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

Child malnutrition is a major global public health problem. Wasting (low weight-for-height) is a particularly severe form of malnutrition affecting 49 million children and responsible for 900,000 deaths/year in children aged <5years. With climate change disproportionately affecting vulnerable populations, there is real danger of the problem worsening over coming decades. The need for optimal treatment programmes is immediate and great. Whilst malnutrition treatment programmes do exist, obstacles to their success include the need to: (1) Ensure children thrive long-term – not just survive short term Current programmes address the immediate risk of malnutrition-associated death. They do not account for increasing evidence that survivors are at greater risk of long term health problems from non-communicable disease (NCD) e.g. heart disease, diabetes, obesity. Because underlying mechanisms for the link are poorly understood, potential to tackle the ‘double-burden’ of malnutrition (i.e. coexistent undernutrition and overweight/obesity/NCD) is limited. (2) Understand & measure more meaningful outcomes – including future health risks Current programmes consider return to normal weight as the key marker of success. What really matters however is health. Predicting ill health many years later (adult NCD) is challenging. (3) Question assumptions around rapid post-malnutrition weight gain (PMWG) Current programmes often encourage rapid weight gain following an episode of malnutrition. However, high income country (HIC) data suggest show that too rapid a weight gain in small infants can cause harm by increasing future NCD risk2. Whether this trade-off between too slow vs too fast weight recovery also applies in low-and middle income countries (LMIC) is unknown. Responding to and addressing these challenges, the CHANGE project is a 3 year package of work with several aim and objectives (see User Guide for information).