Inequalities related to nutrition and physical activity: Opportunities to reduce the social gradient during the first 1000 days of life

Aileen Robertson, Mahesh Sarki

    Publikation: Bog/antologi/rapport/kliniske retningslinjerRapportForskning


    A healthy start to life is the key to reducing health inequalities across Europe, and important for future generations. This review illustrates the evidence that health inequalities, according to level of maternal education, exists at different stages during the first 1000 days of life.
    For example in EU high levels of obesity in reproductive age women result in high risk of excess weight gain during pregnancy. This in turn results in either small (SGA) or large for gestational age (LGA) newborns. In addition women with low levels of education breastfeed less and practice less appropriate infant feeding practices compared with mothers with high levels. During the different stages of the first 1000 days the risk factors accumulate, compound and perpetuate the high risk of childhood obesity and subsequent adult ill-health. This review highlights specific actions through policies, guidelines and interventions, that can help reduce the risk of childhood obesity in families with low socioeconomic status.
    This first part of the review (section 1) summaries the recommendations. Section 2 provides an overview of key epidemiological data which indicate the extent of disparities at different stages during the first 1000 days. This includes: prevalence of obesity in reproductive age women; evidence that obese women tend to gain excessive gestational weight and data showing incidence in small-for-gestational age (SGA) and large-for-gestational age (LGA) newborns; lastly prevalence of breast-feeding rates and infant feeding practices are disaggregated by levels of maternal education.
    The third part of this review presents a narrative literature review on: policy measures, guidelines, and interventions related to: reduction of obesity levels in reproductive age women (section 3.1); reduction of excessive gestational weight gain, infant mortality and SGA and LGA prevalence (section 3.2); and how to increase breastfeeding rates (section 3.3) and improve complementary feeding practices (section 3.4) Opportunities to reduce the social gradient in health inequalities by intervening during the first 1000 days are discussed.
    One overarching recommendation is that a more joined-up and coordinated approach is needed within maternal and young child health and care services. Improved coordination could simultaneously decrease risk of childhood obesity, improve maternal health and reduce disparities among the most disadvantaged. A coordinated approach is conceptualised as a life cycle where if obese women become pregnant they are likely to gain excessive weight during pregnancy and retain it after giving birth. Women with low socioeconomic tend to have more children and thus are exposed to the impact of repeated pregnancies. Women, who are obese and/or gain excessive weight during pregnancy, are likely to deliver either a SGA or LGA newborn who is predisposed to childhood obesity. In addition feeding of the newborn is likely to pose problems as obese women are predisposed to difficulties with breastfeeding which leads to formula feeding regimen which along with too early introduction of foods is associated with childhood obesity.

    This sequence of events set the infant on course, especially girl infants, to become obese before they themselves become pregnant and so increase the risk of transfer of obesity to the next generation. Evidence shows how difficult it is to optimise gestational weight gain in obese mothers and thus it is crucial to aim to prevent obesity before conception. In addition women, to lose their excess retained weight, need skilled support to enable them to breastfeed exclusively for 6 months. Moreover, it is key for parents to learn about “anticipatory feeding” methods and to know when, what and how much safe, nutritious foods to feed their infant.

    A more “joined up” health sector requires much better integration and communication between maternal and infant health care providers, along with welfare and young childcare services. In order to reduce inequalities, governments must aim for a continuum of care from preconception through maternity, birth, post-delivery, infancy, and into early childhood and take the social determinants of health into account. The boundaries have to be broken down between healthcare and non-health sectors and across home and community settings. Traditional professional “silos” have to be linked and coordinated to reduce the inequalities in childhood obesity and so gain health and economic benefits.
    Central governments can initiate joined-up approaches through creating joint priorities and building social safety-nets for the most disadvantaged. This includes honouring pledges concerning the Convention of Rights of Child and other UN Resolutions, including the length of paid maternity leave and clamp down on exploitative tactics of infant food companies.
    This review adds new evidence:
    • high prevalence of obesity in reproductive age women where 1 out of 7 women in EU, with low levels of education, are obese;
    • strong correlation between SGA prevalence and an EU Member State’s gender equality index;
    • significant differences between low breastfeeding rates and maternal education;
    • infant feeding practices in the EU do not reflect the guidelines where the enjoyment of vegetables depends on young taste buds being repeatedly exposed to them.
    • suggests 3 initiatives for potential future case studies within the EU.

    Without the correct start in life infants are set on a trajectory where unhealthy exposures accumulate, compound and perpetuate the high risk of childhood obesity and inequalities.

    ForlagProfessionshøjskolen Metropol
    Antal sider200
    StatusUdgivet - 2016