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The role of micronutrients in the first
1,000 days of life
Information for
Philippine Association of Nutrition (PAN), Inc. and
Philippine Society of Nutritionist-Dietitians (PSND), Inc.
Joint Convention, Manila
7 July, 2016
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Presented by
Regina Moench-Pfanner, PhD
ibn360 Pte Ltd, Singapore
SCALE OF MALNUTRITION IN 2016
2
Source: IFPR. 2016. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, DC.
NUMBER OF CHILDREN STUNTED IN ASEAN
Source: ASEAN/UNICEF/WHO (2016). Regional Report on Nutrition Security in ASEAN,
Volume 2. Bangkok; UNICEF
PREVALENCE OF ANEMIA IN CHILDREN AND
WOMEN
Source: ASEAN/UNICEF/WHO (2016). Regional Report on Nutrition Security in ASEAN,
Volume 2. Bangkok; UNICEF
GLOBAL NUTRITION TARGETS
Source: IFPR. 2016. Global Nutrition Report 2016: From Promise5to Impact: Ending Malnutrition by 2030. Washington, DC.
THE FIRST 1000 DAYS
Conception
Birth
Pregnancy
-9
-6
-3
Adequate
complementary
feeding AND
continued
breastfeeding
Exclusive
breastfeeding
0
2nd Birthday
6 months
3
6
9
Months
12
15
18
21
24
MICRONUTRIENT MALNUTRITION (VMDS)
WHAT IS IT?
►Micronutrient Malnutrition: Deficiencies in essential vitamins and
minerals required in small amounts by the body including :
• Iron
• Vitamin A
• Iodine
• Zinc
• Folic Acid
►Deficiencies caused by:
• Insufficient, poor or unvaried diets
• Losses or poor absorption (due to infections like HIV/AIDS, malaria,
diarrhea and parasites)
THE HEALTH SIGNIFICANCE OF VITAMINS
AND MINERALS (MICRONUTRIENTS)
Micro
Nutrients
• needed in small amounts
• vitamins and minerals are needed by the body to perform hundreds of roles
• body cannot manufacture on its own in sufficient amounts
• must be consumed
Some of the roles of micronutrients
VITAMINS – FAT SOLUBLE AND WATER
SOLUBLE
Vitamin A
(retinol)
Vitamin B6
(pyridoxine)
Vitamin B2
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(riboflavin)
WHAT FOODS ARE RICH IN MICRONUTRIENTS?
Water soluble vitamins
(vitamin C and B complex)
are rich in fruits and
vegetables.
Fat soluble carotenes –
vitamin A precursors and
others – are responsible for
some of the colours of fruit
and vegetables.
Trace minerals are
found in many foods but
bioavailability is low from
most plant sources.
Vitamin D is found in few foods
(cheese, margarine, butter, fortified
milk, fortified cereals, fatty fish) unless
fortified. The body makes vitamin D
when exposed to ultraviolet rays. Milk
and fish bones are also rich in calcium.
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RECOMMENDED NUTRIENT INTAKE
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Source: World Health Organization, 2006. Essential Nutrition Actions: improving maternal, newborn, infant and young child health
and nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
KEY NUTRIENTS BEFORE AND DURING 1,000 DAYS
ARE CRUCIAL FOR LIFELONG POTENTIAL
Protein
• amino acids are essential for building, maintaining, and repairing new tissues; manufacturing important
enzymes, hormones, antibodies, and other components; and performing specialized functions in regulating body
processes;
• Quality protein from breast milk and/or complementary foods
Lipids (EFAs)
• The brain is made primarily of fat (50-60% of the adult dry brain is fat) with AA and DHA being among the most
important FA in the brain.
• The critical period for accretion of these fats into the infant’s brain is during the last trimester of gestation up to 2
years of age
• Supplementation with omega-3 fatty acids reduced risk of preterm birth (<34 weeks gestation) by 31% in all
pregnancies and by 61% in high-risk pregnancies
Vitamin A
• Needed before and during pregnancy to boost maternal vitamin A levels, immune system, and iron intake
• Intake through breast milk can improve Vitamin A status of nursing infants and lower mortality by 11%
• 40% reduction in vitamin A deficiency among 1-3 year olds
Vitamin D
• An essential fat-soluble vitamin that is required for proper formation of bones and utilization of calcium and
phosphorous in the body
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KEY NUTRIENTS BEFORE AND DURING 1,000
DAYS ARE CRUCIAL FOR LIFELONG POTENTIAL
Vitamin E
• A fat soluble vitamin that protects lipids and proteins from oxidation in the body, preventing the breakdown of
tissues.
Vitamin K
• Anti-haemorrhaging agent (promotes blood clotting) and maintains bone health
Folic acid
• Adequate pre-pregnancy folate levels reduce incidence of spina bifida by 41% and reduce perinatal mortality
due to NTDs by 66%
Iodine
• Needed for fetal brain development and IQ, WHO states ID as most common preventable cause of early
childhood mental deficiency
• Reduces risk of miscarriage and stillbirth
Iron
• Reduces pregnancy complications, perinatal and maternal mortality related to iron deficiency anemia
(hemorrhage)
• Can reduce anemia in <24 months by up to 62%
Calcium
• An important mineral with a role in bone and tooth development, blood clotting and maintenance of healthy
nerves and muscles.
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THE FIRST 1000 DAYS
Conception
Birth
Pregnancy
-9
-6
-3
Adequate
complementary
feeding AND
continued
breastfeeding
Exclusive
breastfeeding
0
2nd Birthday
6 months
3
6
9
Months
12
15
18
21
24
PREGNANCY AND NUTRIENTS
Conception
Birth
Pregnancy
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WHAT A PLATE SHOULD
CONSIST OF
• Many different foods
• Colourful
• Stomach filling
• Low in salt, unhealthy
fat and refined sugar
• Pregnancy: increased
micronutrient intake
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WHAT A PLATE OFTEN
CONSISTS OF
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FOOD INADEQUACY
18
Source: ASEAN/UNICEF/WHO (2016). Regional Report on Nutrition Security in ASEAN, Volume 2. Bangkok; UNICEF
PREGNANCY: IRON AND FOLIC ACID
SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
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nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
IRON AND FOLIC ACID SUPPLEMENTATION
IN PREGNANT WOMEN
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Source: ASEAN/UNICEF/WHO (2016). Regional Report on Nutrition
Security in ASEAN, Volume 2. Bangkok; UNICEF
THE FIRST 1000 DAYS
Conception
Birth
Pregnancy
-9
-6
-3
Adequate
complementar
y feeding AND
continued
breastfeeding
Exclusive
breastfeeding
0
2nd Birthday
6 months
3
6
9
Months
12
15
18
21
24
LACTATION
Birth
6 months
Diversified nutritious adequate diet for
lactating mothers
Increased micronutrient intake
Exclusive
breastfeeding
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PREGNANT AND LACTATING: IODINE
SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
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nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
COVERAGE OF IODIZED SALT
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Source: ASEAN/UNICEF/WHO (2016). Regional Report on Nutrition
Security in ASEAN, Volume 2. Bangkok; UNICEF
MULTIPLE MICRONUTRIENT
SUPPLEMENTATIONI FOR PREGNANT AND
LACTATING WOMEN
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
25
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
THE FIRST 1000 DAYS
Conception
Birth
-9
-6
-3
Adequate
complementar
y feeding AND
continued
breastfeeding
Exclusive
breastfeeding
Pregnancy
0
2nd Birthday
6 months
3
6
9
Months
12
15
18
21
24
LACTATION AND COMPLEMENTARY FEEDING
6 months
2nd Birthday
Nutrient dense complementary
foods as increased micronutrient
needs for specific months of age
Nutritious diversified diet for
lactating mother
Adequate
complementa
ry feeding
AND
continued
breastfeeding
Micronutrient increase in:
• B-vitamins, vitamin A, C
• Magnesium, calcium,
phosphorus
• Zinc, Copper
• Iodine, Selenium (particularly for
lactation beyond 4 months)
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UK: VITAMINS – RNI FOR CHILDREN (0-2Y)
AND WOMEN (19-50Y)
0-6m
7-9m
10-12m
1-3y
Woman (19-50y)
Pregnancy
Lactation
Vitamin A
350
350
350
400
600
700
950
Vitamin D
8.5
7
7
7
10
10
Vitamin K
5
10
10
15
55
55
55
Vitamin E
2.7
2.7
2.7
5
7.5
7.5
7.5
Vitamin C
25
25
25
30
40
50*
70
Vitamin B1
0.2
0.2
0.3
0.5
0.8
0.9*
1
Vitamin B2
0.4
0.4
0.4
0.6
1.1
1.4
1.6
Vitamin B3
3
4
5
8
13
13
15
Vitamin B5
1.7
1.8
1.8
2
5
6
7
Vitamin B6
0.2
0.3
0.4
0.7
1.2
1.2
1.2
Vitamin B7
5
6
6
8
30
30
35
Vitamin B12
0.3
0.4
0.4
0.5
1.5
1.5
2
Folic Acid
50
50
50
70
200
300
260
* For third trimester only
Source: British Nutrition Foundation, Nutrition Requirements, 2015.
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https://www.nutrition.org.uk/attachments/article/234/Nutrition%20Requirements_Revised%20Nov%202015.pdf
FAO, Human vitamin and mineral requirements, Report of a joint FAO/WHO expert consultation, 2001. http://www.fao.org/3/a-y2809e.pdf
UK: MINERALS – RNI FOR CHILDREN (0-2
YEARS) AND WOMEN (19-50 YEARS)
All minerals needed in the body are essential nutrients.
Bulk minerals
0-3m
4-6m
7-9m
10-12m
1-3y
Woman (19-50y)
Pregnancy
Lactation
Potassium (mg/d)
800
850
700
700
800
3500
3500
3500
Chloride (mg/d)
320
400
500
500
800
2500
2500
2500
Sodium (mg/d)
210
280
320
350
500
1600
1600
1600
Calcium (mg/d)
525
525
525
525
350
700
700
1250
Phosphorous
400
400
400
400
270
550
550
990
Magnesium
55
60
75
80
85
270
270
320
Trace minerals
0-3m
4-6m
7-9m
10-12m
1-3y
Woman (19-50y)
Pregnancy
Lactation
(≤4m)
Lactation
>4m)
Iron (mg/d)
1.7
4.3
7.8
7.8
6.9
14.8
14.8
14.8
14.8
Zinc (mg/d)
4
4
5
5
5
7
7
13
9.5
Copper (mg/d)
0.2
0.3
0.3
0.3
0.4
1.2
1.2
1.5
1.5
Iodine (µg/d)
50
60
60
60
70
140
140
140
155
Selenium (µg/d)
10
13
10
10
15
60
60
60
75
Source: British Nutrition Foundation, Nutrition Requirements, 2015.
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https://www.nutrition.org.uk/attachments/article/234/Nutrition%20Requirements_Revised%20Nov%202015.pdf
FAO, Human vitamin and mineral requirements, Report of a joint FAO/WHO expert consultation, 2001. http://www.fao.org/3/a-y2809e.pdf
ECONOMIC LOSS DUE TO MICRONUTRIENT
MALNUTRITION
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INTERNATIONAL RECOMMENDATIONS
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PRE-PREGNANCY: IRON AND FOLIC ACID
SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
32
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
PREGNANCY: IRON AND FOLIC ACID
SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
33
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
PREGNANCY: IRON AND FOLIC ACID (NON
ANAEMIC)
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
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nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
PREGNANCY: VITAMIN A SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
35
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
CALCIUM SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
36
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
PREGNANT AND LACTATING: IODINE
SUPPLEMENTATION
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
37
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
MULTIPLE MICRONUTRIENT
SUPPLEMENTATIONI FOR PREGNANT AND
LACTATING WOMEN
Source: World Health Organization, Essential Nutrition Actions: improving
maternal, newborn, infant and young child health and
38
nutrition http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf
DIETARY FAT INTAKE FOR PREGNANT AND
LACTATING WOMEN
Source: International Society for the
Study of Fatty Acids and Lipids.
http://www.issfal.org/dietary_fat_intak
es_for_pregnant_and_lactating_wom
en_bjn_2007.pdf
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TAKE HOME MESSAGES
Adequate nutrition is key during first 1,000 days of life – a requirement
to meet global nutrition targets
Diversified nutritious diet is key to provide required micronutrients –
when difficult to obtain, food fortification should be used
In early childhood the need for essential nutrients (i.e. iron, zinc) and
essential amino acids is very high due to growth – foods need to be
nutrient dense (fortified complementary foods)
International recommendations on adequate nutrition, including
micronutrients, exist for pregnancy, lactation and adequate
complementary feeding – but difficulties to implement
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Thank you
Information & correspondence:
Regina Moench-Pfanner, PhD
Chief Executive Officer, Ibn 360 Pte Ltd
3 Pickering Street, #02-36 Nankin Row,
China Square Central, Singapore 048660
m +65 8387 2535 • t +65 6327 8824 • f +65 6223 7314
[email protected] • www.ibn-360.com •
@Moenchpfanner
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