Featured article in the Winter 2019 Issue of Nutrition Close-Up; written by Kathleen Zelman, MPH, RDN

Good nutrition is important at every stage of life but most dynamic and with the greatest vulnerability in the first 1000 days (pregnancy and the first two years).

Researchers are connecting the impact of vital nutrients early in life with overall health, growth and neurodevelopment.

The first 1000 days establishes an imprint on the development of healthy tissues, organ structure and function for lifelong health.1 Brain development is most rapid during the last trimester of pregnancy and the first 1000 days harboring the greatest opportunity to ensure normal development. An emerging body of scientific evidence shows that providing essential building blocks during this crucial time period establishes a foundation of health across a person’s lifespan and their predisposition to chronic diseases such as heart disease, obesity, diabetes, cancer and more.1 This is, in part, because dietary habits, food preferences and behaviors are set early on and have the potential to affect choices throughout life. Improving nutrition during the first 1000 days safeguards children to reach their full potential.

It Starts in the Womb

A mother’s diet and lifestyle are critical to the infant’s health. Following a healthy eating pattern and taking complete pre-natal vitamins is the best thing a pregnant woman can do to promote normal development of the baby. Striking the right balance of proper nutrition sets the stage for good health whereas over or under nutrition can impact neurocognitive development and increase risks for metabolic syndrome, obesity and heart disease later in life.1

• Emerging evidence has shown that early microbiota colonization may influence brain development and the occurrence of diseases later in life.2,3

 Malnutrition early in life can lead to poor cognition and physical growth that ultimately impact the ability to learn and increases susceptibility to infection.4

• Some experts opine that the childhood obesity epidemic is in part due to maternal overnutrition along with infant feeding practices.

• Studies have shown body mass index at two years of age is predictive of adult obesity.5,6

Maximize the First 1000 Days

The American Academy of Pediatrics recommends exclusive breastfeeding for about the first 6 months with continued breastfeeding alongside introduction of complementary foods until 1 year.

Nutritional needs change early in life and are constantly changing to meet growth and development. Nutrients not provided during this period may result in poor cognition even with nutrient repletion.1

Complementary feeding of a variety of foods including fruits, vegetables and single grains are recommended at 4-6 months of age. Baby’s diet should be slowly advanced with variety and texture including cooked soft meat, poultry and seafood, beans, whole milk dairy and eggs. Studies show that infant feeding practices influence food preferences and dietary patterns and can set the foundation for life long habits.7


While all nutrients are important for brain development and overall growth, key nutrients during the first 1000 days are protein, polyunsaturated fatty acids, iron, zinc, copper, iodine, choline, folate and vitamins A, D, B6 and B12.1

Choline is a little-known nutrient that is under consumed yet vitally important to the functioning of all cells, and especially in the first 1000 days for brain development and the prevention of birth defects.8 Shockingly, 90-95 percent of pregnant women and 90 percent of adults don’t consume adequate choline.9
Most multivitamins and prenatal supplements do not supply adequate choline. A recent study found none of the top 25 prenatal vitamins contain the 450 mg daily-recommended choline intake for a pregnant woman.10

As a result, the American Medical Association highlighted this underappreciated nutrient by recommending that all prenatal vitamins contain 450 mg — the amount needed during pregnancy. Lactation requires 550 milligrams.

Closing the choline gap can be done with foods rich in choline such as eggs, beef liver, meat, seafood and wheat germ. Eggs are among the richest sources. Two large eggs contain 294 milligrams of choline, more than half the recommended amount for pregnant women.

Educating Caretakers

Since babies are totally dependent on caregivers for nourishment, educating them about the importance of appropriate infant feeding practices is essential. Messages should be targeted to adequate dietary patterns with clear and simple guidance. Utilizing digital and mobile technologies is an opportunity to promote healthy eating patterns for infants. Guidelines for birth to twenty-four months has not been included in previous Dietary Guidelines for Americans (DGA) but this is about to change. The 2020 DGA will include recommendations for birth to twenty-four months for the first time.

Bottom Line

Good nutrition during the first 1000 days is a unique window of opportunity and tremendous chance to impact neurodevelopment and a child’s ability to establish a healthy dietary pattern and lifestyle that will promote lifelong health.

Early intervention has the potential for enormous advantage across the life span. As dietitians, we have the capacity to improve early neurodevelopment and lifelong health with effective messaging and interventions.

  1. Schwarzenberg, SJ, et al. Advocacy for Improving Nutriti on in the First 1000 Days To Support Childhood Development and Adult Health. Pediatrics. 2018;141:e20173716.
  2. Goulet, O. Potenti al role of the intesti nal microbiota in programming health and disease. Nutr Rev. 2015;73 Suppl 1:32-40.
  3. Diaz Heijtz R. Fetal, neonatal, and infant microbiome: perturbations and subsequent eff ects on brain development and behavior. Semin Fetal Neonatal Med. 2016;21:410–417.
  4. Marti ns, Vinicius JB, et al. Long-Lasti ng Effects of Undernutrition. Int J Environ Res Public Health. 2011;8: 1817–1846.
  5. Winter JD, et al. Newborn adiposity by body mass index predicts childhood overweight. Clin Pediatr (Phila). 2010;49:866-70.
  6. Taveras EM, et al. Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics. 2009;123:1177-83.
  7. Briefel, RR. New Findings from the Feeding Infants and Toddlers Study: Data to Inform Action. J Am Diet Assoc. 2010;110:S5-7.
  8. Christi an, P, et al. Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal. JAMA, 2010; 304:2716-23.
  9. Wallace TC, et al. Assessment of Total Choline Intakes in the United States. J Am Coll Nutr. 2016;35:108-12.
  10. Bell, CC, et al. Prenatal Vitamins Deficient in Recommended Choline Intake for Pregnant Women. J Fam Med Dis Prev. 2016;2:048.