Dietary changes can substantially reduce greenhouse gas emissions in Great Britain. Guidelines recommend reducing meat and dairy consumption while increasing plant-based foods, but household purchasing habits achieving these shifts are not well understood. Here we analysed food purchase data from ~30,000 British households (2012–2019), identifying 709 households that reduced their dietary greenhouse gas emissions by 34%. Using latent class analysis, we identified two distinct clusters among these households: plant-based adopters who reduced meat and dairy, adopting healthier diets; and households replacing meat with dairy and convenience foods, showing less healthy dietary changes. Plant-based adopters typically had higher education, higher incomes, were older (45+ years), and smaller in size. Households shifting toward dairy and convenience foods were older and smaller. Supporting healthy and sustainable diets requires targeted policies to enhance affordability, availability, and convenience of nutritious plant-based foods.

Globally, some 45 million children under five years of age are wasted (low weight-for-height). Although 2023 World Health Organisation guidelines on their care did not aim to identify optimal weight gain, they did mention 5–10 g/kg/day as a target, which is a change from prior guidelines that recommended 10–15 g/kg/day, when inpatient-only care was the norm. We aimed to inform future policy/programming on weight gain targets. For this systematic review and meta-analysis, we searched Embase, Global Health and Medline. The final search was on 23/02/2024. Papers were included if they reported weight gain of children aged 6–59 months with severe malnutrition during inpatient (facility-based), outpatient (home-based), and hybrid treatment (initially inpatient and progressing to outpatient treatment). Summary data were extracted, and quality was assessed using a NICE Quality Appraisal Checklist. Our primary outcome was mean rate of weight gain (g/kg/day) during treatment. We conducted random-effects meta-analysis to describe pooled mean weight gain by programme type. Meta-regression investigated potential associations of weight gain with length of stay and programme outcomes. We registered the study on PROSPERO (CRD42023266472). Our search yielded 3173 papers. We reviewed 321 full texts, identifying 126 eligible papers. Of these, 104 papers, including some 240,650 participants, reported weight gain as g/kg/day and were eligible for meta-analysis. Mean rate of weight gain was 8.8 g/kg/day (95% CI: 7.6, 9.9; I² = 97.8%) across 18 inpatient programmes, 3.4 g/kg/day (95% CI: 2.0, 4.7; I² = 99.4%) across 12 hybrid programmes, and 3.9 g/kg/day (95% CI: 3.4, 4.4; I² = 99.7%) across 60 outpatient programmes. We found inconsistent evidence of an association between slower weight gain and higher mortality: there was weak evidence of association after adjusting for programme type (coefficient = −0.4; 95% CI: −0.7, −0.02; p = 0.04; n = 118 programmes). There was high heterogeneity between studies. Details of weight gain calculation methods varied. We found no evidence for publication bias when accounting for programme type (Egger's test p-value = 0.2). Weight gain in outpatient programmes was markedly slower than in inpatient treatment. Clearer reporting of weight gain and a better understanding of the sequelae of faster/slower recovery is important to set future weight gain targets. Our results set an important baseline for current programmes to benchmark against. Medical Research Council/Global Challenges Research Fund, grant number: MR/V000802/1.

Background: Although 45 million children under five are wasted, the optimal rate of weight gain during treatment for severe malnutrition is unknown. Historically, inpatient treatment programmes focused on rapid weight gain (WG), with the rationale that this would optimise outcomes. However, recent evidence suggests that too rapid WG might be associated with higher cardiometabolic risk. Our objectives are as follows: describe WG in different programme types (e.g., inpatient, outpatient); explore any association between WG, average length of stay, and mortality/recovery; describe heterogeneity in WG reporting. Methods: For this systematic review and meta-analysis, we searched three databases: Embase (1947–2023), Global Health (1910–2023), and Medline (1946–2023), running the final search on 2nd May 2023. Papers were included if they reported average WG of children aged 6–59 months with severe malnutrition undergoing treatment. Non-English language and grey literature were excluded, except Emergency Nutrition Network Field Exchange articles. Summary data were extracted, and quality appraisal was done using a NICE Quality Appraisal Checklist. We conducted meta-analysis to describe pooled mean WG by programme type. We conducted meta-regression to investigate potential associations of WG with length of stay and programme outcomes. This study is registered with PROSPERO (CRD42023266472). Results: Our search yielded 3001 papers. We reviewed 307 full texts, identifying 127 eligible papers. Of these, 105 papers, with over 240,000 participants in total, reported WG as grams per kilogram per unit time and were eligible for meta-analysis. Mean rate of WG was 9.1 g/kg/d (95%CI 7.9, 10.3) across 19 inpatient programmes, and 3.9 g/kg/d (95%CI 3.5, 4.3) across 58 outpatient programmes. Faster WG was associated with shorter length of stay (p < 0.001), but this was moderated by programme type. There was no association between WG and mortality/recovery in unadjusted analyses. There was high heterogeneity between studies. Lastly, 17% of papers did not report WG as grams per kilogram per unit time. Conclusions: Slower WG can be expected in outpatient programmes, compared to inpatient programmes. However, this is not an immediate cause for concern because we found no important association between WG and mortality. It may even be beneficial considering long-term cardiometabolic risk.

Introduction: The treatment of severe childhood malnutrition focuses on short-term outcomes, like mortality prevention and anthropometric recovery. However, emerging evidence suggests a possible association between post-malnutrition growth and later non-communicable disease (NCD) risk. Our aim was to inform future child malnutrition treatment programmes by describing perceptions of optimal rates of post-malnutrition weight gain/growth; assessing how short- and long-term outcomes are currently understood and prioritised; understanding perceptions of the role of malnutrition treatment services in preventing longer-term NCDs. Methods: A mixed methods study, involving a global cross-sectional online survey (December 2023-March 2024) and key informant interviews (March-July 2024). Participants were professionals with experience in severe malnutrition and/or child health, identified through convenience and snowballing sampling. Quantitative data were analysed by descriptive statistics, while qualitative data were explored by thematic analysis. Results: Sixty-eight survey respondents were included, from a range of backgrounds. Ten were also interviewed. Almost half of survey participants perceived 5-10 g/kg/d as optimal weight gain in both inpatient and outpatient treatment. In terms of programme aims, 71% ranked ‘preventing mortality’ as the most important. Two-thirds (66%) rated reducing the risk of adulthood NCDs as a ‘very important’ long-term aim, while 3% said this was of ‘low/no importance’. Slower post-malnutrition weight gain was seen as beneficial by 69% of respondents, while 13% had opposing views and 18% were unsure. Key concerns were avoiding overfeeding/physiological disturbances and radical changes among those who supported slower weight gain, and worries about not meeting energy requirements among those who did not. Conclusions: There is strong consensus that preventing mortality remains the key aim of malnutrition treatment programmes but also increasing recognition of a potential to impact long-term NCD risk. Towards this, perceptions of optimal post-malnutrition weight gain targets vary, and better evidence is urgently needed to inform future policy/practice. What is already known on this topic: Treatment of severe childhood malnutrition focuses on short-term outcomes, such as mortality prevention and anthropometric recovery. Longer-term outcomes are rarely considered, yet recent evidence suggests a possible association between rapid post-malnutrition growth and later non-communicable disease (NCD) risk. What this study adds: Policy makers, programme managers, researchers, and other professionals leading current nutrition treatment programmes prioritise short-term outcomes of malnutrition treatment but most also believe that treatment can impact long-term outcomes, including NCDs. However, perceptions of the importance of any impact vary, as do ideas about how this can be achieved and concerns regarding risk-benefit balance ( e.g., slower growth might reduce future NCD risk but compromise short-term outcomes like mortality). How this study might affect research, practice or policy: Varied opinions on post-malnutrition weight gain and growth reflect large current evidence gaps and the urgent need for future research to determine optimal weight gain targets and growth patterns. Our data also highlights the need for greater consideration of long-term outcomes when planning malnutrition-related programmes and policy.