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

点击翻译按钮获取中文摘要

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.