Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006, USA.
Lancet. 2013 Aug 10;382(9891):536-51. doi: 10.1016/S0140-6736(13)60843-0. Epub 2013 Jun 6.
Acceleration of progress in nutrition will require effective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and effectiveness of nutrition-specific interventions. We reviewed evidence of nutritional effects of programmes in four sectors--agriculture, social safety nets, early child development, and schooling. The need for investments to boost agricultural production, keep prices low, and increase incomes is undisputable; targeted agricultural programmes can complement these investments by supporting livelihoods, enhancing access to diverse diets in poor populations, and fostering women's empowerment. However, evidence of the nutritional effect of agricultural programmes is inconclusive--except for vitamin A from biofortification of orange sweet potatoes--largely because of poor quality evaluations. Social safety nets currently provide cash or food transfers to a billion poor people and victims of shocks (eg, natural disasters). Individual studies show some effects on younger children exposed for longer durations, but weaknesses in nutrition goals and actions, and poor service quality probably explain the scarcity of overall nutritional benefits. Combined early child development and nutrition interventions show promising additive or synergistic effects on child development--and in some cases nutrition--and could lead to substantial gains in cost, efficiency, and effectiveness, but these programmes have yet to be tested at scale. Parental schooling is strongly associated with child nutrition, and the effectiveness of emerging school nutrition education programmes needs to be tested. Many of the programmes reviewed were not originally designed to improve nutrition yet have great potential to do so. Ways to enhance programme nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimise women's nutrition, time, physical and mental health, and empowerment. Nutrition-sensitive programmes can help scale up nutrition-specific interventions and create a stimulating environment in which young children can grow and develop to their full potential.
加速营养方面的进展需要采取有效、大规模的营养敏感方案，解决营养的关键根本决定因素，并加强营养具体干预措施的覆盖范围和效果。我们审查了四个部门（农业、社会安全网、儿童早期发展和学校教育）方案对营养的影响证据。增加农业生产、保持低价和增加收入的投资需求是无可争议的；有针对性的农业方案可以通过支持生计、增加贫困人口获得多样化饮食的机会以及促进妇女赋权来补充这些投资。然而，农业方案的营养效果证据尚无定论——除了通过生物强化橙色甘薯增加维生素 A 以外——主要是因为评估质量较差。社会安全网目前为数以亿计的贫困人口和冲击（如自然灾害）受害者提供现金或食品转移。个别研究表明，对于接触时间更长的年幼儿童有一些影响，但营养目标和行动存在缺陷以及服务质量较差，可能是缺乏整体营养效益的原因。综合儿童早期发展和营养干预措施对儿童发展——以及在某些情况下营养——显示出有希望的附加或协同效果，并可能在成本、效率和效果方面带来实质性收益，但这些方案尚未在大规模情况下进行测试。父母的受教育程度与儿童营养密切相关，新兴学校营养教育方案的有效性需要进行测试。许多被审查的方案最初并非旨在改善营养，但具有很大的潜力。增强方案营养敏感性的方法包括：改进目标定位；利用条件来刺激参与；加强营养目标和行动；并优化妇女的营养、时间、身心健康和赋权。营养敏感方案有助于扩大营养具体干预措施，并创造一个激励环境，使幼儿能够充分发挥其潜力成长和发展。
