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The first 1,000 days

The health of our nation

he incidence of non-communicable diseases (NCDs) like cardiovascular disease (CVD), allergy, diabetes and obesity has rapidly increased over the past two decades becoming one of the leading causes of premature morbidity, disability and death globally4. The performance of the UK in terms of premature mortality is persistently and significantly below the mean of comparable countries5. In addition:

  • Cases of CVD are expected to rise to 2.8million by 20206
  • 300,000 cases of cancer are diagnosed every year6
  • 4.05 million people in the UK have been diagnosed with diabetes7
  • 70% of NHS spending is on people with long term conditions6
Some experts believe that our genes only determine 20% of our lifelong health

It is now believed that lifelong health is predominantly determined by environmental influences such as1:

  • Nutrition – dietary habits, nutrient intake, taste exposure
  • Lifestyle – sleep, physical exercise, smoking
  • Disease – infection, obesity
  • Others – for example pollution

Scientific evidence suggests that the environmental factors affecting an individual’s early life may influence their health in later life1,8 indicating that a more positive health outcome may be achieved by intervening as early as possible9.

Reducing health risks

The individual’s ability to respond to their environment is known as ‘adaptive capacity’ or ‘plasticity’. It is thought that plasticity is at its greatest during the first 1000 days of life10 which is why environmental factors can also have the greatest effect during this period2,3.

The prevalence of childhood obesity is increasing with 1 in 5 of 4-5 year olds in England being overweight/obese11.


The first 1,000 days: a window of opportunity

The first 1,000 days of an infant’s life, from conception until their second birthday, are key to determining their lifelong health12,13. This is when environmental factors – such as nutrition – can influence rapidly developing organs and body systems2,3.

The 1,000 Days partnership is a worldwide initiative that promotes positive action to improve the nutrition of mothers and their children during this critical period12,13.


Early life nutritional programming

Many environmental factors have an impact on later health, but diet and early life nutritional exposure are particularly significant2. By making the right nutritional choices from conception to toddlerhood, mothers can make a significant difference to their children’s long term health. There is a growing body of evidence that early life nutritional programming (ELNP) can affect both physiology and behaviour.

ELNP can affect both behaviour and physiology.

Behavioural effects:

  • Influences early feeding habits14
  • Impacts on taste preference15,16
  • Affects food texture preferences17,18

Physiological effects

  • Metabolic – processes may be set during early life, determining how the body learns to break down, absorb and use nutrients for lifelong growth and development19.
  • Immune – immune system development may be influenced, affecting the future risk of asthma and allergic diseases20.
  • Cognitive – brain development may be influenced, with potentially long-term effects on cognitive function and behaviour21.

Healthcare professionals’ nutritional intervention from conception to toddlerhood may have a lifelong impact, supporting optimal health with the potential to positively influence long term health outcomes2,3.

  1. Gluckman P. Article in Medical Tribune: Impact of early-life nutrition on NCD development in adulthood. 2013. http://enews.mims.com/landingpages/mt/pdf/Medical_Tribune_February_2013_HK.pdf [Accessed Nov 2016]
  2. Scientific Advisory Committee on Nutrition. The influence of maternal, fetal and child nutrition on the development of chronic disease in later life. London: TSO, 2011.
  3. British Nutrition Foundation Task Force. Nutrition and Development: short and long term consequences for health. Chichester: Wiley-Blackwell, 2013.
  4. World Health Organisation. Global status report on non-communicable diseases
    2014. Available from: http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1 [Accessed Nov 2016]
  5. Murray et al., UK health performance: findings of the Global Burden of Disease Study 2010, The Lancet, Volume 381, Issue 9871, Pages 997 – 1020, 23 March 2013
  6. The King’s Fund. Non-communicable diseases [Online]. Available at: https://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and-disability/non-communicable-diseases [Accessed Nov 2016]
  7. Diabetes UK. Number of people with diabetes reaches over 4 million (online). Available from: https://www.diabetes.org.uk/About_us/News/Number-of-people-with-diabetes-reaches-over-4-million/ (Accessed Nov 2016)
  8. Hochberg Z et al. Child Health, Developmental Plasticity, and Epigenetic Programming. Endocrine Reviews 2011;32:159-224.
  9. Hanson,M. et,al. Developmental plasticity and developmental origins of non- communicable disease: Theoretical considerations and epigenetic mechanisms. Progress in Biophysics and Molecular Biology. 2011:106.1
  10. Hanson MA, Low FM, Gluckman PD. Epigenetic epidemiology: the rebirth of soft inheritance. Ann Nutr Metab 2011;58(2):8-15
  11. NHS Digital. National Child Measurement Programme – England, 2015-16. Available from: http://content.digital.nhs.uk/article/2021/Website-Search?productid=23381&q=obese+children&sort=Relevance&size=10&page=1&area=both#top [accessed Dec 2016]
  12. National Childbirth Trust. First 1000 days [Online]. Available at: http://www.nct.org.uk/about-nct/first-1000-days [Accessed Nov 2016]
  13. 1,000 Days. Why 1,000 days? [online]. Available at: www.thousanddays.orgdoi:10.1016/S0140-6736(13)60355-4 [Accessed Nov 2016]
  14. Scaglioni et al. Determinants of children’s eating behavior. Am J Clin 2011;94(6):2006s-2011s
  15. Mennella et al. Prenatal and Postnatal Flavor Learning by Human Infants. Pediatrics 2001;107:e88
  16. Sullivan SA and Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics 1994;93(2):271-7
  17. Lundy B et al. Food texture preferences in infants versus toddlers. Early Child Dev Care 1998;146:69-85
  18. Northstone K et al. The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. J Hum Nutr. Diet 2001;14:43-54
  19. Lillycrop KA. Effect of maternal diet on the epigenome: implications for human metabolic disease. Proc Nutr Soc 2011;70(1):64-72.
  20. Martin R et al. Early life: gut microbiota and immune development in infancy. Benef Microbes 2010;1(4):367-82.
  21. Schlotz W and Phillips DI. Fetal origins of mental health: evidence and mechanisms. Brain Behav Immun 2009;23(7):905-16.