By Diane Baik; World Vision Canada, Carmen Tse; World Vision Canada, and Miriam Yiannakis; World Vision International
The 20th International Congress of Nutrition (ICN) took place in Granada, Spain earlier this year. It was a global gathering of the International Union of Nutritional Sciences that happens every four years. In total, sixteen abstracts presented were on World Vision’s work.
The presentations, posters, and sessions at the ICN were all certain in two key messages relevant for World Vision as health program implementers:
1. An integrated approach is required to address child stunting.
2. Improvement in child growth of any kind in the first 1000 days (from conception to 2 years of age) has long term protective effects.
For example, in academia today, there are still many studies that focus on single health interventions (e.g. nutrient supplements, multiple micronutrient tablets, etc.). However, we know that single interventions like this are not likely to sustainably improve child growth and nutrition because in most cases, there is more than one factor that contributes to malnutrition. An integrated approach is needed.
Addressing malnutrition is a complex issue, especially with the increasing evidence that improvement in child growth is more accurately measured by height, rather than weight. This is leading to a global shift from focusing on underweight to stunting. Presentations sharing the results of recent studies were clear in that rapid and large weight gain after 2 years of age can be harmful and can result in increased risks of non-communicable diseases. Consequently, focusing on improving the linear growth of children, rather than weight gain, is becoming the new standard. These studies further support the need to focus prevention and rehabilitation efforts on children in the 1000 day window.
The ICN also highlighted current concerns on the lack of coordination and regulation for multiple vitamin A interventions. For example, studies demonstrated that high-dose supplementation in addition to national fortification of staple foods with vitamin A can result in toxicity in children. Studies also found that using the current standard for testing vitamin A levels, serum retinol, we may not be able to accurately identify responses to interventions as the complex homeostatic mechanisms result in that proxy responding only in extreme deficiency or excess cases.
Despite this, new recommendations are likely forthcoming to support newborn dosing of vitamin A in the Asia region due to the significant decrease in infant mortality demonstrated in the Asian studies. This is not applicable to the African context.
There is also likely to be more discussion and a potential of new global recommendations to switch from an iron/folate tablet for pregnant women, to the use of a multiple-micronutrient tablet. Earlier concerns of potential adverse outcomes have been thoroughly reviewed and tested over the past few years and the evidence is now building. The Nutrition Centre of Expertise (NCOE) will be tracking this discussion and will keep the organisation updated if and when a new global policy is adopted.
Overall, the ICN made it clear that there is still a large disconnect and gap between the academic world and field programs. World Vision has an important role to help bridge the gap by continuing to improve our planning prior to implementation, to improve our monitoring and evaluation and improve how we assess the effectiveness of our interventions to contribute to the evidence base that is used to inform decisions and policies. Partnerships with academic institutions will help to improve the quality of programming, and also will contribute to a wider audience in the learnings and recommendations generated.
By better managing these areas we can contribute to more effective implementation and scale up of evidence-based interventions. We have the potential to not only significantly improve the impact that we as an organization have on child wellbeing, but we could also significantly improve the global response to the stubborn challenge of malnutrition globally.