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Maternal and child undernutrition: consequences for adult health and human capital

Published: January 2008 

Publication: The Lancet 

Authors: Prof. Cesar G. Victora, M.D., Prof. Linda Adair, Ph.D., Prof. Caroline Fall, D.M., Pedro C Hallal, Ph.D., Prof. Reynaldo Martorell Ph.D., Prof. Linda Richter Ph.D., Prof. Harshpal Singh Sachdev, M.D., for the Maternal and Child Undernutrition Study Group 

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
    • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
    • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
    • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
    • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • Malnutrition in pregnancy and childhood can cause generational health problems 
  • Undernutrition in pregnant mothers and children was strongly associated with… 
    • Shorter adult height 
    • Less schooling 
    • Reduced economic productivity  
    • Lower offspring birthweight in women (birthweight is positively associated with lung function, the incidence of some cancers; undernutrition could be associated with mental illness) 
  • Lower weight and malnutrition in childhood followed by weight gain after two years of age was found to be risk factors for high glucose concentrations, elevated blood pressure and harmful lipid profiles once adult BMI and height were adjusted for, suggesting that rapid postnatal weight gain, after infancy, is linked to these conditions 

Key Quotes: 

  • “Poor fetal growth or stunting in the first 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birthweight.” 
  • “Children who are undernourished in the first 2 years of life and who put on weight rapidly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition.” 
  • “We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations.” 

Read the original article here

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a forty-year study

Published: Nov. 26, 2013

Publication: National Library of Medicine

Authors: Deborah P. Waber, Ph.D., Cyralene P. Bryce, M.D., Jonathan M. Girard, B.A., Miriam Zichlin, B.S., Garrett M. Fitzmaurice, Sc.D., and Janina R. Galler, M.D.

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
  • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
  • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
  • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
  • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • While previously malnourished individuals were able to catch up physically to their healthy peers, their cognitive and behavioral development lagged behind 
  • IQ scores in the intellectual disability range were 9 times more prevalent in the previously malnourished group 
  • Previously malnourished individuals had lower IQs, lower grades in school, and higher rates of attention problems. They also suffered from intellectual disabilities at a higher rate than their healthy peers. 
  • Malnutrition during the first year of life carries risk for significant lifelong functional morbidity.  

Key Facts: 

  • The estimated difference in IQ between the two groups was 15 points when tested as adolescents and 18 points when tested as adults 
  • 26.3 percent of individuals in the previously malnourished group had IQs indicating intellectual disabilities compared to only 3 percent in the control group 

Read the original article here

Long term consequences of early childhood malnutrition

Published: December 2003 

Publication: International Food Policy Research Institution 

Authors: Harold Alderman, John Hoddinott, Bill Kinsey 

Background

  • Researchers studied the preschool nutritional status (measured by height, given age) of children in Zimbabwe who experienced civil unrest and/or a drought before the age of three
  • Civil war and droughts were used as an indicator of malnourishment
  • Nutritional status was then compared to subsequent health and education achievements of these children to show the effects of early-childhood malnutrition on adult outcomes

Summary

  • The study indicates that early childhood malnutrition can lead to continued stunting and lower school achievement in adolescence as compared to peers who experienced no malnutrition or a lesser degree of malnutrition in childhood
  • Children who measured at median height in preschool were more likely to measure at median height by adolescence and have completed an additional 0.7 grades of schooling than students who measured below median height in preschool
  • This study also indicates that improving preschool nutrition can facilitate growth and higher educational achievement in adolescence
  • Because of the negative impact of “shocks” (i.e. war and drought), interventions should focus on mitigating the impact of these shocks.

Read the original article here

A Conversation with Action Against Hunger

Blythe Thomas, Initiative Director at 1,000 Days, an initiative of FHI Solutions, recently spoke with Dr. Charles Owubah, CEO of Action Against Hunger, to discuss the vital work of his organization to detect, treat and prevent malnutrition. The two discussed the effects of COVID and climate change on food and nutrition, the role of women farmers in ending malnutrition, and LifePack, an innovative tool to raise money for malnutrition treatment.

Watch the video to learn more. 

Keeping Healthy During Pregnancy & Breastfeeding

During pregnancy and when you’re breastfeeding, nutritious food choices will help fuel your
baby’s growth and keep you healthy.

Watch and learn 6 steps you can take during your 1,000-day window to nourish you and your little
one.


Taking a Prenatal Vitamin

Eating the Rainbow

Limiting Certain Foods

Managing your Weight

Focusing on Good Nutrition

Breastfeeding for the Benefits to You and Baby

Follow us on social for more!

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What We’re Watching – July 2022

July is bringing hot temperatures to the Nation’s Capital and work is also heating up on Child Nutrition Reauthorization and the White House Conference on Hunger, Nutrition and Health. To the delight of child nutrition advocates, House Education and Labor Chairman Bobby Scott (D-VA) and House Civil Rights and Human Services Subcommittee Chair Suzanne Bonamici (D-OR) released the Healthy Meals, Healthy Kids Act, the Committee’s much-anticipated Child Nutrition Reauthorization bill. The legislation addresses critical needs and recommended improvements in the programs that serve children including the National School Lunch Program, Summer Food Service Program, Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Child and Adult Care Food Program (CACFP). Proposals in the bill are designed to increase access to these programs and strengthen the nutritional resources provided to participants. Many of the recommendations are based on learnings from the COVID-19 pandemic about strategies to reach more children and meet the critical needs of program providers to ensure program sustainability.

1,000 Days is particularly excited to see provisions that

  • modernize WIC by improving access to telehealth so that receiving program benefits is not limited due to physical burdens;
  • expand the WIC Breastfeeding Peer Counselor Program to ensure more families have access to breastfeeding support;
  • strengthen CACFP by providing reimbursement for an additional meal or snack per child, allowing young children in care for longer hours to receive the nutrition they need; and
  • permit children in households participating in the Supplemental Nutrition Assistance Program (SNAP) to be automatically eligible for CACFP, ensuring more young children will receive nutritious meals and snacks.

The team at 1,000 Days will monitor the Committee markup on Wednesday, July 27 and work closely with partners and lawmakers to advance this bill and its critical components that improve nutrition security for birthing people, young children, and their families.

1,000 Days also worked across the public health community and in specific coalitions to inform the Administration about our priorities for the White House Conference on Hunger, Nutrition and Health by the July 15 deadline. Examples include working with Council for a Strong America’s CEO Barry Ford to submit this letter to reinforce the need for policies to support maternal and child health, equitable policy implementation and more. Paid Leave for All, where Blythe Thomas, 1,000 Days’ Initiative Director, serves on the steering committee, submitted a letter leveraging 1,000 Day’s report that demonstrates paid leave is a public health imperative and must be considered as an intersectional policy that supports and builds stability for low-income and other marginalized communities. Finally, although it’s not an official part of White House property, the Task Force on Hunger, Nutrition and Health collected policy reports and white papers to help inform their recommendations. That portal includes four papers authored by 1,000 Days and four papers from other organizations with a focus on the 1,000-day window in the title. We’re working hard to ensure the White House hears us!

Historic Commitment from US Government to Fight Severe Malnutrition

“There are many problems in this world that will take decades to solve sustainably. Ending child deaths from wasting is not one of them. This is something we can do now.” – Will Moore, CEO, Eleanor Crook Foundation at the State of Global Food Security and Nutrition event on July 18.

At the State of Global Food Security and Nutrition event hosted July 18, 2022, by the Center for Strategic and International Studies (CSIS), United States Agency for International Development (USAID) and the Eleanor Crook Foundation (ECF), USAID Administrator Samantha Power announced that the United States will provide UNICEF with an additional $200 million to procure and distribute ready-to-use therapeutic foods (RUTF). The announcement is the most significant commitment that has ever been made to treat wasted children and the largest leap in coverage on record. 

In addition to the $200 million commitment, the Eleanor Crook Foundation, the CRI Foundation and The ELMA Relief Foundation also pledged $50 million to support the effort. Administrator Power announced a goal to match another $250 million from the private sector, high net worth individuals, corporations and other philanthropies with hopes to announce additional funds raised at the U.N. General Assembly in September 2022. 

“Perhaps the most immediate, life saving, humanitarian aid we can provide is assistance to revive severely malnourished children,” said Administrator Power. “Despite the power of (RUTF) in the fight against child wasting, it is drastically underutilized.”

Malnutrition is the greatest threat to child survival worldwide, contributing to more child deaths than AIDS, malaria, and tuberculosis combined. Those who do survive severe malnutrition in early childhood are much more likely than their well nourished peers to suffer from physical and mental stunting that affect future educational attainment, health and earning potential. 

RUTF treatment for six weeks can help nearly 90 percent of children suffering from wasting recover.  According to UNICEF, “Reaching virtually every child in need can be achieved with just US$300 million in additional funding.” The $200 million pledge, coupled with the $50 million pledged today by private philanthropies, could equate to 80% of the way toward the UNICEF goal.

However, RUTF is not the only high-impact nutrition intervention ready to be scaled today. Using a modeling tool developed by the Johns Hopkins Bloomberg School of Public Health, researchers identified four of the most life-saving and cost-effective actions we can take. Known as the Power 4, they include the following: 

  1. Supply all pregnant women with prenatal vitamins;
  2. Support breastfeeding mothers;  
  3. Continue large-scale vitamin A supplementation; and 
  4. Expand coverage of specialized foods (RUTF) for treatment. 

Along with RUTF, the Power 4 have significant potential to reduce child deaths from malnutrition and make up some of the “best buys” in global development. In the United States, just over 1 percent of US global health funding in FY2022 goes to nutrition programming, while AIDS, malaria, and tuberculosis collectively net about 76 percent. It is time to increase global nutrition investments and end the preventable child and maternal deaths malnutrition causes. 

As Administrator Power said today, “No child should die from malnutrition when we have the tools to stop it, it’s that simple.” At 1,000 Days, we agree.

Paid Leave Must Have a Place at the White House Conference on Hunger, Nutrition, and Health

The following is a statement from the Paid Leave for All coalition, of which 1,000 Days is part.


Dear members of WHCHNH Advisory Committee Members,

As parents, caregivers, early childhood and public health experts, race and gender equity advocates, social justice organizations, and on behalf of our tens of millions of members, we strongly urge you to include paid family and medical leave in the White House Conference on Hunger, Nutrition, and Health and its national strategy. We recommend the White House continue to promote its original proposal of at least 12 weeks of inclusive and comprehensive paid family and medical leave for all working people as a public health imperative. 

Paid leave is a proven tool in addressing the United States’ most pressing health issues, whether it be mitigating the ongoing COVID-19 pandemic, addressing breastfeeding needs in light of a national formula shortage, addressing our worsening maternal mortality rates, or improving our overall health outcomes and families’ well-being. It is also a tool for alleviating the systemic racism and sexism in health care, by allowing more people and those with more caregiving responsibilities access and time to care for themselves along with their loved ones. Yet only 23 percent of workers in this country have access to paid family leave through their jobs and we remain one of the only countries in the world without this protection. 

Paid leave is interconnected with a broad number of health indicators and outcomes. Workers without access to paid leave are more likely than workers with paid leave to experience financial and material hardships, including being more than twice as likely to be unable to pay for rent or utilities and twice as likely to experience food insecurity. Implementing paid leave in California, for example, reduced very low household food security by about two percentage points. Workers without access to paid leave are also more likely to be uninsured, have trouble paying for medical bills, and have less access to medical care because of the cost. A quarter are not confident they could come up with $400 for an unexpected emergency.

Paid leave is also a critical tool to support healthier pregnancies, better birth outcomes, more successful breastfeeding, and both physical and mental health in the postpartum period. This is particularly important while the United States faces a formula shortage—and has the worst maternal mortality rate among wealthy countries, disproportionately impacting Black women, and one that is worsening after COVID-19. Paid leave is critical to giving birthing people the opportunity to establish breastfeeding patterns as an option for their family, and we know that for those who are able and choose to breastfeed, it plays a powerful role in women’s health. Research has shown that breastfeeding is associated with a lower risk of heart disease—the leading cause of death among women in the U.S.—as well as breast cancer, ovarian cancer, type-2 diabetes, and hypertension later in life. It also has health benefits for the child, including improving the digestive and immune system. The American Academy of Pediatrics recently increased their recommended duration of breastfeeding to two years or beyond, a near impossibility for working families without access to paid leave. For low-income families in New Jersey, where a statewide paid family leave program has been in effect since 2009, researchers found that new mothers who use the state paid leave program breastfeed, on average, one month longer than new mothers who do not use the program. According to the Department of Health and Human Services, if 90 percent of women in the United States breastfed their babies for the first 6 months of life, it would save 900 babies’ lives and $13 billion in healthcare expenses annually.

We know that paid sick, family, and medical leave are critical to the overall health—including mental and emotional health—and well-being of working people, families, and whole communities. They are key to diagnosis, treatment and recovery, and the containment of disease. 

Every one of us is going to need to give and receive care in our lifetimes, and without a federal guarantee of paid leave, we will all suffer. We urge you to include paid family and medical leave in this conference and its related strategies, and to prioritize it across the administration. 

Additional Resources: 

1,000 Days Submits Comments to USDA and HHS for Next Edition of the Dietary Guidelines for Americans

The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) are preparing for the next edition of the Dietary Guidelines for Americans. They recently proposed a list of scientific questions to inform the next version, with a focus on diet and health outcomes across the lifespan. In response, 1,000 Days submitted comments emphasizing the critical importance of nutrition in shaping future health and outcomes. Our comments specifically recommend adding developmental milestones as outcomes of study for infant and toddlers, including key questions on maternal and child nutrition and health outcomes from the 2020 Dietary Guidelines Advisory Committee report, and updating research on breastmilk composition and consumption.

See the comments here.

U.S. Breastfeeding Committee’s Statement on the Formula Shortage

The following guidance is also available from the Academy of Breastfeeding Medicine and HealthyChildren.Org.

Dear Members,

It’s been a long week/month/year (already, here in May). We see you. We are you. Much love.

As the United States faces a serious shortage of infant formula, we know that no baby should ever go hungry. Families are scared and stressed, and like every other crisis facing our nation, BIPOC and economically vulnerable communities are pressed even harder. This is a national crisis.

Long standing public health advocates know this was predictable and thus preventable. The USBC-Affiliated COVID-19 Infant & Young Child Feeding in Emergencies Constellation published a Statement at the start of the pandemic outlining actions needed to prevent the formula shortage and care gaps seen at that time from growing to a dangerous level. Being prescient is only valuable in the context of investment, action, and policy change to ensure every family has access to care. Yet here we are.

A robust infrastructure to support infant and young child feeding in emergencies includes both inventories of available commercial milk formula and lactation support and resources in every community. Public officials are currently calling for increased production of formula – which is desperately needed – yet without also investing in lactation support in every community. This exacerbates existing gaps, and as such feels short-sighted. Thank you to all the organizations lifting up resources and information on boosting milk supply, re-lactation, human milk donation, informed consent for safer milk sharing, all while calling out the systems failure that caused this to be necessary.

Long term, this is still a call to action to build systems and infrastructure to ensure that breastfeeding/human milk feeding is the easy and obvious feeding choice for most families. This includes routine skin to skin at birth; continuity of care from trained lactation support providers; family paid leave; workplace accommodations; a regulated commercial milk formula industry that invites formula-feeding parents to the table as valued stakeholders; a national network of milk banks; and IYCF-E infrastructure for disaster relief. Systems, in other words, that hold us all in care. Collectively we can build the resiliency to support a single community during a flood, a region during a power outage, or a nation during a pandemic or supply chain crisis. Dear choir – we know you know this sermon.

As the nation grapples with the immediate and present impact of this emergency, we need to do everything we can to support infant nutrition, including ensuring access to lactation support, supplies, and accommodations, donor milk, and infant formula. Organizations and agencies from across the nation are mobilizing in response to the shortage, offering support and messaging response according to the scope, stance, and capacity within their reach.

Throughout its history, the U.S. Breastfeeding Committee has worked to ensure food security for our nation’s infants by addressing gaps in the policy landscape with policy, systems, and environmental change solutions that include building an infrastructure for infant and young child feeding in emergencies. We remain committed to this cause and will continue to curate and amplify resources from the field, for the field, so that you are equipped to support the families you serve.

Thank you for all you are doing, including taking respite as you need.