Child malnutrition& Adult NCDs-Generating Evidence on mechanistic links in Jamaica, Malawi & Ethiopia to inform future policy/practice (CHANGE study)

幼儿期严重营养不良是全球一个主要的公共卫生问题。这造成了严重的后果：-短期：为了儿童的生存：全世界所有5岁以下儿童死亡中约有45%是由各种形式的营养不良造成的。长期：让孩子茁壮成长：越来越多的人认识到，生命早期营养不良是导致全球非传染性疾病（NCD）快速增长的原因。随着越来越多的儿童在童年时期营养不良的情况下幸存下来，越来越需要了解是什么导致了长期问题。这方面的证据将导致：改善儿童营养不良的早期治疗;改善旨在减少长期不良影响的长期治疗。在这个项目中，我们有一个独特的机会来探讨三组儿童/成人：-牙买加：20世纪80年代患有严重营养不良的儿童已经多次随访，有机会从已经收集的数据中进一步分析。马拉维：我们最近对2005/2006年因严重营养不良入院的一组儿童进行了跟踪。我们计划更深入地分析现有数据，并在未来可能收集新数据。- 埃塞俄比亚：在1983-85年埃塞俄比亚大饥荒时还是幼儿的个人即将在一项试点研究中进行随访。从上述两个项目中学习将为埃塞俄比亚的工作计划提供信息和改进。我们的目标是了解幼儿营养不良后的长期问题是什么以及它们发生的原因（这两个问题联系在一起的“机制”）本申请中提出的工作是上述未来项目的背景。计划开展两项主要活动：A）审查证据：我们将搜索科学文献，以更好地了解迄今为止其他人发现的生命早期营养不良与成人非传染性疾病之间的联系。B）合作者会议-我们将召集从事上述三类儿童工作的团队，以便相互学习和分享经验。通过这个更好的未来的工作将是可能的，有很大的潜力，以加强整体学习相比，以下每个组作为一个独立的。本次会议将于2019年秋季在埃塞俄比亚举办：我们将邀请一些重要专家为今后的工作制定详细计划。埃塞俄比亚/马拉维/英国小组还将访问牙买加（最先进/最有经验的小组）学习他们的经验，从而帮助规划马拉维和埃塞俄比亚更好的未来项目。

Severe malnutrition in early childhood is a major public health concern globally. This has serious consequences:- Short term: for children to survive: malnutrition in all its forms underlies some 45% of all under 5 child deaths worldwide.- Long term: for children to thrive: there is increasing realisation that early life malnutrition contributes to the fast-growing global epidemic of non-communicable diseases (NCDs). As more children now survive episodes of malnutrition in childhood there is increasing need to understand what causes the long term problems. Evidence on this would lead to: improved early treatment of child malnutrition; improved longer term treatment aiming to reduce long term adverse effects.In this project we have a unique opportunity to explore three groups of children/adults in:- Jamaica: children suffering from severe malnutrition in the 1980s have been followed up on several occasions already, with scope for further analysis from already collected data.- Malawi: We recently followed up a group of children admitted for severe malnutrition in 2005/6. We plan to both analyse existing data in more depth: also to possible collect new data in future. - Ethiopia: Individuals who were young children at the time of the great Ethiopia famine of 1983-85 are about to be followed up in a pilot study. Learning from the above two projects will inform and improve plans for the Ethiopia work.We aim to understand what are the long term problems following early child malnutrition and why they occur (the 'mechanisms' by which the two problems are linked)The work proposed in this applicaiton is background towards the above future project. There are two main activities planned A) Review of exisiting evidence: we will search the scientific literature to better understand what other have found to date re links between early life malnutrition and adult NCDs. Through this we will identify key knowledge gaps to target in future work.B) Collaborator meeting - we will bring together the teams working on the above three groups of children to: learn from each other and share experiences. Through this better future work will be possible and there is great potential to enhance the overall learning compared to following each group as a stand-alone.This meeting will be organised in Ethiopia in Autumn 2019: we will invite a number of key experts to make detailed plans for future work.The Ethiopia/Malawi/UK teams will also visit Jamaica (the most advanced/experienced group) to learn from their experience and thus help plan better future projects in Malawi and Ethiopia.