Disclosure

How Important is Complete Nutrition

I, declare that there is no con ict of interest
for Cognitive Development

Meta Herdiana Hanindita

KSM Ilmu Kesehatan Anak
FK Unair/ RSUD Dr. Soetomo Surabaya

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The role of nutrition in cognitive

The rst 1000 days of life are a crucial
development brain development period in which
nutrition is vital for optimal growth and
cognitive development.
Adequate nutritition is necessary for Roberts, 2022

Outline
normal brain development, especially
Macronutrients and during crucial periods for the brain
formation, laying foundation for the
micronutrients that affect early development of cognitive, motor and
brain development socio-emotional skills throughout
childhood and adulthood. Nutrients provide structural elements
Dewey, 2014
which play a critical role in cell
multiplication, DNA composition and
Clinical implications the neurotransmitter and hormone
metabolism, as they are vital
components of enzyme systems in
the brain.

Nyaradi, 2013; Oddy, 2013

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Adequate nutritition is necessary for
normal brain development, especially
during crucial periods for the brain
formation, laying foundation for the
development of cognitive, motor and
socio-emotional skills throughout
childhood and adulthood.
Dewey, 2014
Different types of malnutrition
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The rst 1000 days of life are a crucial
brain development period in which
nutrition is vital for optimal growth and
cognitive development.
Roberts, 2022
Nutrients provide structural elements
which play a critical role in cell
multiplication, DNA composition and
the neurotransmitter and hormone
metabolism, as they are vital
components of enzyme systems in
the brain.
Nyaradi, 2013; Oddy, 2013
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Mayneris‑Perxachs, 2019
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Timing is crucial, once a particular
developmental sequence fails, it may
not be possible to retrieve all the lost
function. Although neurodevelopment
continues throughout the life of a
person, by age 2 years the brain has
undergone tremendous restructuring.
Schwarzenberg, 2018
The consequences of malnutrition during the rst 1000 days of life
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Normal neurodevelopment is a
complex process involving cellular
and structural changes that proceed
in a speci ed sequence. Changes
that are too rapid/too slow—> failure
of crucial pathway connections.
Roberts, 2022
Focusing on this early period for the
prevention of nutrient de ciencies may
have long-term and widespread
bene ts for individuals and societies.
Positive/negative nutrient effects on
brain based on timing, dose and
duration of exposure.
Dewey, 2014; Kretchmer, 1996
Mayneris‑Perxachs, 2019
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 The human brain requires all essential Macronutrient suf ciency is essential for
nutrients including macronutrients normal brain development. Early
(protein,fats,carbohydrates) and macroutrient undernutrition is associated
micronutrients (vitamins, minerals) to form with lower IQ scores, reduced school
and maintain its structure. succes and more behavioral dysregulation.
Monk, 2013
McGregor, 1995

Macronutrients play an important role in In addition to generalized macronutrient

optimizing brain development during 1000 undernutrition, de ciencies of individual
rst days. Protein-energy malnutrition—> nutrient may have a substantial effect on
impede adequate brain growth. neurodevelopment.
Cusick, 2016 Schwarzenberg, 2018

Although all nutrients are necessary for

Micronutrients enable the enzymes work brain growth, there are key nutrients that
properly, essential for proper growth and support neurodevelopment. Failure to
development. They are not produced in provide these during critical period may
body, the consequences of their absence result in lifelong de cits despite subsequent
are severe. nutrient repletion.
WHO, 2019 Schwarzenberg, 2018

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Critical Processes During Neurodevelopment A ected by Speci c Nutrients

Cusick, 2016

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 Nutrients Needed for Normal Brain Development E ects of Nutrient De ciency During Brain Development

Disclosure

Cormack, 2019 Cormack, 2019

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Macronutrients
High-calorie, high-protein group before 2
years scored higher on test of
k n o w l e d g e , n u m e r a c y, r e a d i n g ,
vocabulary, faster reaction times in
information processing tasks.
LCPUFA did not in uence performance
on test of language and performance at
18 mo, but signi cant positive effects
In villages receiving high-calorie, high-
were observed from 3-5 y on rule
protein, there were no differences in
learning and inhibition tasks, the
scores between children of high and low
vocabulary test at 5 y and the Weschler
socioeconomic, but in low calorie,
IQ at 6 y.
children in the higher socioeconomic had
higher test score.

Early supplementation of nutrients to

children at risk for macronutrient de ciency
improved neurodevelopmental outcomes
over an extended period of life, beyond the
priod of supplementation.
Pollit, 1995
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Micronutrients Development of Micronutrient De ciency

Eradication of the three most prevalent micronutrient de ciencies -iron, zinc and
iodine-could increase the world IQ by 10 points.
Morris, 2008

Shenkin, 2006

Wessel & Brown, 2012

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Halterman, 2001
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 Hindawi publishing corpora2on, 2013
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Vitamin C Enhances Iron Absorption

Heme Non Heme
Animal-based: Red meat, liver, Plant-based:
sh, seafood, chicken, beef, Dark green vegetables
etc Egg
Absorption is affected by
Absorption 20x better
others nutrient

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 Factors that contribute to zinc Iodine is needed as structural

de ciency include consumption of
high phytate-containing foods and
low protein intake, commonly found
in the diets of non-industrialised
populations, which impairs zinc
absorption. Prasad, 2009
component of thyroid hormones.
Thus, important for the regulation of
body temperature, basal metabolic
rate, growth and reproduction.
Shahid, 2022

Zinc is important for the structure and
function of the nervous system. Zinc
de ciency can lead to retardation of
growth and development.
Mertens, 2021
Iodine de ciency early in the human
life cycle—the “ rst 1000 days”—can
irreversibly impair brain development,
cause neurocognitive impairment,
and increase infant mortality. 
Stinca, 2017

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Clinical Implications

Breastmilk provides many of the Babies with appropriate birth weight

nutritional building blocks that
supports growth, immune system,
brain maturation, includes macro and
micronutrients, short and long-chain
PUFAs, phospholopids, biofactors
and hormones that are important for
myelination.
born with suf cient iron storage for
the rst 6 mo. After that, depend on
the food intake.
Complementary foods should be
given timely, adequate (macro and
micronutrients), safe and hygiene, in
appropriate way (responsive feeding).

Dewey, 2001

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Dewey.Ped.Clin.North 2001

Permenkes, 2019
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Dewey, 2001 29

Adequate
Impact of Animal Source Foods

Eating ASF reduced stunted growth in

ASF is effective not only in children. 1 ASF—> 3,7%, 2 ASF 5,7%, 3
improving diet quality but also ASF—> 6,1%
nutritional status, promoting health
outcomes including growth,
cognitive function, physical activity,
school performance in developing
ASFs are dense in wide range of
countries.
micronutrients linked to growth
Zhang, 2016 and development including iron,
zinc, B12, choline.

Headey, 2018

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 Vegetables
Arugula Kohirabi

Broccoli Leeks

Brussels Sprouts Mustard Greens

Cabbage Okra

Cassava Root Radish

Cauli ower Spinach

Collard Greens Squash

Eggplant Sweet Potato

Horseradish Tomato

Kale Turnips

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Social Media Trends

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Take home messages

• The rst 1000 days—> opportunity and vulnerability for
neurodevelopment, high nutrient requirements and rapid
development. Sources of nutrition in this period are maternal human
milk and complementary foods.

• Proper nutrition is crucial for normal brain and neurocognitive THANK YOU
development. Failure to optimize neurodevelopment early in life can
have profound long-term implications for both mental and quality
of life.

• Breastmilk and adequate (in macro and micronutrients)

complementary foods are important for optimal brain development.
Growth monitoring is needed to evaluate the nutrition adequacy.
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