A call for joined-up action to promote nutrition across the first 2000 days of life using a food systems approach.

Introduction: Nutrition across the first 2000 days of life, from conception to age five, is considered critical in shaping lifelong nutrition and health outcomes, with dietary patterns tracking from infancy into later childhood and adulthood. Identifying potential policy, programmatic, and research opportunities is essential to inform action in this area.

Objectives: This research was undertaken to provide an overview of the evidence support, policy mechanisms and stakeholder perspectives on opportunities for improving nutrition across the first 2000 days of life to guide future investments and to inform policy dialogues with relevant government, non-government and external agencies within the state of Victoria, Australia.

Methods: Underpinned by UNICEF's Innocenti Framework, this research comprised: a) a rapid review of existing systematic reviews (n = 60) supplemented with key grey literature reports; b) mapping of potential policy and programmatic levers and partnerships against 14 identified areas; and c) qualitative semi-structured interviews with key stakeholders across health (n = 4), education (n = 2), local government (n = 1), non-government organisations/not-for-profits (n = 5), and peak bodies (n = 2).

Results: The 'caregiver behaviours' determinant within the Innocenti Framework yielded the largest number of systematic reviews and had the strongest alignment to existing policy frameworks. Victoria has a robust state-level policy mechanism for preventive health. However, policy voids were identified within the 'external food environment' and 'food supply chains' determinants due to a lack of regulation to restrict marketing and advertising by harmful food industries and no national food and nutrition plan. Thematic analysis of interviews revealed three key themes: a) continuity of care from pre-conception to childcare; b) consistency and strengthening of early years nutrition messages; and c) capacity for early years nutrition initiatives.

Conclusion: Numerous opportunities were identified to improve nutrition across the first 2000 days of life within national, state and local government systems, using policy, practice and research mechanisms. More joined-up action and greater program/policy coherence is needed, with funded capacity to facilitate the delivery of coordinated and integrated services to address nutrition in the first 2000 days of life. Further exploration is needed of the feasibility, acceptability and equity impacts, and in some cases effectiveness, of these opportunities in close collaboration with stakeholders.