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The first 1,000 days describes the period from conception to 24 months of age in
child development Child development involves the Human development (biology), biological, psychological and emotional changes that occur in human beings between birth and the conclusion of adolescence. It is—particularly from birth to five years— a foundation ...
. This is considered a "critical period" in which sufficient nutrition and environmental factors have life-long effects on a child's overall health. While adequate nutrition can be exceptionally beneficial during this critical period, inadequate nutrition may also be detrimental to the child. This is because children establish many of their lifetime
epigenetic In biology, epigenetics is the study of changes in gene expression that happen without changes to the DNA sequence. The Greek prefix ''epi-'' (ἐπι- "over, outside of, around") in ''epigenetics'' implies features that are "on top of" or "in ...
characteristics in their first 1,000 days. Medical and public health interventions early on in child development during the first 1,000 days may have higher rates of success compared to those achieved outside of this period. Adequate
nutrition Nutrition is the biochemistry, biochemical and physiology, physiological process by which an organism uses food and water to support its life. The intake of these substances provides organisms with nutrients (divided into Macronutrient, macro- ...
during the first 1,000 days can have a direct and indirect influence on both short and long term health outcomes. There are various risk factors in the first 1,000 days which, if present, are predictors of later
obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
. Stunted growth may be remedied ( catch-up growth) by attainment of proper nutritional status. This is especially important in adolescent girls, where it may break a cycle of inter-generational underdevelopment. As a period of rapid growth and development, the first 1,000 days of life are foundational to child development and vulnerabilities to future non-communicable diseases such as cardiovascular or metabolic diseases.


Microbiota

The first 1,000 days of the human microbiome starting from time of conception until 2 years old is a critical time period for growth and development, including nutrients and microbiota. Proper nutrition is an essential to support healthy life; lack of nutrition may have a lifelong negative impact to the child's development. During this time frame of early childhood growth, there are many immune and developmental pathways that are dependent on environmental factors such as nutrients; malnutrition can disrupt growth and development leading to obesity or malnutrition. During pregnancy, the key microbiota are maternal microbiota and fetal microbiota. Microbiota from the mother is essential for the child's growth even before birth. Pre-birth microbial exposure, either excessive or lack of, can impact growth and development negatively and have long-term effect. For this reason, the mother's nutritional intake becomes important for the child both before birth and after birth. The first 6 months after birth is characterized mainly by external exposure to microbiota. For instance, different feeding practices leads to different outcomes; breastfeeding and commercial milk will have different essential nutrients and microbiota. Antibiotics may have an effect on the gut microbiota; antibiotic exposure before birth may disrupt the gut microbiota permanently and disrupt the gut functions. Transitioning into childhood, food intake after 6 months will be changed from milk to complementary foods; this is a critical period for children to get adequate nutrition necessary for growth. From this period, environmental factors start to impact the children more. In underserved communities where families may face food insecurities or poor living conditions, the risk of undernutrition and negative affect to microbial pathway may increase. Cases of undernutrition may be treated by gut microbiota targeted interventions in combination with nutrition; this will restore the lack/loss of microbiota the child has faced during their childhood and promote healthy growth. Breastfeeding and vaginal birth forms the infant's microbiota which can protect against allergies from developing. However, not everyone can safely give vaginal birth or provide breastmilk due to different circumstances; for infants in these situations, it may be important to look out for specific ingredients such as probiotics in certain infant formulas to makeup for those microbiota.


Epigenetics


Nutrition

Both maternal and early-childhood nutrition influence epigenetic changes, which then inform immunologic and metabolic outcomes throughout development and into later life. Present in
human milk Breast milk (sometimes spelled as breastmilk) or mother's milk is milk produced by the mammary glands in the breasts of women. Breast milk is the primary source of nutrition for newborn infants, comprising fats, proteins, carbohydrates, and a va ...
are
HMOs In integrated circuits, depletion-load NMOS is a form of digital logic family that uses only a single power supply voltage, unlike earlier NMOS (n-type metal-oxide semiconductor) logic families that needed multiple power supply voltages. Althou ...
, bioactive components which aid in immune function and regulation, and
miRNA Micro ribonucleic acid (microRNA, miRNA, μRNA) are small, single-stranded, non-coding RNA molecules containing 21–23 nucleotides. Found in plants, animals, and even some viruses, miRNAs are involved in RNA silencing and post-transcri ...
-containing exosomes. HMOs can be fermented into
short-chain fatty acid Short-chain fatty acids (SCFAs) are fatty acids of two to six carbon atoms. The SCFAs' lower limit is interpreted differently, either with one, two, three or four carbon atoms. Derived from intestine, intestinal microbe, microbial fermentation of ...
s, which play important roles in modulating the microbiome and in
T cell T cells (also known as T lymphocytes) are an important part of the immune system and play a central role in the adaptive immune response. T cells can be distinguished from other lymphocytes by the presence of a T-cell receptor (TCR) on their cell ...
differentiation, and may positively correlate with methylation levels. miRNA found in milk-derived exosomes may increase immune tolerance. Metabolic disease, and particularly type 2 diabetes mellitus and
insulin resistance Insulin resistance (IR) is a pathological response in which cells in insulin-sensitive tissues in the body fail to respond normally to the hormone insulin or downregulate insulin receptors in response to hyperinsulinemia. Insulin is a horm ...
, is strongly associated with
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...
. Both parental undernutrition and overnutrition predispose a child to developing these conditions. Under these circumstances, differential methylation of
adipose tissue Adipose tissue (also known as body fat or simply fat) is a loose connective tissue composed mostly of adipocytes. It also contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, Blood vessel, vascular endothel ...
genes and miRNA upregulation in adipose tissue and the
pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...
may occur.


Stress exposure

Exposure to emotional, physical, and environmental stressors significantly affect the developing brain, which may later manifest in negative mental- and health-related outcomes through the
HPA axis The pascal (symbol: Pa) is the unit of pressure in the International System of Units (SI). It is also used to quantify internal pressure, stress, Young's modulus, and ultimate tensile strength. The unit, named after Blaise Pascal, is an SI ...
' role in stress regulation. Maternal depression, anxiety, and stress may be associated with increased rates of
mental disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s, including
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
, depression,
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
,
ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity, impulsivity, and emotional dysregulation that are excessive and pervasive, impairing in multiple ...
, and
autism Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing d ...
in the child. Smoking in pregnancy is associated with differential methylation of genes implicated in brain development, central nervous system disorders, asthma, and various cancers. Stress management and smoking cessation in the birthing parent provide avenues for reducing this risk. Babies born prematurely are often separated from the birthing parent and sequestered in
neonatal intensive care unit A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. The NICU is divided into several areas, including a critical c ...
s, where they may require additional care and procedures. Stress caused to the infant during this process is associated with epigenetic modifications relating to behavioral issues and stress regulation, notably hypermethylation of the SLC6A4
gene In biology, the word gene has two meanings. The Mendelian gene is a basic unit of heredity. The molecular gene is a sequence of nucleotides in DNA that is transcribed to produce a functional RNA. There are two types of molecular genes: protei ...
. Other forms of childhood adversity, which include abuse or neglect, similarly impact a child's development through differential epigenetic programming and stress response dysregulation. In addition to adverse effects on mental health, children who experience these events often exhibit dampened immune responses.


Nutrition and development

Sufficient overall nutrition within the first 1,000 days is vital to healthy neurological and physical growth. This includes, but is not limited to adequate amounts of macronutrients, micronutrients, as well as essential vitamins. The concept of adequate nutrition applies to both the carrying mother as well as the child. Carrying mothers have an increased physiological demand due to their unique circumstance of pregnancy. Their bodies immediately undergo huge changes which require additional nutritional needs. It is also important that mothers sustain adequate nutrition post delivery. This is not just for their own health but the health of their child as breastfeeding is a way that newborns obtain vital macronutrients, micronutrients, and vitamins. There are some macronutrients, micronutrients, and vitamins that may be better obtained and retained if acquired through breastfeeding which is why it is crucial that mothers maintain adequate nutrition post delivery. Key macronutrients include proteins and long-chain polyunsaturated fatty acids (LC-PUFA), while some key micronutrients include
choline Choline is a cation with the chemical formula . Choline forms various Salt (chemistry), salts, such as choline chloride and choline bitartrate. An essential nutrient for animals, it is a structural component of phospholipids and cell membrane ...
,
iron Iron is a chemical element; it has symbol Fe () and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, forming much of Earth's o ...
,
zinc Zinc is a chemical element; it has symbol Zn and atomic number 30. It is a slightly brittle metal at room temperature and has a shiny-greyish appearance when oxidation is removed. It is the first element in group 12 (IIB) of the periodic tabl ...
,
iodine Iodine is a chemical element; it has symbol I and atomic number 53. The heaviest of the stable halogens, it exists at standard conditions as a semi-lustrous, non-metallic solid that melts to form a deep violet liquid at , and boils to a vi ...
,
calcium Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to it ...
, and
magnesium Magnesium is a chemical element; it has Symbol (chemistry), symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 ...
. Essential vitamins are also vital for growth and development. This includes:
Vitamin A Vitamin A is a fat-soluble vitamin that is an essential nutrient. The term "vitamin A" encompasses a group of chemically related organic compounds that includes retinol, retinyl esters, and several provitamin (precursor) carotenoids, most not ...
, which is key for fetal development, organogenesis, limb formation, immune functions, mucosal integrity and body symmetry. A lack of vitamin A can lead to xerophthalmia, night blindness, and anemia.
Vitamin D Vitamin D is a group of structurally related, fat-soluble compounds responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, along with numerous other biological functions. In humans, the most important compo ...
: which is essential for bone development while a deficiency in Vitamin D can lead to the development of rickets disease.
Folate Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
/
folic acid Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
: which prevents neural tube defects (NTDs). Children who do not receive adequate nutrition in the first 1,000 days can suffer short and long term health consequences. Some of these consequences can be mitigated if identified and addressed early, however they may become harder to rectify as more time passes. For the most part macronutrients, micronutrients, and essential vitamins can and should be obtained through a healthy and well balanced diet. However sometimes this may not be feasible for either the carrying mother or child. In these cases supplementation may be recommended or required. Overall, adequate nutrition within the first 1,000 days is a responsibility shared by caregivers (e.g. parents), as well as providers (e.g. pediatricians, social workers, dieticians).


Childhood obesity

Since the first 1,000 days of life span both intra- and extrauterine development, dietary requirements can be separated into three distinct phases of dietary development: prenatal, breast or formula feeding, and complementary diet.


Prenatal

Maternal factors such as Type I diabetes, pre-pregnancy weight, gestational diabetes, and gestational weight gain are all risk factors for childhood obesity. While this relationship between maternal factors and development of childhood obesity is not completely understood, it is theorized that altered intrauterine conditions due to elevated nutrient exposure affect fetal development such that the child is programmed to be at higher risk. Interventions to manage maternal pre-existing conditions, as well as gestational complications, such as maintaining health blood sugar levels and blood pressures may help to reduce this risk.


Breast/Formula feeding

Population studies have shown that breast feeding has a long-term benefit of preventing obesity in the future. Formula-fed children tend to follow an "accelerated growth curve" compared to breast-fed children who develop along a slower growth curve because they tend to have higher levels of Insulin-like Growth Factor (IGF)-1. This difference in levels of IGF-1 may be due to differences in nutrient compositions of breast milk and formula milk. This phase of dietary development is also highly dependent on the dietary behaviors of the mother.


Complementary diet

The final stage of dietary development is the longest of the three stages, spanning from months 6-24 and presents the most potential for developing risks for obesity. This is partially due to the fact that the complementary diet comprises the largest fraction of dietary development, but particularly because transitioning from liquid to solid foods presents a challenge of its own. More recent research has been expanding on the role of epigenetics and microbiota during the first 1,000 days in the development of childhood obesity.


References

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External links


First 1000 Days
a UNICEF publication Child development Pediatrics