University of California, Davis, Estados Unidos
Objectives: This lecture will describe the challenges in meeting nutrient needs during the first 1000 days, from pregnancy through the first two years of life, in low- and middle-income countries, and the implications of these challenges for designing nutrition interventions and policies. Development: Pregnant and lactating women and their young children need diets with high micronutrient density. However, in low-income populations, their diets are usually dominated by staple foods with low nutrient density and poor mineral bioavailability, resulting in intakes well below recommended amounts for several key nutrients. These gaps in nutritional adequacy have likely been a characteristic of human diets in such populations since the Agricultural Revolution ~10,000 years ago. Estimates of nutrient intakes before then, based on a hypothetical composite pre-agricultural diet, suggest much higher intakes of key nutrients than observed today. There are several strategies for improving nutrient adequacy of modern diets for pregnant and lactating women and their infants, including dietary diversification and increased intake of nutrient-rich foods, improved complementary feeding practices, micronutrient supplements, and fortified foods or products specifically designed for these target groups. To illustrate the potential impact of ensuring adequate nutrition during the first 1000 days, this lecture will include recent results of randomized trials in Africa and Bangladesh using home fortification with small-quantity lipid-based nutrient supplements (SQLNS). Conclusions: Much remains to be learned regarding heterogeneity in response to nutrition interventions during the first 1000 days, and the mechanisms that may inhibit or facilitate beneficial responses to nutrition interventions in general. Nonetheless, evidence already accumulated suggests that investment in better diets during the first 1000 days is likely to have a substantial impact on human capital formation and prevention of chronic disease and disability later in life.
key words: maternal and child nutrition; malnutrition; nutrition interventions; home fortification; low-income populations