Angood Chloe, Khara Tanya, Dolan Carmel, Berkley James A
ENN, Oxford, Oxfordshire, United Kingdom.
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
PLoS One. 2016 May 9;11(5):e0153221. doi: 10.1371/journal.pone.0153221. eCollection 2016.
Wasting and stunting are global public health problems that frequently co-exist. However, they are usually separated in terms of policy, guidance, programming and financing. Though both wasting and stunting are manifestations of undernutrition caused by disease and poor diet, there are critical gaps in our understanding of the physiological relationship between them, and how interventions for one may affect the other. The aim of this exercise was to establish research priorities in the relationships between wasting and stunting to guide future research investments.
We used the CHNRI (Child Health and Nutrition Research Initiative) methodology for setting research priorities in health. We utilised a group of experts in nutrition, growth and child health to prioritise 30 research questions against three criteria (answerability, usefulness and impact) using an online survey. Eighteen of 25 (72%) experts took part and prioritised research directly related to programming, particularly at the public health level. The highest-rated questions were: "Can interventions outside of the 1000 days, e.g. pre-school, school age and adolescence, lead to catch-up in height and in other developmental markers?"; "What timely interventions work to mitigate seasonal peaks in both wasting and stunting?"; and "What is the optimal formulation of ready-to-use foods to promote optimal ponderal growth and also support linear growth during and after recovery from severe acute malnutrition?" There was a high level of agreement between experts, particularly for the highest ranking questions.
Increased commitment to rigorous evaluations of treatment and prevention interventions at the public health level, addressing questions of the timing of intervention, and the extent to which impacts for both wasting and stunting can be achieved, is needed to inform global efforts to tackle undernutrition and its consequences.
消瘦和发育迟缓是经常同时存在的全球性公共卫生问题。然而，它们在政策、指导、规划和资金方面通常是分开处理的。尽管消瘦与发育迟缓都是由疾病和不良饮食导致的营养不良表现，但我们对二者之间生理关系以及针对其中之一的干预措施如何影响另一个方面的理解仍存在重大差距。本研究的目的是确定消瘦与发育迟缓关系方面的研究重点，以指导未来的研究投资。
我们采用了儿童健康与营养研究倡议（CHNRI）方法来确定卫生领域的研究重点。我们利用一组营养、生长和儿童健康方面的专家，通过在线调查，依据三个标准（可回答性、实用性和影响力）对30个研究问题进行优先排序。25名专家中有18名（72%）参与了调查，并对与规划直接相关的研究进行排序，特别是在公共卫生层面。评分最高的问题是：“1000天之外的干预措施，如学前、学龄期和青春期的干预，能否使身高及其他发育指标实现追赶？”；“哪些及时的干预措施能有效缓解消瘦和发育迟缓的季节性高峰？”；以及“即食食品的最佳配方是什么，既能促进最佳体重增长，又能在严重急性营养不良恢复期间及之后支持线性生长？”专家之间达成了高度共识，尤其是对排名最高的问题。
需要加大力度在公共卫生层面严格评估治疗和预防干预措施，解决干预时机问题以及实现消瘦和发育迟缓影响的程度问题，为全球应对营养不良及其后果的努力提供依据。
