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

问题：儿童营养不良是一个主要的全球公共卫生问题，包括营养不足和超重/肥胖。消瘦（身高体重比过低）是营养不良的一种特别严重的形式。它影响全球约4900万儿童，每年造成90万5岁以下儿童死亡（占总死亡人数的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：a)确保儿童茁壮成长和生存目前的方案侧重于避免与营养不良有关的死亡的直接风险。越来越多的证据表明，幸存者往往无法茁壮成长，并且在晚年罹患心脏病、糖尿病和肥胖症等非传染性疾病的风险更大。造成这种现象的机制尚不清楚。b)了解和衡量更有意义的结果目前的方案侧重于将恢复正常体重作为成功的标志。然而，真正重要的是健康。预测未来的不良健康状况尤其困难，因为在儿童时期形成的风险直到许多年后才显现为成人非传染性疾病。目前的减肥计划往往把迅速恢复到正常体重看作是可取的，因此鼓励快速的追赶增长。然而，高收入国家的研究表明，小婴儿体重增加过快会增加未来非传染性疾病的风险，从而造成危害。这是否也适用于低收入环境尚不清楚。计划：目的：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。目的：1)了解营养不良后体重增加的速度和模式如何影响成人非传染性疾病的风险2)开发简单的血液/尿液测试来预测哪些儿童营养不良幸存者未来患非传染性疾病的风险最大团队：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，并结合4组早期营养不良幸存者的临床和实验室数据（队列）青少年/成年人。在埃塞俄比亚和马拉维，我们将再招募两组高危婴儿，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起来，将共同实现任何一个团队都无法单独实现的目标。好处：1)在实现2030年可持续发展目标（SDG）方面取得进展如果我们成功地实现了为未来更好的治疗方案提供信息的目标，那么我们就为两个主要的可持续发展目标及其具体目标做出了贡献：b>可持续发展目标2（消除饥饿）b>可持续发展目标3（良好的健康和福祉）这些目标反过来影响许多其他目标，例如教育，经济发展2)加强与营养不良相关的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”（即营养不足与超重/肥胖/非传染性疾病共存）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，我们希望科学家、政策制定者和营养项目管理者能够更好地平衡短期和长期风险，并专注于对两者都有利的“双重责任”行动。这可能会打开宝贵的新资金流。它也可能是全球非传染性疾病流行的更有效和更具成本效益的解决办法。3)改善严重营养不良治疗方案可能的变化是微小的，因此容易/快速扩展，例如，使用相同的治疗性食品，但处方剂量较低，这样体重恢复既不会太慢也不会太快。4)新的血液/尿液检测来衡量营养不良儿童的非传染性疾病风险能够衡量问题是解决问题的关键。从我们的工作中产生的简单的新测试将使研究人员/程序员能够更好地理解它。非传染性疾病规划正在取得成功。

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.