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The Biology of the First 1,000 Days


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Table of Contents

FOREWARD. Rational and objective for the book. Understanding the biology of the 1,000 days. INTRODUCTION. Epidemiology of the 1,000 days (problem & magnitude). WHAT IS NORMAL GROWTH? INTERGROWTH. Fetal Growth Standards. WHO Growth Standards. Birth Cohorts. NUTRITION REQUIREMENTS IN THE LIFE STAGES. Preconception. Pregnancy and fetal. Lactation. Infant/Young Child. ENDOCRINOLOGY IN THE REGULATION OF GROWTH. Role of growth factors and hormones in pregnancy and child growth (vitamin D/calcium/vitamin D, calcium, vitamin K). Thyroid function and growth: mechanisms of iodine. ABNORMAL FETAL DEVELOPMENT AND CONGENITAL BIRTH DEFECTS. Neural tube defects: mechanisms of folate. Other congenital defects: Cleft lip/palate, heart defects, gastrointestinal defects, neuroblastoma. ADVERSE PREGNANCY AND BIRTH OUTCOMES. Nutrition and pathophysiology of gestational diabetes & macrosomia. Nutrition and pathophysiology of preeclampsia. Nutrition and gestational hypertension. Pathophysiology of low birthweight/SGA. Preterm infants. PATHOPHYSIOLOGY AND NUTRITION REQUIREMENTS IN CHILD MALNUTRITION. Moderate acute malnutrition. Severe acute malnutrition. Chronic malnutrition. Oedema and other metabolic complications of malnutrition. BODY COMPOSITION. Maternal weight gain and body composition during pregnancy and lactation. Stages of body composition change from infancy to young childhood. THE GUT MICROBIOME. Early life gut microbiome. Impact of different exposures on gut flora and integrity. Effects of early feeding practices on immunological response/allergy. EFFECTS OF EARLY-LIFE NUTRITION ON ADULT HEALTH AND DISEASE. Impact of epigenetic and environmental exposures on fetal, infant, child growth. Fetal origins of obesity, cardiovascular disease and type 2 diabetes. BEFORE AND BEYOND THE 1,000 DAYS. A role for preconception nutrition. Interpregnancy intervals and birth spacing. Child/adolescent growth. EFFECTIVE INTERVENTIONS DURING THE 1,000 DAYS. Summary of the evidence from the Lancet series. Global progress in the SUN movement. FUTURE DIRECTIONS FOR RESEARCH. Summary of authors responses from each chapter.

About the Author

Crystal D. Karakochuk, PhD, RD, is an assistant professor in the Department of Food, Nutrition, and Health at the University of British Columbia, and an investigator in Healthy Starts at BC Children's Hospital, Vancouver, British Columbia, Canada. She has worked internationally as a nutritionist for the United Nations World Food Programme (Rwanda, Malawi, Ethiopia, and Rome) and UNICEF (New York and Timor-Leste). Her research focuses on anemia, nutritional biomarkers (namely, iron and zinc), the effect of inflammation on nutritional biomarkers, and genetic hemo-globinopathies and blood disorders (e.g., sickle cell). Kyly C. Whitfield, PhD, is an assistant professor in the Department of Applied Human Nutrition at Mount Saint Vincent University, Halifax, Nova Scotia, Canada. Her research focuses on identifying culturally appropriate public health interven-tions to combat micronutrient deficiencies in low-resource settings, particularly among lactating mothers and their infants. Her current work explores fortification to address thiamin deficiency among breastfed infants in Southeast Asia. She is also interested in exploring the long-term effects of infant feeding behaviors on disease risk later in life. Tim J. Green, PhD, is a principal nutritionist in the Healthy Mothers, Babies, and Children Theme at the South Australian Health and Medical Research Institute, and an affiliate professor in the Discipline of Paediatrics at the University of Adelaide, Adelaide, Australia. His research focuses on micronutrients in prepregnancy, preg-nancy, lactation, and early life with studies conducted in Canada, Oceania, Asia, and Africa. His group seeks to identify micronutrient deficiencies through nutrition surveys, better define micronutrient requirements and pregnancy outcomes in these groups through randomized control studies, and develop sustainable strategies to improve micronutrient status. Klaus Kraemer, PhD, is the managing director of the Sight and Life Foundation, a nutrition think tank working toward a world free from malnutrition, headquar-tered in Basel, Switzerland; and an adjunct associate professor in the Department of International Health of Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. With over 30 years of experience in research and advocacy in the field of nutrition and health, he has developed an expertise in nutrition and safety of micronutrients, and translating discovery research into effective and tai-lored nutrition solutions at scale. He is a member of the Steering Committee of the Micronutrient Forum, Executive Committee of the Home Fortification Technical Advisory Group, Executive Board of the Mongolian Health Initiative, and a found-ing member of the Society for Implementation Science in Nutrition, among others.


"The Biology of the First 1000 Days compiles the substance behind what we know to be the key to progress. Investing in good nutrition during a child's first 1000 days is essential for not only unlocking a child's physical and mental development. It is the way forward for improved health, productivity, income and a sustainable future - with no one left behind. This book compiles our experience, and showcases it for policy makers, strategists and programmers. I hope the knowledge captured in these pages plays an important role in achieving the ultimate goal - an end to malnutrition, in all its forms."

Gerda Verburg, Scaling Up Nutrition (SUN) Movement Coordinator and UN Assistant Secretary General

"The book is a comprehensive and synthetic review of key spatial factors ranging from preconception to age two- it is a critical reference and will shape public policy and improve interventions for mother and child - impacts that will last a lifetime."

Emorn Udomkesmalee, Institute of Nutrition, Mahidol University, Thailand

"Nutrition policy accepted that the first 1,000 days are critical for life. Now knowledge about the biology of that critical window - so important for specific policy actions - is provided by this volume. It is essential reading for the nutrition community. The list of contributors reads like a Who is Who in nutrition research."

Prof. Joachim von Braun, Bonn University, Vice Chair of the Board of Global Alliance for Improved Nutrition (GAIN)

"In The Biology of the First 1,000 Days we find, clearly and profoundly, the scientific evidence of how good nutrition truly shapes the future of our world - a most valuable contribution to our understanding of a long-neglected issue."

Roger Thurow, author of The First 1,000 Days: A Crucial Time for Mothers and Children - And the World

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