Evidence-Based Nutritional Assessment, Intervention, and Supplementation in the First 1000 Days: A Community Pharmacy Perspective

The first 1000 days, from conception to the second birthday, represent a period of exceptional developmental plasticity during which nutritional exposures may influence metabolic, immune, and neurodevelopmental trajectories. Nutritional assessment during this period requires distinction between universally recommended preventive interventions, targeted supplementation for defined risk groups, correction of documented deficiency, and avoidance of unnecessary or excessive nutrient intake. This narrative review synthesizes current evidence on nutritional assessment, intervention, and supplementation across preconception, pregnancy, lactation, infancy, and complementary feeding. Periconceptional folic acid remains the most consistently supported universal intervention, whereas recommendations for iron, multiple micronutrients, calcium, iodine, vitamin D, omega-3 fatty acids, and choline depend to varying degrees on maternal nutritional status, dietary intake, population context, and clinical risk, and they should be checked against upper intake levels to avoid excess. During lactation and infancy, nutritional care extends beyond supplementation to breastfeeding support, medication safety, infant micronutrient prophylaxis, and assessment of feeding difficulties. From approximately 6 months, complementary feeding requires attention to dietary diversity, nutrient adequacy, allergen introduction, and avoidance of unnecessary dietary restriction. Because several preventive interventions must begin before conception to influence pregnancy and infant outcomes, preconception nutrition is included within the developmental framework of this review. Community pharmacy is considered as an accessible point of care through which this evidence may be translated into practice. Accordingly, the review maps the nutritional evidence onto a stage-structured pharmaceutical care pathway and uses the Croatian Breastfeeding-Friendly Pharmacy initiative as an implementation example. The proposed framework illustrates how evidence-based nutritional assessment, supplementation, counselling, and referral may be operationalised in community practice but requires prospective evaluation before its effectiveness can be established.