Improved nutrition in the first 1000 days and adult human capital and health

Abstract

Objective: The aim of this article is to review why the first 1000 days of life are a vulnerable period of human development and the long-term effects of a nutrition experiment carried out in Guatemala (1969-1977).

Methods: In 1969-77, a supplement called Atole, containing high quality protein, energy and micronutrients, was provided to women during pregnancy and lactation and to children <7 years of age in two villages while in two control villages a low-energy drink called Fresco was provided. The villages were assigned at random to the treatment groups.

Results: Several reasons explain the vulnerability of the first 1000 days: rapid growth and development, high nutritional requirements, greater susceptibility to infections, high sensitivity to programming effects and full dependence on others for care, nutrition, and social interaction. Compared with Fresco, Atole improved total nutrient intakes (protein, energy, and micronutrients) and reduced stunting, but only in children < 3 years of age. A study in 2002-2004 showed that schooling, reading, and intelligence were improved in Atole villages, but only in those who received Atole before the age of 3 years. Wages of men were increased by 46% in those provided Atole through the age of 2 years. Findings for cardiovascular disease risk factors were inconclusive, perhaps because of the young age of the sample. A new study focusing on chronic diseases is ongoing (ages 38-54 years).

Conclusions: The Guatemalan studies indicate that substantial improvement in adult human capital and economic productivity resulted from the nutrition intervention. This provides a powerful argument for promoting improvements in nutrition in pregnant women and young children in low income countries.

Figure 1

Human brain development. [Source: Casey BJ, Tottenham N, Liston C, Durston S. 2005. Imaging the developing brain: what have we learned about cognitive development? Trends in Cognitive Sciences 9:104–110.]

Figure 2

Velocity curve (cm/4 weeks) for growth in crown-heel length in prenatal and early postnatal periods in boys. The interrupted line represents the theoretical curve if no uterine restriction had taken place. [Source: Tanner JM. Foetus into Man. 1978. Cambridge, MS: Harvard University Press, p 250.]

Figure 3

Typical velocity curves for length/height in English girls and boys (Source: Tanner JM, Whitehouse RH and Takaishi M. 1965. Standards from birth to maturity for height, weight, height velocity and weight velocity; British children. Arch Dis In Child 41:454–71; 613–35.]

Figure 4

Stature for age z-scores; analyses of national surveys. [Source of Panels A and B : Víctora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. 2010. Worldwide timing of growth faltering: Revisiting implications for interventions. Pediatrics 125(3):e473–80.]

Figure 5

Prevalence of stunting (< −2 SD) in Guatemala in the National Survey of Maternal and Child Health (ENSMI) of 2014/2015. [Drawn using data in http://www.osarguatemala.org/osartemporal/Archivos/PDF/201603/259_4.pdf. Accessed June 20, 2016]

Figure 6

Causes of child malnutrition [Modified from: United Nations Children’s Fund (UNICEF). 1998. The State of the World’s Children: A UNICEF Report. Malnutrition: Causes, Consequences, and Solutions. New York: Oxford University Press, p 131.]

Figure 7

Difference in length at 3 years of age between children (n = 453) exposed to supplement during their entire lives and those measured at baseline in 1968: village level analysis. [Drawn from data in Habicht J-P, Martorell R, Rivera JA. 1995. Nutritional Impact of Supplementation in the INCAP Longitudinal Study: Analytic Strategies and Inferences. J Nutr 125(S4):S1042-S50.]

Figure 8

Dose response relationship: Differences in length at 3 years of age between children consuming different amounts of Atole and those measured at baseline. [Drawn from data in Martorell R, Habicht J-P and Klein RE. 1982. “Anthropometric indicators of changes in nutritional status in malnourished populations.” Joint U.S.-Japan Malnutrition Panels, U. S.-Japan Cooperative Medical Science Program, Bethesda, Maryland. In: B. A. Underwood (ed.), Methodologies for Human Population Studies in Nutrition Related to Health. NIH Publication No. 82–2462. U.S. Government Printing Office: Washington, D.C., p 99–110.]