Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Bill & Melinda Gates Foundation, Seattle, WA, USA.
Lancet. 2021 Apr 10;397(10282):1400-1418. doi: 10.1016/S0140-6736(21)00568-7. Epub 2021 Mar 7.
As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda-now amplified by the COVID-19 crisis.
随着世界迈向 2025 年世界卫生大会营养目标和 2030 年可持续发展目标倒计时,尽管有关于有效干预措施的证据,并且对营养的政治承诺和财政投资不断增加,但全球仍有数百万人处于营养不良(体重不足、发育迟缓、微量营养素缺乏)状态。新冠疫情使卫生系统瘫痪,加剧了家庭粮食不安全,并使经济增长出现倒退,这些因素加在一起可能使低收入和中等收入国家在减少营养不良方面的进展出现倒退。本文重点介绍自 2013 年柳叶刀系列关于母婴营养以来,营养、健康、粮食系统、社会保护以及水、环境卫生和个人卫生干预措施的证据基础是如何演变的,并确定了在未来十年内恢复和加速进展所需的优先行动。针对生命最初 1000 天的政策和干预措施,包括自 2013 年以来新确定的一些措施,需要重新承诺、实施研究,并增加国内和全球行为体的供资。减少发育迟缓方面的国家和州一级成功案例的新证据表明,多部门行动对于解决营养不良的根本决定因素至关重要,并确定了有利政治环境的关键特征。为了支持这些行动,充足的营养数据和信息系统是必不可少的。本文最后呼吁 2021 年营养促进增长峰会将全球和国家营养利益攸关方团结起来,围绕解决一个庞大而未完成的营养不良议程的共同优先事项采取行动——现在因新冠疫情而加剧。