CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice (CHANGE project)
Lead Research Organisation:
London School of Hygiene and Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
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 NCD
THE 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 development
2) ENHANCED MALNUTRITION-RELATED ADVOCACY
Effective 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 CHILDREN
Being 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.
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 NCD
THE 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 development
2) ENHANCED MALNUTRITION-RELATED ADVOCACY
Effective 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 CHILDREN
Being 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.
Technical Summary
WP1: DATA SYNTHESIS/STANDARDIZATION
Our project involves data from 7 distinct patient cohorts. We will first harmonise available datasets, highlighting common variables & agreeing on joint data strategies & definitions of exposure/outcomes
WP2: UNDERSTANDING HOW POST-MALNUTRITION-WEIGHT-GAIN (PMWG) INFLUENCES RISK OF NCD (towards objective 1)
Existing data from 3 prospective cohorts forms a natural experiment whereby:
-Jamaica-LION involved inpatient treatment for malnutrition and overall had the fastest rates of PMWG
-Ethiopia-ACAM was outpatient-only and had slowest PMWG
-Malawi-ChroSAM was mixed in/outpatient and had intermediate PMWG
Secondary analysis will explore inter-?ra-site PMWG and its association with NCD variables already captured in the datasets
WP-3: DESCRIBING BIOCHEMICAL CHARACTERISTICS OF MALNUTRITION SURVIVORS (obj. 2a)
Old blood samples from J-LION, M-ChroSAM, E-ACAM cohorts will be combined with new blood/urine samples collected from Malawi-2002-4 and Ethiopia-1980s famine cohorts. Metabolomic and lipidomic analysis will attempt to identify differences between: malnutrition survivors vs controls; survivors with/without NCD
WP-4: DESCRIBING BIOCHEMICAL PROFILES OF DIFFERENT PATTERNS OF PMWG (obj. 2b)
Blood/urine samples will be collected from two new cohorts: an observational birth cohort in Malawi; a cohort nested in an Ethiopian RCT. Metabolic/lipidomic profiles of different post-malnutrition growth patterns will be described
WP-5: IDENTIFYING BIOCHEMICAL SIGNATURES LINKING PMWG & NCD RISK (obj. 2c)
Data from WP3&4 will be compared. Biochemical markers common to early malnutrition/PMWG and later NCD can be used in future work as early markers of NCD risk
WP-6: GRIPP (Getting Research into Policy/Practice) & Stakeholder engagement/research co-creation (towards overall AIM)
Qualitative work will explore views of PMWG & malnutrition/NCD risk. A follow-on RCT will be co-created with key stakeholders to maximise impact
Our project involves data from 7 distinct patient cohorts. We will first harmonise available datasets, highlighting common variables & agreeing on joint data strategies & definitions of exposure/outcomes
WP2: UNDERSTANDING HOW POST-MALNUTRITION-WEIGHT-GAIN (PMWG) INFLUENCES RISK OF NCD (towards objective 1)
Existing data from 3 prospective cohorts forms a natural experiment whereby:
-Jamaica-LION involved inpatient treatment for malnutrition and overall had the fastest rates of PMWG
-Ethiopia-ACAM was outpatient-only and had slowest PMWG
-Malawi-ChroSAM was mixed in/outpatient and had intermediate PMWG
Secondary analysis will explore inter-?ra-site PMWG and its association with NCD variables already captured in the datasets
WP-3: DESCRIBING BIOCHEMICAL CHARACTERISTICS OF MALNUTRITION SURVIVORS (obj. 2a)
Old blood samples from J-LION, M-ChroSAM, E-ACAM cohorts will be combined with new blood/urine samples collected from Malawi-2002-4 and Ethiopia-1980s famine cohorts. Metabolomic and lipidomic analysis will attempt to identify differences between: malnutrition survivors vs controls; survivors with/without NCD
WP-4: DESCRIBING BIOCHEMICAL PROFILES OF DIFFERENT PATTERNS OF PMWG (obj. 2b)
Blood/urine samples will be collected from two new cohorts: an observational birth cohort in Malawi; a cohort nested in an Ethiopian RCT. Metabolic/lipidomic profiles of different post-malnutrition growth patterns will be described
WP-5: IDENTIFYING BIOCHEMICAL SIGNATURES LINKING PMWG & NCD RISK (obj. 2c)
Data from WP3&4 will be compared. Biochemical markers common to early malnutrition/PMWG and later NCD can be used in future work as early markers of NCD risk
WP-6: GRIPP (Getting Research into Policy/Practice) & Stakeholder engagement/research co-creation (towards overall AIM)
Qualitative work will explore views of PMWG & malnutrition/NCD risk. A follow-on RCT will be co-created with key stakeholders to maximise impact
Planned Impact
Main potential impacts arising from our work include:
1) PROGRESS TOWARDS THE 2030 SUSTAINABLE DEVELOPMENT GOALS (SDGs)
We focus on child undernutrition and later life NCD. 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) Target 2.2: End all forms of malnutrition, including achieving ... internationally agreed targets on stunting and wasting in children
>> SDG 3 (GOOD HEALTH & WELL-BEING) Target 3.4: Reduce by one third premature mortality from non-communicable diseases through prevention & treatment
These in turn impact numerous others since nutrition and health are closely related to: the ability to benefit from education (SDG4); gender equality (SDG5); employment (SDG8); inequalities (SDG10)
2) MALNUTRITION-RELATED ADVOCACY (incl. "Double Burden", "Double Duty" advocacy)
Effective advocacy is vital to generate the sufficient political will and sufficient resources to tackle malnutrition. Though "positive" results are often easier to work with, advocates can use even 'negative' studies to highlight needs and lobby for resources. Ours is thus a 'safe' investment. Even in a worst case scenario that we don't succeed in our project objectives (identifying PMWG as a mechanism towards future NCD; identifying NCD biomarkers) we can still make valuable contributions towards local, national and international advocacy efforts in the field. Whatever our final results, our work will:
>> Highlight that undernutrition and overweight/obesity/NCD are important and related problems needing urgent solutions through "double duty actions" which benefit both
>> Inspire others to search for other mechanisms/biomarkers (or elucidate further details of ones we do identify)
For this reason, advocates will be among our stakeholders in WP6. Our dissemination plans include:
>> Direct advocacy - via papers, reports, social media posts we write & events we organize
>>Indirect advocacy - via policy briefs and result we share to other advocates to use in their work.
Among our advocacy messages we will note that climate change is a serious global threat and there is a real danger that natural disasters will lead to resurgent food crises and famines: this makes the task of optimising treatments for undernutrition as important as ever.
3) IMPROVED SEVERE MALNUTRITION TREATMENT PROGRAMMES
We focus on PMWG as our key "nutrition>>NCD" mechanism since potential for it to be directly modifiable is high. This would be done via small, hence scalable, changes to the dose of therapeutic food prescribed in severe malnutrition treatment packages. We acknowledge that RCT-level evidence would be needed to verify our project findings experimentally before wide-scale change to current protocols. It is to speed this process that we directly include planning of such an RCT into our project timeline.
4) NEW METRICS (NCD BIOMARKER TESTS) TO MEASURE PROGRESS
Measuring a problem is key to tackling it. It is very rarely possible, even in research contexts to track malnourished children till adulthood to determine whether or not they develop NCD. If our search for early-life biomarkers of preclinical and clinical NCD risk succeeds, then such long term follow-up will not be needed. Benefits of an intervention on NCD can be assessed much earlier in life via presence/absence of those biomarkers. This will help others in the search for 'double duty' actions and interventions
1) PROGRESS TOWARDS THE 2030 SUSTAINABLE DEVELOPMENT GOALS (SDGs)
We focus on child undernutrition and later life NCD. 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) Target 2.2: End all forms of malnutrition, including achieving ... internationally agreed targets on stunting and wasting in children
>> SDG 3 (GOOD HEALTH & WELL-BEING) Target 3.4: Reduce by one third premature mortality from non-communicable diseases through prevention & treatment
These in turn impact numerous others since nutrition and health are closely related to: the ability to benefit from education (SDG4); gender equality (SDG5); employment (SDG8); inequalities (SDG10)
2) MALNUTRITION-RELATED ADVOCACY (incl. "Double Burden", "Double Duty" advocacy)
Effective advocacy is vital to generate the sufficient political will and sufficient resources to tackle malnutrition. Though "positive" results are often easier to work with, advocates can use even 'negative' studies to highlight needs and lobby for resources. Ours is thus a 'safe' investment. Even in a worst case scenario that we don't succeed in our project objectives (identifying PMWG as a mechanism towards future NCD; identifying NCD biomarkers) we can still make valuable contributions towards local, national and international advocacy efforts in the field. Whatever our final results, our work will:
>> Highlight that undernutrition and overweight/obesity/NCD are important and related problems needing urgent solutions through "double duty actions" which benefit both
>> Inspire others to search for other mechanisms/biomarkers (or elucidate further details of ones we do identify)
For this reason, advocates will be among our stakeholders in WP6. Our dissemination plans include:
>> Direct advocacy - via papers, reports, social media posts we write & events we organize
>>Indirect advocacy - via policy briefs and result we share to other advocates to use in their work.
Among our advocacy messages we will note that climate change is a serious global threat and there is a real danger that natural disasters will lead to resurgent food crises and famines: this makes the task of optimising treatments for undernutrition as important as ever.
3) IMPROVED SEVERE MALNUTRITION TREATMENT PROGRAMMES
We focus on PMWG as our key "nutrition>>NCD" mechanism since potential for it to be directly modifiable is high. This would be done via small, hence scalable, changes to the dose of therapeutic food prescribed in severe malnutrition treatment packages. We acknowledge that RCT-level evidence would be needed to verify our project findings experimentally before wide-scale change to current protocols. It is to speed this process that we directly include planning of such an RCT into our project timeline.
4) NEW METRICS (NCD BIOMARKER TESTS) TO MEASURE PROGRESS
Measuring a problem is key to tackling it. It is very rarely possible, even in research contexts to track malnourished children till adulthood to determine whether or not they develop NCD. If our search for early-life biomarkers of preclinical and clinical NCD risk succeeds, then such long term follow-up will not be needed. Benefits of an intervention on NCD can be assessed much earlier in life via presence/absence of those biomarkers. This will help others in the search for 'double duty' actions and interventions
Organisations
- London School of Hygiene and Tropical Medicine (Lead Research Organisation)
- University of Cambridge (Collaboration)
- Malawi Epidemiology & Intervention Research Unit (Collaboration)
- Swiss School of Public Health (Collaboration)
- University of West Indies (Collaboration)
- University of Malawi (Collaboration)
- University of Jimma (Collaboration)
- University of Southampton (Collaboration)
Publications
Grey K
(2021)
Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review.
in BMJ global health
Olga L
(2022)
Lipid profiling analyses from mouse models and human infants.
in STAR protocols
Kirolos A
(2022)
Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: a systematic review.
in BMJ global health
Bander A
(2023)
Childhood BMI and other measures of body composition as a predictor of cardiometabolic non-communicable diseases in adulthood: a systematic review.
in Public health nutrition
Cheng M
(2023)
Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective.
in PLOS global public health
Thompson DS
(2023)
Faster rehabilitation weight gain during childhood is associated with risk of non-communicable disease in adult survivors of severe acute malnutrition.
in PLOS global public health
Lelijveld N
(2023)
Post-malnutrition growth and its associations with child survival and non-communicable disease risk: a secondary analysis of the Malawi 'ChroSAM' cohort
in Public Health Nutrition
| Description | Severe malnutrition in childhood is a major global problem affecting at least 19million children worldwide and responsible for almost 1 million deaths per year. To date, national and international responses have (quite correctly) focused on the devastating short-term impacts of malnutrition - risk of death and disease. By highlighting long-term outcomes following child malnutrition, our project adds important new knowledge and new perspectives which are already contributing towards improved future treatments of child malnutrition. Key findings and outcomes from our work include: 1. STRONG EVIDENCE OF ADVERSE LONG-TERMEFFECTS OF CHILD MALNUTRITION Via a growing number of academic papers we have shown that survivors of malnutrition experience significant risk of non-communicable disease (e.g. heart disease, diabetes, obesity) in later life. Project outputs towards this include: - Two highly cited review papers - A growing number of papers arising from our own cohorts in Malawi, Jamaica and Ethiopia. Several are already published but more are in-progress This long-term perspective matters since it shifts the balance from prevention/treatment of child malnutrition being (as we argue in a recent editorial: https://pubmed.ncbi.nlm.nih.gov/38309820/ ) a. Just a cost to bear to avoid/limit short-term problems b. To being in fact an INVESTMENT in the long-term future of individuals, communities and societies. Not least because there are even important inter-generational effects of malnutrition. 2. EVIDENCE THAT RAPID POST-MALNUTRITION WEIGHT-GAIN MAY PLAY A ROLE IN INCREASING LONG-TERM RISKS Weight recovery post-malnutrition is clearly a key part of recovery post malnutrition, but we show that there may be an optimal zone for this whereby: - Too slow a weight recovery is obviously problematic since it means a child is not recovering - Too rapid a weight gain may predispose to long-term risk of NCD. We have shown this in two major papers to date and others are in-progress. This knowledge is important for future malnutrition guidelines and treatment programmes. 3. EVIDENCE THAT WEIGHT GAIN IN CURRENT PROGRAMMES IS LIKELY OK IN CURRENT MALNUTRITION TREATMENT PROGRAMMES Very high rates of weigh gain that we found to be possibly associated with adverse NCD outcomes were observed in older cohorts using old-style inpatient focused treatments. Newer malnutrition treatment programmes are outpatient based. In an major analysis which went above and beyond our original project plan (https://pubmed.ncbi.nlm.nih.gov/40026833/ ) we showed that rates of weight gain in today's outpatient-focused programmes are mainly lower, in the zone not associated with risk. This is very reassuring and means that future work can be focused: - From too many changes on short-term treatments - To considering how better to support patients long-term following malnutrition. We are already working on future grant applications to explore these issues. Our results are not only relevant but timely. In these times of severe cuts to global health funding which occur at the same time as rising needs and rising number of children malnourished globally, our work shows that there is more need than ever to improve the efficacy and effectiveness of malnutrition treatment programmes. This has great potential for future economic benefit and value across the many countries (especially ODA countries) affected by malnutrition. A recent Global Nutrition Report recently highlighted that nutrition was an incredibly (cost) effective intervention: for every $1 spent, there was $16 return across multiple other related Sustainable Development Goals (e.g. improved nutrition leads to better health, better educational achievement, better economic outputs, better gender equity etc). Our results showing longer term benenifts are likely to further enhance this value of early investments in preventing/treating malnutrition. DAC relevance DAC countries are especially affected by malnutrition and our results are thus of direct interest to many countries and many populations worldwide. Over 50 countries have severe malnutrition guidelines, reflecting that the condition is very common in these countries. Our project partner countries (Ethiopia, Malawi) are typical of many others. Hence the results are likely to be much more widely generalizable. Jamica is typical of yet more DAC countries which have undergone social and economic transition so that undernutrition is no longer so common. However, there is a rapidly growing epidemic of overweight/obesity and associated chronic disease. Many older Jamaicans (and those in similar countries worldwide) will have been malnourished as children, hence our results are also relevant to them in flagging populations who are at high risk of NCD and thus need more proactive and effective preventative and treatment programmes. Gender Equality We have a diverse and mixed gender research project team who are leading the research in our different settings. This gives us a valuable range of different perspectives. Our participants are also a mixed group, with all malnutrition survivors followed up. As academics we recognize important differences between sex and gender (as per SAGER guidelines) However, in the countries where we work, it is culturally appropriate and expected to ask about sex rather than gender. Following local lead and advice, this is what we have therefore done. It is to respect local customs and cultures that we have framed our work as we have. When analyzing and presenting results, we present male/female sex-specific results. Related other work that we have done shows sex-specific risks of malnutrition (boys being more vulnerable in many settings) and different outcomes in male vs female survivors. Such differences are important to know about in order to maximise future policy/practice-relevant learnings. This sex-specific data that we have in our papers will also inspire other future researchers explore any possible reasons for observed differences. We hope that in this way improved future equity will be promoted and maintained. |
| Exploitation Route | 1. Academic papers and conferences - outcomes and impact for other researchers and scientists. We have already published a number of well cited papers and presented at academic conferences which influence and can be used by other scientists. By logging our data and outputs on a research depository, it is also possible that wider groups of future scientists as well as our own team will benefit from our work 2. Community and national dissemination meetings - outcomes and impact for local communities As per our project plans we have presented our work to the communities we have been working with and to national policy-makers and programme managers in Ethiopia and Jamaica. Impact on these is raised awareness of long-term consequences of malnutrition so that: - There is greater incentive and perceived need to prevent and treat malnutrition - There is greater awareness among any affected in early childhood to take care of their long-term health (though project fieldwork we were able to flag and refer any early risk factors like high blood pressure which otherwise would have gone unnoticed) 3. National media: outcomes and impact for the general public We were delighted to be interviewed and have our work on long-term malnutrition outcomes highlighted in a news report by Reuters, one of the world's leading news agencies https://www.reuters.com/world/middle-east/millions-children-food-crises-heightened-risk-lifelong-damage-2025-01-31/ The knowledge can thus be put to better advocacy and awareness raising purposes. 4. International and National policy fora - outcomes and impact for decision-makers and programme managers Two of our team, Debbie Thompson (Jamaica PI) and Marko Kerac (Overall project PI) were members of the WHO Guideline Development Group who worked towards the 2023 WHO Guideline on Severe Malnutrition in Infants and Children. Though issues of long-term outcomes and optimal rates of weight gain were not formally examined in this round of guideline updates, directly related issues about therapeutic food dosing were reviewed and we were able to thus bring our project-related learnings knowledge into those discussions. More recently, as countries are seeking to implement the new guidelines, issues of optimal post-malnutrition weight gain are again coming up and we are able to input into those discussion. Marko Kerac is an advisor to a follow-up project led by NGO Action Against Hunger, but supported by WHO, which is seeking to also contribute data to the question of "what is optimal post-malnutrition weight gain?". Overall, via these areas as well as others logged in detail in the ResearchFish site, our project work is thus having ongoing relevance and impact and can be used by many others in the global child health and nutrition community, and is especially relevant for those involved in treating child malnutrition. |
| Sectors | Healthcare |
| Description | Our results are already being noted and used by several key groups via our engagment activities: 1. Community and national dissemination meetings - outcomes and impact for local communities and partner countries As per our project plans we have presented our work to the communities we have been working with and to national policy-makers and programme managers in Ethiopia and Jamaica. Impact on these is raised awareness of long-term consequences of malnutrition so that: - There is greater incentive and perceived need to prevent and treat malnutrition - There is greater awareness among any affected in early childhood to take care of their long-term health (though project fieldwork we were able to flag and refer any early risk factors like high blood pressure which otherwise would have gone unnoticed) 2. National media: outcomes and impact for the general public We were delighted to be interviewed and have our work on long-term malnutrition outcomes highlighted in a news report by Reuters, one of the world's leading news agencies https://www.reuters.com/world/middle-east/millions-children-food-crises-heightened-risk-lifelong-damage-2025-01-31/ This helps raise awareness of the full devastating nature of malnutrition among the general public. 3. International and National policy fora - outcomes and impact for decision-makers and programme managers Two of our team, Debbie Thompson (Jamaica PI) and Marko Kerac (Overall project PI) were members of the WHO Guideline Development Group who worked towards the 2023 WHO Guideline on Severe Malnutrition in Infants and Children. Though issues of long-term outcomes and optimal rates of weight gain were not directly examined in this round of guideline updates, directly related issues about therapeutic food dosing were reviewed and we were able to thus bring our project-related learnings knowledge into those discussions. More recently, as countries are seeking to implement the new guidelines, issues of optimal post-malnutrition weight gain are again coming up and we are able to input into those discussion. Marko Kerac is an advisor to a follow-up project led by NGO Action Against Hunger, but supported by WHO, which is seeking to also contribute data to the question of "what is optimal post-malnutrition weight gain?". Overall, via these areas as well as others logged in detail in the ResearchFish site, our project work is thus having ongoing relevance and impact for the wider child health and nutrition community for those involved in treating child malnutrition. |
| First Year Of Impact | 2023 |
| Sector | Healthcare |
| Impact Types | Policy & public services |
| Description | MAMI Global Network (co-chair) |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Contribution to new or improved professional practice |
| Impact | Many organizations are now doing MAMI infant nutrition programme: these are inspired, helped and indirectly supported by us at the MAMI Global Network, including via monthly "implementors' meeting" and by many links and coversations that arise via the group. Several of us are also involved in the WHO Guideline Development Group - infants aged <6m are a key population being considered by WHO in this process. |
| URL | https://www.ennonline.net/ourwork/research/mami |
| Description | Member of WHO Guideline Development group for Severe Malnutrition 2021, 2022, 2023 |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | Though final guidelines are still not out the process is already influencing the work and thinking of the global experts who are, like myself, part of the WHO Guideline Development Group. Our work has been discussed in the guideline meetings: both MAMI infant malnutrition work and CHANGE project work of weight gain post malnutrition. 2024 update Final WHO guidelines have now been released. Our work has fed into these: - The approach to infants u6m at risk of poor growth and development is very heavily informed on our MAMI care pathway, developed over many years https://www.ennonline.net//mediahub/blog/mami-and-the-new-2023-who-recommendations-on-at-risk-infants-under-6-months - The paucity of evidence around optimal rates of weight gain (and hence what energy rations are optimal) is being addressed by the CHANGE project. |
| URL | https://app.magicapp.org/#/guideline/noPQkE/section/n32P8W |
| Description | Teaching and training future global health leaders and practitioners at LSHTM |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | In my teaching role at LSHTM I have multiple opportunties to teach and train (as well as learn from) our Msc and PhD students - many of whom will go on to be future leaders in global health in their own right. For example, I regularly: - Teach on Malnutrition on the Diploma in Tropical Medicine & Diploma in Tropical Nursing at LSHTM - Lead the organization of the "Nutrition in Emergencies" module - where there's a particuarly key opportunity to influence future leaders (as well as sharing details of the reserach I do in collaboration with various partners globally) - Discuss research-related issues with MSc students on the "Nutrition for Global Health MSc" - of which I am programme director - Discuss research-related issues with student and staff in the MARCH (Maternal, Adolescent, Reproductive and Child Health) Centre - of which I am co-lead for the C(Child) theme - this includes regular seminars and other meetings. MARCH newletters and other media also help disseminate key reserach findings and papers. All these are ongoing - I arrived at LSHTM in Sept 2014 and contibue to build and consolidate teaching/training at the university. |
| URL | https://www.lshtm.ac.uk/aboutus/people/kerac.marko |
| Description | Child malnutrition& Adult NCDs-Generating Evidence on mechanistic links in Jamaica, Malawi & Ethiopia to inform future policy/practice (CHANGE study) |
| Amount | £49,819 (GBP) |
| Funding ID | MR/T008628/1 |
| Organisation | Medical Research Council (MRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 07/2019 |
| End | 01/2020 |
| Description | MRC GCRF (top up grant - via LSHTM, to supplement and enable new outputs from CHANGE project: enhanced lab outputs project for Malawi ChroSAM cohort) |
| Amount | £25,600 (GBP) |
| Organisation | Medical Research Council (MRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 01/2023 |
| End | 03/2023 |
| Description | MRC GCRF (top up grant - via LSHTM, to supplement and enable new outputs from CHANGE project: quasi-RCT analaysis project) |
| Amount | £83,333 (GBP) |
| Organisation | Medical Research Council (MRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 07/2022 |
| End | 03/2023 |
| Title | A methodology to assess the risk of future non-communicable disease in children treated for severe malnourishment: analysis of a quasi-experimental trial |
| Description | Supported by a top-up grant to our MRC/GCRF CHANGE project, we developed a novel method to assess possible long-term impact of different quantity of nutrition rations. We have presented this at two meetings: - Nutrition & Growth, London, UK March 2023 - European Federation of Nutrition Societies, Belgrade, Serbia, Nov 2023 We are currently working on a manuscript for a peer-review paper. THis will make the tool more widely available to others |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | Too early for this - will report on this next year. |
| Title | CHANGE Cohort 1: Long-term Implications Of Nutrition (LION) dataset |
| Description | LION is an existing prospective cohort of survivors of severe malnutrition in Jamaica which has been followed-up post-discharge after been identified as severely malnourished and treated with specialised feeds. The cohort consist of malnourished children treated in inpatient care (1965-93). Included in the study are children with severe wasting (weight-for-age < 60%) or oedematous malnutrition (weight-for-age 60-80%, plus oedema). NCHS reference. The data comes from a cross-sectional retrospective survey on non-communicable disease (NCD) risk in adult survivors of severe malnutrition in childhood carried out between 2008-2012 at the Tropical Metabolism Research Unit (TMRU), the University of the West Indies (UWI), Jamaica. Adult data include blood pressure, anthropometric measures, body composition data, laboratory test results, and self-reported data relating to medical history, drug history and socioeconomic status. Childhood data include birth weight, and weight, length (height) and mid upper arm circumference (MUAC) measurements taken on admission, during hospitalization and up to 2 years post discharge from hospital. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | This has recently been posted and forms the background to one of our CHANGE project analyses |
| URL | https://datacompass.lshtm.ac.uk/id/eprint/2656 |
| Title | CHANGE Cohort 2: Chronic disease outcomes after Severe Acute Malnutrition (ChroSAM). Malawi |
| Description | A dataset containing information collected from a prospective cohort of children originally admitted for treatment of severe acute malnutrition (SAM) in Blantyre, Malawi during 2006 and 2007. It includes health and anthropometric data from admission to care, during treatment, at discharge, at 1 year post-discharge, and at 7-years post-discharge. During original admission to care, data was collected as part of a randomised controlled trial into the effects of pre- and probiotics on treatment recovery - findings were null (trial registry number ISRCTN19364765). At the most recent follow-up in 2013/14, data pertaining to NCD risk were also collected, and data on 1 sibling control and 1 community control (age and sex matched) was also added. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | This has just recently been posted and will form the basis of our CHANGE project analysis |
| URL | https://datacompass.lshtm.ac.uk/id/eprint/2657 |
| Title | CHANGE Cohort 3: Assessment of Long-Term Health Consequences of Acute Malnutrition (ACAM). Ethiopia |
| Description | ACAM is an existing prospective cohort of wasting treatment survivors in Ethiopia which has been followed-up post-discharge after been identified as severely malnourished and treated with therapeutic food. Population cohort includes malnourished children treated in outpatient care in 2014-15. Included in the study are children with WLZ |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | This has just recently been posted and will form the basis of our CHANGE project analysis |
| URL | https://datacompass.lshtm.ac.uk/id/eprint/2658 |
| Title | CHANGE Project (CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice) - main project page |
| Description | This is the main page for our CHANGE project describing overall aims and objectives. As papers come out they will be linked to this. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | We are still in process of gathering data but outputs will emerge over the coming years. Already the topic of weight gain after severe malnutrition has been discussed at a WHO Guideline meeting since evidence in this area is lacking: we anticipate that our project will help contribute important evidence to future disucssions/international/national guidelines. 2024 - further outputs will be added and linked to this project page. |
| URL | https://datacompass.lshtm.ac.uk/id/eprint/2655/ |
| Title | Data and code for: "Weight gain among children with severe malnutrition in therapeutic feeding programmes: a systematic review and meta-analysis" |
| Description | The aim of this systematic review and meta-analysis is to inform policy and programme discussions on optimal rate of weight gain in children being treated for severe malnutrition. Specific objectives are to: describe how weight gain has been measured and reported by treatment programmes; describe the rate of in-programme weight gain in different types of treatment programmes (e.g. inpatient, outpatient, hybrid); describe average length of stay (LOS) in different types of treatment programmes and explore any association with rate of weight gain; explore any association between rate of weight gain and programme outcomes (e.g. mortality, recovery). |
| Type Of Material | Database/Collection of data |
| Year Produced | 2024 |
| Provided To Others? | Yes |
| Impact | This is important background data to complement our systematic review on weight gain. As well as being a critical underpinning for the publication it has value for future projects - and is for example already feeding into a related NGO-led project on weight gain. |
| URL | https://datacompass.lshtm.ac.uk/id/eprint/4346 |
| Description | College of Medicine Malawi - Nutrition Projects |
| Organisation | University of Malawi |
| Department | Department of Paediatrics & Child Health |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | I have a long standing relationship with CoM Malawi, since originally working there as a volunteer paediatric registrar/lecturer in 2003-4. The link has both inspired and directly enabled my research career, hosting my PhD in 2005-8 and hosting subsequent links and projects ever since. Since the start of ACF/ACL posts I have maintained close links and have had several UCL MSc students visit Malawi to work on their projects there - all themed around my overall area of research into severe acute malnutrition / infant nutrition. We are currently collaborating on my AMS Clinical Lecturer Starter Grant - COM colleagues are co-authors on work presented at meetings to date and will be co-authors on the future papers arising. |
| Collaborator Contribution | The CoM (Department of Paediatrics in particular) have hosted my UCL MSc students and facilitated access to patients / staff for the the project. Without this the projects would not have been possible. They have also helped with room hire for the community dissemination event which I organized as a key output of my AMS starter grant. |
| Impact | Please see publications list: - Lelijveld et al - Ahmad et al. Other papers are in-progress (two are directly arising from the AMS starter grant: 1) Carers' and health workers' perspectives on Community Management of Acute Malnutrition (CMAM) in infants of less then 6 months: qualitative founding of a formative study from Malawi. (awaiting comments from co-authors; to be submitted to BMC Nutrition Journal) 2) Management of Acute Malnutrition in Infants aged <6 months (MAMI) in Malawi: prevalence and risk factors in an observational study (accepted for presentation at Royal College of Paediatrics Annual Meeting, April 2015. Will be submitted to peer review journal immediately after that) All the above pieces of work are already informing future research discussion / policy-discussions (e.g. in the ENN collaboration to develop assessment / patient management 'tools' for infants <6m). Hence there are already early impacts on policy/health services. 2016 update: This collaboration continues. CoM I hope will be involved in the adolescent study for which I have just been awarded a grant. We also continue collaborating on student projects. 2017 update I remain in contact with colleages at CoM. We are joint investigators on an application to look at body composition in our cohort of ex-malnourished children in Blantyre, Malawi - this is hoped to start later in 2017 (funding allowing) 2019 update - This past year I have not been out to Malawi but did have a MSc student visit over summer 2018 to work on a project looking at nutritional status of surgical patients. 2020 update - another MSc student did her MSc project on Malawi data which we hope to publish together. COM colleagues were also co-applicants on a MRC application (the full version of the CHANGE study). This is a good example of long term outcomes arising from a long established contact. 2024 update - We recently finished co-supervising a Malawi-Liverpool-Wellcome trust PhD focusing on a cohort of children originally treated for malnutrition in Malawi in 2006/7 (I originally recruited these into an RCT for my PhD). This is part of the CHANGE project and we are still collaborating on that (the project has been extended until Oct 2024) |
| Description | Jimma University MAMI Project (funded) & Post-malnutrition follow-up project (seeking funding) |
| Organisation | University of Jimma |
| Country | Ethiopia |
| Sector | Academic/University |
| PI Contribution | I am PI on the $2.5m Eleanor-Crook Foundation funded project on infant malnutrition. It is the culmination and major step forward for the infant nutriton work I've been doing for many years now. Related to but separate from the above project, Jimma are also partners on the MRC CHANGE study. We submitted the main application in Jan 2020 and are awaiting outcomes from a MARCH 2020 panel meeting. |
| Collaborator Contribution | Colleagues at Jimma are leading the research locally in Ethiopia where our study is set. |
| Impact | We have just started the project in Aug 2019 so are in year 1 developing formative work to inform our main RCT planned to start Oct 2020. March 2021 update: - We have completed MAMI project formative work though our main RCT plans have been delayed for a year due to COVID. - We were awared the follow-on larger grant and look forward to continued collaboration on the CHANGE project in 2021/22 (though an overall 3 year project we only have year 1 funding to begin with and need to meet project milestones in order to progress to full 32 month project) March2023 - collaboration still active. Publications and other outputs still in progress March 2024 update: - Following a 1 year no-cost extension to the CHANGE project, this collaboration is still active and working towards project aim/objectives. March 2025 update - We are finalizing the CHANGE project outputs but will still have data to analyse after project formal end in March 2025. We have agreed as a team to continue with regular meetings and to plan future papers and future grant applications together. So the collaboration is still very much active. |
| Start Year | 2019 |
| Description | Partnership with Cambridge University on CHANGE Project Child malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) |
| Organisation | University of Cambridge |
| Department | Institute of Metabolic Science (IMS) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Following a seed award in Sept 2019 - Jan 2020 we successfully applied for a 32 month MRC project to explore long term outcomes post severe malnutrition in more detail. We have to deliver on year 1 milestones for the project to proceed - these focus on profiling the cohorts and ensuring detailed plans for follow-up work. I am PI on the project and led both the writing of the seed award and also the main award. |
| Collaborator Contribution | Cambridge (Dr Albert Koulman - Wellcome-MRC Institute of Metabolic Science) are our key lab partner in the CHANGE project and will lead on lipidomic work |
| Impact | The main project is due to start this month, March 2021. Overall aims and objective are as below: THE AIM: To optimise severe malnutrition treatment programmes by better understanding the mechanisms linking infant/child undernutrition to longer-term (adult) NCD OBJECTIVES: 1. To understand how post-malnutrition weight gain (PMWG) affects risks of cardiometabolic NCD a. How does the timing of an episode of malnutrition influence this risk? b. How does severity of malnutrition influence this risk? c. How do different patient management approaches influence this risk? 2. To develop biomarkers for predicting NCD risk in survivors of child malnutrition by: a. Describing the biochemical characteristics of malnutrition survivors, differentiating those with/without NCD. b. Describing the biochemical profiles of different patterns of PMWG c. Identifying biomarkers common to different patterns of PMWG and NCD risk in survivors March2023 - collaboration still active. Publications and other outputs still in progress March 2024 update: - Following a 1 year no-cost extension to the CHANGE project, this collaboration is still active and working towards project aim/objectives. March 2025 update - We are finalizing the CHANGE project outputs but will still have data to analyse after project formal end in March 2025. We have agreed as a team to continue with regular meetings and to plan future papers and future grant applications together. So the collaboration is still very much active. |
| Start Year | 2020 |
| Description | Partnership with MEIRU (Malawi Epidemiology & Intervention Research Unit) - CHANGE Project Child malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) |
| Organisation | Malawi Epidemiology & Intervention Research Unit |
| Country | United Kingdom |
| Sector | Learned Society |
| PI Contribution | Following a seed award in Sept 2019 - Jan 2020 we successfully applied for a 32 month MRC project to explore long term outcomes post severe malnutrition in more detail. We have to deliver on year 1 milestones for the project to proceed - these focus on profiling the cohorts and ensuring detailed plans for follow-up work. I am PI on the project and led both the writing of the seed award and also the main award. |
| Collaborator Contribution | MEIRU are one of our 3 key partners and will collect data from two cohorts: - A cohort of children from 2003-4 (the "MEIRU 1000" cohort) who were small/undernourished then and who we will follow-up now in their teens to look for early signs of NCD - A birth cohort |
| Impact | The main project is due to start this month, March 2021. Overall aims and objective are as below: THE AIM: To optimise severe malnutrition treatment programmes by better understanding the mechanisms linking infant/child undernutrition to longer-term (adult) NCD OBJECTIVES: 1. To understand how post-malnutrition weight gain (PMWG) affects risks of cardiometabolic NCD a. How does the timing of an episode of malnutrition influence this risk? b. How does severity of malnutrition influence this risk? c. How do different patient management approaches influence this risk? 2. To develop biomarkers for predicting NCD risk in survivors of child malnutrition by: a. Describing the biochemical characteristics of malnutrition survivors, differentiating those with/without NCD. b. Describing the biochemical profiles of different patterns of PMWG c. Identifying biomarkers common to different patterns of PMWG and NCD risk in survivors March2023 - collaboration still active. Publications and other outputs still in progress March 2024 update: - Following a 1 year no-cost extension to the CHANGE project, this collaboration is still active and working towards project aim/objectives. March 2025 update - We are finalizing the CHANGE project outputs but will still have data to analyse after project formal end in March 2025. We have agreed as a team to continue with regular meetings and to plan future papers and future grant applications together. So the collaboration is still very much active. |
| Start Year | 2020 |
| Description | Partnership with Southampton University - CHANGE Project Child malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) |
| Organisation | University of Southampton |
| Department | Human development and health |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Following a seed award in Sept 2019 - Jan 2020 we successfully applied for a 32 month MRC project to explore long term outcomes post severe malnutrition in more detail. We have to deliver on year 1 milestones for the project to proceed - these focus on profiling the cohorts and ensuring detailed plans for follow-up work. I am PI on the project and led both the writing of the seed award and also the main award. |
| Collaborator Contribution | Southampton (Prof Jon Swan) are our key lab partner and will lead on metabolomic aspects of this work |
| Impact | The main project is due to start this month, March 2021. Overall aims and objective are as below: THE AIM: To optimise severe malnutrition treatment programmes by better understanding the mechanisms linking infant/child undernutrition to longer-term (adult) NCD OBJECTIVES: 1. To understand how post-malnutrition weight gain (PMWG) affects risks of cardiometabolic NCD a. How does the timing of an episode of malnutrition influence this risk? b. How does severity of malnutrition influence this risk? c. How do different patient management approaches influence this risk? 2. To develop biomarkers for predicting NCD risk in survivors of child malnutrition by: a. Describing the biochemical characteristics of malnutrition survivors, differentiating those with/without NCD. b. Describing the biochemical profiles of different patterns of PMWG c. Identifying biomarkers common to different patterns of PMWG and NCD risk in survivors March2023 - collaboration still active. Publications and other outputs still in progress March 2024 update: - Following a 1 year no-cost extension to the CHANGE project, this collaboration is still active and working towards project aim/objectives. March 2025 update - We are finalizing the CHANGE project outputs but will still have data to analyse after project formal end in March 2025. We have agreed as a team to continue with regular meetings and to plan future papers and future grant applications together. So the collaboration is still very much active. |
| Start Year | 2020 |
| Description | Partnership with UWI Tropical Metabolism Research Unit (TMRU) on application to study links between child malnutrition and adult NCD |
| Organisation | University of West Indies |
| Department | Tropical Metabolism Research Institute |
| Country | Jamaica |
| Sector | Academic/University |
| PI Contribution | Together with TMRU, Jimma University and MEIRU Malawi we applied to and obtained seed funding to develop a project to explore links between early child malnutrition and later life NCD. I am PI on the project and had a research assistant lead on a background systematic review / contribute to grant-writing. |
| Collaborator Contribution | TMRU colleauges made key scientific contributions to multiple aspects of this project: - The original concept - Co-authors on the systematic review - Co-authors of the full grant application - Hosted a research planning meeting in Jamaica in November |
| Impact | We submitted a full application to MRC in Jan 2020 and are awaiting results. Irrespective of what happens with that we hope that the collaboration can continue. March 2021 update: - We were awared the follow-on larger grant and look forward to continued collaboration on the CHANGE project in 2021/22 (though an overall 3 year project we only have year 1 funding to begin with and need to meet project milestones in order to progress to full 32 month project) March2023 - collaboration still active. Publications and other outputs still in progress March 2024 update: - Following a 1 year no-cost extension to the CHANGE project, this collaboration is still active and working towards project aim/objectives. March 2025 update - We are finalizing the CHANGE project outputs but will still have data to analyse after project formal end in March 2025. We have agreed as a team to continue with regular meetings and to plan future papers and future grant applications together. So the collaboration is still very much active. |
| Start Year | 2019 |
| Description | Swiss School of Public Health / University of Lausanne - China famine study |
| Organisation | Swiss School of Public Health |
| Country | Switzerland |
| Sector | Academic/University |
| PI Contribution | Following a PhD student event at which I was external speaker, I was invited to join the author group on a paper describing non-communicable disease outcomes. This was recently published. and contributes to our overall CHANGE project theme of work looking at child malnutrition/adult NCD links. This also let to an opportunity to write a AJCN editorial. 2025 Update As a team we are still in contact. An abstract looking at inter-generational issues has been submitted and we are still planning furhter follow-up papers. |
| Collaborator Contribution | Our partners here led the analysis and writing on the main paper. I inputted as a co-author. More recently, we discussed the possibility of a follow-on paper |
| Impact | We have together published one paper and one editorial 1) Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective. Cheng M, Sommet N, Kerac M, Jopp DS, Spini D. PLOS Glob Public Health. 2023 Aug 16;3(8):e0002161. doi: 10.1371/journal.pgph.0002161. eCollection 2023. PMID: 37585364 2) Long-term and intergenerational impacts of famine: why preventing and treating child malnutrition must be seen as an investment and not a cost. Kerac M, Cheng M. Am J Clin Nutr. 2024 Feb;119(2):239-240. doi: 10.1016/j.ajcnut.2023.12.001. Epub 2023 Dec 29. PMID: 38309820 Both these feed into societal/policy/public services impact regarding highlighting the importance of long-term sequelae of severe malnutrition. 2025 update - other abstract presented https://academic.oup.com/innovateage/article/8/Supplement_1/658/7937854 |
| Start Year | 2022 |
| Description | ACF (Action Contre la Faim) Research for Nutrition conference |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | The International Scientific Research for Nutrition Conference #R4NUT, organised by Action Contre la Faim, is a major meeting place to bring to light the latest research findings and topics related to undernutrition. It brings together internationally renowned field experts and researchers for a two-day exchange of knowledge and critical perspectives on the prevention, diagnosis and treatment of undernutrition. Based on field experiences, research projects, strategic guidelines or nutrition & health policies and programs, all the evidence generated is discussed during the conference. It will contribute to strengthening the knowledge and capacity of professionals involved in the fight against undernutrition. Action Contre la Faim recognizes the importance of harnessing local solutions in the fight against nutritional insecurity. It encourages operational, participatory, accountable, innovative and transformative research. At this meeting I was part of a session focusing on long term outcomes from severe malnutrition and with two junior colleagues presented on our CHANGE project work. This led to a good discussion and again focused people's attention on this often neglected part of malnutrition care. We hope that this information and change of focus will in future lead to more programmes/policies focusing on these long-term risks. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://research-for-nutrition-conference.org/ |
| Description | ANH (Agriculture, Nutrition & Health) Academy, Malawi, 2023 |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | The ANH Academy Week is a series of annual events that bring together the community of researchers, practitioners and policymakers working at the intersection of agriculture, food systems, nutrition, and health. The objective of the ANH Academy Week is to foster knowledge exchange, innovation and learning around interdisciplinary ANH research. The ANH Academy Week format may consist of one or two of these interlinked components: Learning Labs - a series of training workshops in interdisciplinary skills and knowledge for agriculture, nutrition and health research and practice; (explore all previous labs here) Research Conference - an abstract-driven symposium featuring oral presentations, poster sessions and keynote speeches, as well as plenary round tables, side events and working group discussions. At this 2023 ANH academy work I co-led a "learning lab" on severe malnutrtion and shared details and latest results from the MRC CHANGE project. This helped focus audience attention (and hopefully future programme/policy directions) on the importance of considering not just short-term outcomes from malnutrition but long-term outcomes too. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.anh-academy.org/academy-week/2023 |
| Description | ESPGHAN (European Society for Paediatric Gastroenterology & Nutrition) Webinar. September - Food insecurity: implications for child and public health |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Following an invited guest lecture to the ESPHGAN annual conference in May 2024, I was invited to present a webinar in Sept 2024. This was to a general audience. WIth the video now on youtube there is ongoing reach and impact and opportunity to share the presentation with a wide audience. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.youtube.com/watch?v=H6YwVjml9JQ |
| Description | IUNS (International Union of Nutrition Societies) Webinar March 2025 - Global Nutrition - talk on CHANGE project (Child Malnutrition & Adult NCD) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was a IUNS webinar. I was invited to present following a successful talk at an academic conference in Belgrade in Nov 2024. |
| Year(s) Of Engagement Activity | 2025 |
| URL | https://iuns.org/2024/12/joint-iuns-fens-webinar-in-march-2025/ |
| Description | New Scientist interview - Starvation-resistant cave fish |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | In March 2024 I was interviewed by a New Scientist jounralist about an article they were publishing on starvation-resistant cave fish (which authors were arguing might lead to improved future treatments for malnutrition) I took the opportunity to share wider information about severe malnutrition globally and also highlighted MRC-GRCF CHANGE project work on longer-term outcomes following severe malnutrition. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.newscientist.com/article/2421466-blind-cave-fish-offers-lessons-in-how-to-survive-starva... |
| Description | Presentation on "Zero Hunger" at Dec 2024 RCPCH International Child Health Group winter meeting |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | I was invited to give a guest lecture on "Zero Hunger" at the International Child Health winter meeting. This was mainly targetted at paediatricians - but also others interested in global child health. I has some nice feedback mails at the end of the talk. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.internationalchildhealthgroup.org/winter-meeting-2024 |
| Description | Rank Prize meeting on Severe Undernutrition |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | I was invited as a guest speaker to a RANK PRIZE symposium organized by Imperial College London. This was a meeting of about ~20 professionals and policy makers working in severe malnutrition. THe meetings are usually reported on the RANK website. DIscussions were had about possible future links and collaborations after sharing of ideas at the meeting. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.rankprize.org/symposia/ |
| Description | Reuters Article on Long-term outcomes following severe malnutrition |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Both I and two other colleagues on our MRC/GCRF CHANGE project on long-term outcomes from severe malnutrition were interviewed for this piece written by one of the world's biggest press agencies, REUTERS. On this platform there is a global reach and hence and opportunity to influence many worldwide, educating people that there are serious long-term as well as short-term implications of child malnutrition. From the piece "Scientists said much more research is needed to determine the precise causes of the many long-term impacts of malnutrition. Kerac, the London School of Hygiene and Tropical Medicine professor, said filling this "important evidence gap" could help improve both the initial treatment and the long-term support for formerly malnourished children." |
| Year(s) Of Engagement Activity | 2025 |
| URL | https://www.reuters.com/world/middle-east/millions-children-food-crises-heightened-risk-lifelong-dam... |
| Description | STRONGER foundation talk |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Supporters |
| Results and Impact | I was invited speaker to a STRONGER Foundations talk, speaking to core team and other funders who are part of coalition about my research and it's impact / what it might mean for future funding efforts. Though too early to say I planned this talk to influence future funding efforts and approach to work by funders (including reflection on why longer term investments are so important) |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://stronger-foundations.org/ |
| Description | Teaching on LSHTM courses: Diploma in Tropical Medicine; Diploma in Tropical Nursing; Nutrition in Emergencies Module |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | I regularly teach on severe malnutrition on the above three courses at LSHTM. All talks are informed by / include descriptions of research I'm also engaged with and a key aim (from my perspective) is to broaden awareness of the research - and in turn to imporve policy/practice in the field of severe malnutrition. THis happen because: - Some students go directly to research in this area (e.g. via summer project with myself; via projects with others) - Many of our students will go onto be leading policy-makers/practitioners in their own right. All the above begins with change in views/knowledge - as evidenced by positive feedback I get. |
| Year(s) Of Engagement Activity | 2019,2020,2021,2022,2023 |
| Description | USAID ELEVATE Nutriton programme - meeting on wasting and severe malnutrition, Dec 2024 |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an expert consultation organized by USAID. It brought together many international researchers, practitioners and policy makers to discuss improvements to the treatment of severe malnutrition. I presented data and results arising from our MRC/GCRF CHANGE project. |
| Year(s) Of Engagement Activity | 2024 |
| Description | WHO Meeting on "Feeding of At-Risk Infants" (FARI) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was a WHO-convened meeting bringing together researchers, policy-makers, funders and others working on nutrition/malnutrition in infants aged u6months. By sharing research and experience (mainly on my infant malnutrition MAMI project but also touching on others) the aim of the meeting was to influence future international and national guidelines. We had follow-up calls and communications to adopt some of the principles raised in our work. For now, with 2025 WHO funding crisis the work is on pause but we are hopeful things will resume in future. |
| Year(s) Of Engagement Activity | 2024 |
| Description | WHO Meeting on "Follow-up Care of the Small and Sick Newborn (SSN)" 10-12 June 2024, Geneva, Switzerland |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | This was a WHO-convened meeting bringing together researchers, policy-makers, funders and others working on small and at-risk infants. I was one of about 50 participants. It was a different group to the March 2024 FARI meeting - but with lots of overlaps topic wise. By sharing research and experience (mainly on my infant malnutrition MAMI project but also touching on others) the aim of the meeting was to influence future international and national guidelines. We had follow-up calls and communications to adopt some of the principles raised in our work. For now, with 2025 WHO funding crisis the work is on pause but we are hopeful things will resume in future. |
| Year(s) Of Engagement Activity | 2024 |