Abstract
Winick M. J Pediatr 1969;74:667-79 In this seminal review, Myron Winick cited animal experiments and human studies on childhood nutritional deprivation, endeavoring to answer the question “What is the functional result of having survived malnutrition as an infant?” He concluded that there was sufficient evidence linking early childhood malnutrition to permanent neurodevelopmental deficits (ie, reductions in brain weight and head circumference, cellular proliferation, myelination, and diminished cognition) to shift the bulk of nutrition resources toward the critical period before birth and during early postnatal life. He was a pioneer in determining that these deficits have an intergenerational component, and he anticipated the importance of acknowledging and measuring the social determinants of disease. Since the publication of this review, 50 years of mounting evidence has solidified “the first 1000 days” as the prime target for nutritional interventions. Research on the topic now includes the roles of individual nutrients, systemic inflammation, and breastfeeding on neurodevelopmental outcomes. However, our understanding remains plagued by the same challenges cited by Winick, including the difficulty in establishing causal relationships and the lack of consensus and standardization regarding assessment tools. As a result, growth attainment measures, including linear growth1Sudfeld C.R. McCoy D.C. Danaei G. Fink G. Ezzati M. Andrews K.G. et al.Linear growth and child development in low- and middle-income countries: a meta-analysis.Pediatrics. 2015; 135: e1266-e1275Crossref PubMed Scopus (237) Google Scholar and head circumference, remain frequently utilized surrogates for cognitive development, highlighting the limits of our advancement. Notable improvements in the field include more detailed neuroimaging, techniques to measure neurophysiologic outcomes, and new development assessment tools. Conservatively, an estimated >200 million children fail to reach their potential in cognitive development, resulting in reductions in educational achievement, economic productivity, and earnings.2Victora C.G. Adair L. Fall C. Hallal P.C. Martorell R. Richter L. et al.Maternal and child undernutrition: consequences for adult health and human capital.Lancet. 2008; 371: 340-357Abstract Full Text Full Text PDF PubMed Scopus (2309) Google Scholar, 3Grantham-McGregor S. Cheung Y.B. Cueto S. Glewwe P. Richter L. Strupp B. Developmental potential in the first 5 years for children in developing countries.Lancet. 2007; 369: 60-70Abstract Full Text Full Text PDF PubMed Scopus (1955) Google Scholar Going forward, we must insist on incorporating these outcomes, alongside growth attainment, in the design and interpretation of child nutrition and cognitition research. J.L. was supported by the Feed the Future Innovation Lab for Nutrition (AID-OAA-L-10-00006). C.D. was supported in part by National Institutes of Health (K24DK104676 and 2P30 DK040561).
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