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Boston University School of Medicine

Post Graduate Program in PEDIATRIC NUTRITION

Summary Booklet — Module 1

I M P O RTA N C E O F E A R LY N U T R I T I O N A N D H E A LT H O U TC O M E S

An educational initiative, supported by

For the use of healthcare professionals only.

 Module 1

I M P O RTA N C E O F E A R LY N U T R I T I O N
A N D H E A LT H O U TC O M E S

Importance of the First 1000 of fetal growth, cognition, stunting of

Days of Life linear growth, and subsequent obesity and
noncommunicable diseases in adulthood.2
Poor nutrition places vulnerable populations
at risk of the intergenerational cycle of Breastfeeding: The Gold
malnutrition. Nutrition challenges persist Standard for Infant Nutrition
throughout the life of an individual.1
The World Health Organization (WHO)
Undernutrition among women propagates
recommends exclusive breastfeeding for
a cycle of undernutrition in children.
the first 6 months of life. Breastfeeding
Therefore, adequate maternal nutrition is
confers several short-term and long-term
crucial to breaking this intergenerational
advantages on an infant.1
cycle of growth failure (Figure 1). The first
1000 days, i.e. the period from the start Complementary Feeding:
of conception through a child’s second Foundation of Good Health
birthday, is a most critical period, as it offers
a window of opportunity to improve child After 6 months of age exclusive breast-
health. Undernutrition during gestation feeding is insufficient to meet the increasing
and up to 2 years of life is a determinant energy and nutrient demands of a properly

Figure 1 Intergenerational cycle of malnutrition.1

Poor nutrition places vulnerable populations at risk of multigenerational malnutrition, from both the under- and over-nutrition perspectives.
EED: Enteric dysfunction; WAZ: Weight for age; HAZ: Height for age; WASH: Water, sanitation, and hygiene; CVD: Cardiovascular diseases.
growing infant. Hence, complementary
foods should be introduced to meet these
nutrient gaps. Inappropriate complementary
foods or failure to introduce complementary
foods by 6 months of age may lead to
infant growth faltering. Furthermore,
complementary feeding helps children
explore different tastes and develop food
preferences.3,4
Malnutrition: Global Prevalence
and Socioeconomic Impact
An estimated 2 billion people have
long-term deficiencies of essential
vitamins and minerals (micronutrients),
together referred to as “hidden hunger.”5
Undernutrition and micronutrient
deficiencies cause a global loss in economic
productivity, estimated to be more than
10% of lifetime earnings and 2%–3% of the
global gross domestic product (GDP). The
GDP loss translates to a global cost of 1.4–
2.1 trillion US dollars per year.6,7 Therefore,
failing to address malnutrition could have a
significant economic impact, especially in
developing countries.8
Investing in Nutrition for High
Pay-offs
Investing in nutrition, to reduce
micronutrient deficiencies, can offer
great benefits. Estimates indicate that
investing 1.2 billion US dollars every year
on nutrition interventions over a period of
5 years can offer annual benefits of 15.3
billion US dollars. This is equivalent to a
benefit-to-cost ratio of almost 13:1.
Moreover, investing in micronutrient
supplements can lead to improved health,
fewer deaths, and increased future
earnings.6,7 The dividends from investing
in preventive nutrition, reducing disease
burden, and improving quality of life can
be significant. Pediatric health care is an
appropriate segment for the implementation
of preventive nutrition behaviors, since
eating preferences are established early in
life.9
KEY POINTS
• Poor maternal nutrition
propagates the cycle
of malnutrition across
generations.
• The first 1000 days of life
are a window of opportunity,
as good nutrition during this
period lays the foundation for a
healthy and productive future.
• Malnutrition has a significant
social impact that is
measurable in economic terms.
• Investing in nutrition can yield
economic benefits.
References
1. Prendergast AJ, Humphrey J. The stunting syndrome in developing
countries. Paediatr Int Child Health. 2014; 34(4):250–265.
2. Black RE, Victora CG, Walker SP, et al. Maternal and Child Nutrition
Study Group. Maternal and child undernutrition and overweight in
low-income and middle-income countries. Lancet. 2013;382(9890):
427–451.
3. World Health Organization. Infant and young child feeding (IYCF)
Model Chapter for textbooks for medical students and allied health
professionals. 2009.
4. ESPGHAN Committee on Nutrition. Agostoni C, Decsi T, Fewtrell M, et
al. Complementary feeding: A Commentary by the ESPGHAN Committee
on Nutrition. J Pediatr Gastroenterol Nutr.2008; 46(1):99–110.
5. Muthayya S, Rah JH, Sugimoto JD, et al. The global hidden
hunger indices and maps: An advocacy tool for action. PLoS One.
2013;8(6):e67860.
6. FAO. The state of food and agriculture. Food systems for better
nutrition. Food and Agriculture Organization of the United Nations,
Rome, 2013. Available at: http://www.fao.org/3/a-i3300e/. Accessed
on: 30 September 2015.
7. FAO. The state of food and agriculture. Social protection and
agriculture: Breaking the cycle of rural poverty. 2015. Available at:
http://www.fao.org/3/a-i4910e.pdf Accessed on: 27 October 2015.
8. Stein AJ, Qaim M. The human and economic cost of hidden hunger.
Food Nut Bull 2007;28(2):125–134.
9. Bendich A, Deckelbaum RJ. Health Economics of Preventive Nutrition.
In: Bendich A, Deckelbaum RJ. (eds). Preventive Nutrition, Nutrition
and Health. Humana Press. Springer Science and Business Media.
2010. Available at: http://www.springer.com/cda/content/document/
cda_downloaddocument/9781603275415-c1.pdf?SGWID=0-0-45-
803105-p173833741. Accessed on: 20 March 2015.
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Release date: January 2018

Expiration date: December 2018

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For the use of healthcare professionals only.