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World Health Organization Releases Guidelines on the Prevention of Acute Malnutrition

World Health Organization Releases Guidelines on the Prevention of Acute Malnutrition

In November 2023, the World Health Organization released updated guidelines on the prevention of acute malnutrition, also known as wasting. The guidelines followed the release of guidelines specific to the management and treatment of wasting and nutritional oedema that the organization published in July 2023.

Preventing malnutrition is key to long-term growth, development, and positive economic outcomes. Nutrition interventions, including those that prevent malnutrition, are some of the best buys in global development. Ensuring children have access to good nutrition when it matters most is one of the most powerful and cost-effective ways to create brighter, healthier futures. Leading economists consistently rank nutrition interventions among the most cost-effective ways to save and improve lives around the world with every $1 invested yielding up to $35 in economic returns.

Malnutrition continues to be one of the leading drivers of child death and disability. Malnutrition is the greatest threat to child survival worldwide and is the underlying cause of half of preventable child deaths. That is roughly 3 million children dying before their fifth birthday every year. Those who do survive severe malnutrition in early childhood are much more likely than their well-nourished peers to suffer from lifelong illnesses and disabilities.

We continue to see unprecedented rates of malnutrition and nutrition insecurity as the result of conflicts, climate shocks and stressors, and lingering impacts of the pandemic. New child malnutrition estimates from UNICEF released in May 2023 found that stunting (too short for their age) impacted 22.3% of children under 5 (148.1 million) globally and wasting (too thin for his or her height), the deadliest form of malnutrition, threatened the lives of 6.8%, or 45 million children under 5 globally.

1,000 Days welcomes the two new recommendations specific to the prevention of wasting and nutritional oedema as well as the two new good practice statements:

  • Recommendation 1: In areas of, or during times of high food insecurity, in addition to infant and young child feeding counselling, specially formulated foods (SFFs), including medium-quantity lipid-based nutrient supplements (MQ-LNS) or small-quantity lipid-based nutrient supplements (SQ-LNS), may be considered for the prevention of wasting and nutritional oedema for a limited duration for all infants and children 6-23 months of age, while continuing to enable access to adequate home diets for the whole family; and in areas of, or during times of high food insecurity, children living in the most vulnerable households should be prioritized for SFF interventions through a targeted approach. However, when targeting is not possible, these SFFs may need to be given to all households through a blanket approach for infants and children 6-23 months of age, while continuing to enable access to adequate home diets for the whole family and providing infant and young child feeding counselling. (Conditional recommendation; Grade: Low certainty evidence)
  • Recommendation 2: In contexts where wasting and nutritional oedema occur, multiple micronutrient powders (MNPs) should not be given to infants and children 6-23 months of age for the specific purpose of preventing wasting and nutritional oedema. (Strong recommendation; Grade: Moderate certainty evidence)
  • Good Practice Statement 1: In contexts where wasting and nutritional oedema occur, preventive interventions should ideally be implemented through a multisectoral and multisystem approach (i.e. food, health, safe water, sanitation and hygiene, and social protection systems). These interventions should include access to healthy diets and nutrition and medical services as appropriate, counselling (breastfeeding, health and nutrition related, especially helping families use locally available nutrient-dense foods for a healthy diet), should address maternal and family needs, and should involve psychosocial elements of care to ensure healthy growth and development.
  • Good Practice Statement 2: Infant and young child feeding counselling must be provided as part of routine care especially in contexts where wasting and nutritional oedema occur. In order for this counselling to have the most benefit for the prevention of wasting and for other child health and nutrition outcomes, personnel carrying out the counselling should have comprehensive training and be supervised regularly, with dedicated resources and time within health system strategic planning for this intervention.

In both the recommendations and in the practice statements, we were pleased to see mention of a multi-sectoral and family approach to these interventions to prevent wasting and nutritional oedema. It is key to provide access to nutritious foods and nutrition support, including breastfeeding counseling and complementary feeding, to whole families to address maternal, infant, and child nutritional needs. The guidelines note that prevention requires a package of interventions to be implemented together rather than focusing on one single intervention. We also support the recommended psychosocial elements of care to ensure healthy growth and development as preventing malnutrition early in life impacts long-term health.

These guidelines provide organizations with the tools necessary to prevent, manage, and treat malnutrition. WHO also notes that further research is needed for many of the recommendations outlined in the guidelines to be most effective in efforts to prevent and treat wasting. The guidelines provide a critical opportunity to advocate for the essential resources to support good, life-long nutrition, particularly among vulnerable populations, including those in the 1,000-day window.

World Health Organization Updated Guidelines on the Prevention & Management of Acute Malnutrition

In July 2023, the World Health Organization (WHO) released updated guidelines for the management section of wasting and nutritional oedema, also known as acute malnutrition, in infants and children under 5. An update of the prevention section of the guidelines is expected this fall. The guidelines build on the 2013 guidelines by further enhancing care of infants and children with wasting and nutrition oedema as these conditions lead to higher mortality rates and other negative health outcomes. The guidelines were drafted and completed as one of the key commitments of WHO to the Global Action Plan for Child Wasting which was released in 2019 by the United Nations (UN) Secretary-General. The guidelines include four areas of focus:

  • Management of infants less than 6 months of age at risk of poor growth and development,
  • Management of infants and children 6-59 months with wasting and/or nutritional oedema,
  • Post-exit interventions after recovery from wasting and/or nutritional oedema, and
  • Prevention of wasting and nutritional oedema from a child health perspective (to be developed).

Ongoing crises such as climate change, the COVID-19 pandemic, conflict, and rising costs of food have exacerbated rates of malnutrition, particularly among those under 5 years of age. Currently, over 45.4 million infants and children under 5 years of age experience wasting each year. Governments and other stakeholders have struggled to make progress on Sustainable Development Goal 2 which is to reach “Zero Hunger” by 2030. The new guidelines include 19 total recommendations, 12 of which are new and 7 of which are updated, along with 10 good practice statements. Key recommendations and good practice statements for each focus area include:

Focus area: Management of infants less than 6 months of age at risk of poor growth and development

  • Admission, referral, transfer and exit criteria for infants at risk of poor growth and development:
    • Referring infants for inpatient care if they have one or more Integrated Management of Childhood Illness (IMCI) danger signs, acute medical problems, or conditions under severe classification as per IMCI, nutritional oedema, or recent weight loss. If they do not meet any of the above criteria, an in-depth assessment should be conducted to determine if inpatient admission or outpatient management is necessary and guidelines are provided on transitioning from inpatient care to outpatient care as well as to transferring out of, and/or ending outpatient care due to improved health status and growth and development.
    • Follow-up visits, with possible reduced frequency of visits, should continue until 6 months of age followed by referral to appropriate services.
  • Management of breastfeeding/lactation difficulties in mothers/caregivers of infants at risk of poor growth and development
    • Comprehensive assessments should be conducted by health care providers and best practices for managing breastfeeding/lactation challenges should be followed.
  • Supplemental milk for infants at risk of poor growth and development
    • For infants less than six months of age with severe wasting and/or nutritional oedema who are admitted for inpatient care should be breastfed where possible and support should be provided to the mothers or female caregivers. If an infant is not breastfed, support should be given to the mother or female caregiver to re-lactate. If this is not possible, wet nursing should be encouraged. A supplementary feed should be provided when clinically necessary. An assessment of the physical and mental health status of mothers or caregivers should be promoted and relevant treatment or support provided.
  • Interventions for mothers/caregivers of infants at risk of poor growth and development
    • To optimize growth and development in infants at risk of poor growth and development, a comprehensive assessment and support is recommended to ensure maternal/caregiver physical and mental health and wellbeing.

Focus area: Management of infants and children 6-59 months of age with wasting and/or nutrition oedema

  • Admission, referral, transfer, and exit criteria for infants and children with severe wasting and/or nutritional oedema
    • Referring infants and children (6-59 months) with severe wasting and/or nutritional oedema for inpatient care if they have one or more Integrated Management of Childhood Illness (IMCI) danger signs, acute medical problems, severe nutritional oedema, or poor appetite (failed appetite test). If they do not meet any of the above criteria, an in-depth assessment should be conducted to determine if inpatient admission or outpatient management is necessary and guidelines are provided on transitioning from inpatient care to outpatient care as well as to transferring out of, and/or ending outpatient care due to improved health status and growth and development. Continuity of care is vital for the safe and effective follow-up of infants and children with severe wasting and/or nutritional oedema. Ongoing medical and psychological support services are key and one important aspect of discharge panning is assessing the child’s home environment to ensure environmental health aspects (water, sanitation, hygiene), food security, economic stability, and the mental and physical health of caregivers.
  • Identification of dehydration in infants and children with wasting and/or nutritional oedema
    • Classifying hydration status in children with wasting and/or nutritional oedema to provide and monitor appropriate treatment.
  • Rehydration fluids for infants and children with wasting and/or nutritional oedema and dehydration but who are not shocked
    • Providing appropriate rehydration fluids, like Rehydration Solution for Malnourished Children (ReSoMal) or Oral Rehydration Solution (ORS).
  • Hydrolyzed formulas for infants and children with severe wasting and/or nutritional oedema who are not tolerating F-75 or F-100
    • There is insufficient evidence to recommend switching to hydrolyzed formulas if they are not tolerating F-75 or F-100 milks.
  • Ready-to-use therapeutic foods (RUTF) for treatment of severe wasting and/or nutritional oedema
    • RUTF should be given in specific quantities that will provide 150-185 kcal/kg/day until anthropometric recovery and resolution of nutritional oedema; or 150-185 kcal/kg/day until the child is no longer severely wasted and does not have nutritional oedema, then the quantity can be reduced to provide 100-130 kcal/kg/day, until anthropometric recovery and resolution of nutritional oedema.
  • Dietary management of infants and children with moderate wasting
    • Nutrient dense diet should be provided to meet extra needs or recovery of weight and height and for improved survival, health, and development.
    • Those with moderate wasting should be assessed comprehensively and treated wherever possible for medical and psychosocial problems leading to or exacerbating this episode of wasting.
    • Specially formulated foods (SFF) interventions with counseling should be considered with a number of clinical factors, including failing to recover from moderate wasting, co-morbidities, and others, in addition to social factors like poor maternal health and wellbeing.
    • SFF as well as counseling and the provision of home foods for them and their families should be considered.
    • For those needing supplementation with SFF, lipid-based nutrient supplements (LNS) are the preferred type. When not available, Fortified Blended Foods with added sugar, oil, and/or milk are preferred compared to Fortified Blended Foods without these attributes. Additionally, SFF should be given to provide 40-60% of the total daily energy requirements needed to achieve anthropometric recovery. High-risk moderate acute malnutrition is defined with a mid-upper arm circumference (MUAC) of 11.5 to <11.9 or weight-for-age (WAZ) <-3.5.
  • Identification and management of wasting and nutritional oedema by community health workers
    • Assessment, classification and management or referral of infants and children 6-59 months of age with wasting and/or nutritional oedema can be carried out by community health workers as long as they receive adequate training, and regular supervision of their work is built into service delivery.

Focus area: Post-exit interventions after recovery from wasting and/or nutritional oedema

  • Support for mothers/caregivers should be provided after infants and children are treated for wasting and/or nutritional oedema. This can include counseling and education, responsive care, and safe water, hygiene, and sanitation interventions.
  • Psychosocial stimulation should continue to be provided by mothers/caregivers after transfer from inpatient to outpatient treatment.
  • Cash transfers in addition to routine care may be provided to decrease relapse and improve overall child health during outpatient care and after exit from treatment, depending on contextual factors such as cost.
  • In infants and children with severe wasting and/or nutritional oedema who are HIV negative, daily oral co-trimoxazole prophylaxis should not be provided after transfer from inpatient treatment and/or exit from outpatient treatment as part of routine care.

Additional standing WHO recommendations and best practice statements on wasting and nutritional oedema were also carried over from previous guidelines, including classifying nutritional status according to WHO child growth standards, providing children with severe wasting and/or nutritional oedema the recommended daily nutrient intake of vitamin A throughout treatment period, promotion and support for exclusive breastfeeding in the first 6 months and continued breastfeeding until 24 months and beyond, and others.

In addition to these guidelines, WHO will be putting out operational guidance to accompany them. As policymakers, governments and governmental agencies, program implementers, non-governmental organizations and other civil society organizations, and healthcare workers aim to reduce and prevent wasting and nutrition oedema in infants and children, they should rely on these guidelines to develop and implement evidence-based policies, programs, best practices, and regulations.

Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women

Photo credit: Paula Bronstein/Getty Images/Images of Empowerment

Published: March 2023 

Publication: Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women 

Authors: United Nations Children’s Fund (UNICEF) 

Background: 

In the 12 hardest-hit countries, the number of pregnant and breastfeeding women and adolescent girls suffering from acute malnutrition has soared from 5.5 million to 6.9 million – or 25 per cent – since 2020.  

More than 1 billion adolescent girls and women worldwide suffer from undernutrition which includes underweight and short height, micronutrient deficiencies, and anemia.  

Globally, 51 million children under 2 are stunted. Almost half of all stunting early childhood originates during pregnancy or in the first six months of life – a time when children are entirely dependent on their mothers for nutrition.  

Summary: 

The report analyzes the current status, trends and inequities in the nutritional status of adolescent girls and women of reproductive age (15-49 years), the barriers they face in achieving a nutritious diet, utilizing essential nutrition services, and benefiting from nutrition and health-focused practices. Data were analyzed from more than 190 countries and territories, representing more than 90% of adolescent girls and women from around the globe. 

Findings: 

  • Progress on addressing adolescent girls’ and women’s nutrition is not advancing quickly enough and has been deprioritized. The current global food and nutrition crisis may slow progress even further and no region is on track to meet the 2030 global targets to reduce anemia in adolescent girls and women by half and low birthweight in newborns by 30%. 
  • Prevalence of undernutrition and anemia is highest in the lowest income regions and disadvantaged adolescent girls and women are more likely to experience it. The prevalence of underweight among adolescent girls and women belonging to the poorest households is double the prevalence in the wealthiest households (14% v. 7%). 
  • Poor nutrition is generational. The nutritional status of a mother, including weight, height, and low birthweight, are consistent predictors of stunting and wasting in early childhood. Child undernutrition is concentrated in the same regions as maternal undernutrition.  
  • The global food and nutrition crisis is worsening the health and nutrition in adolescent girls and women. Adolescent girls and women have been disproportionately impacted by the COVID-19 pandemic and its impact on livelihoods, income, and access to nutritious food. They are also disproportionately impacted by conflict, climate change, poverty, and other economic shocks.  
  • Diets of adolescent girls and women are not diverse enough to meet nutritional needs. Fewer than 1 in 3 adolescent girls and women have diets meeting the minimum dietary diversity in the Sudan, Burundi, Burkina Faso, and Afghanistan. In other countries, the percentage of women being able to access nutritionally adequate, diverse diets, continues to fall.  
  • Gender and social inequalities have further slowed progress on improving nutrition in adolescent girls and women. Child marriage and adolescent pregnancy have profound negative impacts for nutrition in adolescent girls and their children. Often, women do not have the ability to make their own decisions, including those that would enhance their education and employment opportunities. 
  • The nutrition programs and services designed to address undernutrition have not reached the number of women or adolescent girls impacted or has not met the full nutritional needs of these populations. Only 2 in 5 pregnant women benefit from iron and folic acid supplementation for the prevention of maternal anemia and only 29 low- and middle-income countries provide multiple micronutrient supplements, or prenatal vitamins. Conflict and humanitarian crises like the one in Afghanistan, have made these gaps in coverage grow even larger. 
  • There are policy gaps in addressing undernutrition in adolescent girls and women. Of the eight key policies reviewed that address adolescent girls’ and women’s nutrition, only 8% of countries have all of the policies while 39% have only four or less. 

Governments, development and humanitarian partners, the private sector, civil society organizations, and research and academia sectors must work together to strengthen nutrition governance, activate the food, health and social protection systems, and transform harmful social and gender norms to deliver nutritious and affordable diets, essential nutrition services and positive nutrition and care practices for adolescent girls and women everywhere. 

Key Quotes: 

“Women and girls need access to nutritious and affordable diets, including fortified foods, and essential nutrition services before and during pregnancy and while breastfeeding.” 

Multiple micronutrient supplements versus iron-folic acid supplements and maternal anemia outcomes: an iron dose analysis

Published: February 25, 2022

Publication: MMS in Pregnancy Technical Advisory Group, New York Academy of Sciences

Authors: Filomena Gomes, Rina Agustina, Robert E. Black, Parul Christian, Kathryn G. Dewey, Klaus Kraemer

Background

  • The World Health Organization currently recommends 30 to 60 mg of iron during pregnancy, with higher doses recommended in areas of high maternal anemia
    • Multiple micronutrient supplement (MMS) and iron folic acid (IFA) are both used to deliver iron during pregnancy
  • Comprehensive analysis was conducted examining 19 studies to address concerns related to 30mg of iron through MMS vs. 60mg of iron through IFA, with regard to maternal anemia outcomes in low- and middle-income countries (LMICs)

Summary

  • Of the 19 studies that were screened for inclusion, 11 were included and were part of the analyses of the three outcomes of interest:
    • Effect of MMS vs. IFA on maternal anemia in the third trimester
    • Effect of MMS vs. IFA on hemoglobin in the third trimester
    • Effect of MMS vs. IFA on iron deficiency anemia in the third trimester
  • When compared to 60 mg of IFA, MMS providing 30 mg of iron did not result in an increased risk of anemia, nor lower levels of hemoglobin, or increased risk of iron deficiency anemia
  • The included studies found that MMS with 30 mg of iron is comparable to IFA with 60 mg of iron with regard to these above-mentioned outcomes
  • MMS is known to have additional benefits in the risk of infant mortality at 6 months, low birthweight, preterm birth, born small-for-gestational age, and reduction of stillbirth. Greater reductions are found among anemic pregnant women so the data suggest that transitioning from IFA with 30 or 60 mg of iron to MMS with 30 mg of iron would not increase the risk of maternal anemia and has additional maternal/child health benefits.

Key Quotes

  • “Because MMS with 30 mg of iron influenced hemoglobin with clinically comparable results to IFA with 60 mg iron, and because MMS significantly improves fetal growth and survival, especially in anemic women, we suggest that policymakers in LMIC proceed with the transition from IFA to MMS.”

Read the original article here

Effect of multiple micronutrient supplements vs iron and folic acid supplements on neonatal mortality: a reanalysis by iron dose

Published: April 25, 2022

Publication: MMS in Pregnancy Technical Advisory Group, New York Academy of Sciences

Authors: Filomena Gomes, Rina Agustina, Robert E. Black, Parul Christian, Kathryn G. Dewey, Klaus Kraemer

Background

  • Multiple micronutrient supplements (MMS) are a cost-effective method of delivering iron to a mother and fetus, as well as reducing adverse pregnancy and birth outcomes, including anemia
  • However, there are concerns that MMS may increase the risk of neonatal mortality as compared to the use of iron and folic acid supplements (IFA), a similar prenatal vitamin

Summary

  • The study aimed to assess the effect of MMS vs. IFA on neonatal mortality stratified by iron dose in each supplement
  • The study authors updated the neonatal mortality analysis of the 2020 WHO guidelines to calculate the effects of MMS vs. IFA on neonatal mortality in subgroups that provided the same or different amounts of iron – varying amounts of MMS and IFA
  • The study found that there were no significant differences in neonatal mortality between MMS and IFA within any of the subgroups therefore, neonatal mortality did not differ between MMS and IFA regardless of iron dose in either supplement.

Read the original article here

Maternal and child undernutrition: consequences for adult health and human capital

Published: January 2008 

Publication: The Lancet 

Authors: Prof. Cesar G. Victora, M.D., Prof. Linda Adair, Ph.D., Prof. Caroline Fall, D.M., Pedro C Hallal, Ph.D., Prof. Reynaldo Martorell Ph.D., Prof. Linda Richter Ph.D., Prof. Harshpal Singh Sachdev, M.D., for the Maternal and Child Undernutrition Study Group 

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
    • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
    • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
    • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
    • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • Malnutrition in pregnancy and childhood can cause generational health problems 
  • Undernutrition in pregnant mothers and children was strongly associated with… 
    • Shorter adult height 
    • Less schooling 
    • Reduced economic productivity  
    • Lower offspring birthweight in women (birthweight is positively associated with lung function, the incidence of some cancers; undernutrition could be associated with mental illness) 
  • Lower weight and malnutrition in childhood followed by weight gain after two years of age was found to be risk factors for high glucose concentrations, elevated blood pressure and harmful lipid profiles once adult BMI and height were adjusted for, suggesting that rapid postnatal weight gain, after infancy, is linked to these conditions 

Key Quotes: 

  • “Poor fetal growth or stunting in the first 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birthweight.” 
  • “Children who are undernourished in the first 2 years of life and who put on weight rapidly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition.” 
  • “We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations.” 

Read the original article here

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a forty-year study

Published: Nov. 26, 2013

Publication: National Library of Medicine

Authors: Deborah P. Waber, Ph.D., Cyralene P. Bryce, M.D., Jonathan M. Girard, B.A., Miriam Zichlin, B.S., Garrett M. Fitzmaurice, Sc.D., and Janina R. Galler, M.D.

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
  • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
  • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
  • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
  • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • While previously malnourished individuals were able to catch up physically to their healthy peers, their cognitive and behavioral development lagged behind 
  • IQ scores in the intellectual disability range were 9 times more prevalent in the previously malnourished group 
  • Previously malnourished individuals had lower IQs, lower grades in school, and higher rates of attention problems. They also suffered from intellectual disabilities at a higher rate than their healthy peers. 
  • Malnutrition during the first year of life carries risk for significant lifelong functional morbidity.  

Key Facts: 

  • The estimated difference in IQ between the two groups was 15 points when tested as adolescents and 18 points when tested as adults 
  • 26.3 percent of individuals in the previously malnourished group had IQs indicating intellectual disabilities compared to only 3 percent in the control group 

Read the original article here

Long term consequences of early childhood malnutrition

Published: December 2003 

Publication: International Food Policy Research Institution 

Authors: Harold Alderman, John Hoddinott, Bill Kinsey 

Background

  • Researchers studied the preschool nutritional status (measured by height, given age) of children in Zimbabwe who experienced civil unrest and/or a drought before the age of three
  • Civil war and droughts were used as an indicator of malnourishment
  • Nutritional status was then compared to subsequent health and education achievements of these children to show the effects of early-childhood malnutrition on adult outcomes

Summary

  • The study indicates that early childhood malnutrition can lead to continued stunting and lower school achievement in adolescence as compared to peers who experienced no malnutrition or a lesser degree of malnutrition in childhood
  • Children who measured at median height in preschool were more likely to measure at median height by adolescence and have completed an additional 0.7 grades of schooling than students who measured below median height in preschool
  • This study also indicates that improving preschool nutrition can facilitate growth and higher educational achievement in adolescence
  • Because of the negative impact of “shocks” (i.e. war and drought), interventions should focus on mitigating the impact of these shocks.

Read the original article here

The Impact of MMS on Moms and Babies

Official title: Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries

Published: November 2017

Publication: The Lancet Global Health

Authors: Emily R Smith, Anuraj H Shankar, Lee S-F Wu, Said Aboud, Seth Adu-Afarwuah, Hasmot Ali, Rina Agustina, Shams Arifeen, Per Ashorn, Zulfiqar A Bhutta, Parul Christian, Delanjathan Devakumar, Kathryn G Dewey, Henrik Friis, Exnevia Gomo, Piyush Gupta, Pernille Kæstel, Patrick Kolsteren, Hermann Lanou, Kenneth Maleta, Aissa Mamadoultaibou, Gernard Msamanga, David Osrin, Lars-Åke Persson, Usha Ramakrishnan, Juan A Rivera, Arjumand Rizvi, H P S Sachdev, Willy Urassa, Keith P West Jr, Noel Zagre, Lingxia Ze

Read the original paper here.

Summary 

  • Pregnant women need extra nutrition for themselves and their babies.
  • Many pregnant women don’t get enough nutrients from the food they eat.  
  • Micronutrient deficiencies during pregnancy put both mothers and babies at risk of birth complications and death.
  • Lack of nutrients in this critical period can prevent children from reaching their full physical and mental potential.
  • To help avoid this, nutrition programs often give pregnant women iron and folic acid (IFA) to supplement the nutrients they get from the food they eat.
  • Recent research has suggested that women might be better off if they got a multiple micronutrient supplement (MMS) instead of just iron and folic acid (IFA). 
  • Researchers have been trying to figure out if MMS is safe, effective, and cheap enough to recommend switching out IFA and replacing it with MMS
  • This paper analyzed 17 different studies testing MMS and IFA.
  • The analysis found that compared to IFA, MMS:
    1. Reduced the risk of low birthweight babies, preterm babies, and small babies.
    2. Reduced the number of infant deaths in the days after birth, especially for girls. 
    3. Reduced the number of kids who were born to anemic mothers and died before 6 months.
    4. Reduced the number of preterm births.
  • Researchers also discovered something they hadn’t known before: The benefits of taking MMS during pregnancy instead of IFA were even bigger if moms were malnourished. Malnourished women who took MMS while they were pregnant saw an even greater decrease in low bithweight, preterm, and small births compared to malnourished women who only took IFA while they were pregnant. 
  • The studies didn’t find any negative effects of taking MMS

 

Conclusions

  • MMS is safe and more effective than IFA at preventing multiple conditions and death in newborns and babies, especially when moms are malnourished. 
  • The WHO should consider updating its guidelines to reflect the benefits of MMS

The importance of food systems and the environment for nutrition

Published: 24 November 2020

Publication: The American Journal of Clinical Nutrition

Authors: Jessica Fanzo, Alexandra L Bellows, Marie L Spiker, Andrew L Thorne-Lyman, and Martin W Bloem

Read the original paper here.

Summary 

  • Food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability
  • We’re going to need more research to tell us what food policy changes we should make to ensure everyone has access to nutritious food despite the impacts of climate change.
  • We need to think about this key question: how can both human and planetary health thrive while meeting the demands of a growing human population, and if we can’t have it all, what trade-offs are we willing to live with?

Background

  • Food systems involve the production, processing, packaging, distribution, marketing, purchasing, consumption, and waste of food.
  • By “transforming” (improving) food systems, we could make healthy food more accessible and reduce environmental impact 
  • We need a lot more research to figure out how best to structure this transformation
  • Silos within the field make this research harder

Research Gaps

The impact of climate change on food systems

  • The link between climate and food systems is getting more and more attention, but there are still a lot of gaps in our knowledge. Specifically, we need more research on:
    •  The “missing middle” of the food supply chain (aka anything other than people’s diets and agricultural production) 
    • How climate change will affect non-staple crops (most research to date has only looked at staple crops).
    • How to create context-specific policies (eg. financial incentives, targeted messaging campaigns etc.) that encourage/allow people to eat sustainable diets and how to measure whether these policies are working:

Food systems 

  • Diets. We need more information on:  
    • The best way to measure how sustainable someone’s diet is
    • How people’s diets are changing as incomes rise
    • Healthy, locally appropriate, and sustainable diets are sometimes at odds with one another. How should we prioritize?
      • “One of the shortcomings of the EAT–Lancet Commission report was that it provided a single healthy reference diet for the world, and did not take into account that healthy and sustainable diets may differ in their availability, accessibility, and cost at the global, regional, and individual levels. Even more so, what is considered healthy is not always sustainable, and what is considered a sustainable diet is not always a healthy one.”
  • Food safety. We need more information on:
    • The danger of using pesticides and chemicals, and whether these dangers affect consumer purchases.
    • The danger of plastics (in food packaging, production etc.).
  • Food loss and waste.  We need more information on:
    • How to measure and reduce food waste/loss.

Interesting Stats

  • “Some models suggest that changes in food availability due to climate change, specifically reduced availability of fruit and vegetables, are estimated to result in an additional 529,000 deaths by 2050.”
  • “Globally, agriculture and livestock production utilize ∼40% of arable land account for ∼70% of fresh water withdrawn for human purposes, and are responsible for ∼11% of GHG emissions (although some estimates range from 11% to 24% depending on what is counted).”
  • “​​Food wasted at the retail and consumer levels alone averages 1217 calories, 33 g protein, 6 g fiber, and 286 g Ca per person per day.”

Figure: Link between food systems and the environment