Collaborative network for adolescent nutrition and health in sub-Saharan Africa and India

Our proposed project will focus on the nutrition and health of adolescent boys and girls. Adolescence is the stage of life, from 10 to 19 years of age, when children transition into adults. It is characterized by rapid growth, sexual maturation, widespread 're-wiring' and re-organisation of the brain, and an increase in the scope and complexity of social interactions. We currently have the largest generation of 10 to 19 year olds in human history, more than 1 billion worldwide, and half of these grow up in countries characterised by high levels of poor quality nutrition and rising rates of non-communicable disease (NCDs: obesity, heart disease and diabetes). In sub-Saharan Africa and South Asia, adolescents form 20-35% of the population.
It has recently become clear that adolescence is a critical phase in life for achieving human potential, and during which the physical, psychological, behavioural, social and economic foundations of adult health are consolidated. The recent Lancet commission on adolescent health points out that investment in this stage of the lifecourse has the potential to produce a 'triple dividend' benefiting adolescents now, into their future adult life, and into the lives of their children. Half of the inequality in the value of lifetime earnings is due to factors determined before the end of adolescence.
Despite its significance, adolescence has been largely neglected in health and social policy terms; a phenomenon recognised by the recent UN Global strategy for women's, children's and adolescents' health. Adolescent nutrition has, in particular, been under-researched, leading to large knowledge gaps. There have been no comprehensive studies of nutritional status and physical activity across different populations and settings. Little is known about how nutrition and physical activity change through adolescence, what determines these changes, and how they influence growth, current health, future disease risk, and the health of the next generation. We do not understand the drivers of dietary and activity behaviours among adolescents, and how these could be changed to benefit health.
Our application brings together a multi-disciplinary network of researchers interested in adolescent health from the UK, India and different regions of sub-Saharan Africa, with the collective expertise to carry out large-scale nutrition research. Our long-term vision is to 1) conduct in-depth studies of the dietary behaviour, nutritional status, body composition and physical activity of adolescents in vulnerable populations in these countries, and how these change through adolescence; 2) to understand, through qualitative research, the factors which determine their diet and activity behaviour at each stage of adolescence; and 3) develop and test context-specific interventions to improve adolescent health through nutrition.
In preparation for this ambitious future work, the current pump-priming application is to 1) consolidate the new network by holding two workshops, one in India, one in Africa; 2) conduct training in qualitative research methods and carry out pilot qualitative data collection to explore influences on dietary and activity behaviour in adolescents across multiple settings; 3) carry out literature reviews of existing data on the nutritional status of adolescents and existing policies for adolescent nutrition in the countries represented; 4) carry out secondary analyses using data from existing cohorts within the group, to examine how nutrition in young adolescence relates to adolescent growth and adult NCD risk markers; and 5) work together to develop the design of the future project, and prepare a larger grant application in 2018. A major objective of both the pump-priming work and the future larger study is to build capacity among early-and mid-career researchers in these countries for rigorous and cutting-edge nutrition research.

Adolescence (10-19 years of age) is a critical stage for physical, cognitive, psychological, social and economic development. Of 1 billion adolescents worldwide, half are in LMICs characterised by poor quality nutrition and rising rates of non-communicable disease (NCDs). Investment in adolescent nutrition has the potential to benefit adolescents themselves, their adult health, and the health of their children.
Despite its importance, research into adolescent nutrition has been relatively neglected. There are lareg knowledge gaps about the nutritional status and nutritional behaviour of adolescents, how these change during adolescence, and how they influence growth, neuro-development, later disease risk and the health of the next generation. The drivers of adolescent diet and activity, and how these could be modified to benefit health, are poorly understood.
We have formed a network of researchers in the UK, India and different regions of sub-Saharan Africa with the expertise to carry out large-scale nutrition research among adolescents. Its long-term vision is to 1) conduct in-depth studies of diet, nutritional status, body composition and physical activity among adolescents and how these change through adolescence; 2) understand the factors that determine diet and activity behaviour; and 3) develop and test context-specific interventions to improve adolescent nutrition.
In preparation for this work, the pump-priming application is to 1) consolidate the network by holding two workshops; 2) train early-career researchers in qualitative research methods and collect pilot data on diet and activity behaviour in adolescents; 3) review existing data on adolescent nutritional status and policies for adolescent nutrition in the countries represented; 4) conduct secondary analyses using data from existing cohorts to examine how nutrition relates to adolescent growth and NCD risk markers; and 5) design the future project and submit a major grant application in 2018.

Scientific advancement: We expect a significant burden of sub-optimal diet and activity patterns among adolescents in our populations. In the larger study we will also record their micronutrient and inflammatory status, body composition and fitness, and measure outcomes of sub-optimal nutrition such as growth, cognitive function, brain development and cardio-metabolic health. The work will define the need to improve adolescent nutrition, the potential benefits, and create impetus at local, national and international levels to do so. We will investigate whether adolescence is a critical period in which nutritional deficits can have long-term effects and interventions can reverse the adverse effects of earlier nutritional deficits, both of which would be of considerable scientific interest and justify a focus on this age group at policy level. Through the qualitative research we will understand barriers to good adolescent nutrition, and how these can be overcome in context-specific ways. The methods are not novel in themselves, though their application across multiple populations, in adolescents, is innovative, as will be their longitudinal use in the larger study. The study of epigenetic changes during adolescence in the larger study, and their relationship to nutrition and outcomes, will be highly original in a LMIC context.
Capacity building: The work will build capacity among the investigator groups at many levels. It will introduce some to population research, providing training and support within an experienced network. Field teams will benefit from community and participant engagement and training in harmonised data collection. In each site we will appoint an early/mid- career nutrition researcher for the pump-priming phase, to play a major role in co-ordination and community engagement, which will be invaluable research experience. They will benefit from qualitative research training, data collection and analysis, as well as participating in teams, working groups and network discussions to develop the future study. If we are successful in continuing to the larger study, we will aim to keep these researchers in the team and further their experience and career development. Other early- and mid-career investigators across several disciplines in each centre will have opportunities to participate in the research; contribute to training; develop ways of making their research accessible to lay and scientific groups; understand what makes collaborations 'tick' and the advantages of sharing data and skills; and deepen their expertise in nutrition and generic areas such as ethics, governance, advocacy and translation.
Economic and social impact: The project will have economic and social impact by leading to interventions and policies that improve the nutrition of adolescents and thus their health and that of their children. Much of this impact will be delivered through partnerships with stakeholders locally and internationally.
The pump-priming phase is unlikely to generate commercially exploitable results but there is potential for partnerships with nutrition food and leisure/sports industries in future, eg. to adapt and market digital devices and foods attractive to adolescents.
Each site will have a participant and community advisory group. In the larger study we will hold stakeholder workshops for teachers and health workers, those responsible for their activities, and policy-makers, to engage in thinking about how to improve adolescent nutrition. The study website will be for training in the pump-priming phase and in the larger project will be expanded with areas dedicated to engagement with participant, scientific and wider communities. The network and its partners have good links with national and international policy advisory groups such as the Indian and South African Medical Research Councils, WHO, the International Union of Nutritional Sciences and Unicef, which will be used to maximise the study's policy impact.