CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice (CHANGE project)

儿童营养不良

• 批准号: MR/V000802/1
• 负责人: Marko Kerac
• 金额: $ 265.49万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FV000802%2F1
• 关键词: CHild; malnutrition; Adult; NCD; Generating

THE PROBLEM: Child malnutrition is a major global public health problem and includes both undernutrition and overweight/obesity. Wasting (low weight-for-height) is a particularly severe form of undernutrition. Affecting some 49 million children globally, it contributes to 900,000 deaths per year in children aged <5 years (12% of total deaths). Whilst severe malnutrition treatment programmes do exist, problems limiting their success include the need to: a) ENSURE THAT CHILDREN THRIVE AS WELL AS SURVIVE Current programmes focus on averting the immediate risks of malnutrition-associated death. They don't account for increasing evidence that survivors often fail to thrive and are at greater risk of non-communicable disease (NCD) in later life e.g. heart disease, diabetes and obesity. Mechanisms causing this are poorly understood. b) UNDERSTAND & MEASURE MORE MEANINGFUL OUTCOMES Current programmes focus on return to normal weight as a marker of success. What really matters however is health. Predicting future ill health is especially difficult since risks laid down in childhood do not become apparent as adult NCD till many years later. c) QUESTION ASSUMPTIONS ABOUT WEIGHT GAIN Current programmes often see rapid return to normal weight as desirable and thus encourage fast catch-up growth. However, studies in high income countries show that too rapid a weight gain in small infants causes harm by increasing risk of future NCDs. Whether this also applies to low-income settings is unknown.THE PLAN: AIMS: To improve future treatment programmes by better understanding how child malnutrition affects the risk of long-term (adult) NCD.OBJECTIVES: 1) To understand how the speed and pattern of post-malnutrition weight gain affects the risks of adult NCD 2) To develop simple blood/urine tests to predict which survivors of child malnutrition are most at risk of future NCDTHE TEAM: We will bring together teams from 4 countries: Jamaica, Malawi, Ethiopia, UK and combine clinical and lab data from 4 groups (cohorts) of adolescents/adults who survived early life malnutrition. In Ethiopia and Malawi, we will recruit 2 more cohorts of at-risk infants so we can learn from their progress. Combining these datasets and bringing together varied scientific skills and disciplines will achieve together what no one team could achieve alone. THE BENEFITS:1) PROGRESS TOWARDS THE 2030 SUSTAINABLE DEVELOPMENT GOALS (SDGs)If we succeed in our aim of informing better future treatment programmes we thus contribute to two major SDGs and their targets: >>SDG 2 (END HUNGER) >> SDG 3 (GOOD HEALTH & WELL-BEING) These in turn impact numerous others e.g. education, economic development2) ENHANCED MALNUTRITION-RELATED ADVOCACYEffective advocacy is vital to generate the sufficient political will and sufficient resources to tackle malnutrition. The 'double-burden' of malnutrition (i.e. coexistence of undernutrition alongside overweight/obesity/NCDs) is increasingly common even in the world's poorest countries. By describing how one form affects the other, we hope that researchers, policy-makers and nutrition programmes managers will better be able to balance short vs long term risks and focus on 'double-duty' actions benefitting both. This could open up valuable new funding streams. It could also be a more effective and cost-effective solution to the global NCD epidemic.3) IMPROVED SEVERE MALNUTRITION TREATMENT PROGRAMMES Likely changes would be minor and thus easily/rapidly scalable, e.g. use of the same therapeutic foods but prescribed at lower dose so that weight recovery is neither too slow nor too fast.4) NEW BLOOD/URINE TESTS TO MEASURE NCD RISK IN MALNOURISHED CHILDRENBeing able to measure a problem is key to tackling it. Simple new tests arising from our work would enable researchers/programmers to better understand if nut.>NCD programmes are succeeding.

问题：儿童营养不良是一个主要的全球公共卫生问题，包括营养不良和超重/肥胖。消瘦（身高体重比低）是一种特别严重的营养不良形式。它影响到全球约4 900万儿童，每年造成900 000名5岁以下儿童死亡（占死亡总数的12%）。虽然确实存在严重营养不良治疗方案，但限制其成功的问题包括需要：a）确保儿童茁壮成长和生存目前的方案侧重于避免营养不良相关死亡的直接风险。他们没有考虑到越来越多的证据表明幸存者往往无法茁壮成长，并且在晚年患非传染性疾病（NCD）的风险更大，例如心脏病，糖尿病和肥胖症。造成这种情况的机制知之甚少。B）了解和衡量更有意义的结果目前的方案侧重于恢复正常体重作为成功的标志。然而，真正重要的是健康。预测未来的健康状况不佳尤其困难，因为儿童时期的风险直到多年后才在成人非传染性疾病中显现出来。 c）关于体重增加的假设问题目前的计划往往认为迅速恢复正常体重是可取的，因此鼓励快速追赶增长。然而，在高收入国家进行的研究表明，小婴儿体重增长过快会增加未来患非传染性疾病的风险，从而造成伤害。这是否也适用于低收入环境尚不清楚。目标：通过更好地了解儿童营养不良如何影响长期（成人）非传染性疾病的风险，改善未来的治疗方案。1）了解营养不良后体重增加的速度和模式如何影响成人NCD的风险2）开发简单的血液/尿检预测哪些儿童营养不良的幸存者未来最有可能患上NCD团队：我们将汇集来自4个国家的团队：牙买加、马拉维、埃塞俄比亚、英国和联合收割机结合了4组（队列）早期营养不良幸存的青少年/成人的临床和实验室数据。在埃塞俄比亚和马拉维，我们将再招募两批高危婴儿，以便我们能够从他们的进步中学习。将这些数据集结合起来，将各种科学技能和学科结合在一起，将实现任何一个团队都无法单独实现的目标。好处：1）迈向2030年可持续发展目标（SDGs）如果我们成功实现了为未来治疗方案提供更好信息的目标，我们将为两个主要的SDGs及其目标做出贡献：>> SDGs 2（消除饥饿）>> SDGs 3（良好的健康和福祉）这些反过来又会影响许多其他方面，例如教育、经济发展2）加强营养不良相关宣传有效的宣传对于产生足够的政治意愿和足够的资源来解决营养不良问题至关重要。营养不良的“双重负担”（即营养不良与超重/肥胖/非传染性疾病并存）即使在世界上最贫穷的国家也越来越普遍。通过描述一种形式如何影响另一种形式，我们希望研究人员，政策制定者和营养计划管理人员能够更好地平衡短期与长期风险，并专注于使两者受益的“双重责任”行动。这可能会开辟宝贵的新资金流。这也可能是一个更有效和更具成本效益的解决方案，以全球非传染性疾病的药物。3）改善严重营养不良的治疗方案可能的变化将是轻微的，因此容易/快速扩展，例如，使用相同的治疗食物，但以较低的剂量处方，以便体重恢复既不太慢也不太快。尿液测试测量畸形儿童的NCD风险能够测量问题是解决问题的关键。我们的工作产生的简单新测试将使研究人员/程序员能够更好地了解NCD风险。>非传染性疾病方案正在取得成功。

项目成果

Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective.

• DOI: 10.1371/journal.pgph.0002161
• 发表时间: 2023
• 期刊: PLOS global public health

Childhood BMI and other measures of body composition as a predictor of cardiometabolic non-communicable diseases in adulthood: a systematic review.

儿童体重指数和其他身体成分测量作为成年期心脏代谢非传染性疾病的预测因子：系统评价。

• DOI: 10.1017/s136898002200235x
• 发表时间: 2022
• 期刊: Public health nutrition
• 影响因子: 3.2
• 作者: Bander A

Post-malnutrition growth and its associations with child survival and non-communicable disease risk: a secondary analysis of the Malawi 'ChroSAM' cohort.

麦芽营后的生长及其与儿童生存和非传染性疾病风险的关联：对马拉维“ Chrosam”同伙的次要分析。

• DOI: 10.1017/s1368980023000411
• 发表时间: 2023-08
• 期刊: PUBLIC HEALTH NUTRITION
• 影响因子: 3.2
• 作者: Lelijveld, Natasha;Cox, Sioned;Anujuo, Kenneth;Amoah, Abena S.;Opondo, Charles;Cole, Tim J.;Wells, Jonathan C. K.;Thompson, Debbie;McKenzie, Kimberley;Abera, Mubarek;Berhane, Melkamu;Kerac, Marko
• 通讯作者: Kerac, Marko

Lipid profiling analyses from mouse models and human infants.

小鼠模型和人类婴儿的脂质分析分析。

• DOI: 10.1016/j.xpro.2022.101679
• 发表时间: 2022-12-16
• 期刊: STAR PROTOCOLS
• 作者: Olga, Laurentya;Bobeldijk-Pastorova, Ivana;Bas, Richard C;Seidel, Florine;Snowden, Stuart G;Furse, Samuel;Ong, Ken K;Kleemann, Robert;Koulman, Albert
• 通讯作者: Koulman, Albert

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review.

• DOI: 10.1136/bmjgh-2020-003161
• 发表时间: 2021-03
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Grey K;Gonzales GB;Abera M;Lelijveld N;Thompson D;Berhane M;Abdissa A;Girma T;Kerac M
• 通讯作者: Kerac M