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Our favorite time of year: #March4Nutrition

Our favorite time of year: #March4Nutrition

We’re thrilled to celebrate the 50th anniversary of National Nutrition Month in March 2023. Developed by our friends and colleagues at the Academy of Nutrition and Dietetics, every March we work especially to amplify the importance of nutrition for families in the first 1,000 days: the time between pregnancy and a baby’s second birthday.

Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. Backed by decades of research and most recently the American Journal of Public Health’s special nutrition series, we know nutrition plays a foundational role in a child’s development and her country’s ability to prosper.

We invite you to follow #March4Nutrition on Facebook, Instagram, and Twitter all month long and join the conversation. Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures.

Week 1 March 1-10: Women’s nutrition – Access to proper nutrition can help women grow their power.

Week 2 March 13-17: Benefits of breastfeeding – Breastfeeding has critical benefits for both moms and babies.

Week 3 March 20-24: Healthy foods and drinks for babies and toddlers – Growing babies need good nutrition to flourish.

Week 4 March 27-31: Raise your voices – Help us spark action to change the world for moms, babies and families, 1,000 days at a time.

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition.

Join us this month as we #March4Nutrition for moms and babies!

New Research Highlights Critical Need for Strong Policies to Leverage the Value of Breastfeeding

February 9, 2023

Dear Members of the 118th Congress,

As leaders advocating for healthy families and children, 1,000 Days and the U.S. Breastfeeding Committee invite you to join us in creating a landscape of breastfeeding support across the United States.

Breast milk is recognized as the optimal food for babies and plays a critical role in their growth and development.[i] Numerous studies have shown that breastfeeding promotes healthy cognitive and social-emotional development.[ii] It also saves lives by helping to protect babies from infections and conditions such as sudden infant death syndrome (SIDS).[iii] Breastfeeding even lowers a child’s risk of obesity and type 2 diabetes later in life. In addition, women who breastfed reduce their risk of specific chronic diseases, including type 2 diabetes, cardiovascular disease, and breast and ovarian cancers.[iv]

Unfortunately, the U.S. has many barriers to establishing and maintaining breastfeeding. While four out of five babies born in the United States start out being breastfed, about half are still doing so at six months.[v] This is not due to capacity or wishes of the parent, but rather because environments in the U.S. do not support breastfeeding.

Our country’s policies, systems, and environments must be improved to make breastfeeding a realistic option for all families. New research released this week highlights the critical need for strong policies to fully leverage the value of breastfeeding.

  • Breastfeeding rates can be rapidly improved by scaling up known interventions, policies, and programs in the workplace and health system.
  • Infant formula companies utilize intrusive marketing strategies to families, health care providers, and policy makers to portray these products as solutions to common infant health issues in ways that systematically undermine breastfeeding and prey on parental concerns.
  • Policy changes are needed to address the power imbalances and political and economic structures that influence feeding practices and health outcomes.

As we approach the one-year anniversary of the infant formula crisis, it is critical that you and your colleagues in the House and Senate take action to address infant nutrition security, including through support for breastfeeding.

As you know, changing environments and systems requires everyone do their part – parents, policymakers, health facilities, communities, and employers. As a Member of Congress, you have an incredible opportunity to create the policy changes families need. Together, we can build on the momentum from recent advancements like the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act to build a robust infrastructure for infant nutrition security.

Breastfeeding has such a profound impact on population health outcomes that increasing breastfeeding rates and creating lactation-friendly environments have been identified as critical public health priorities in the U.S. as well as across the world. Breastfeeding is included in a variety of national initiatives, including the Dietary Guidelines for Americans, Healthy People 2030, The Surgeon General’s Call to Action to Support Breastfeeding, and more.

It is time to move from reports and vision statements, to taking action on the policy priorities that families deserve. We hope you will take the time to explore the new Lancet series on breastfeeding and join us as we work to build a country where infant nutrition security and breastfeeding is valued, protected, promoted, and supported.

Sincerely,

Amelia Psmythe Seger,
U.S. Breastfeeding Committee		 Blythe Thomas,
1,000 Days

 

About 1,000 Days

An Initiative of FHI Solutions, 1,000 Days is the leading non-profit organization working in the U.S. and around the world to ensure women and children have the healthiest first 1,000 days. Our mission is to make the well-being of women and children in the first 1,000 days a policy and funding priority. We are passionate about turning evidence into action and use our deep understanding of the science and the issues to help shape policies that improve the lives of moms and babies in the U.S. and throughout the world.

About the U.S. Breastfeeding Committee

The mission of the U.S. Breastfeeding Committee (USBC) is to drive collaborative efforts for policy and practices that create a landscape of breastfeeding support across the United States. USBC functions as a national coalition of 100+ organizational members representing nonprofits, breastfeeding coalitions, federal agencies, and businesses working at national, state/territorial, tribal, local, and community levels to protect, promote, and support human milk feeding. The USBC uses an equity-centered collective impact approach to facilitate multisectoral collaborations.

 

[i] Breastfeeding. World Health Organization. https://apps.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html.  Published Aug. 2018. Accessed February 6, 2023.

[ii] Nutrition in the First 1,000 Days: A Foundation for Brain Development and Learning, 1,000 Days and Think Babies. https://thousanddays.org/wp-content/uploads/1000Days-Nutrition_Brief_Brain-Think_Babies_FINAL.pdf. Accessed February 4, 2023.

[iii] Breastfeeding Benefits Both Baby and Mom. Centers for Disease Control and Prevention, https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html. Published July 27, 2021. Accessed February 6, 2023.

[iv] Making the decision to breastfeed | womenshealth.gov. womenshealth.gov. https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed/#1. Published 2020. Accessed December 20, 2022.

[v] Breastfeeding Report Card, United States 2022. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/data/reportcard.htm. Published August 31, 2022. Accessed February 8, 2023.

New Series in the American Journal of Public Health Identifies 1,000-Day Window as Untapped Potential to Improve Health of Families

Opportunities, Challenges Identified for Pregnant People and Babies 0-2

(WASHINGTON D.C.) Over the last two decades, science has shown that the 1,000-day window, the time between a pregnancy and the baby’s second birthday, is most critical for brain development and when good nutrition has the greatest influence on future health. Today, on the heels of the first White House Conference on Hunger, Nutrition, and Health in more than 50 years, The American Journal of Public Health released a special series that identifies opportunities to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth.

“Prioritizing the health of babies, younger children, and mothers will reap significant returns on investment, setting the foundation for the health of our nation,” said Ambassador Susan Rice, White House Domestic Policy Advisor, in one of the editorials in the series. “Everyone has a role to play—the private sector; state, local, tribal, and territory governments; civil society; academia; philanthropy; and other partners.”

The 70-page series with more than 15 authors outlines the role of Early Childcare and Education (ECE) settings to strengthen overall support systems for low-income families and influence the healthy growth and development of children; how to improve breastfeeding outcomes without leaving anyone behind; new analysis on COVID’s impact for people who gave birth during the height of the pandemic; investments needed to achieve nutrition security; and new opportunities for pediatricians to better support families in their care with nutrition advice and access.

“This special issue sets the stage for what we know about nutrition in the first 1,000 days in the U.S. and what is needed to move forward. Unfortunately, nutritious foods are not uniformly and equally available to all. This has unique relevance to the first 1,000 days as inequities in childhood growth and development due to poor nutrition can have long-term effects on cognitive development and health throughout that child’s life,” said Dr. Ruth Petersen, MD, MPH, Director of the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention (CDC), guest editor of the series and an author (R. Petersen).  The series identifies:

  • Gaps in data of nutrition status and eating behaviors through pregnancy, infancy and toddlerhood (H. Hamner), including micronutrient deficiencies such as iron status, which leaves women vulnerable to poor maternal outcomes (M.E. Jefferds).
  • Steps to improve nutrition of pregnant people, including how to realize the potential benefits of breastfeeding so no one is left behind (R. Perez-Escamilla).
  • Impacts of early disparities from historically underserved communities, especially racial disparities that stem from systemic racism in food access, education, housing, health care and employment that have been exacerbated by the COVID-19 pandemic (S. Bleich).
  • Efforts to counter repeated exposure of marketing of unhealthy foods and drinks (J. Harris),  and address overconsumption of ultra-processed food through government policies (J. Krieger).
  •  Opportunities to leverage federal and state programs and policies, such as ECE funding streams, state licensing regulations, state quality improvement programs, and accrediting organizations to strengthen nutrition security in childcare settings. (C. Dooyema).
  • Actions key sectors can take immediately, including childcare, healthcare and the philanthropic sector, as well as policy recommendations for the U.S. government (B. Thomas).  

“What happens in the first 1,000 days sets the foundation for every day that follows. How well or how poorly mothers and children are nourished and cared for during this time has a profound impact on a child’s ability to grow, learn and thrive,” said Blythe Thomas, initiative director of 1,000 Days, an initiative of FHI Solutions. “Achieving nutrition security during the first 1,000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather. We invite all to join us in prioritizing and realizing the opportunity presented by this AJPH supplement.”

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Celebrating Progress Towards Leaving No One Behind on World Food Day

Low and middle-income countries are still grappling with the ongoing COVID-19 pandemic, conflict, and weather shocks which continue to impact global food and nutrition security. The World Food Programme estimates that 50 million people in 45 countries are on the edge of famine. On World Food Day 2022, we take stock of the hard-fought progress that has been made to strengthen nutrition during the first 1,000 days, and we renew our commitment to continue the fight. Though work still needs to be done to truly leave no one behind, we applaud the following actions that have been taken by the US government to address food and nutrition insecurity in low and middle-income countries.

United Nations General Assembly Food Security Announcements

US Government Global Food Security Commitments

Multiple events were held at the United Nations General Assembly (UNGA) in New York related to food and nutrition security efforts. President Biden announced $2.9 billion in additional funding to strengthen food security, which included funding for humanitarian assistance and global development assistance. As part of UNGA, the Global Food Security Summit, which was held one year after the UN Food Systems Summit, took place on September 20th and included remarks from Secretary of State Antony Blinken. Secretary Blinken highlighted current actions to address food insecurity, including progress made on the Roadmap for Global Food Security, and called for  more countries to respond to the food insecurity crisis. He mentioned commitments made by the US government, which include $6.1 billion in humanitarian assistance and $2.3 billion in development assistance, and the expansion of Feed the Future. Much of the funding provided by the US government addresses the negative impact on food insecurity throughout the world due to the war in Ukraine.

Commitments to Prevent and Treat Severe Malnutrition

On September 21st, USAID, UNICEF, the Government of Senegal, and the Children’s Investment Fund Foundation co-hosted “The Child Malnutrition Crisis: Pledging to Save Lives.” The event followed the call to action and announcement from United States Agency for International Development (USAID) Administrator Samantha Power in July when the US committed $200 million to scale up access to wasting treatment, including Ready-to-Use-Therapeutic Food (RUTF). During the September event at UNGA, $280 million was announced which included new funding from donors around the world to address severe malnutrition and wasting. Between these events, over $530 million has been committed through public and private sector funds which has the potential to reach the majority of children suffering from wasting with treatment.

Passing the Global Malnutrition Prevention and Treatment Act

In September, the Senate passed the Global Malnutrition Prevention and Treatment Act and it is awaiting President Biden’s signature. The legislation was led by USAID and non-governmental organizations (NGOs) like 1,000 Days of FHI Solutions dedicated to preventing and treating malnutrition. It makes nutrition an even higher priority within the US government by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs and allows USAID administrators to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. 1,000 days is proud to have supported this lifesaving bill!

Advancing the Global Food Security Reauthorization Act of 2022

The House of Representatives passed the Global Food Security Reauthorization Act of 2022 on September 29, 2022. This legislation reauthorizes the Global Food Security Act (GFSA) through 2028 and continues to build upon and strengthen the Feed the Future initiative. It supports agriculture-led economic growth, bolsters small-holder and women-owned farms, and improves maternal and child nutrition, including during the 1,000-day window. GFSA will strengthen local and regional economies and promote resiliency in some of the world’s lowest income countries. This legislation aims to not only improve food and nutrition security, but also national security, and meets the moment to address rates of increased hunger and malnutrition globally.

Moving Progress Forward

Further progress on a global scale is still needed to address the food and nutrition insecurity crises. While we recognize and celebrate the commitments made by donors, the US government, other country governments, and the NGO community, we will continue to advocate for efforts to improve nutrition, particularly during the 1,000-day window. We know the critical role that nutrition plays in a child’s development, and the investments during this time allow communities to prosper. 1,000 Days looks forward to continuing to be a part of efforts to advocate for strong food and nutrition security programs and investments, including evidence-based nutrition interventions.

A Much-Needed Win for Moms and Babies: the Global Malnutrition Prevention and Treatment Act

Photo Credit: USAID

Nutrition plays a foundational role in a child’s development and her country’s ability to prosper. It is why several of the world’s leading economists have called for greater investments in the nutrition and well-being of mothers, babies, and toddlers as a way to create brighter and more prosperous futures for us all.

On September 20, 2022, the Senate passed the Global Malnutrition Prevention and Treatment Act (H.R. 4693) a lifesaving bill that will positively impact tens of millions of women and young children especially in their 1,000-day window, the time between pregnancy and the baby’s second birthday. This is the precious window of opportunity that enables all children to reach their full potential. When children are well nourished, cared for, and protected from disease, violence and toxic stress, they have the best chance at a thriving future. And when children get a strong start, we all benefit.

About the bill

The legislation will support countries in their efforts to prevent the current 2.6 million childhood malnutrition-related deaths worldwide, approximately 150 million children with stunted development, and the 13.6 million children globally under the age of 5 experiencing wasting because they do not have adequate nutrition.

The Global Malnutrition Prevention and Treatment Act, led by the U.S. Agency for International Development (USAID) and non-governmental organizations (NGOs) like 1,000 Days dedicated to preventing and treating malnutrition, makes nutrition an even higher priority by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs, such as prenatal vitamins, fortifying foods with essential nutrients (like Vitamin D, iron, and iodine), providing young children with vitamin A supplementation, supporting new mothers to breastfeed, and lifesaving treatment for severely malnourished children.

With this bill, the USAID administrators will be able to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. The USAID administrators will select priority countries to receive prioritized nutrition assistance and develop clear goals for increasing coverage of high-impact, evidence-based nutrition programs. USAID will be required to submit an annual report to Congress on the progress made toward preventing and treating global malnutrition.

“With the passing of this legislation, we believe the effectiveness of these nutrition programs can be significantly increased with greater strategic vision, accountability, integration, and coordination,” said Blythe Thomas, 1,000 Days of FHI Solutions Initiative Director.

The power to change lives

For example, large-scale vitamin A supplementation has played a major role in decreasing Senegal’s under-five mortality rate from 59 to 37 per 1,000 live births in 5 years. In Nepal through the Suaahara II program, USAID increased the rate of exclusive breastfeeding in supported communities from 45% to 71% in 5 years.

This Global Malnutrition Prevention and Treatment Act is an investment in the future of many lives and aims to address malnutrition at the core so that our most vulnerable populations have access to proper nutrition for continued health throughout the lifespan. As Congresswoman Chrissy Houlahan (D-PA) stated “investing in global nutrition translates to lives saved.”

With both the House and Senate passage, we enthusiastically await the legislation being signed into law by President Biden.

1,000 days is proud to have supported this lifesaving bill and will continually engage with USAID and our partners as the act is implemented.

New Peer-Reviewed Series Reinforces Powerful 1,000-Day Window in U.S.

The “1,000-day window” as an organizing agenda is a new and relatively unknown concept in the United States despite its established role in global health. But, there is opportunity to unite public health communities through the relevant, compelling framework.

We believe further focus on creating the best conditions for families in their 1,000-day window can change the trajectory of the path we’re on. We seek to present a comprehensive picture of the state of the science, research needs, and a policy agenda for optimal maternal and child health in the United States through a dedicated series in the American Journal of Public Health (AJPH).

Three papers were released at 4 p.m. ET September 19, 2022 (and can be found below once published). The full series will be released October 26, 2022 on the AJPH website.

RESEARCH NEWS STORY – The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children

September 20, 2022

The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children

Optimizing federal programs and policies can significantly improve nutritional outcomes in the 1,000-day window—a vital period of development for children

Optimal nutrition between pregnancy and a child’s 2nd birthday (i.e., the first 1,000 days) is critical for the development and long-term health of the child. The 1,000 Days initiative of FHI Solutions aims to improve the health of pregnant people and babies by giving them a healthy start. The 1,000 Days initiative sponsored a new series in the American Journal of Public Health, to publish October 26, 2022, with a pre-release of three papers today.

How can we help create a healthier and more equitable future for all pregnant people and their children? The infant and maternal mortality rates in the US are among the highest of any wealthy country, with glaring racial and ethnic disparities. There is significant room to develop a unifying plan for the right policies and systems to improve nutritional security and well-being for vulnerable families.

A new essay published in the American Journal of Public Health by Dr. Heather Hamner—a health scientist at the Centers for Disease Control and Prevention—reveals numerous gaps between the dietary intake of pregnant people, infants, and toddlers and the US Department of Agriculture and the Department of Health and Human Services’ Dietary Guidelines for Americans, 2020–2025, with race and ethnicity disparities persisting across the spectrum. The average consumption of sugars, saturated fat, and sodium are higher than the recommendations of the Dietary Guidelines. The article also reveals that nearly 75% of infants are not exclusively fed human milk for the first 6 months of their lives and 1 in 3 of them are started on complementary foods (other than human milk or infant formula) before the recommended age. Most children between 12 and 23 months do not consume the recommended amounts of vegetables, dairy, and fruits.

How do we set about addressing these nutritional deficits? The essay states “Advancing efforts related to research and surveillance, programs and communication, and dissemination could help positively, and equitably, influence the health and well-being of mothers and children.” It also outlines a framework by which current federal policies and programs can be strengthened and how access to and participation in programs can be improved.

Another paper in the collection, authored by Blythe Thomas, Initiative Director of 1,000 Days, an initiative of FHI Solutions, points out that a clear plan that unifies maternal and early childhood nutrition policy and systems has eluded implementation in the US. The paper emphasized four sectors where immediate actions can be taken, and where long-term investment can make a significant impact on maternal and child health: early childhood development, health care, philanthropy, and US government relations. “Achieving nutrition security during the first 1000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather,” says Thomas, in her editorial.

A third paper in the collection—authored by Dr. Kofi Essel, community pediatrician, Children’s’ National Hospital, discusses the limited focus on nutrition-related medical education as a significant constraint on the ability of pediatricians to deliver sound feeding and nutritional guidance during the first 1,000 days. Using examples from the author’s own experience during his pediatric residency, the editorial explains that a paradigm shift on the importance of nutrition and nutrition guidance is important to enhance clinical care. According to Dr. Essel, “This shift requires a collective effort that activates pediatricians to work in cross-sector collaboratives to influence change alongside industry, researchers, and even early childhood educators. It requires pediatricians to use their voices to support local policy that shifts the food landscape, supports national policy that enhances nutrition security for our families, and transforms medical education for current and future providers.”

These three papers are part of a special series, sponsored by 1,000 Days of FHI Solutions, that will appear in AJPH on October 26, 2022. The full series will present the state of science, research needs, and a policy agenda for optimal maternal and child nutrition in the United States. Never before has a journal series brought together papers on these topics during pregnancy, birth, the postpartum period, and early childhood for the US population.

Reference

  Authors                   Titles of original papers                 Journal   Heather C. Hamner, PhD, MS, MPH, Jennifer M. Nelson, MD, MPH, Andrea J. Sharma, PhD, MPH, Maria Elena D. Jefferds, PhD, Carrie Dooyema, MPH, MSN, RN, Rafael Flores-Ayala, DrPH, MApStat, Andrew A. Bremer, MD, PhD, Ashley J. Vargas, PhD, MPH, RDN, Kellie O. Casavale, PhD, RD, Janet M. de Jesus, MS, RD, Eve E. Stoody, PhD, Kelley S. Scanlon, PhD, RD, and Cria G. Perrine, PhDKofi Essel, MD, MPHBlythe Thomas, BS   Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective   The First 1000 Days—A Missed Opportunity for Pediatricians   From Evidence to Action: Uniting Around Nutrition in the 1000-Day Window     American Journal of Public Health
   
DOI         10.2105/AJPH.2022.30706310.2105/AJPH.2022.307028NA
10.2105/AJPH.2022.307028
NA

 

 

Q&A with Dr. Kofi Essel: AJPH Special Series on Nutrition in the 1,000-Day Window

An interview with Dr. Kofi Essel, Community Pediatrician, Children’s National Hospital

What inspired you to become a pediatrician?

I always found the field of pediatrics to be a very fertile ground.  Families are interested in the wellbeing of their children, doing whatever it takes to improve the health of the next generation.  This made my clinical experiences very positively reinforcing as we engaged in effective, shared decision-making.  In addition, my mentors in my early training were all pediatricians and huge community advocates.  I knew I wanted my career to expand beyond the clinical examination room, and I found the opportunity to advocate for marginalized young children and families to be meaningful and necessary.

Your recently published a paper entitled, “The first 1,000 days: A Missed Opportunity for Pediatricians.” Why are the first 1,000 days important?

The first 1,000 days are a critical stage for young children.  Unfortunately, healthcare is often very reactionary and prioritizes management and treatment of disease.  However, the opportunity to engage young children and families in prevention and take advantage of these early years to optimize brain development and maturation, eating patterns, and healthy family relationships is critical.  We know that children are incredibly vulnerable during these first 1,000 days and small insults to their brain and environment can cause permanent challenges down the line.  Helping families and creating systems that protect and support the most vulnerable is essential for our nation.

Why is this a missed opportunity for pediatricians?

This article gave me a chance to highlight the gaps in nutrition education for future and practicing providers, but also magnify the importance of pediatricians like myself to take the mantle to support our young children and families.  Systemic change is crucial and necessary, but the need for strong counseling and advocacy is always going to be an important piece of the puzzle.  The gap in nutrition education is a disservice to our patients, so I call on our training programs to recognize the essential nature of equipping our current and future pediatricians with the knowledge, tools, and skill to work alongside our patients and through shared decision-making support their desire to optimize the health of their children.  We also must remember that the 21st century clinician must engage using modern tools of integration.  We must seamlessly integrate our clinical work with population health to provide more voices to advocate for the changes needed that our families share with us each and every day.

How does your awareness of nutrition in the 1,000-day window influence who you are as a pediatrician and what you prioritize?

I truly believe nutrition is a powerful tool that I use in my clinical arsenal, and it deserves more attention.  Food is medicine, and I use this medicine with confidence in the same way I have developed confidence in the tried-and-true inhalers, pills, and liquid solutions that my prescriptions help my families acquire.  Unfortunately, as a pediatrician I realize that the access to the medicine of food is often limited for many populations and this inequity leads to worsening disease with its origins beginning in the womb.  As a pediatrician with an awareness of the power of nutrition I am compelled to advocate for programs, tools, and interventions that support equitable access to nutritious foods so that all my families can have a chance from the start.

What needs to happen to support pediatricians with this opportunity?

In order to support pediatricians to use food and nutrition as medicine to impact the first 1,000 days of young children, it is important to keep a few things in mind: 

  1. Incorporate required, high-quality, substantial and practical nutrition education in medical schools and residency training, so that future providers become aware of its necessity.
  2. Ensure curricula that inform current and future providers engage with the tangible social needs that are ubiquitous throughout the country, such as food and nutrition security.  If not integrated into training, we set the stage for worsening inequities by only promoting a message that appears unreachable for many. 
  3. We often focus on the challenges within communities, but we need to recognize their strengths and assets. Pediatricians need support to screen families for food insecurity and must have in place strong, community, clinical-collaborative referral programs to seamlessly connect families from clinics and health systems to meaningful, nutrition-based, local and federal programs as needed and beneficial (i.e. food as medicine, local pantries, community cooking classes, WIC, SNAP, etc).
  4. Systems change requires systemic solutions.  To redirect the health system will require more than a few pediatric advocates on the ground, but rather larger licensing bodies and federal policy to turn the tide, such as the recent bipartisan resolution authored by Congressman McGovern & Burgess in May of 2022 calling for “substantial training in nutrition” for physicians.

Nutrition During the First 1,000 Days in the United States: Current Status and Recommendations for Improvement

Research question: What is the state of nutrition during the 1,000-day window for families in the United States, and what are the opportunities to strengthen federal research and surveillance, programs, and communication and dissemination efforts aimed at improving nutrition and influencing the health and well-being of pregnant people and children?

Why this research was needed: An analytical essay published in The American Journal of Public Health summarizes the current state of nutrition for families in the 1,000-day window in the United States. It further proposes a framework by which nutrition during this period can be improved. These recommendations could inform policymakers, public health and health care communities, and program leaders.

The 1,000-day window is the period between pregnancy and a child’s 2nd birthday and is a critical time in the development of a child. Good nutrition during the first 1,000 days can have a profound impact on the health and well-being of pregnant people and children.

How the research was conducted: The researchers carefully reviewed dietary intake compared with the US Department of Agriculture and US Department of Health and Human Services Dietary Guidelines for Americans 2020–2025, as well as the primary literature covering health, nutrition, and clinical outcomes for pregnant people and children during the 1,000-day window. They then created a high-level summary on the status of nutrition in the United States with focuses on dietary status, health, and outcomes of pregnant people, infants, and toddlers during the 1,000-day window. They also provided a framework for future improvements to research and public health surveillance, programmatic approaches, and communication and dissemination initiatives.

What the research found: The current state of nutrition during the 1,000-day window shows numerous gaps between dietary intake and recommendations, with race and ethnicity disparities across the spectrum. The average intake of total vegetables, fruits, and dairy are below federal recommendations during pregnancy and lactation. At the same time most pregnant and lactating people exceed the thresholds for sugars (70% and 51%), saturated fat (75% and 77%), and sodium (88% and 97%) respectively. In addition, nearly 50% of pregnant persons gain more than the recommended amount of weight during pregnancy and 20% gain less.

While it is recommended for infants to be exclusively fed human milk for the first 6 months, data from 2019 revealed that only 24.9% of infants exclusively received human milk through 6 months. Race- and ethnicity-based disparities in human milk feeding remain. Moreover, while it is recommended that complementary foods—those other than human milk or formula—should not be introduced before 4 months, this is the case with about 31.9% of infants.

Children between 12–23 months had total vegetable intake below recommendations while total intake of fruits, grains, and dairy were above recommendations. The average intake of added sugars and sodium were above recommendations.

What the research proposed: The proposed framework to improve nutrition encompassed three aspects—strengthening federal research and surveillance, optimizing programs, and improving communication and dissemination.

Historically, surveys have not included, or have had insufficient samples of pregnant and lactating women, infants and toddlers, and different racial and ethnic groups, leading to gaps in the data. Improving research and surveillance can start with modifying existing systems to improve coverage and data gathering for underrepresented subpopulations.

Programs can be optimized by reducing barriers to participation and reducing inequity among participants to alleviate disparity. Improving participation and engagement in these programs, as well as implementing standards, recommendations, and interventions that affect these programs could improve health and nutrition outcomes.

Scientific nutritional recommendations can be communicated through tailored and specific messages that target key audiences and are consistent with the Dietary Guidelines for Americans and supplemental recommendations. With the rapidly changing landscape of reaching audiences, implementing agencies and organizations need to collaborate effectively to provide tools and messaging that are culturally and linguistically relevant.

What this research means for key stakeholders: The framework proposed in this paper could inform key stakeholders in the following ways.

For policymakers: Data-gathering objectives to fill the current information gaps can be met by early care and education programs (ECE), clinics implementing the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and federally qualified health care centers that act as sentinel surveillance sites. Implementing standards that affect programs (e.g., licensing standards in ECEs) could improve health and nutrition outcomes. Updating clinical guidelines could also help improve how care is provided. Targeted, audience-specific messaging can help disseminate information to vulnerable groups.

For the public health and health care communities: The electronic health records of underrepresented populations can be used to bolster technological advances in supplementing existing data like feeding decisions, health outcomes, and biologic data. Clinical guidelines and recommendations for programs can be improved by healthcare delivery through tele-health visits, engaging health care support teams, and updating guidelines to improve how and when care is provided. Interventions should be prioritized that have significantly affected health outcomes, can be scaled, reach high-risk populations, reduce inequities, and complement existing federal or state programs. Linguistically and culturally sensitive communication could improve nutrition status in vulnerable populations.

For program leaders: Improving participation and engagement in programs such as WIC, the Child and Adult Care Food Program, and the Maternal, Infant, and Early Childhood Home Visiting Program could contribute to improving health and nutrition outcomes. The following interventions should be prioritized—those that have significantly affected health outcomes, can be scaled, reach high-risk populations, reduce inequities, and complement existing federal or state programs. Tailored, audience-specific messaging will help communicate and disseminate information on early childhood care and education more effectively.

Key takeaway: Optimal nutrition in the first 1,000 days can have lifelong effects on the health and well-being of pregnant people and children. Working collectively through a framework focused on advancing research and surveillance, programs, and communication and disseminationcould improve health equity, reduce maternal mortality and morbidity, and improve child health outcomes for current and future generations.

*DISCLAIMER: This write-up is derived from a published article and does not reflect the views of the author of the article, their affiliation, or the journal in which this content is published.

Authors/Reference/DOI: Heather C. Hamner, PhD, MS, MPH, Jennifer M. Nelson, MD, MPH, Andrea J. Sharma, PhD, MPH, Maria Elena D. Jefferds, PhD, Carrie Dooyema, MPH, MSN, RN, Rafael Flores-Ayala, DrPH, MApStat, Andrew A. Bremer, MD, PhD, Ashley J. Vargas, PhD, MPH, RDN, Kellie O. Casavale, PhD, RD, Janet M. de Jesus, MS, RD, Eve E. Stoody, PhD, Kelley S. Scanlon, PhD, RD, and Cria G. Perrine, PhD. Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective. American Journal of Public Health. doi: 10.2105/AJPH.2022.307028. 2022

Corresponding author contact information: To speak with the author, please contact CDC press office: (404) 639-3286 or media@cdc.gov. To speak with the media team at 1,000 Days, contact Blythe Thomas

1,000 Days Applauds Bipartisan Introduction of Global Food Security Act

1,000 Days applauds the bipartisan and bicameral introduction of the Global Food Security Act (GFSA), which would primarily reauthorize funding for Feed the Future, a U.S. Government initiative to address the root causes of global hunger and poverty to improve nutrition and food security. The Senate bill (S. 4649) was introduced by Senators Bob Casey (D-PA), Jim Risch (R-ID), Chris Coons (D-DE), and John Boozman (R-AR). The House bill (H.R. 8446) was introduced by Representatives Betty McCollum (D-MN-04), Chris Smith (R-NJ-04), Gregory Meeks (D-NY-05), and Michael McCaul (R-TX-10).

The Global Food Security Act was first enacted in 2016 to reduce hunger and malnutrition, improve resilience in food insecure communities, and support agricultural-led development. GFSA authorized Feed the Future through 2018 and again through 2023. The recently introduced GFSA legislation would reauthorize the program through 2028. To date, Feed the Future has reached over 26 million children with nutrition-specific interventions.

Blythe Thomas, Initiative Director of 1,000 Days welcomes the introduction of GFSA – “We were particularly pleased to see the mention of the 1,000-day window in the House bill language as we know that is a critical period and good nutrition is of the utmost importance. As the bills move through committee, we encourage legislators to focus on the importance of nutrition interventions during the first 1,000 days. We look forward to meeting with Congressional offices and advocating for passage of GSFA during this critical period of global food and nutrition insecurity.”