Assessing the public health impact of developmental origins of health and disease (DOHaD) nutrition interventions.

Investing in the maternal and early-infancy periods (the first 1,000 days, i.e. from -1 to +2 years) is presently acknowledged as a key priority to ensure good nutrition and prevent all forms of malnutrition. The concept is to invest during this period to maximize the human development potential, and the early-life agenda includes prevention of stunting and promotion of optimal brain development as well as ensuring the quality of life of those who survive. Thus, public health assessments of specific interventions need to go beyond the traditional indices of prevention of death and disease. We need to consider including a full range of outcomes such as disability-adjusted life years (DALY) and quality-adjusted life years (QALY) and not only the number of deaths. The long-term outcomes of maternal and infant interventions to prevent obesity and related noncommunicable diseases remain uncertain in terms of their biological impact even under ideal conditions (efficacy); we need interventions with proven effectiveness under real-world conditions (effectiveness). Conversely, interventions to prevent undernutrition have already been proven effective and are considered cost-effective based on rigorous economic analyses. Continuous evaluation of interventions implemented using the developmental origins of health and disease (DOHaD) model needs to be undertaken, as this will allow progressive improvement and thus maximize the potential impact on the health and well-being of populations. We need to consider the population-attributable risk of obesity and chronic disease and conduct an economic evaluation of the lifelong impact of chronic diseases not only in terms of lives lost but also in relation to lost DALY and QALY. This should help to prioritize preventive actions in line with patterns of disease and disability considering the existing resources and demands.