Intersecting health and nutrition, infectious disease and the environment in low-to-middle income settings

The origins of this symposium

The idea for this symposium emerged from discussions at two previous Rank Prize-funded events. The first was a symposium held in June 2022 on “Alternatives to antimicrobials: Implications for the food chain” during which it became clear that, if we are going to address the issues around antimicrobial resistance (AMR) effectively, we will need to consider a wide range of environmental and socioeconomic factors that contribute to antimicrobial use and misuse. These issues are particularly critical in low- and middle-income countries (LMIC) where poverty and inadequate access to sufficient nutritious food lead to poor immune function and higher rates of infectious diseases that exacerbate the effects of undernutrition, especially among young children. Poor sanitation results in faecal contamination in water sources, leading to contamination of food directly or indirectly, and to contamination of local environments that exacerbate the problems of AMR.

A few months later in January 2023, Rank Prize funded a Forum on “Understanding the impact of severe undernutrition on morbidity and mortality in later life” that was organised by Professors Gary Frost and Kath Maitland (Imperial College London). Presentations and discussion at this Forum revealed that children in LMIC who have experienced severe undernutrition are particularly vulnerable to the adverse effects of chronic exposure to Western-style energy-rich foods (that are changing the food environment globally) with greater risk of developing major non-communicable diseases e.g. obesity, type 2 diabetes, and cardiovascular disease in later life.  Although there is good evidence to support this double hit hypothesis, little is known about how to protect populations from this major health problem.

Discussions with Professor David Graham (a speaker at the “Alternatives to antimicrobials” symposium) and with Professors Frost and Maitland led to the idea of bringing together key themes from the Symposium and from the Forum to address intersecting health and nutrition, infectious disease and the environment in LMIC settings.

The aims of the symposium

This symposium was designed to advance nutritional knowledge by bringing together expertise across climate change, nutrition, infection, agriculture, and policy to understand how nutritional systems could be maintained and enhanced and infectious disease reduced in the face of the climate crisis.

Key topics discussed

The symposium opened with a high-level review of the challenges in bringing together the jigsaw of nutrition, environmental challenges and human physiology. A discussion of field studies and use of AI to mitigate AMR in low resource settings globally was followed by evidence of the impact of AMR on public health. This led to consideration of interactions between AMR, food production systems and the climate crisis.  The focus then shifted to malnutrition, especially of children in LMIC, and included the hypothesis that environmental enteropathy is the missing link in understanding stunted growth in childhood undernutrition. The focus on the gut continued with discussion of the global rise in intestinal colonisation with AMR bacteria. Actions for mitigation in LMIC also included consideration of AMR in the water-plant-food nexus. Finally, each of the themes of the symposium was brought together in a presentation arguing for the urgency of taking a systems approach and that adopting such a paradigm shift would enable the transition to sustainability.

The winners of the best speaker ECR prizes

The quality of presentations by ECRs was very high and the organisers decided to make three awards that recognise the excellence of the presentations, of the science and of the discussion following each ECR presentation. The prizewinners were:

• Ruairi Robertson, postdoctoral researcher from Queen Mary University London speaking on Multi-omics signatures of one-carbon metabolism differentiate oedematous versus non-oedematous severe acute malnutrition
• Bethany Duffy, postdoctoral researcher from Ulster University speaking on Maternal riboflavin deficiency during pregnancy and its relationship with hypertension, anaemia and offspring growth
• Mahek Jain, PhD student from University of Glasgow speaking on Gut bi-directional rehabilitation of children with severe malnutrition

Professor John Mathers (Newcastle University, Rank Prize Nutrition Committee)

Professor Gary Frost (Imperial College London)

Professor David Graham (Durham University)

Professor Kathryn Maitland (Imperial College London)