Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021
- PMID: 39667386
- PMCID: PMC11703702
- DOI: 10.1016/S0140-6736(24)01821-X
Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021
Abstract
Background: The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.
Methods: The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.
Findings: In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.
Interpretation: Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.
Funding: Bill & Melinda Gates Foundation.
Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests S Afzal reports support from King Edward Medical University for study material, research articles, valid data sources and authentic real time information for the present manuscript. S Afzal reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, University of Massachusetts, King Edward Medical College Alumni Association of North America (KEMCAANA), and King Edward Medical College Alumni Association UK (KEMCA UK) for international scientific conferences, webinars, and meetings; support for attending meetings and/or travel from King Edward Medical University; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Ethical Review Board, Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital as a member of the Technical Working Group on Infectious Diseases; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with Pakistan Association of Medical Editors, Faculty of Public Health Royal Colleges UK (FFPH) as a fellow, Society of Prevention, Advocacy and Research, King Edward Medical University (SPARK), and Pakistan Society of Infectious Diseases as a member; other financial or non-financial interests as Dean of Public Health and Preventive Medicine at King Edward Medical University, Chief Editor of Annals of King Edward Medical University since 2014, Director of Quality Enhancement Cell at King Edward Medical University, Fellow of Faculty of Public Health United Kingdom, Advisory Board Member and Chair of Scientific Session KEMCA UK, Chairperson of International Scientific Conference KEMCAANA, Member of Research and Publications Higher Education Commission (HEC) Pakistan, Member of Research and Journals Committee Pakistan Medical and Dental Council, Pakistan Member of National Bioethics Committee at Punjab Level, Member of Corona Experts Advisory Group, Member of Technical Working Group on Infectious Diseases, Member of Dengue Experts Advisory Group, and Chair of Punjab Residency Program Research Committee; all outside the submitted work. R Ancuceanu reports consulting fees from AbbVie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Laropharm, Reckitt, Merck Romania; supports for attending meetings and/or travel from Merck Romania; all outside the submitted work. T Bärnighausen reports grants or contracts paid to their institution from the US National Institutes of Health (NIH), Alexander von Humboldt Foundation, German National Research Foundation (DFG), European Union, German Ministry of Education and Research, German Ministry of the Environment, Wellcome, KfW; honoraria as Editor-in-Chief of PLoS Medicine; participation on a Data Safety Monitoring Board or Advisory Board, unpaid, on two Scientific Advisory Boards for NIH-funded research projects in Africa on Climate Change and Health; stock or stock options in CHEERS, a subject matter expert focusing on approaches to measure climate change and health-related variables in population cohorts; all outside the submitted work. J Baker reports grants or contracts paid to their institution from World Cancer Research Fund, Novo Nordisk Foundation, Independent Research Fund Denmark; consulting fees to them and their institution from Novo Nordisk A/S; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events paid to their institution from Novo Nordisk A/S; leadership or fiduciary roles in board, society, committee, or advocacy groups, unpaid, with European Association for the Study of Obesity as Trustee; all outside the submitted work. O Baltatu reports grants or contracts from Alfaisal University; Anima Institute (AI) Research Professor Fellowship; and a National Council for Scientific and Technological Development Fellowship (CNPq, 304224/2022-7); leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with VividiWise Analytics as Managing Partner, São José dos Campos Tech Park – CITS as Health and Biotech Advisory Board Member; all outside the submitted work. S L Bell reports grants or contracts paid to their institution from US Environmental Protection Agency (EPA), NIH, High Tide Foundation, Health Effects Institute, Yale Women Faculty Forum, Environmental Defense Fund, Wellcome Trust Foundation, Yale Climate Change and Health Center, Robert Wood Johnson Foundation, Hutchinson Postdoctoral Fellowship; consulting fees from Clinique, ToxiMap, SciQuest; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, Organization of Teratology Information Specialists, University of Pennsylvania, Boston University, IOP Publishing, NIH, Health Canada, EHS, PAC-10, UK Research and Innovation (UKRI), AXA Research Fund Fellowship, Harvard University, University of Montana, and SciQuest; support for attending meetings and/or travel from Colorado School of Public Health, University of Texas, Duke University, Boston University, University of Pennsylvania, Harvard University, American Journal of Public Health, Columbia University, CMAS Conference, and Nature Conference; leadership or fiduciary roles in board, society, committee, or advocacy groups unpaid with Fifth National Climate Assessment, Lancet Countdown, Johns Hopkins EHE Advisory Board, Harvard external advisory committee for training grant, WHO Global Air Pollution and Health Technical Advisory group, National Academies Panels and Committees, and paid with US EPA Clean Air Scientific Advisory Committee (CASAC); all outside the submitted work. S Bhaskar reports grants or contracts from Japan Society for the Promotion of Science (JSPS) and Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) for a grant-in-aid for Scientific Research (KAKENHI) (P23712), and from JSPS and the Australian Academy of Science for a JSPS International Fellowship (P23712); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Rotary District 9675, Sydney, Australia (District Chair, Diversity, Equity & Inclusion), Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany (Chair, Founding Member and Manager), PLoS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research, and BMC Medical Research Methodology (Editorial Board Member), College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada (Member), World Headache Society, Bengaluru, India (Director of Research), Cariplo Foundation, Milan, Italy (Expert Adviser/Reviewer), National Cerebral and Cardiovascular Center, Department of Neurology, Suita, Osaka, Japan (Visiting Director), and Cardiff University Biobank, Cardiff, UK (Member, Scientific Review Committee); all outside the submitted work. Z A Bhutta reports grants or contracts from Gates Ventures and Bill & Melinda Gates Foundation, outside the submitted work. M Carvalho reports support from Laboratório Associado para a Química Verde (LAQV/REQUIMTE), and University of Porto, Porto, Portugal Foundation for Science and Technology (FCT) Portuguese Ministry of Science, Technology, and Higher Education (MCTES) under the scope of the project UIDP/50006/2020 (DOI 10.54499/UIDP/50006/2020), outside the submitted work. A L Catapano reports grants or contracts from Amryt Pharma, Menarini, Ultragenyx; consulting fees from Menarini - Menarini Ricerche, Sanofi; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amarin Amgen Amryt Pharma, AstraZeneca, Daiichi Sankyo Esperion Ionis Pharmaceutical Medscaper, Menarini, Merck, Novartis, Novo Nordisk, Peervoice, Pfizer, Recordati, Regeneron, Sandoz, Sanofi, The Corpus, Ultragenyx, and Viatris; all outside the submitted work. S Cortese reports grants or contracts from National Institute for Health and Care Research (NIHR) UK, European Research Agency; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Association for Child and Adolescent Mental Health (ACAMH), Medice, British Association of Psychopharmacology (BAP), and Canadian ADHD Resource Alliance (CADDRA); support for attending meetings and/or travel from Medice, BAP, and CADDRA; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with European ADHD Guidelines Group (EAGG) as Chair; all outside the submitted work. R C Franklin reports support for attending meetings and/or travel from ACTM – Tropical Medicine and Travel Medicine Conference 2022, 2023, ISTM – Travel Medicine Conference, Basel 2023; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Kidsafe as President/Director, Farmsafe as Director, Auschem as Director, ISASH Governance Committee as PHAA Injury Prevention SIG Convenor, and ACTM as President Elect; all outside the submitted work. N Ghith reports grants or contracts from Novo Nordisk Foundation (NNF16OC0021856) paid to their institute, Technical University of Denmark, between 2019 and 2022; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Danish Data Science Institute at the Technical University of Denmark, travel grant in 2023; support for attending meetings and/or travel from Danish Data Science Institute at the Technical University of Denmark; all outside the submitted work. P Gill reports support for the present manuscript paid to their institution from NIHR Senior Investigator Award. C Herteliu reports grants or contracts from the Romanian Ministry of Research, Innovation and Digitalization through UEFISCDI (project “Analysis of the impact of COVID-19 on the main demographic indicators in Romania and the Republic of Moldova by using econometric modeling”; code PN-IV-P8-8.3-ROMD-2023-0208), the European Commission Horizon 4P-CAN (Personalised Cancer Primary Prevention Research through Citizen Participation and Digitally Enabled Social Innovation), European Union – NextgenerationEU and Romanian Government under National Recovery and Resilience Plan for Romania through the Romanian Ministry of Research, Innovation and Digitalization, within Component 9, Investment I8 (projects “Societal and Economic Resilience within multi-hazards environment in Romania” contract no.760050/ 23.05.2023, cod PNRR-C9-I8-CF 267/ 29.11.2022 and “A better understanding of socio-economic systems using quantitative methods from Physics” contract no.760034/ 23.05.2023, cod PNRR-C9-I8-CF 255/ 29.11.2022); all outside the submitted work. I Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological development, Republic of Serbia (project No 175042, 2011-2023). M Ilic reports support for the present manuscript from the Ministry of Science, Technological Development and Innovation of the Republic of Serbia (no. 451-03-47/2023-01/200111). N E Ismail reports unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with the Malaysian Academy of Pharmacy as Bursar and Council Member and the Malaysian Pharmacists Society as Committee Member of the Education Chapter; all outside the submitted work. J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, Adamed, and Amgen; all outside the submitted work. K Kewal reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. B Lacey reports support for the present manuscript from UK Biobank, funded largely by the UK Medical Research Council and Wellcome, paid to their institution, the University of Oxford. M-C Li reports support for the present manuscript from the National Science and Technology Council, Taiwan (NSTC 113-2314-B-003-002). M-C Li reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with the Journal of the American Heart Association as Technical Editor, outside the submitted work. S Lorkowski reports grants or contracts paid to their institution from dsm-firmenich (formerly DSM Nutritional Products); consulting fees from Danone, Novartis Pharma, and Swedish Orphan Biovitrum (SOBI); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AMARIN Germany, Amedes Holding, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, Swedish Orphan Biovitrum (SOBI), and SYNLAB Holding Deutschland; support for attending meetings and/or travel from Amgen; participation on a Data Safety Monitoring Board or Advisory Board with Amgen, Daiichi Sankyo Deutschland, Novartis Pharma, and Sanofi-Aventis; all outside the submitted work. Y A Melaku reports grants or contracts from National Health and Medical Research Council of Australia (NHMRC) Investigator Grant (2009776) outside the submitted work. A-F Mentis reports grants or contracts from ‘MilkSafe: A novel pipeline to enrich formula milk using omics technologies’, a research co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH - CREATE - INNOVATE (project code: T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment for expert testimony from Fondazione Cariplo, Italy as external peer-reviewer; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Systematic Reviews and Annals of Epidemiology as Editorial Board Member, and with Translational Psychiatry as Associate Editor; stock or stock options in a family winery; other financial or non-financial support from BGI Group as Scientific Officer; all outside the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. A P Okekunle reports support for the present manuscript from National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265). A P Okekunle reports supports for attending meetings and/or travel from National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265) outside the submitted work. A Ortiz reports grants or contracts from Sanofi (paid to their institution: IS-FJD Universidad Autonoma de Madrid (UAM)) and as Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra Astrazeneca-UAM of chronic kidney disease and electrolytes (paid to their institution: UAM); consulting fees from Advicciene , Astellas, AstraZeneca, Amicus, Amgen, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Idorsia, Chiesi, Otsuka, Novo Nordisk, and Vifor Fresenius Medical Care Renal Pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Advicciene, Astellas, AstraZeneca, Amicus, Amgen, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Idorsia, Chiesi, Otsuka, Novo Nordisk, and Vifor Fresenius Medical Care Renal Pharma; support for attending meetings and/or travel from Advicciene, Astellas, AstraZeneca, Fresenius Medical Care, Boehringer-Ingelheim, Bayer, Sanofi-Genzyme, Menarini, Chiesi, Otsuka, and Sysmex; participation on a Data Safety Monitoring Board or Advisory Board with Astellas, AstraZeneca, Boehringer-Ingelheim, Fresenius Medical Care, Bayer, Sanofi-Genzyme, Idorsia, Chiesi, Otsuka, Novo Nordisk, and Sysmex; leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid with Council European Renal Association (ERA) Madrid Society of Nephrology (SOMANE); all outside the submitted work. 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A E Schutte reports grants or contracts from NHMRC of Australia and Medical Research Future Fund of Australia; consulting fees from Abbott, Skylabs, Medtronic, and Servier; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Medtronic, Servier, Omron, Aktiia, Sanofi, and Novartis; support for attending meetings and/or travel from Medtronic and Servier; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with National Hypertension Taskforce of Australia as Co-Chair and Hypertension Australia and Australian Cardiovascular Alliance as Board Member; all outside the submitted work. V Shivarov reports one patent and one utility model planned, issued, or pending filed with the Bulgarian Patent Office; stock or stock options in ICON plc; other financial or non-financial support via a salary from ICON plc; all outside the submitted work. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale University, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA Inc, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, and the NIH; payment or honoraria for speakers bureaus from Simply Speaking; past support for attending meetings and/or travel from OMERACT as a steering committee member; participation on a Data Safety Monitoring Board or Advisory Board (unpaid) with the US Food and Drug Administration Arthritis Advisory Committee; leadership or fiduciary roles in other board, society, committee, or advocacy groups with OMERACT as past steering committee member (paid), the Veterans Affairs Rheumatology Field Advisory Committee as Chair (unpaid), and the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as Editor and Director (unpaid); stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding, Aebona Pharmaceuticals, and Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals; all outside the submitted work. J D Stanaway reports support for the present manuscript from the Bill & Melinda Gates Foundation via grants paid to their institution. A G Thrift reports grants or contracts paid to their institution from NHMRC (Australia), Heart Foundation (Australia), and Stroke Foundation (Australia); all outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Benang Merah Research Center, Indonesia as Co-Founder outside the submitted work. M Y Wei reports grants or contracts paid to their institution with NIH National Institute on Aging and Veterans Health Administration; leadership or fiduciary roles in board, society, unpaid committee, or advocacy groups with the Society of General Internal Medicine; all outside the submitted work.
Figures
Comment in
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The uncertainties of monitoring progress towards achieving global nutrition targets.Lancet. 2025 Dec 21;404(10471):2488-2489. doi: 10.1016/S0140-6736(24)02180-9. Epub 2024 Dec 9. Lancet. 2025. PMID: 39667383 No abstract available.
References
-
- WHO . World Health Organization; Geneva: 2014. Comprehensive implementation plan on maternal, infant and young child nutrition.https://www.who.int/publications-detail-redirect/WHONMH-NHD-14.1 - PMC - PubMed
-
- UNICEF. WHO . World Health Organization; Dec 11, 2017. The extension of the 2025 maternal, infant and young child nutrition targets to 2030.https://www.who.int/docs/default-source/nutritionlibrary/global-targets-...
