Maternal and child malnutrition, encompassing both undernutrition and overweight, are global problems with important consequences for survival, incidence of acute and chronic diseases, healthy development, and the economic productivity of individuals and societies. Maternal and child undernutrition, including stunting, wasting, and deficiencies of essential vitamins and minerals, was the subject of a Series1, 2, 3, 4, 5 in The Lancet in 2008, which quantified their prevalence, short-term and long-term consequences, and potential for reduction through high and equitable coverage of proven nutrition interventions. The Series identified the need to focus on the crucial period of pregnancy and the first 2 years of life—the 1000 days from conception to a child’s second birthday during which good nutrition and healthy growth have lasting benefits throughout life. The 2008 Series also called for greater national priority for nutrition programmes, more integration with health programmes, enhanced intersectoral approaches, and more focus and coordination in the global nutrition system of international agencies, donors, academia, civil society, and the private sector. 5 years after that series, we intend not only to reassess the problems of maternal and child undernutrition, but also to examine the growing problems of overweight and obesity for women and children and their consequences in low-income and middle-income countries (LMICs). Many of these countries are said to suffer the so-called double burden of malnutrition, with continuing stunting of growth and deficiencies of essential nutrients along with obesity in national populations and within families. We also want to assess national progress in nutrition programmes and international actions consistent with our previous recommendations.
Key messages
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Iron and calcium deficiencies contribute substantially to maternal deaths
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Maternal iron deficiency is associated with babies with low weight (<2500 g) at birth
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Maternal and child undernutrition, and unstimulating household environments, contribute to deficits in children’s development and health and productivity in adulthood
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Maternal overweight and obesity are associated with maternal morbidity, preterm birth, and increased infant mortality
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Fetal growth restriction is associated with maternal short stature and underweight and causes 12% of child deaths
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Stunting prevalence is slowly decreasing globally, but affected at least 165 million children younger than 5 years in 2011; wasting affected at least 52 million children
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Suboptimum breastfeeding results in more than 800 000 child deaths annually
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Undernutrition, including fetal growth restriction, suboptimum breastfeeding, stunting, wasting, and deficiencies of vitamin A and zinc, cause 45% of child deaths, resulting in 3·1 million deaths annually
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Prevalence of overweight and obesity is increasing in children younger than 5 years globally and is an important contributor to diabetes and other chronic diseases in adulthood
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Undernutrition during pregnancy, affecting fetal growth, and the first 2 years of life is a major determinant of both stunting of linear growth and subsequent obesity and non-communicable diseases in adulthood
The present Series is guided by a framework (figure 1) that shows the means to optimum fetal and child growth and development, rather than the determinants of undernutrition as shown in the conceptual model developed by UNICEF and used in the 2008 Series.1 This new framework shows the dietary, behavioural, and health determinants of optimum nutrition, growth, and development and how they are affected by underlying food security, caregiving resources, and environmental conditions, which are in turn shaped by economic and social conditions, national and global contexts, resources, and governance. This Series examines how these determinants can be changed to enhance growth and development. These changes include nutrition-specific interventions that address the immediate causes of suboptimum growth and development. The framework shows the potential effects of nutrition-sensitive interventions that address the underlying determinants of malnutrition and incorporate specific nutrition goals and actions. It also shows the ways that an enabling environment can be built to support interventions and programmes to enhance growth and development and their health consequences. In the first paper we assess the prevalence of nutritional conditions and their health and development consequences. We deem a life-course perspective to be essential to conceptualise the nutritional effects and benefits of interventions. The nutritional status of women at the time of conception and during pregnancy is important for fetal growth and development, and these factors, along with nutritional status in the first 2 years of life, are important determinants of both undernutrition in childhood and obesity and related diseases in adulthood. Thus, we organise this paper to consider prevalence and consequences of nutritional conditions during the life course from adolescence to pregnancy to childhood and discuss the implications for adult health. In the second paper, we describe evidence supporting nutrition-specific interventions and the health effects and costs of increasing their population coverage. In the third paper we examine nutrition-sensitive interventions and approaches and their potential to improve nutrition. In the fourth paper we examine the features of an enabling environment that are needed to provide support for nutrition programmes and how they can be favourably changed. Finally, in a Comment6 we will examine the desired national and global response to address nutritional and developmental needs of women and children in LMICs.