Experts tackle the challenges of malnutrition

The double burden of malnutrition (DBM) is characterized by the simultaneous manifestation of undernutrition and later-life increased risk of obesity. It poses an emerging global public health concern, predominantly in low and middle-income countries (LMICs).

A Rank Forum on Malnutrition was hosted at the Wellcome Collection in London in January 2023, and attended by global research experts on the field of undernutrition and obesity. The symposium addressed the challenges and gaps in malnutrition research as well as encouraging research collaborations that will lead to the reduction of DBM prevalence in LMICs countries.

The challenges of malnutrition

Speakers identified challenges in tackling the issue of malnutrition and proposed new research ideas that rethink the way current studies are planned and conducted. Some of the main challenges included the poor understanding of the mechanisms behind the metabolic and inflammatory pathways of all forms of severe complex undernutrition and the effect of concurrent disease on malnutrition exacerbation.  Severe undernutrition with concurrent disease, such as infections (pneumonia, sepsis and diarrhoea) causes increased mortality which continues to increase over time compared to the healthy reference group. The use of antibiotics fail to ameliorate this mortality risk. What is more, the use of broad spectrum antibiotics have a negative impact on the gut microbiota, especially of malnourished individuals that is already lacking microbial diversity.  This can have negative effects on morbidity and mortality by giving the right environment for pathogenic organisms to dominate. The effect of malnutrition and obesity in early infancy on diabetes was also discussed and mentioned that these result in a different diabetic phenotype characterised more by beta cell failure.

New avenues for research

The main propositions included adopting a holistic approach, covering both physiological and socioeconomic factors in in both severe malnutrition and DBM management, and targeting the critical first 1000 days of a child’s life, which can provide new insights concerning the gaps in the shift from undernutrition to obesity. Another area of interest was globally examining the population-level and individual levels of variations in pathophysiology and phenotypes, to encourage tailored prevention and treatment programs. Furthermore, since anthropometric measurements poorly predict long-term recovery, it was discussed that research on alternative inflammatory and metabolic markers can provide a more robust approach to assessing systemic recovery. Moreover, the gut is one of the organs predominantly affected by undernutrition which may compromise digestion and absorption of nutrients as well as the immune response.  Despite a plethora of research that supports the idea that the gut is affected by malnutrition, which in turn affects long-term recovery, there is a noticeable gap surrounding protein and energy digestibility and absorption, which makes it a vital topic to explore. With respect to clinical management, researchers proposed working towards improved and sustainable therapeutic feeds from locally sourced ingredients that aim to support gut integrity and gut microbiota. In addition, there is a need to re-evaluate the evidence behind the current advice on the nutritional composition of current milk-based feeds recommended by the WHO (called F75/F100) and explore different protein and energy contents.

The importance of fibre

Fibre was highlighted as the centre of obesity discussion since current diet trends leading to obesity in LMIC countries are rich in highly digestible carbohydrates but low in dietary fibre. Therefore, increasing dietary fibre consumption is a key factor in addressing the obesity issue. Increasing dietary fibre consumption can also play a part in reducing the colon cancer risk is this population. Dietary fibre can be increased through increasing fruit, vegetable and legume intake and addressing the social, economic and behavioural issues around the consumption of these foods. Programmes targeting school meals have been shown to have success and should continue to be implemented. In addition, novel food products, such as wrinkled peas which are high in resistant starch, can increase the delivery of fibre to the large intestine to support the microbiota and address the issue of obesity in the future.

The Nutrition Committee Forum grants provide scientists with funding to explore a topic of special interest relating to human nutrition, animal nutrition or crop husbandry. You can find out more about the scheme here. The grant is currently closed but will open again later in the year.

Professor Gary Frost (Imperial College London)

Professor Kath Maitland (Imperial College London)