Nutritional programming theory and 1000 days

The development of the child's health begins at conception, although the so-called pre-conceptual period also plays a role due to parental health or genetic factors. In recent years, the concept of nutritional programming (otherwise known as metabolic programming) has been promoted, according to which the body weight, nutritional status and diet of the mother during pregnancy affect the development of the foetus and the birth weight of the child ^[1]. The first 1,000 days encompassing foetal life and the first years of life are considered a critically important time for the child's development. The availability of macro- and micronutrients during this period is a factor in optimal growth and development ^[2]. One important part of the mother's, and later the child's, diet is omega-3 fatty acids^[3].

The role of omega-3 fatty acids in foetal life

Our body cannot produce omega-3 fatty acids, so we need to supply them through the diet. These acids are involved in the development of the central nervous system of the foetus, including the formation of neurons and synapses ^[4]. One of them, docosahexaenoic acid (DHA), accumulates in the brain, especially during the third trimester of pregnancy and the first year after birth. It is suspected that the child's neurocognitive development is probably dependent on the omega-3 fatty acid content of the mother's diet. Scientific reports suggest that consumption of fish and seafood rich in omega-3 fatty acids during pregnancy is positively associated with cognitive, speech and communication development in young children ^[3]. DHA acid is also incorporated into the outer membranes of the rods and cones of the retina, which is important for the child's clear and normal vision ^[5]. Analysis of almost 20,000 births highlights the importance of omega-3 fatty acid intake for fetal health. Pregnant women who consumed omega-3 fatty acids had a lower incidence of preterm birth and also observed - a reduced risk of the likelihood of perinatal death, neonatal hospitalisation and low birth weight babies ^[6]. Fish consumption by lactating mothers was associated with better visual development in infants born at term ^[7].

The role of omega-3 fatty acids in infancy

Any method of feeding an infant allows omega-3 fatty acids to be supplied to the child. Both breast milk contains omega-3 fatty acids and the available fortified milk replacers can contain these important components for proper development from the first days of life. DHA acid has a beneficial effect on the infant's retinal sensitivity and visual acuity. In addition, observations suggest that neurological development and cognitive abilities are also enhanced by early provision of omega-3 fatty acids through breast milk or DHA-enriched foods ^[7]. Incorporating the intake of omega-3 fatty acids at the stage of dietary expansion, e.g. in the form of fish administration, may play a preventive role in the development of allergies in the child. Studies show that EPA and DHA acids have a protective effect against the development of any allergy in the first years of life ^[8]. Ensuring adequate omega-3s in infancy is important for eye and brain development, cognitive function, information acquisition, learning, behavioural formation and even fertility in later years. Randomised trials suggest that supplementation of preterm infants with DHA acids may improve their intelligence, accelerate visual information processing and promote better attention. Even infants born at term may have better cognitive abilities when they receive DHA acids in the early months after birth ^[4].

Omega-3 fatty acids in child development

After infancy, omega-3 fatty acids are just as important as in the first months of life. As the child learns about the world around him/her, he/she develops at a dynamic pace, so ensuring that he/she has everything he/she needs in the diet promotes health and optimal development.

Omega-3 fatty acids and children's brain development and mood

During pregnancy and the first years of life, the brain develops very rapidly. Omega-3 polyunsaturated fatty acids contribute to the normal functioning of the brain, and their deficiency in the diet may be involved in mood changes and the occurrence of depressive disorders in children. DHA fatty acids are part of the phospholipid structure of the neuronal cell membrane, and their intake influences proper neurotransmitter binding and signalling in the brain. It has been noted that low omega-3 concentrations in the body may be associated with lower levels of serotonin and dopamine, which are involved in maintaining good mood and mental health. Another potential mechanism that makes omega-3 fatty acids so good for children's brains is their involvement in regulating inflammation in the brain ^[4]. A meta-analysis has shown that omega-3 fatty acid intake improves learning, memory, supports well-being and cognitive function, as well as blood flow in the brain ^[9].

Omega-3 fatty acids for heart health, normal body weight and blood glucose levels

The omega-3 fatty acids EPA and DHA may reduce the risk of cardiovascular events through a number of mechanisms, including, among others, lowering blood triglyceride levels or influencing the maintenance of normal blood coagulation ^[10]. In addition, they improve glucose uptake and have a beneficial effect on insulin sensitivity, which is important for maintaining normal blood glucose and insulin concentrations and reducing the risk of future diabetes ^[4]. In observations of the diet of obese children, an insufficient presence of omega-3 fatty acids in the diet has been noted. It is suspected that regular consumption of fish rich in these acids may be an element in preventing the onset of excess body weight and obesity in children ^[11].

Omega-3 fatty acids and cognitive function, ADHD and autism

Cognitive function is a very broad term and includes, among other things, a set of many skills that a child acquires from birth. It also includes the ability to use the senses (vision, hearing), to process information, to concentrate on a task and during learning or memory processes. These functions develop rapidly from the first days of life. At pre-school age, the child becomes familiar with the shapes of objects and colours, then comes learning letters, numbers, writing, reading, and thus a great activation of the memorising and information processing processes. Finally, the intensity of learning increases with age, so there is a great need for the brain and vision to function effectively. In order to take care of a child's cognitive functions, we should ensure an adequate intake of omega-3 fatty acids. In order to understand why omega-3 fatty acids are so important for the development of a child's cognitive functions, it is worth finding out what brain plasticity is. In a nutshell, it is the brain's ability to develop, shape and self-repair, which provides protection against external factors. This allows the brain to adapt to changing conditions, enabling it to learn and process information, among other things. The effects of nutrient deficiencies essential for child brain development and malnutrition occurring during periods of rapid growth can result in delayed child development, including cognitive development. Studies from developing countries suggest that malnutrition and inadequate intake of omega-3 fatty acids are associated with cognitive, behavioural problems and long-term consequences such as attention deficits, higher rates of aggressive behaviour and global cognitive deficits. All this demonstrates that a child's nutritional status and intake of omega-3 fatty acids is extremely important for the child's proper development and cognition of the world^[17].
Low intake of omega-3 fatty acids may also affect behaviour. It has been noted that reduced concentrations of omega-3 fatty acids in erythrocytes in early childhood were associated with attention deficit hyperactivity disorder (ADHD). Therefore, regular intake of omega-3 fatty acids by the child may be important to support the child's development of behavioural and self-regulatory processes and executive functions. It is suspected that a child's impulse control, working memory and constructive problem solving may also depend on having foods rich in EPA and DHA acids on the plate. Researchers suggest that better self-regulation is associated with better engagement in learning, while poorer self-regulation is linked to problems at school. The long-term effects of proper self-regulation in early childhood positively influence its health in adulthood ^[12,13]. In a study involving 54 children diagnosed with autism, supplementation with omega-3 fatty acids resulted in improvements in stereotypic behaviour and social communication ^[14]. Insufficient intake of omega-3 fatty acids may also negatively affect the gut microflora and the gut-brain axis, which is thought to be a factor that may increase the risk of autism ^[15]. It should be noted, however, that there is no recommendation for omega-3 fatty acid supplementation by autistic children, although the topic is of interest to many researchers and requires further observation. In general, the intake of EPA and DHA acids is involved in the maintenance of normal cognitive functions of the child and is therefore important for, among other things, orientation in space, learning and assimilation of knowledge and processing of information, which shape the child's thoughts, intellect and behaviour ^[16].

Omega-3 fatty acids and immunity of the child

In addition to reducing the risk of allergies in the child, the intake of omega-3 fatty acids affects several more important immune-related functions. These valuable components are primarily involved in the regulation of the immune system and affect inflammation in the body ^[8]. The immune system in the first years of life is immature, and every contact with a virus or bacteria is a kind of immune training. Because of this, the child catches a lot of infections and this is a natural process affecting immunity in later years. If we want to support the formation of immunity in our child, we should pay attention to ensure that his or her diet does not lack protein, prebiotics, micronutrients and, precisely, omega-3 fatty acids. Studies have shown that omega-3 fatty acids modulate both innate and acquired immunity. DHA acid may inhibit the inflammatory response through mediators and, together with EPA acid, be involved in reducing inflammation^[18]. In practical terms, this means that omega-3 fatty acids have an impact, for example, on proper healing processes when your child suffers an injury or scratch during everyday play and on the acquisition of immunity when undergoing an infection during the cold season. It has also been noted that the consumption of these valuable ingredients has a positive effect on the risk of one of the autoimmune diseases in children. Large-scale observational clinical studies have shown clear benefits in preventing and treating the development of type 1 diabetes through the consumption of EPA and DHA acids by infants and children ^[19].

Sources of omega-3 fatty acids

The source of omega-3 fatty acids in the diet of infants is breast milk and fortified modified milk, followed by food products. On the basis of dietary observations, it has been concluded that, in general, children's intake of products rich in omega-3 fatty acids is low ^[12]. The state of knowledge, nutritional awareness, material status of parents, food selectivity, neophobia, and dietary preferences may determine the proportion of EPA and DHA in the diet of the youngest ^[20]. Among the most important sources of omega-3 fatty acids are fish and seafood, especially fatty marine fish such as salmon, herring, mackerel and sardines. It is recommended to avoid the consumption of smoked fish. If the child does not consume these products, an alternative and equally good source of omega-3 fatty acids can be cod liver oil and other fish oils, e.g. from pelagic fish.

How much omega-3 fatty acids should a child consume?

Breastfeeding an infant provides 100% of the omega-3 fatty acid requirement in its diet. In the case of the use of modified milk, the recommended intake is also possible; however, if the intake of DHA acid is insufficient - then additional sources of this valuable acid are recommended. Children up to 3 years of age should consume 150-200 mg of DHA per day, whereas e.g. in the form of consumption of fatty fish 1-2 times a week, children over 3 years of age should consume 1-2 portions (1 portion = min. 130 g) of fatty fish per week or min. 250 mg of omega-3 acids EPA and DHA per day, e.g. in the form of a dietary supplement, when the recommendation of fish consumption is not met ^{[21, 22]}.

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[21] Szajewska H. (2014), Czy zalecenie dotyczące podawania wszystkim noworodkom i niemowlętom suplementów diety zawierających kwasy tłuszczowe omega-3 (np. kwasu dokozaheksaenowego) jest uzasadnione wynikami badań klinicznych?, https://www.mp.pl/pytania/pediatria/chapter/B25.QA.2.4.1. [dostęp 30.04.2023r.]
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