Childhood malnutrition is one of the world's most pressing health challenges, and Kathryn Dewey, distinguished professor emerita in the UC Davis Department of Nutrition, has been at the forefront of efforts to address it. Her pioneering research led to an innovative supplement to combat nutritional deficiencies and has informed and improved global health policies.

“So many people think that child malnutrition will be with us forever, and there’s not much you can do about it,” Dewey said. “That’s not at all true. We’ve made quite a lot of progress, and the global nutrition community takes the view that it’s possible to eradicate childhood malnutrition.”

The prevalence of stunting in height has declined by 33% in children under five years of age since 2000, Dewey notes. Additionally, childhood mortality for those under age 5 declined globally by 60% since 1990. Nutrition is one of the many reasons for the improvement, Dewey said.

From Farming to Nutrition

Dewey was drawn to nutrition in part through her interest in how the shift to farming some 10,000 years ago affected human diet and development. “Diets as a whole got worse after the agricultural revolution because we rely too much on cereal grains,” she said. “On average, people became shorter in height, which we call stunting. That situation is still the case in many lower-income countries.”

Worldwide, 148 million children under the age of 5 years suffer from nutrition-related growth stunting. The lack of necessary nutrients during the crucial first 1,000 days from conception to a child’s second birthday can influence a child's entire life, from physical health to cognitive abilities.

Dewey started to tackle the issue of how to improve nutrient intakes of young children more than 20 years ago, testing locally available nutrient-rich foods (such as fish powders), sprinkles containing vitamins and minerals, and other “home fortificants” that could be added to porridge to bump up nutritional value. The research team found success with a lipid-based supplement, which is a paste that includes oil, peanut butter (or other legume), milk powder, vitamins and minerals. The supplement is tasty and doesn't require refrigeration or clean water, making it an ideal solution in resource-limited settings. It can also be eaten directly or added to other foods. The paste provides key minerals like iron and zinc — per 100 calories, infants need four times as much zinc and nine times as much iron as an adult male.

Through global collaborations with scientists and community partners, Dewey and her colleagues conducted extensive trials in low- and middle-income countries like Ghana and Malawi to test the supplement paste. Much of this work was funded by the Gates Foundation grant to conduct four large randomized trials in three countries in Africa. In 2019-2022, results from these trials and 10 additional trials were compiled in pooled analyses that included more than 37,000 children, led by the UC Davis team. The combined results indicated that the supplement reduced mortality by 27%, severe wasting malnutrition by 31%, severely stunted growth by 17%, iron deficiency anemia by 64%, and developmental delay by 16–19% among children six to 23 months old.

This research contributed to the inclusion of the supplement in the Lancet Series on Maternal and Child Nutrition, an influential resource in the field. In 2023, it was included in two sets of World Health Organization Guidelines, one on complementary feeding and another on prevention and management of wasting.  In October 2024, the supplement will feature prominently in the World Bank’s Investment Framework for Nutrition, which guides numerous countries in prioritizing health expenditures to maximize economic growth and development outcomes. “Childhood nutrition has fundamental consequences for the economic growth of countries and the ability of populations to be productive,” Dewey said.

Engaging Locally and Globally

Dewey’s approach to research has been deeply collaborative. She has worked to ensure that local researchers and organizations are not just participants but active contributors to the research and publications. This inclusive method ensures that the interventions developed are practical and sustainable within local contexts. “It takes a lot of time and care to make it work,” she said. “One of the things I appreciate most about my colleagues in global nutrition is that their major motivation is improving the welfare of people in disadvantaged populations, and that comes with a framework of equity and fairness.”

Looking forward, Dewey is passionate about the potential for collaborative initiatives to address not just malnutrition but also the associated health challenges like infections, inflammation and adverse birth outcomes. She continues to be actively involved in research and professional service, focusing on integrating nutrition with broader public health efforts.

“I’ve always wanted the work that I do to have an impact,” she said.