Monica Lakhanpaul

www.ucl.ac.uk/ich/research/population-policy-practice/People/lakhanpaul-monica

Professor Lakhanpaul graduated from Medicine in 1992. She trained in paediatrics, gained her doctorate in Paediatrics and Child Health in 2003, and proceeded to Senior Lecturer and Consultant Paediatrician at the University of Leicester and University Hospitals of Leicester NHS Trust. In 2012 Professor Lakhanpaul joined the UCL GOS Institute of Child Heath as Professor of Integrated Community Child Health. In 2016 she was appointed Head of Population, Policy and Practice.

BIOGRAPHY

Professor Lakhanpaul graduated from Medicine in 1992. She trained in paediatrics, gained her doctorate in Paediatrics and Child Health in 2003, and proceeded to Senior Lecturer and Consultant Paediatrician at the University of Leicester and University Hospitals of Leicester NHS Trust. In 2012 Professor Lakhanpaul joined the UCL GOS Institute of Child Heath as Professor of Integrated Community Child Health. In 2016 she was appointed Head of Population, Policy and Practice.

Professor Lakhanpaul now leads a multi-disciplinary translational research group that focuses on Health Services Research, which has direct impact on health policy and clinical practice. Her research program aims to take a multi-disciplinary, structured and collaborative approach to improving outcomes for children and transform services for patients. Her research particularly focuses on the translation of evidence into clinical practice and health policy, drawing together primary, community and hospital care, social care, education and primary and secondary research to improve health outcomes for children. Professor Lakhanpaul also holds posts as Deputy Theme Lead for Collaborations in Leadership in Applied Health Research and Care – North Thames (CLAHRC; 2013-present) and Program Director for Children and Young People, UCL Partners Academic Health Sciences Network (AHSN; 2014-present).

Professor Lakhanpaul’s research falls under four main themes; Applied Translation of Evidence In to Policy and Practice (through systematic review, guideline development, decision and prediction rule development), Improvement Science (with a particular focus on partnership production with parents, patients and health professionals; co-production with communities to develop tailored health interventions), Conditions (with a specific interest in asthma, the acutely sick child, nutrition and disability) and Inequalities in Health (tailoring interventions for hard to reach groups, health tourism and the use of translators and interpreters to reduce inequalities).

The role of nutrition in pregnancy and infancy in children’s cognitive development

Monica Lakhanpaul and Taryn Smith

Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health,

The first 1,000 days – from conception to a child’s second birthday – is a critical period of rapid growth and brain development. During this period, nutrition plays an important role in a child’s cognitive development. Cognition represents a complex set of mental functions sub-served by the brain, including memory, learning, perception and attention. Cognitive skills in childhood are a strong predictor of educational achievement, which in turn affects adult socioeconomic attainment and health behaviours (lifestyle, nutrition and physical activity) and may have implications for cognitive ageing.

Many nutrients have a profound effect on foetal brain development and mental function through early childhood. Consumption of oil-rich fish during pregnancy has been associated with a range of outcomes including fine motor skills, social development and communication in childhood. It is recommended that pregnant women aim to consume two portions of oil-rich fish per week in order to achieve a dietary intake of omega-3 fatty acids. The presence of these fatty acids in breast milk is also thought to be responsible for the positive associations between breastfeeding and cognitive development. Also important during the gestational period is adequate intakes of iodine – an important component of thyroid hormones that are crucial for brain development. For this reason iodine requirements are two-thirds higher for pregnant women compared to non-pregnant women. Recent national data has revealed mild iodine deficiency among adolescent females and women of childbearing age in the UK, giving cause for concern. Good dietary sources of iodine are fish (particularly white fish), milk and dairy foods. While less is known about cognitive development and the infant diet, high consumption of fruit, vegetables and home-prepared foods during the complementary feeding phase (6-24 months) has been linked to higher IQ. Furthermore, infants may be susceptible to low iron intakes. Low uptake of iron into the brain can lead to tiredness, low mood and poor concentration, variables themselves that can impact upon cognitive function, behaviour and school performance in children.

As well as those mentioned above, vitamin B12, folic acid and zinc are also important for cognitive development through pregnancy and early childhood. Poor overall diet can cause multiple micronutrient deficiencies and imbalances and so achieving a well balanced diet is important for cognitive function through the developmental stages. Maternal nutrition may also have an impact on the mental health of the mother herself, as well as influencing the infant via parenting behaviour and infant attachment. Finally the importance of interaction and active play should not be underestimated in a child’s cognitive development.

Laying the foundations for life: Developing culturally tailored approaches to optimising healthy eating habits in early life

Monica Lakhanpaul and Taryn Smith

Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health,

Childhood obesity is a challenging public health issue with foundations in the earliest stages of human development, namely pre-conception, in utero and during early infancy. At school entry (4-5 years), 1 in 5 children in England are overweight or obese, and this disproportionally affects those of ethnic minority and socially deprived backgrounds. Children of South Asian origin are genetically pre-disposed to excess adiposity that tracks into adulthood, consequently increasing the risk of non-communicable diseases, including type 2 diabetes and cardiovascular disease. Early life therefore provides a critical window of opportunity to promote healthy lifelong habits, particularly the first 1,000 days.

Complementary feeding and the introduction of solid foods is a key period when dietary diversity and food preferences are established and when infants are most willing to accept new flavours and textures. Universal recommendations state that infants should receive safe and nutritionally adequate complementary foods in an appropriate and timely manner. Recommended first foods are vegetables, fruits and cereals.

However ethnic and cultural differences in dietary intakes and feeding practices during this time indicate the need for culturally appropriate interventions and approaches to optimising an infant’s diet. Bangladeshi and South Asian populations are more likely to feed sweetened foods and drinks and energy dense rice-based dishes compared to white British populations. These unfavourable cultural practices developed during this time continue to beyond 2 years of age, affecting short- and long-term health. In addition to the risk of obesity, inappropriate feeding practices can also lead to childhood dental caries and nutrient deficiencies, particularly iron and vitamin D.

Through bi-directional knowledge transfer, UK health services may learn from resource-poor approaches to health promotion by engaging communities in their own care. Participatory community mobilisation approaches may provide a platform for culturally tailored support to optimise infant feeding practices in the British Bangladeshi population. The Participatory Learning and Action (PLA) cycle, successful in Bangladesh, India and Nepal in reducing maternal and neonatal adverse health outcomes, allows the community to identify and prioritise problems and then implement and evaluate strategies to solve the problems while utilising local resources. The acceptability and feasibility of an adapted PLA cycle is currently being piloted in the Bangladeshi population of Tower Hamlets, East London, using infant feeding practices as an exemplar. Participatory techniques have the potential to facilitate education surrounding optimal infant feeding and nutrition in a culturally acceptable and sustainable way.