutrition in the First 1,000 Days to Support Childhood Development and Adult
Health from the Committee on Nutrition, is available at
https://doi.org/10.1542/peds.2017-3716 and will be published in the February
issue of Pediatrics.
Adequate
overall nutrition (i.e., absence of malnutrition) and provision of adequate
amounts of key macro- and micronutrients at critical periods in development are
necessary for normal brain development. Importantly, the definition of
“malnutrition” includes both undernutrition (inadequate amounts of macro-
and/or micronutrients) and obesity (excessive calories, often at the expense of
other crucial nutrients). Many nutrients exhibit a U-shaped risk curve, whereby
inadequate or excessive amounts place the individual at risk, according to the
policy. Both forms of malnutrition affect neurodevelopment, and they may
coexist in an individual.
The key
nutrients studied thus far that support neurodevelopment include protein, zinc,
iron, choline, folate, iodine, long-chain polyunsaturated fatty acids and
vitamins A, D, B6 and B12.
Promoting healthy nutrition
The policy
focuses on supporting pediatricians and other health care providers in
promoting healthy nutrition and advocating for the expansion of programs that
affect early life nutrition as a means of preventing early developmental loss.
In this way, the policy offers an opportunity to improve each child’s chance
for the healthiest and most productive life possible.
Pediatricians
are encouraged to be knowledgeable about nutritional issues across the first
1,000 days. For the fetus and newborn, this includes partnering with
obstetricians and family physicians to encourage improvements in maternal diet
and attention to clinical situations that may limit the fetus’s access to crucial
micronutrients (e.g., maternal diabetes); educating pregnant women about
breastfeeding; and supporting them during breastfeeding.
As the child
becomes older, pediatricians can become conversant about food sources that
supply the critical nutrients necessary for brain development during
particularly important times. The AAP Pediatric Nutrition Handbook (Yellow
Book), Bright Futures and the AAP breastfeeding recommendations (see resources)
provide guidance for pediatricians.
Families
also need support to take advantage of programs that provide nourishing food,
particularly the Special Supplemental Nutrition Program for Women, Infants and
Children (WIC) after the first year of life.