Perceptions of Optimal Post-Malnutrition Weight Gain & Growth: a global mixed methods study

IntroductionThe 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. MethodsA 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. ResultsSixty-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. ConclusionsThere 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 topicTreatment 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 addsPolicy 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 policyVaried 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.