Neurodevelopment: The Impact Of Nutrition And Inflammation During Infancy In Low-Resource Settings

Estimates of the burden of neurodevelopmental impairments in low-and middle-income countries (LMIC) are limited and highly variable, but are generally reported to be higher than in high-resource settings. In all settings, the prevalence of mild impairments is higher than severe disability. 1, 2 Among several factors identified as contributors to developmental disabilities in LMIC, infections and malnutrition, including micronutrient deficiencies, are particularly important and potentially modifiable.(3)Infancy and early childhood (ie, birth through age 24 months) represent a period of life with both exquisite opportunity and vulnerability for neurodevelopment. Not only are many aspects of brain development undergoing rapid anatomic and functional expansion during this postnatal component of the "1000 days critical window," but nutrient requirements are also high due to rapid physical growth and maturation. The complex interactions that exist among nutritional status (deficits and surfeits) as well as the social and physical environments and exposures they entail are particularly potent during this period of rapid change. Furthermore, the interactions are bidirectional, such that the developing infant not only responds to his/her environment but also, in ideal circumstances, elicits responses from adult care providers that additionally stimulate more inputs. The newborn brain also reflects maternal exposures that occurred as the product of many interacting forces during gestation.The connections between nutrient use (absorption, excretion, and retention) and acute and chronic inflammation and stress are increasingly recognized.(4) Recent reviews have addressed selected aspects of this sensitive period, but the evidence base linking both nutrition and inflammation to neurodevelopment is only modest and even more limited for this young age group specifically. This article in the supplement will provide an overview of key aspects of interactions that are particularly relevant to the infant and young child during this critical developmental stage. The underlying framework reflecting these interrelationships and the issues particular to infants in low-resource settings (LRS) are depicted in Fig 1. Furthermore, emphasis will be placed on these sectors as they exist in, and are impacted by, environments in LRS. To advance the field, knowledge gaps and research priorities will be highlighted.