We recently brought attention to an article marking the launch of a new global investment framework called Investing in Nutrition (see the second item in our Nutrition and the Brain news story). It was co-authored by the World Bank and Results for Development Institute.
The initiative “firmly establishes the importance of nutrition as a foundational part of development… The science is now indisputable on investing in the first 1000 days of a baby’s life, from pre-pregnancy to a child’s second birthday.”
It’s encouraging and inspiring stuff, but a huge amount of effort is now required to bring these facts and findings into the wider public domain, and to shift some of the emphasis to the pre-conception period.
This is Professor Michael Crawford’s response to the World Bank’s article and initiative:
“One has to applaud their effort in highlighting the first 1000 days of life. Childhood nutrition and environment are obviously of crucial importance. However, this ignores the supreme importance of the mother and prenatal nutrition.
Our recent work at Imperial College (see Preterm delivery linked to mother’s pre-conception health) emphases the critical importance of the nutritional status of the mother in the months before conception. The data is compelling, with a predictive ROC value of 0.926 for preterm births, obtained from analysis of 296 pregnancies. It holds regardless of other factors in the mother’s life – such as whether she was taking supplements, smoking, or had gestational diabetes or hypertension. That is, the condition of the mother prior to conception sets the stage.
The marker is membrane oleic acid, which is an indicator of essential fatty acid status. The brain is a fat rich organ, and this marker specifically refers to the status for brain-specific essential fats. The oleic acid prediction of premature birth refers to the most significant risk factor for neuro-developmental disorder.
Bear in mind, the biological priority of humanity is the brain: a principle illustrated by the fact that 70% of the energy going from mother to fetus is devoted to brain development.
Composition of the brain
The brain is made largely of fat. Fat is stored in the body in large amounts, and around 20% of a mother’s bodyweight should be fat at the time of fertilisation. The fat is not just an energy store but also a store for fat-soluble nutrients. These are stored after a meal and utilised when needed. Hence there is an equilibrium. Although it is usually thought ‘last in first out’, the fact is that the fat store will be a determinant of the essential fatty acid status of the mother.
The composition of the fat store does not change overnight. That all leads to the conclusion that when the mother conceives, her membrane status, circulating lipids and fat store will be in an equilibrium derived from the experience of several months beforehand. Indeed, it may even relate back to nutrition during puberty when the physiology for reproduction is getting its act together.
Another relevant fact is that by the time the mother reports to the antenatal clinic, at about 12 weeks, the brain cells that will migrate to form the cortex and other regions of the brain in the fetus are already beginning to migrate. This is followed by the development of the placenta to feed the fetus. By the time we reach the fetal growth spurt in the last trimester, the placenta has reached its peak.
There is a massive amount of rapid neural organization and connectivity, so that what looks like a blank state in MRI at 28 weeks is a regionally organized brain ready for action at 40 weeks. Any inadequacy that might stunt cortical development, or any other aspect, sentences the child to a life-time of disability of one form or another. Unlike body growth, you cannot make good a deficit or damage during prenatal brain development. Infant nutrition post-natally will be important, of course, as there is still much development taking place in response to life outside the womb. Again, maternal nutrition to ensure optimal milk production and composition will be vital.
There are two analogies that come to mind. First: Nature prepares in advance of important matters – in this case, conception. You would not crouch at the starting block next to Usain Bolt ready for the 100 meters race without a great deal of preparation. Anything we do that is really important, we prepare for. Nature is the same. She prepares for reproduction in advance.
Second: cognition is dependent on neurons, connectivity, and synapses. You can put a computer in a big box, but if it only has a few chips it will not be as good as one with many more chips but a smaller box. Moreover, these boxes are sealed, so while you may teach the smaller number of chips to do amazing things, the lifelong potential of that computer can never be as powerful as the one with the much larger number of chips.”