By Marion Roche, PhD

Approximately 162 million children are stunted.In the global nutrition community the human costs of stunting are well recognized: stunted children complete less school, have less learning and earning opportunities, and females who become moms in the future are more likely to give birth to stunted children. Intervening early in 1000-day window (from conception to the age of two) and even earlier, pre-pregnancy, is recognized as most cost-effective way to prevent, as in many settings it challenging to reverse the physical and cognitive deficits from chronic malnutrition. Beyond the human costs, there is also an economic case to be made for investing in stunting reduction.

Every four years, the world’s leading economists and experts from diverse development fields come together to rank the best investments for development in what is called the Copenhagen Consensus. Nutrition is one such investment that is consistently ranked as a “best buy”. Specific interventions such as vitamin A supplementation, salt iodization, zinc & ORS for diarrhea treatment and support for breastfeeding and adequate complementary feeding have all been in the top 10 best investments in previous years. In addition, nutrition-sensitive approaches, such as keeping girls in school, improvements to agriculture yields and crop quality, enabling gender equity for women, and overall poverty reduction, are all necessary to sustainable long-term stunting reductions for communities and countries.

This month, world leaders and experts met in Addis Ababa, Ethiopia for the Third International Financing for Development conference. A presentation by Dr. Meera Shekar of the World Bank and Dr. Robert Hetch of Results for Development at an MI co-hosted side-event on nutrition at the conference laid out what it would take to achieve the World Health Assembly target of reducing stunting by 40% by 2025. They emphasized that strategic investing in improving the nutrition situation for 68 million children would offer a long-term $45 dollar return on each dollar invested. More specifically, every dollar invested in reducing stunting is estimated to generate an $18 return in the long run. However, although many nutrition interventions look affordable on an individual scale, a more detailed analysis has been done to show what it would cost to deliver these interventions and reduce stunting at a global scale.

The Financing for Development conference was centred on funding the Sustainable Development Goals, the set of targets relating to the of future international development post-2015. Looking at the return on investment (ROI) in nutrition and knowing that nutrition has such a profound effect on other areas of a person’s life, I think there is no better investment the world can make to reach the SDGs more quickly and effectively than that in nutrition!

By Hassan S Dashti, PhD

When we describe our habitual diets, we often find ourselves talking about its nutritional composition (i.e. what) and quantity (i.e. how much), however novel research suggests that timing of intake might be yet another important component of diet we want to pay attention to. This was the main focus of discussion at the ASN Scientific Sessions at EB 2015 symposium titled, “Is ‘When’ We Eat as Important as ‘What’ We Eat? – Chronobiological Aspects of Food Intake” (read more here: https://www.nutrition.org/asn-blog/2015/04/timing-is-everything/). Biologically, this makes sense as an endogenous clock, commonly termed the circadian clock, regulates a constellation of biologic processes, including metabolism (1). If up to 30 percent of genes in the intestines, liver, and kidney fluctuate throughout the day, yielding varying temporal functional profiles, doesn’t it make sense that there ought to be a time when dietary intake is optimal? Well, if the effect of a calorie on health is dependent on timing, what we all would like to know next is at what time should we be eating?

What currently determines our timing of intake is our culture and lifestyle for the most part. For instance, kids’ lunchtime is predetermined by school cafeterias, adults’ dinnertime is predetermined by rush-hour traffic, but even breakfast also seems to determine when we’ll have our next meal, lunch (2). History also played a role in determining meal times. In certain parts of the world, lunchtime was set for noon to enable workers to cope with long working hours in factories during the Industrial revolution. Perhaps it’s time to have science determine our meal hours.

Preliminary evidence suggests that earlier meal times tend to be healthier and “better aligned” with our biological clock. In one study, it was found that calories consumed after 8:00pm significantly predicted higher BMI (3). Meanwhile results from a 20-week weight loss intervention among overweight and obese individuals suggested that late eaters (lunch after 3:00pm) were less successful at weight loss compared to early eaters (lunch before 3:00pm), independent of 24-hour energy intake (4). Another trial assessing overweight and obese women further identified that high-calorie breakfasts, as opposed to high calorie dinners, were more beneficial for various cardiometabolic traits (5). Consistent with the findings from these trials is a cross-sectional analysis of a diverse cohort in the Los Angeles area that suggested that participants who consumed over a third of their calories by noon were less likely to be overweight and obese (6).

While these findings generally suggest that earlier hours of intake are generally healthier, they are not without their many limitations. One limitation worth noting is the high interrelatedness between timing of intake and other aspects of diet and life that also impact overall health and particularly sleep timing and duration, frequency of intake, and hours of fasting. Therefore, future studies should account for these strongly related dimensions when elucidating the timing of intake that best aligns with our internal clock.

1.Garaulet M, Gómez-Abellán P. Timing of food intake and obesity: a novel association. Physiol Behav. 2014 Jul;134:44–50.
2.Kant AK, Graubard BI. Within-person comparison of eating behaviors, time of eating, and dietary intake on days with and without breakfast: NHANES 2005-2010. Am J Clin Nutr. 2015 Sep;102(3):661–70.
3.Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obesity (Silver Spring). 2011 Jul;19(7):1374–81.
4.Garaulet M, Gómez-Abellán P, Alburquerque-BÉjar JJ, Lee Y-C, Ordovás JM, Scheer FAJL. Timing of food intake predicts weight loss effectiveness. Int J Obes (Lond). 2013 Apr;37(4):604–11.
5.Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring). 2013 Dec;21(12):2504–12.
6.Wang JB, Patterson RE, Ang A, Emond JA, Shetty N, Arab L. Timing of energy intake during the day is associated with the risk of obesity in adults. J Hum Nutr Diet. 2014 Apr;27 Suppl 2:255–62.