Transcript Breastfeeding

1000 DAYS
INTRODUCTION
The first 1000 days…..
A critical window of opportunity to impact on lifelong health
1000 DAYS
INTRODUCTION
The first 1000 days refers to the period from the moment of
conception to when a child is aged 24 months
The first 1000 days:
a period of rapid growth and development
1000 DAYS
INTRODUCTION
Pregnancy
Breastfeeding
Weaning
Toddler
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Why the first
1000 days
are so
important
The significance of the first 1000 days
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What you do, eat or experience
during the first 1000 days has lifelong
consequences for your health.
* McMullen, 2009
A time of rapid growth
gram per day
Speed of growth
22
20
18
16
14
12
10
8
6
4
Between -9m and
2 years something
special happens
10
-9 months to 2 years
Teenagers
Age (years)
WHO Growth Standards, 2006
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Adult
And a time of significant development
Cognitive
development
Metabolic organs
Digestive system
Body composition
Immune maturation
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INTRODUCTION
With an impact on later life health
CRITICAL WINDOW OF OPPORTUNITY
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Healthy Adults
Optimal Growth
Altered growth
Disease
-9 months
Birth
Weaning
Adults
The environment has much more impact on
your health in later life than your genes
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It has been estimated that at most
20% of lifelong health can be
explained by inherited genes.
This means that at least 80% of
disease risk in later life is due to the
environment, including nutrition
and life style.
Gluckman, 2013
Early nutrition leads to ‘Beeing’ different
Queen bees feed on nutrient-rich royal jelly longer than worker bees
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Pregnancy
The development of the foetus
in the 3 trimesters
1st
(week 1 – 12)
Blastocyst implantation
embryo development,
placenta formation, organ
formation
2nd
3rd
(week 13– 27)
Foetus practising
‘breathing’ and movement,
organ development
(week 28 – 40)
Body and organ growth
Rapid increase body fat
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The key challenges of nutrition
during pregnancy
• Nutritional status of a woman before becoming pregnant:
determines early embryo and placenta development
• The body weight of the mother at conception: being underweight
or overweight mother puts a pregnancy at risk, and adversely
affects later disease risk for the child
• Nutritional requirements: are increased in pregnancy, particularly
for some vitamins and minerals
• Total food intake: Mothers do not need to ‘eat for two’, but rather
need to ‘think for two’ – the quality of the diet is key
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Nutritional requirements during pregnancy
• Women should have a supplement of folic acid prior to
pregnancy and in the first trimester, to prevent neural
tube defects such as spina bifida
• Many women of reproductive age have poor vitamin D
status, so a supplement of vitamin D is recommended
in many countries
D
• Iron, iodine and omega 3 fats (also known as DHA)
needs are increased. It may be difficult to meet these
needs even by eating a healthy diet
• Experts have suggested a specific level of omega 3
(DHA) that pregnant women should have daily
• The above nutrients are of particular importance
across the globe with additional nutrient gaps being
apparent in different regions e.g. vitamins A, B1, B2
and calcium in Asia
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INTRODUCTION
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Breastfeeding
Breastfeeding is the best way to feed a child
Breastfeeding is how nature intended a
newborn infant to be fed, and is therefore
undisputedly the best way to feed an infant.
The WHO and UNICEF recommend that a
newborn child is exclusively breastfed for
the first six months after birth, with
breastfeeding continuing along with
appropriate complementary foods up to 2
years of age
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Breastfeeding has benefits for the mother
• Breastfeeding decreases the risk of:
• breast & ovarian cancer
• type II diabetes
• cardiovascular disease*
• Breastfeeding plays a central role in mobilising fat
stores accumulated during pregnancy thus helping a
mother return to her pre-pregnancy weight
• Breastfeeding “resets” maternal metabolism,
thereby reducing maternal risk for metabolic
disease. So when a woman does not breastfeed,
adverse metabolic changes persist for longer, thus
increasing her disease risk**
*Ballard, 2013, **Stuebe, 2009,
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Breastfeeding has benefits for the child
Short term benefits
• protection against gastrointestinal and
respiratory infection and allergy*
Longer term benefits
• associated with lower
incidences of obesity, diabetes
• lower levels of cholesterol and blood pressure
• higher performance in intelligence tests**
(not all studies have demonstrated these benefits conclusively
it depends on sample size, timings of end point measurement)
*ESPGHAN, 2009, **Kelishadi et al, 2014,
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Human milk has a unique composition
Nutritive components
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Fat & LCPUFA
53-61 g/l
Prebiotics
30-50 g/l
8-10 g/l
10-12 g/l
Protein
Lactose
Functional components
• Immunological compounds e.g.: sIgA, Lactoferrin etc.
• Long chain poly-unsaturated fatty acids
• Hormones and growth factors
• Human Milk OligoSaccharides: HMOS
• Beneficial bacteria
Maternal nutrition and breastfeeding
Nutritional requirements are increased even more in
breastfeeding women than in pregnant women
Women are able to produce milk with adequate protein,
fat, carbohydrate and most minerals - even when their
supply of these nutrients are limited
Vitamin A, B1, B2, B12, D, iodine and omega 3 (DHA) levels
in breast milk are linked to dietary intake in the mother
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Maternal nutrition and breastfeeding
Fat is the most highly variable macronutrient of human
milk and maternal diet will influence the quality (not the
quantity) of fat in breast milk
DHA
Low levels of DHA in breast milk has been associated with
low intakes in the maternal diet
It is important that all breastfeeding women or infants
have a supplement of vitamin D
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Four baby miracles after birth
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Physical
growth
Cognitive
development
Immune
maturation
Digestive
maturation
Four baby miracles, all supported by nutrition
Physical growth
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• 1 cell at conception to 500 trillion cells at 3 years
• Triple birth weight in the first year of life
• Growth more in the first three years of life than ever
Cognitive development
• 80% of adult brain mass achieved by 3 years
• 3x increase in brain weight in first three years
• 900 words learnt by 3 years
Neonate
25 years
Four baby miracles, all supported by nutrition
Immune maturation
• It takes 2 years to develop the body’s most
potent immune organ – the gut barrier
• Early life colonisation of the gut with
bacteria is crucial for its development; it is
influenced by the mode of delivery of the
baby, and by nutrition
Digestive system
• An infant is born with an immature gut. Its
digestive and absorptive capacity must
develop in the early years
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Weaning
Reasons to start complementary feeding
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Two key reasons to start complementary
feeding:
• Breastfeeding alone is insufficient to meet
the increased nutritional requirements in
the rapidly developing child
• It is important that a child is introduced to
solid food with new tastes and textures to
develop healthy eating habits
BACKGROU ND IN FORMATION
Development of healthy eating habits…
STARTS IN THE WOMB AND CONTINUES IN THE EARLY YEARS
Food preferences and behavior
Fluid sensory
experience1
Flavor, taste…
1Mennella,
Solid foods
exposure2
Social
environment3
Appearance, taste, texture…
JA et al (2001) 2Sullivan & Birch (1994) ; 3Scaglioni S et al. (2011).
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Mother-child interaction….
Development of healthy eating habits
SOME FACTS
 Fruits tend to be better accepted than
vegetables, due to the innate liking for
sweet tastes
 Variety and repetition is an effective
strategy to increase vegetable linking
 Children who have a delayed
introduction to textures have been
shown to be more ‘fussy eaters’
 Healthy eating habits formed early in
life track into childhood and beyond
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Toddlers
Toddlers gain >15% in height and >25% in
weight in just one year
This would be like a 70kg adult putting on 17 kg of weight in one year.
Height
Weight
kg
22
cm
115
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20
105
97%
18
95
85
75
65
55
45
35
1
Age (years)
WHO Growth Standards, 2006
2
25% weight increase
15% height increase
16
14
12
10
8
6
4
2
0
3
1
Age (years)
2
3%
3
Young children have specific nutritional needs
They need up to 7 times more nutrients than an adult
(per kg body weight)
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Therefore, with every spoon, a child has to eat significantly more
nutrients than an adult
Per Kg
Body
weight
(compared
to adults)
5.5 x more Iron
4 x more Calcium
3 x more Essential Fatty Acids
5x
smaller
Nutritional needs in toddlers
SOME FACTS
 Toddlers have specific nutritional needs
that may not be met by adult diets
 They require up to 4-7 times the amount of
some nutrients per kg compared to an
adult.
 Feeding a toddler can be challenging for
parents. ‘Neophobia’ (the fear of new
foods) may occur from 18 months of age,
and a toddler may be a ‘ fussy eater’.
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Reality of nutritional intake in toddlers
Iron is one of the most important nutrients during this period, to
support brain growth and cognitive development. Inadequate iron
intakes and poor iron status is the most common nutritional issue
seen in this age across the globe
Toddlers in many developed countries are eating:
• too much protein - which may lead to an increased risk of obesity
• too much salt - which may cause raised blood pressure
• too much saturated fat - which may cause heart disease later in life
• too much sugar - linked to the development of dental caries and
childhood obesity
• not enough vitamin D
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Conclusions
Conclusions
 The first 1000 days offer a unique window of
opportunity to build long-term health. The
right nutrition during this critical period really
matters.
 The rapid growth and development during
pregnancy, breastfeeding, weaning and
toddlerhood leads to specific nutritional
requirements during each of these stages.
 Therefore, it is crucial to ensure every mother
and child have access to optimal nutrition
during the first 1000 days!
1000 DAYS
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1000 DAYS
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