Foodborne diseases are important causes of illness and death. The first estimates of their burden were published by WHO in 2015. We updated WHO estimates of the global, regional, subregional, and national foodborne disease burden caused by 42 infectious and chemical hazards in 2021, including time trends for 2000-21. We provide a high-level summary of foodborne disease burden, expressed as incidence, deaths, and disability-adjusted life-years (DALYs). Data for burden estimation were provided from a WHO-commissioned series of systematic reviews on the incidence, aetiology, sequelae, and case fatality or mortality of the hazards. Data were analysed using hierarchical meta-regression modelling with geographical clustering and a global linear time trend, disease-specific computational models, and uncertainty propagation through Monte Carlo simulations to calculate 95% uncertainty intervals. Attribution to foodborne transmission was principally based on a structured expert judgement process. Economic impact was measured as lost productivity. For 2021, foodborne transmission of the 42 hazards caused 866 million (95% uncertainty interval 680-1090) illnesses, 1·52 million (0·783-2·51) deaths, and 57·1 million (39·4-81·1) DALYs. Inorganic arsenic, lead, and non-typhoidal Salmonella enterica (diarrhoeal and invasive disease) resulted in the most DALYs. The greatest burden of foodborne disease was in the African and South-East Asia regions. The incidence in children younger than 5 years was 2·7 times higher than in people aged 5 years or older, resulting in 4·3 times the rate of DALYs. The total burden from all hazards decreased over time. In 2021, these 42 hazards resulted in productivity losses of US$310 billion in nominal terms, and US$647 billion after adjusting for purchasing power parity. Foodborne diseases causes a burden similar to that from tuberculosis, HIV and AIDS, or malaria. The high burden of both communicable and non-communicable foodborne diseases requires countries to prioritise developing strategies to improve the safety of the food supply. WHO.

The World Health Organization’s (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level—the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)—and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition.

Objective To synthesise evidence from contemporary populations (2009-24) across diverse world regions and income settings on associations between gestational weight gain (GWG) and broad clinical outcomes, to inform updated, globally relevant GWG standards. Design Systematic review and meta-analysis. Setting Observational studies in all languages, with >300 participants, reporting pregnancy outcomes stratified by body mass index (BMI) and GWG. Participants Women aged >18 years with singleton pregnancies. Main outcome measures Birth weight and rates of caesarean delivery, hypertensive disorders of pregnancy, preterm birth, small/large for gestational age infant, low birth weight, macrosomia, neonatal intensive care unit (NICU) admission, respiratory distress, hyperbilirubinaemia, and gestational diabetes. Results Of 16 030 studies, 40 met inclusion criteria (n=1 608 711); 6% (n=65 114) of women had underweight, 53% (n=607 258) had normal weight, 19% (n=215 183) had overweight, and 22% (n=252 970) had obesity. GWG was below or above Institute of Medicine (IOM) or study specific recommendations in 23% and 45%, respectively. Using World Health Organization BMI criteria, GWG below IOM recommendations was associated with lower birth weight (mean difference −184.54, 95% confidence interval −278.03 to −91.06); lower risk of caesarean delivery (odds ratio 0.90, 0.84 to 0.97), large for gestational age infant (0.67, 0.61 to 0.74), and macrosomia (0.68, 0.58 to 0.80); and higher risk of preterm birth (1.63, 1.33 to 1.90), small for gestational age infant (1.49, 1.37 to 1.61), low birth weight (1.78, 1.48 to 2.13), and respiratory distress (1.29, 1.01 to 1.63). GWG above IOM recommendations was associated with higher birth weight (mean difference 118.33, 53.80 to 182.85); higher risk of caesarean delivery (odds ratio 1.37, 1.30 to 1.44), hypertensive disorders of pregnancy (1.37, 1.28 to 1.48), large for gestational age infant (1.77, 1.62 to 1.94), macrosomia (1.78, 1.60 to 1.99), and NICU admission (1.26, 1.09 to 1.45); and lower risk of preterm birth (0.71, 0.64 to 0.79) and small for gestational age infant (0.69, 0.64 to 0.75). For Asian BMI criteria, GWG below recommendations was associated with higher risk of hypertensive disorders of pregnancy (3.58, 1.37 to 9.39) and preterm birth (1.69, 1.25 to 2.30) and lower risk of large for gestational age infant (0.80, 0.72 to 0.89). GWG above recommendations was associated with higher risk of caesarean delivery (1.37, 1.29 to 1.46) and large for gestational age infant (1.76, 1.42 to 2.18) and lower risk of small for gestational age infant (0.62, 0.53 to 0.74) and low birth weight (0.44, 0.31 to 0.6). Conclusions This systematic review captured trends of rising maternal age and BMI from diverse world regions and income settings, with broad outcomes across all BMI groups. GWG outside IOM recommendations was associated with increased risk of adverse outcomes. These findings will help to inform the process of the WHO initiative to optimise globally relevant GWG standards for improved perinatal outcomes across world regions. Study registration PROSPERO CRD42023483168.

Over 20 million children under 5 years old in the WHO Eastern Mediterranean Region have stunted growth, as a result of chronic malnutrition, with damaging long-term consequences for individuals and societies. This review extracted and analyzed data from the UNICEF, WHO and the World Bank malnutrition estimates to present an overall picture of childhood stunting in the region. The number of children under 5 in the region who are affected by stunting has dropped from 24.5 million (40%) in 1990 to 20.6 million (24.2%) in 2019. The reduction rate since the 2012 baseline is only about two fifths of that required and much more rapid progress will be needed to reach the internationally agreed targets by 2025 and 2030. Prevalence is highest in low-income countries and those with a lower Human Development Index. The COVID-19 pandemic threatens to undermine efforts to reduce stunting, through its impact on access and affordability of safe and nutritious foods and access to important health services. Priority areas for action to tackle stunting as part of a comprehensive, multisectoral nutrition strategy are proposed. In light of the threat that COVID-19 will exacerbate the already heavy burden of malnutrition in the Eastern Mediterranean Region, implementation of such strategies is more important than ever.

Childhood nutritional status serves as a lens through which nations and communities identify missed opportunities to improve health and wellbeing across the life cycle, as well as economic development and other related sectors. Countries have committed to the global nutrition targets endorsed by the World Health Assembly in 2012, which were included in the Sustainable Development Goals framework under the target to end all forms of malnutrition by 2030. The child malnutrition indicators for tracking countries' progress toward the agreed-upon targets are based on standard definitions of nutritional status against the widely adopted and used World Health Organization (WHO) Child Growth Standards. The standards were based on a sample of healthy breastfed infants and young children from diverse ethnic backgrounds and cultural settings as part of the WHO Multicentre Growth Reference Study. The WHO Child Growth Standards developed represent the best description of physiological growth for children aged <5 y. The standards depict normal early childhood growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socioeconomic status, and type of feeding.