Severe malnutrition: building on the past for a brighter future.

There is increasing awareness that the perennial problem of poor nutrition that has blighted the development of individuals and whole communities is not acceptable in a world where the potential resources are so plentiful, but not infinite. Personal, social, and national development is critically dependent upon good nutrition, and the health costs of not putting the knowledge we have into practice can be neither justified nor sustained. The effectiveness with which the threat of starvation can be ameliorated in emergency situations has raised the question as to why we are not able to address this unacceptably common problem routinely as an integral aspect of healthcare delivery. This more insidious, less obvious challenge is now recognized by the international community, which has responded to the clear evidence of the nature of the problem and the potential solutions through activities such as the agenda of the Scaling Up Nutrition (SUN) Movement [1]. This, together with a focus on the nutritional well-being of all mothers and children, seeks to address the challenge to society of both wasting and stunting through the mobilization of national capability and intersectoral collaboration to achieve sustained change that will widen opportunity at scale and improve the life of all. For the 20th International Congress of Nutrition (ICN) held in Granada, Spain, in September 2013, the International Malnutrition Task Force (IMTF), of the International Union of Nutritional Sciences, in collaboration with the International Atomic Energy Agency (IAEA), organized a symposium on severe malnutrition in childhood in the context of the SUN agenda of the United Nations. In part the symposium was to celebrate the lifetime contributions of Professor John C. Waterlow to the scientific understanding of the natural history, pathophysiology, social determinants, and effective treatment and prevention of the condition. To this end, Dr. David Nabarro, a former student of John Waterlow and coordinator for the SUN Movement, was invited to present the first lecture named in Waterlow’s honor [2]. The symposium served to highlight the importance and activities of the SUN Movement, mark the progress that was being made, and indicate the necessary direction of travel. In preparation for the ICN symposium, IMTF and IAEA had held two meetings to review progress, one for sub-Saharan Africa and the other for Asia. The meeting for sub-Saharan Africa was held in Ghana in December 2012, and the meeting for Asia was held in Thailand in May 2013. Each meeting provided the opportunity for national experience with SUN to be reported and discussion around how the academic and clinical communities could add their support and weight to the SUN Movement itself. Among the notable challenges for the SUN Movement are the need for capacity-building in professional nutritional capability and the establishment of effective intersectoral collaborations at the national level. Central to the aspirations of IMTF are those aspects of technical competence, professional training and practice, and operational research to improve service organization and delivery that are needed to bring about fundamental and sustained improvement in nutritional well-being at scale, most especially among mothers and children [2]. This Supplement consists of a selection of the papers that were presented at the ICN, together with papers prepared at the regional meetings in preparation for the ICN. Overall, the Supplement characterizes the challenges in understanding the science and Alan Jackson, Ann Ashworth, Najat Mokhtar, and Ricardo Uauy