Nutrition: a quintessential sustainable development goal.

In the fi nal paper of our 2008 Lancet Series on maternal and child undernutrition, Saul Morris and colleagues wrote that, “The international nutrition system—made up of international and donor organisations, academia, civil society, and the private sector—is fragmented and dysfunctional”. They concluded that, incredibly, no evidence base existed to prioritise actions to improve nutrition. And they argued that the voice of countries must be better heard, felt, and refl ected in global decision making. Too often country priorities to strengthen nutrition were ignored by donors and agencies alike. 5 years on, thanks to the work of a consortium of scientists led by Robert E Black from Johns Hopkins Bloomberg School of Public Health (the Maternal and Child Nutrition Study Group), we review the progress made against these fi ndings and recommendations. Although some news is better than 5 years ago, there is still a deeply worrying gulf between country needs and global actions. But what is most diff erent—an extraordinary opportunity as well as a severe challenge—is the political urgency of nutrition. This latest Lancet Series updates, with extensive new data, the contribution undernutrition in its various forms makes to child mortality and morbidity. Compared with 2008, the result is a radically diff erent picture of the relation between nutritional defi ciencies and child health. The overall fi nding is that 3·1 million children younger than 5 years die every year from undernutrition; that is a staggering 45% of total child deaths in 2011. To address this enormous and too often hidden cause of child mortality, the Maternal and Child Nutrition Study Group propose a new framework to optimise the delivery of priority evidence-based interventions to prevent and treat undernutrition across the whole life course. Unique to this Series is the systematic approach to both the timing of the interventions and to creating an enabling environment for nutrition. The Maternal and Child Nutrition Study Group emphasises ten interventions targeted to women of reproductive age, during pregnancy, and to infants and children. They calculate the eff ects of these interventions in 34 countries across Africa, Asia, and the Middle East, where 90% of the global burden of undernutrition resides. In doing so, they reinforce the importance of the fi rst 1000 days from conception to 2 years. What goes right and what goes wrong for fetal and child nutrition during this period has lasting and irreversible consequences for later life. There are several entirely new fi ndings in this Series. First, the adolescent girl is identifi ed as especially vulnerable to the eff ects of undernutrition. But that very predicament also makes adolescent girls a group with a special opportunity too. Second, the importance of fetal growth restriction or being born small for gestational age is highlighted. According to new estimates, fetal growth restriction causes more than 800 000 neonatal deaths and 20% of stunting in children younger than 5 years worldwide. These fi ndings are presented by Robert E Black and colleagues, and Joanne Katz and colleagues in the companion Article. Third, the Series is not only concerned with interventions. It also identifi es delivery platforms for the implementation of those interventions, most promisingly in the community and in schools. Fourth, the Series costs these interventions and explains why those costs—an additional Int$9·6 billion annually for the 34 countries identifi ed—are much less prohibitive than they might at fi rst seem. And fi nally, the Series identifi es a further threat to maternal and child nutritional status: overweight and obesity. On June 8, 2013, the Governments of Brazil and the UK will co-host a Nutrition for Growth event. There is therefore an immediate opportunity to foster political Published Online June 6, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)61100-9