 Today we're going to talk about first thousand days and nutrition first thousand days. What is first thousand days? I'm sure we all know it, but just, you know, I'm going to reiterate why it is important. And when we think of first thousand days, forget about other children. Let's talk about us, right? A lot of us are women, men, and you know, some of you are very young and probably thinking of future of having children and you know, thinking about their growth and their, you know, their career. So when we think of that, we always think of short term goal and long term goal. So what is a short and long term goal for children, you know, not only children, but for ourselves. So I mean, obviously in short term, we want our children to be healthy. We want them to be doing well in school and, you know, succeed, of course. And in long term, we want them not to have any diseases, you know, to have good immunity, no blood pressure, no diabetes. And of course, you know, we all want healthy aging for all of us, right? That's our long and short term goal by and large, right? So basically our health comforts, right? Health is wealth. As you know, you know, we all are stuck at home because our health is at stake. So if we don't have good health, you know, nothing else matters really. So literally our goal is to have lifelong health, right? Why first thousand days critical? We need to kind of understand why is it critical? Why those thousand days, you know? So first thousand days is basically conception to second birthday of a child. And it offers the opportunity to build healthier and more prosperous future. As good nutrition during this phase gives building block for brain and physical development, okay? So what is happening during this thousand days is baby's brain has been developed, okay? Not only baby's brain has been developed, but basically there is a full physical growth. Can you imagine from literally from, you know, small little ovum from sperm and that ovum you're having, you know, and birth rate is about 3 kg and by the time child is about two years of age or more 12 kg, 12 and a half kg, right? So you have tremendous growth in this first thousand days. And not only physical growth, but brain. I mean, brain is the most important part of the body, right? So it's very important that we take care of this thousand days, okay? If you have, if you want a brainy child and if you want really healthy robust child and if you look at the growth, brain grows to about 80% of adult size, okay? By age three and it reaches 90% by age five. So body time child goes to schools around four and a half, five years of age, 90% of brain development has already taken place. So you can imagine that mother needs to know so much, right? Not only, you know, when she's pregnant, but even before she is pregnant she needs to know what I need to do so that my child will be tall and, you know, intelligent, right? And what are the, my right nutrients that she needs, okay? And those are very important because, and those are needed at the right time because child's brain is developing so fast and at every state child requires different micronutrients. So it is important and we'll talk about it, what is required, okay? So the right nutrition during this period, it means the difference between a life of productivity or struggle and between life and death. I mean, you know, we work in tribal areas, we work in slums and most of the time you will see that Sam children, you must be knowing Sam, severe good malnourished children, those are mainly under one year of age, under two years of age, mainly under one year of age and even predominantly they are less than six months of age. So if you don't have proper nutrition during first thousand days that's basically that, you know, you're taking away life from the child, literally, okay? And at that child if suppose child is survived and if child grows up but the body is so stunted and with that body child's brain is stunted. So basically that child will struggle for the whole life to survive, okay? Just not life and death in the beginning, but if child survives basically they will have a, you know, a child will have a very poor productivity not only in school but even when he grows up. So it's important that we think of not only surviving the child but also giving him good life. So what does it decide? It decides how healthy the child will be. So less infection, better immunity, reduced chronic condition if you have diabetes and blood pressure. How brainy the child will be? What do you mean by brainy? So brainy means you have good cognition, misintelligence, your memory. So child has a sharp memory. We all want, right? Like believe me, all your mothers must be asking you what grades did you get? How many marks did you get? Did you come first? Did you come second? And for that, for everything to learn not only you need intelligence but what else do you need? You need memory, right? So it's important that why some children in a class they remember everything and some children they just don't remember anything. So that's important to have a good memory. Concentration, if you can't concentrate that means you will not be able to do well. You know, so it's very important that child have a good concentration. Judgment, judgment, we all know what is judgment whether something a child is doing, taking decision whether it's, you know, taking good judgment will call, those are very important. Mood is important. Sometime you find the children are very moody. They're upset, they're all the time irritable. So your mood also depends upon how child was brought up in first thousand days, okay? And then lastly, your skeletal growth. How tall the child will be. So these are the three important aspects that we need to take care of when child is growing in first thousand days. So let's talk about brain. Brain is my favorite topic. So I'm going to talk about brain a little bit and see how we can make this child intelligent, okay? So I'm sure you guys know about neural tube. This is basically a tube. Here, this is a picture. So this is your neural tube, okay? So at around three weeks of age your body starts developing in the form of neural tube. So this is a tube, okay? Now here, this part is basically is going to develop into brain and this part is going to develop into your spinal cord, okay? So here, then what happens during this time? Suppose if you don't have enough nutrients which are required for this neural growth, you will have problems. So what are the micronutrients which are required for development of this neural tube? One is your polygazine. I think everybody knows about polygazine. But what we don't know, there are two, three other micronutrients which are required for a neural tube defect. I mean neural tube development. One is your vitamin B12 and second is your choline. So you require this choline, you know, your vitamin B12 and folic acid. So we only talk about folic acid, but how about B12 and your... And I know that a lot of you are nutritionists and we know that B12 is hardly available in any vegetarian food. So what are you going to tell mother who is not even having milk? Like for example, a lot of these tribal mothers, they don't drink milk. They don't have access to milk. So how will she get B12? So we have to think of what are the nutrients that she or what all food that you can give them. So they'll have initially, I mean this is three weeks, so she doesn't even know that she's pregnant. So you need to start this nutrients not when she's pregnant, but when she gets married, when she's planning a child, that's when you need to start food which is high in all these nutrients. I'll talk about choline later. And when you don't have this most three important micronutrients on neural tube, what will happen? This tube will not develop well. So do you see these tubes? These are not basically, you will see the gap in there. So they saw the gap and this is called neural tube defect. This is a tube, neural tube. This is a neural tube defects. So then what happens when you have a neural tube defect, say posturally like towards the lower part, then you will have a little bit of spinal cord coming out because the spinal canal is not developed well. So then what happens that basically you will see some amount of spinal cord here. Now, many times what happens, you may not have such a big bump over here, but you may just have a little bit of hole, tiny, tiny hole over here. So what does prediatrician we have to do? We always have to examine when the baby is born with a child has little hole and if child has a hole, that means it's called basically spinal bifida and we have to get the MRI done and that particular hole, if it is worse, then child has paralysis for the whole life. They have problem with urination, they have to go through surgery. So imagine a follic acid, a colina and a B12 is so important. And if child has hole in the front part, but the brain is, then this is called an end capillary. Nowadays we don't see it much, but they do have, when they're born obviously they don't survive. So this all basically totally, you can prevent all this condition and that's why follic acid is being done compulsory. Now this is basically anatomy of brain. Now I'm going to go little bit in detail that what happens in child's brain when the brain is developing. So just all basically different parts of your brain. This is the frontal cortex, frontal part, front of your brain. This is the back part. This is your side part, parietal. This is your occipital lobe, temporal lobe. This all different kind of lobes. This is a cross section. This is the cross section. This is the front part. This is the back part. So if you look at it over here, so this is again your prefrontal cortex, your primary motor cortex. These are all the different parts of your brain. Now if you look at the function of brain. So here is your front part of your brain. So do you see over here, this particular frontal part, it is involved in motivation and executive function. Motivation. If you don't have motivation to do anything, you can't succeed. So it's very important that this part of brain is developed well because it functions for execution and for motivation. Now a little bit about the interior singular cortex over here, this part over here. That is involved in your social interaction, affection, attention. So look at this. This part is also so important because that will help with the attention. Do you see over this red part over here, it's called amygdala. Amygdala is important for stress and for learning. So a lot of time what happens is, a lot of children, they get a lot of anxiety, stress, or they have learning problems. That is because of problem with amygdala. And this is your hippocampus. Hippocampus remember is for learning and memory. If you want good memory, you make sure that anything which is required to develop this hippocampus, you work on that and you know, child will have good memory. Okay, so this are your basically brain development. So at fourth week of pregnancy, the brain has about 10,000 cells. And by 24th a week, it contains about 10 billion. So you can imagine in just matter of 20 weeks, look at the number of cells being developed. So nutrition is absolutely important but there are so many other things which are important. This is the neurons. Do you see all these neurons? These are basically connection. So as brain is developing, neuron cells are developing and do you see this layer of myelin sheet? This is called myelin sheet. Myelin sheet is your fat, it's made up of fat. So when you have a good myelin, strong myelin sheet, what happens the message passing through is very fast, the message, the signal, you know the signals, those are very rapid signals, right? So you want to make sure that when mother is pregnant, that she gets good amount of fat, okay? Because baby's brain is made up of fat. These are all basically, it's all fatty sheet, right? And most important, you know, cholesterol is important, saturated fat is really important. This is your, what is this? Neurotransmitters. Remember your synapses, there's a synaptic conjunctions and there are your neurotransmitters. So neurotransmitters are also really, really important basically to pass on the signal, right? So you want to make sure that you have to learn that which are these nutrients which are important for formation of neurotransmitters. One of the neurotransmitters is acetylcholine. If you remember acetylcholine, now choline, remember choline I spoke about. So we need to know how do this mother get choline so that baby gets beautiful amount of neurotransmitters, okay? Now this is another beautiful graph, what we have shown over here. This is basically, you know, from conception, from nine months to birth, okay? This is your first two years of life. So from this first thousand days in this green box is first thousand days. Then here is your child growing up becoming adult and this is just 70 years, so that's your basically, you know, your lifespan, right? So you hear around say eight months of age, I mean, after one month of pregnancy, your child develop neuralation. Here that means that child is developing neural tube, okay? Once the neural tube is developed, here for next few months it causes cell migration. It means different parts of the brain are being formed, frontal lobe, occipital lobe, right? And then just before two months of birth, child start developing myelination. Myelination means you know, you saw those neurons, right? So it start developing that you know, myelin sheet around those neural cells. So if you look at around zero month at birth, you know, some of the myelination has already started. Do you see all this? There are some amount of myelination already started. But then it starts picking up. So if you look at birth over here the green color graph over here, you know, so that is mainly your, so when the baby is born what does baby do, right? Baby can see, baby can hear, right? So those parts of your brain is getting myelinated. You're seeing, hearing, so visual cortex is for seeing and auditory cortex is for hearing, okay? So those parts of your brain start getting myelination, right? Then if you look at your orange graph this peaks at around eight to nine months of age. Do you see around nine months of age? So what happens at nine months of age? Do you remember what happens in the child? They start developing language. So they start speaking a word or two. So there is a receptive language. They can understand what you're saying, okay? And they can also start producing speech. They'll say mama, dada, they'll say a word. So at around nine months of age that area gets myelinated. You know, these are the areas of brain, okay? And this one, the last line, the red line, that is yet around 12 months to one year of age and that is your higher cognition. So by one year of age two years of age, children have good amount of high cognition function. You know, they can understand what you're saying, they can respond, you know, they become extremely smart. So do you see this is the most important part and after two years of age you can see myelination going down. But it is very important that child continues to have good nutrition. Otherwise what will happen if we get myelination problem? We will have a cognition issue. We will forget, we will have a forgetting, our memory will get worse. So it's important that we take care of myelination. Okay? So this too as you could see thousand days are extremely important for brain development. Okay? Now what are the other external factors which affect, as I told you, nutrition is good. But because a lot of these neurons are developing you want to make sure that there is reduction of toxic stress in mothers. Okay? So tomorrow if you want to if you're planning to become you know, when you get married and planning to become pregnant you make sure that you don't have stress, you know you don't have any inflammation in the body so you want to make sure that you don't have any diseases. Okay? And of course presence of strong social support and secure attachment. Very important. Okay? So just make sure those are, physical health is absolutely important but your mental health is also important in provision of optimal nutrition. Okay? Now this are some of the nutrients which are required for brain development. Okay? So I'm going to go quickly because I'll come back to it but mainly look at it. This is vitamin B6. What happens when you don't have vitamin B6? In fact those are important for brain development function. Those are important for neurotransmitters. You know, we talked about acetylcholine but also you know your serotonin and so many other neurotransmitters. Okay? They Norepinephrine which also influences mood. And if you don't have B6 there are chances a child can have difficulty concentrating. Okay? Then B12. As I talked about B12, right? Neurotube defect. Okay? Then poor cognition if child doesn't have B12 when baby is growing in the womb, you know they will have poor cognition. In younger children in fact what we find is we find children have tremors, children can have lifelong problem, neurological problem. So it's important that you know we always think of vitamin B12 because this is quite deficient in the vegan children. Okay? Mothers who are vegan. Colena I spoke about, if you want your child to have a lifelong good memory and learning function make sure the child gets mothers get enough colin. Okay? Copper is important. Folate. We talked about folate is important. We also talked about iodine. I think iodine is important because iodine can prevent mental retardation. You know, long chin polyunsaccharin fatty acid. So mainly talking about DHA and EPA. Okay? ALA can get converted to DHA which I'll come back later but it's the, you know it's probably a 4% to maximum 10% get you know converted. So if it is, if mother is non-veg please offer her factory fish. Okay? That will really help child to become really look at this. If you don't have enough DHA and there is poor attention hyperactivity, problem learning, right? DHA is extremely important. Protein is important. Selenium, zinc right? Why is zinc? Look at this. Remember hippocampus I talked about memory. You want your child to have good memory. Your zinc is really important. Okay? Vitamin K we give it at birth. It's compulsory. We give it all over the world because children don't have enough vitamin K. So we give injection at birth. Okay? Iron is one topic that we can talk about for hours really. It's so important. You know it impacts my nation of nerves. Okay? And we have also found there are a lot of studies which says that if they don't have enough iron it does affect their mental health. You know so they have high level anxiety and depression later in life. So it's important that we take care of food which is iron. Iron. Okay? Now this is some of the studies that I wanted to talk about. So one of the study is what is the influence of prenatal and postnatal growth on intellectual functioning because we all want our children to be intelligent, right? So what they found, actually I love the study really, so what they found that when child had beautiful linear growth, linear means tall right? So when the child was growing quite tall in first year of age, before not after, before 12 months of age and weight. So this was the length part before 12 and the weight of the child before 4 months of age, if child was growing beautifully in first 4 months weight wise and height up to 12 months of age, those children had a higher IQ at 9 years of age. Okay? So you can imagine many times you know mother said, oh my child is not getting weight, my child is not getting weight. And if we don't do anything right away then if you miss those first 3 months of weight gain where children grow tremendously when you look at a WHO growth chart and because they don't grow well their height will also not grow well those other children will have poor IQ right? So many times mother said oh my child is not doing good in math my child is not doing because they must not have gained good amount of weight not only during room, not only during pregnancy but also in first few months so this is this is a really good study that you know we read all the time in pediatrics okay? And also another thing is your IOGR so you know lot of time I mean in India we see a lot of low birth weight babies right? So here what they found that children who were born small for gestational age, small for gestational age means you know for that term or pre-term baby that weight was not enough okay? For whatever gestational age baby was born so here if the baby was born say at around 35 weeks of gestational age 35 is basically a premature baby or later they scored lower score on your neuro developmental assessment means they did not do well neuro developmentally okay? So it is important that basically you know children grow very well in the womb during pregnancy okay? This is another very good study where there was a critical period of brain growth and cognitive function so this is what they found is a brain growth during infancy early childhood is more important than growth during fetal life and determining cognitive function. This means that even if child is born say small you know but if child has beautiful growth in first say 12 months, 18 months then that we can basically rescue the child okay? So even you go on the field and you see children are born to 2.3 kg, 2.4 kg but you know you focus on the breastfeeding scale you focus on the complementary feed and children do beautifully so this was another very good study which was done now timing of growth faltering is very very important okay? Because what we found this is one study which was done they basically took 700,000 children okay? From 0 to 6 years of age and they took it they took this data from 57 different countries look at this huge study and very recent 2018 right? And what they found that basically most linear growth faltering linear growth means height and the wasting which is your acute malnutrition it takes place prior to 23 months of age means most of your malnutrition under nutrition takes place under under in thousand days okay? So here is the growth here is a chart that they shown in their publication so here this is your boys so this are your boys okay? This is your mean 0 is mean most of the 50% children should be over here okay? But here as you see this is your 0 month 6 months 12 months 18 months do you see how boys and this is your height for height okay? Your height for age so your Z score so look at how children are growing going down in 18 months right? These are boys and these are girls so girls are not so small to begin with but basically they fall right? Boys fall definitely much more and then by 16 months pretty much they are pretty much equal right? So girls have advantage in the beginning now this is your waist weight for height means this is your sandman your acute malnutrition right? So here this is your boys this is your this is your mean 0 okay? So children children overall in 57 different countries children are not bad begin with but look at this how badly they fall right? and then they come up so everything whenever you see it this growth faltering occurs in first 24 months and generally wasting occurs much early on that means children are not getting weight so in first year of age look at this in first year of age children are not growing well you know they are not putting on weight and eventually they become stunted also right? So what happens to all these children who are not growing well? who are nutrition will lead to stunting they will become short okay? So if you're thinking that you know oh my god this child is so short and if you see them at 3 years of age 4 years of age the stunting is irreversible so it's irreversible if you don't tackle it within 1 year okay? In my experience if child came to me after 6 months of age I could not do much about the stunting part really I had to bring those children up or a reversal of stunting I could do it just if they came before 6 months of age so that first 6 months is extremely important okay? As they were losing height they were also losing IQ so there is a loss of IQ which is very very detrimental to child's life right? Then what happens to stunting when you are stunted you will be stunted as an adult right? And if you're a woman and if you spive it all then you will be basically passing on the stunting you know stunted girl child at 2 will give birth to a low birth weight baby so your risk of getting a low birth weight baby is very high okay if you're stunted okay? So basically you're passing on that you know that I wouldn't call it gene but epigenetic expression to the child okay? And then that stunted child has a very high risk of developing metabolic syndrome later on okay? So you don't want the child to develop blood pressure diabetes so then you work on them in first 1000 days and you know of course continue on the student will not develop metabolic syndrome okay? And sometime it takes about 2 to 3 generations of combat stunting so suppose child is stunted mother is stunted, grandmother is stunted so that girl child it may take maybe 1 or 2 generations for the child to become 5859 I'm talking about a girl child okay? And we have a lot of cases now that children are really girls are very tall even in India okay? But that takes 2 to 3 generations of good nutrition okay? So there is this journalist Mr. Roger Thoreau, he was in India and he did a lot of study you know on malnutrition and his beautiful paper you guys must read it and he wrote a beautiful he quoted this he wrote that if you want to improve the future if you want to improve the world we have 1000 days to do it mother by mother, child by child for what happens in those 1000 days through pregnancy to second birthday it determines to a large extent the course of child's life his ability to grow, learn work, succeed and by extension the long-term health, stability and prosperity of society in which the child lives okay? If you want to improve the world you can't leave a single child and single mother okay? If you want a beautiful world where no child is malnourished you have to basically go and help each and every mother who comes to your door okay? Or you have to go to her door So I'm sure you understood the importance of first 1000 days and how if first 1000 days are not taken care of then child will go into starting and wasting and also underweight and of course brain development is so important because it's very rapidly growing during first 1000 days and also the physical growth so now we will start with our tutorials so thank you