Thelancet Maternal And Child Nutrition

www.thelancet.comMaternal and Child NutritionExecutive Summary of The Lancet Maternal and Child Nutrition Series“Nutrition is crucial to both individual and national development. The evidence inthis Series furthers the evidence base that good nutrition is a fundamental driverof a wide range of developmental goals. The post-2015 sustainable developmentagenda must put addressing all forms of malnutrition at the top of its goals.”

Executive SummaryMaternal and Child NutritionMaternal and child undernutrition, consisting ofstunting, wasting, and deficiencies of essentialvitamins and minerals, was the subject of a Seriesof papers in The Lancet in 2008.1–5 In the Series, wequantified the prevalence of these issues, calculatedtheir short-term and long-term consequences, andestimated their potential for reduction throughhigh and equitable coverage of proven nutritioninterventions.The 2008 Series identified the need to focus on thecrucial period from conception to a child’s secondbirthday—the 1000 days in which good nutrition andhealthy growth have lasting benefits throughout life.The Series also called for greater priority for nationalnutrition programmes, stronger integration with healthprogrammes, enhanced intersectoral approaches, andmore focus and coordination in the global nutritionsystem of international agencies, donors, academia, civilsociety, and the private sector.5 years after the initial series, we re-evaluate theproblems of maternal and child undernutrition andalso examine the growing problems of overweightand obesity for women and children and theirconsequences in low-income and middle-incomecountries (LMICs). Many of these countries aresaid to have the double burden of malnutrition—continued stunting of growth and deficiencies ofessential nutrients along with the emerging issue ofobesity. We also assess national progress in nutritionprogrammes and international efforts toward previousrecommendations.The first paper6 examines the prevalence andconsequences of nutritional conditions during the lifecourse from adolescence (for girls) through pregnancyto childhood and discusses the implications foradult health. The second paper7 covers the evidencesupporting nutrition-specific interventions and thehealth outcomes and cost of increasing their populationcoverage. The third paper8 examines nutrition-sensitiveinterventions and approaches and their potentialto improve nutrition. The fourth paper9 discussesthe features of an enabling environment that areneeded to provide support for nutrition programmes,and how they can be favourably influenced. A set ofComments10–15 examine what is currently being done,and what should be done nationally and internationallyto address nutritional and developmental needs ofwomen and children in LMICs.Benefits during the life courseMorbidity andmortality in childhoodCognitive, motor,socioemotional developmentSchool performanceand learning capacityAdult statureWork capacityand productivityObesity and NCDsNutrition specificinterventionsand programmes Adolescent health andpreconception nutrition Maternal dietarysupplementation Micronutrientsupplementation orfortification Breastfeeding andcomplementary feeding Dietary supplementationfor children Dietary diversification Feeding behaviours andstimulation Treatment of severe acutemalnutrition Disease prevention andmanagement Nutrition interventions inemergenciesOptimum fetal and child nutrition and developmentBreastfeeding, nutrientrich foods, and eatingroutineFeeding and caregivingpractices, parenting,stimulationLow burden ofinfectious diseasesFood security, includingavailability, economicaccess, and use of foodFeeding and caregivingresources (maternal,household, andcommunity levels)Access to and use ofhealth services, a safe andhygienic environmentKnowledge and evidencePolitics and governanceLeadership, capacity, and financial resourcesSocial, economic, political, and environmental context (national and global)Nutrition sensitiveprogrammes and approaches Agriculture and food security Social safety nets Early child development Maternal mental health Women’s empowerment Child protection Classroom education Water and sanitation Health and family planning servicesBuilding an enabling environment Rigorous evaluations Advocacy strategies Horizontal and vertical coordination Accountability, incentives regulation,legislation Leadership programmes Capacity investments Domestic resource mobilisationFigure 1: Framework for actions to achieve optimum fetal and child nutrition and development2www.thelancet.com

Executive SummaryA new conceptual frameworkThe present Series is guided by a framework(figure 1) that shows the means to optimum fetaland child growth and development.6 This frameworkoutlines the dietary, behavioural, and healthdeterminants of optimum nutrition, growth, anddevelopment, and how they are affected by underlyingfood security, caregiving resources, and environmentalconditions, which are in turn shaped by economicand social conditions, national and global contexts,capacity, resources, and governance. The Series focuseson how these determinants can be changed to enhancegrowth and development, including the nutritionspecific interventions that address the immediatecauses of suboptimum growth and developmentand the potential effects of nutrition-sensitiveinterventions that address the underlying determinantsof malnutrition and incorporate specific nutrition goalsand actions (panel 1). It also shows how an enablingenvironment can be built to support interventions andprogrammes to enhance growth and development.An unfinished agenda for undernutritionThe publication of The Lancet Maternal and ChildUndernutrition Series 5 years ago stimulated atremendous increase in political commitment toreduction of undernutrition at global and nationallevels. Most development agencies have revised theirstrategies to address undernutrition focused on the1000 days during pregnancy and the first 2 years of life,as called for in the 2008 Series. One of the main driversof this new international commitment is the Scaling UpNutrition (SUN) movement.18,19 National commitmentin LMICs is growing, donor funding is rising, and civilsociety and the private sector are increasingly engaged.However, this progress has not yet translatedinto substantially improved outcomes globally.Improvements in nutrition still represent a massiveunfinished agenda. The 165 million children withstunted growth have compromised cognitivedevelopment and physical capabilities, making yetanother generation less productive than they wouldotherwise be.6 Countries will not be able to break outof poverty and sustain economic advances withoutensuring that their populations are adequatelynourished. Undernutrition reduces a nation’s economicadvancement by at least 8% because of directwww.thelancet.comPanel 1: Definition of nutrition-specific and nutrition-sensitive interventionsand programmesNutrition-specific interventions and programmes Interventions or programmes that address the immediate determinants of fetal andchild nutrition and development—adequate food and nutrient intake, feeding,caregiving and parenting practices, and low burden of infectious diseases Examples: adolescent, preconception, and maternal health and nutrition; maternaldietary or micronutrient supplementation; promotion of optimum breastfeeding;complementary feeding and responsive feeding practices and stimulation; dietarysupplementation; diversification and micronutrient supplementation or fortification forchildren; treatment of severe acute malnutrition; disease prevention and management;nutrition in emergenciesNutrition-sensitive interventions and programmes Interventions or programmes that address the underlying determinants of fetal andchild nutrition and development— food security; adequate caregiving resources atthe maternal, household and community levels; and access to health services and asafe and hygienic environment—and incorporate specific nutrition goals and actions Nutrition-sensitive programmes can serve as delivery platforms for nutrition-specificinterventions, potentially increasing their scale, coverage, and effectiveness Examples: agriculture and food security; social safety nets; early child development;maternal mental health; women’s empowerment; child protection; schooling; water,sanitation, and hygiene; health and family planning servicesAdapted from Scaling Up Nutrition16 and Shekar and colleagues, 2013.17productivity losses, losses via poorer cognition, andlosses via reduced schooling.20 We cannot afford fornothing to change.Burden of nutritional conditionsUndernutrition in LMICsStunted linear growth has become the main indicator ofchildhood undernutrition, because it is highly prevalentin nearly all LMICs, and has important consequences forhealth and development. It should replace underweightas the main anthropometric indicator for children. Theprevalence of stunting in children younger than 5 yearsin LMICs in 2011 was 26%, a decrease from 40% in1990, and 32% in 2005, the estimate in the previousnutrition Series.1,6 The number of stunted children hasalso decreased globally, from 253 million in 1990, to 178million in 2005, to 165 million in 2011. This representsan average annual rate of reduction of 2·1%.6The World Health Assembly (WHA) called for a 40%reduction in the global number of children youngerthan 5 years who are stunted by 2025 (compared withthe baseline of 2010).21 This aim would translate into a3·9% reduction per year and imply reducing the numberof stunted children from 171 million in 2010, to about100 million in 2025.6 At the present rate of decline,3