Fulfilling Every Child’s Potential through Integrated Nutrition and Early Childhood Development Interventions A Call to Action and Policy Brief Every Child’s Potential: A Call to Action and Policy Brief This document has been prepared to advance key messages based on Annals of The New York Academy of Sciences, volume 1308. It is a call to action, supported by a policy brief, to commit effort and resources to integrate effective interventions across disciplines and modes of delivery, so as to enable every child to fulfill their potential. We are particularly thankful to the authors who contributed to this volume. All references are available at the end of the document, and full articles are available, with free access, online. Advisory group for drafting key messages: Mandana Arabi, MD, PhD, Executive Director, The Sackler Institute for Nutrition Science (2011-2014) Maureen Black, PhD, Professor, Department of Pediatrics and the Department of Epidemiology and Public Health at the University of Maryland School of Medicine Kathryn Dewey, PhD, Distinguished Professor, Department of Nutrition, Director of Program in International and Community Nutrition, University of California Davis Lia Fernald, PhD, MBA, Professor, Public Health Nutrition and Community Health and Human Development, University of California Berkeley Jane Lucas, PhD, Consultant, WHO and UNICEF Document prepared by: Mireille Mclean, MA, MPH, Associate Director, The Sackler Institute for Nutrition Science Matthew Graziose, MS, Department of Health and Behavior Studies, Teachers College, Columbia University Graphic design by: Katherine Aguilera Recommendation for quoting: The Sackler Institute for Nutrition Science (2015) “Fulfilling Every Child’s Potential through Integrated Nutrition and Early Childhood Development Interventions”. New York, NY, The New York Academy of Sciences 2 ❛❛ Good physical and mental health, achievements in school and work, and the ability to empathize with and help other people have their roots in early childhood. Experiences in the first years of life shape what we become – physically, emotionally, and socially. …Now, more than ever, every individual should have the right to attain their full development potential. – Dr. Margaret Chan, Director - General, World Health Organization (WHO) Foreword to “Every Child’s Potential: Integrating Nutrition and Early Childhood Development Interventions” Volume 1308 of Annals of the New York Academy of Sciences In many tribes, children are not spoken to until they reach the ‘age of knowing’… (approximately 7-8 years old)…Adults may refrain from speaking directly to children until they can respond…It is critical as we conceive our strategies for early child development that we think about addressing those social norms, the cultural traditions that underlie lack of stimulation and the lack of engagement… – Dr. Nicholas Alipui, Programme Director, UNICEF Closing Remarks at the Technical Seminar: Every Child’s Potential, hosted on February 6, 2014 at UNICEF, with The Sackler Institute for Nutrition Science I work with a team that is quite passionate about promoting maternal and child health. We have been ignorant and unaware of the importance of stimulation in our effort of promoting child health…Since I started introducing them to [new training materials], they have been amazed by the learning and discovery and have explored ways of integrating stimulation with our health activities. (Source: Yousafzai et al. 2014) ❛❛ – Lucy Nyaga, Project Manager of Community Health Department (AKHS, Kenya) 3 Every Child’s Potential: A Call to Action Ensuring Every Child’s Potential through Integrated Nutrition and Early Childhood Development Interventions An estimated 200 million children under the age of 5 years, worldwide, do not develop their potential. Poor nutrition, lack of responsive caregiving and too few opportunities to learn undermine children’s development. Growing populations, demographic shifts, violence, and food scarcity put many more children at risk. Damage to growth and development in childhood results in poor health, lower educational achievement and reduced productivity into adulthood. It increases social inequities, and threatens the wellbeing of societies and countries. Existing resources fail to meet these challenges; and we must look for ways to focus our energy and resources on interventions that are most effective in helping young children grow well, be healthy and become more able and self-confident to meet the opportunities and responsibilities of adulthood. A recent issue of Annals of the New York Academy of Sciences (2014, volume 1308) gathers the current state of evidence on integrating effective interventions across two disciplines— nutrition and child development—into one global effort. It sharpens our focus on what best promotes children’s healthy growth and early development. Evidence from nutrition research demonstrates that adequate nutrition early in life, while promoting ideal growth and better health, can also protect children and contribute to the early development of motor, cognitive, and social-emotional abilities. Likewise, interventions to promote the development of skills in early childhood can also improve the family’s feeding and other caregiving skills, which are necessary for children’s healthy growth. Therefore, the considerable evidence presented in Annals indicates that integrating interventions can be more effective than delivering the interventions separately through nutrition and child development services (See ‘What is Integration?’). Integration can simultaneously address multiple, related barriers to children’s development, including poor nutrition, impoverished family circumstances, parents’ poor mental health, and lack of opportunities for early learning. Experiences show that combining efforts can result in a more efficient use of resources. Integration is an approach that helps us set priorities and focus health, education, and other community services. The savings will permit us to direct resources for a greater reach to more children and their caregivers, including families who live in marginalized and underserved communities. Integrating and expanding efforts to improve nutrition and child development can make it possible to meet the needs of impoverished children more effectively, and stretch our resources to benefit more children (See ‘What is Scale-up?’). The range of evidence and program experience documented suggests that the following actions will make the greatest difference: 1 Integrate nutrition and child development interventions for young children and their families, wherever possible. 2 Focus on learning and nutrition in early childhood by promoting high-quality family care. 3 Adapt interventions to address the local capacities and constraints of families and communities. 4 Identify the best practices and appropriate indicators in an integrated delivery of interventions through focused research and program evaluation. 5 Mobilize the endorsements of leaders across intergovernmental and government agencies, nongovernmental organizations, academia, and others in civil society to bring effective interventions to scale and sustain them. 4 This Call to Action is supported by the following scientists (in alphabetical order) Frances Aboud, PhD, Professor of Psychology, McGill University Amina Abubakar, PhD, KEMRI/WTRP Kenya, and Lancaster University Harold Alderman, PhD, Senior Research Fellow, International food Policy Research Institute Orazio Attanasio, FBA, Jeremy Bentham Professor of Economics, Head of the Department of Economics, University College London and Institute for Fiscal Studies Zulfiqar A. Bhutta, PhD, MBBS, FRCPCH, FAAP, Co-Director, Centre for Global Child Health at The Hospital for Sick Children (SickKids) Maureen Black, PhD, Professor, Department of Pediatrics and the Department of Epidemiology and Public Health at the University of Maryland School of Medicine Hillary Creed-Kanashiro, MPhil , Senior Researcher, Instituto de Investigación Nutricional, Lima, Peru Kathryn Dewey, PhD, Distinguished Professor, Department of Nutrition, Director of Program in International and Community Nutrition, University of California Davis Ilgi Ertem, MD, Professor of Pediatrics, Ankara University Jessica Fanzo, PhD, Assistant Professor of Nutrition, Institute of Human Nutrition and Department of Pediatrics, Senior Advisor of Nutrition Policy, Center on Globalization and Sustainable Development, Columbia University Sylvia Fernadez-Rao, PhD, Research Officer, National Institute of Nutrition, India Lia Fernald, PhD, MBA, Professor, Public Health Nutrition and Community Health and Human Development, University of California Berkeley Raghu Lingam, PhD, Clinical Senior Lecturer and Honorary Consul, University of Newcastle Florencia Lopez Boo, PhD, Social Protection and Health Unit Inter-American Development Bank Jane Lucas, PhD, Consultant, WHO and UNICEF Reynaldo Martorell, PhD, Robert W. Woodruff Professor of International Nutrition, Hubert Department of Global Health, Senior Advisor, Global Health Institute, Emory University Bruce McEwen, PhD, Alfred E. Mirsky Professor, Head, Harold and Margaret Milliken Hatch, Laboratory of Neuroendocrinology, The Rockefeller University Gretel Pelto, PhD, Graduate Professor, Cornell University John Phuka, MBBS, PhD, Deputy Dean, Faculty of Public Health and Family Medicine, Department of Community Health, University of Malawi Elizabeth Prado, PhD, Assistant Project Scientist, Department of Nutrition, University of California Davis Atif Rahman, PhD, Professor of Child Psychiatry, University of Liverpool, Institute of Psychology, Health & Society, Child Mental Health Unit Greg Reinhart, PhD, Vice President, Research & Nutrition, The Mathile Institute for the Advancement of Human Nutrition Linda Richter, PhD, DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, The Human Sciences Research Council, South Africa Nathalie Roschnik, Advisor of Nutrition and Early Child Development, Save the Children Edward A Frongillo Jr., PhD, Professor and Chair, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina Christine Stewart, PhD, MPH, Assistant Professor, Department of Nutrition, University of California Davis, Associate Director, Program in International and Community Nutrition Emanuela Galasso, PhD, Senior Economist, Development Research Group, The World Bank Rebecca Stoltzfus, PhD, Professor & Director, Program in Global Health Cornell University Michael Georgieff, MD, Martin Lenz Harrison Land Grant Chair, Professor in Pediatrics and the Institute of Child Development, Head, Division of Neonatology, Vice Chair, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Director, Center for Neurobehavioral Development, University of Minnesota School of Medicine Fahmida Tofail, MBBS, PhD in Child Development & Nutrition (UCL, UK), Scientist, Child Development Unit, Centre for Nutrition and Food Security, Senior Consultant Physician, Dhaka Hospital. International Centre for Diarrheal Disease Research - Bangladesh Melissa Gladstone, MBChB, M., MRCPCH, BSc, University of Liverpool Institute of Translational Medicine Jena Hamadani, MBBS, DCH, PhD, Head, Child Development Unit, Scientist, Centre for Child and Adolescent Health, International Centre for Diarrheal Disease Research – Bangladesh Lynne Jones, OBE, FRCPSych, FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University Mark Tomlinson, PhD, Professor of Psychology, Stellenbosch University Susan Walker, PhD, Professor, University of the West Indies, Jamaica Aisha Yousafzai, PhD, Associate Professor, Department of Paediatrics and Child Health, Aga Khan University Louise Zimanyi, Former Director, The Consultative Group on Early Childhood Care and Development Professor, Humber Institute of technology and Learning, School of Health Sciences Seung Lee, Senior Director of School Health and Nutrition, Save the Children 5 Every Child’s Potential: A Policy Brief 1 Integrate nutrition and child development interventions for young children and their families, wherever possible • Evidence supports the integration of interventions to enhance children’s growth and development (Grantham-McGregor, Fernald et al. 2014). Integrated interventions serve children by targeting the same key risk factors that make children susceptible to stunting and impaired development. Given evidence of relationships between hygiene and child development, an integrated approach should also explore adding a water, hygiene and sanitation component to early child stimulation and nutrition programs (Ngure, Reid et al. 2014). • Integrating program components results in greater access to care for children, mothers and families. The co-location of services enables families to access both nutrition and development resources in one setting and the coordination of messages provides families with appropriate, reinforcing information. Given that individual nutrition and development interventions often target the same underserved families, programmatic synergies from integrated interventions offer the ability to reach more of those children and families in the most efficient manner (DiGirolamo, Stansbery et al. 2014). • Policymakers, funders and program managers are able to secure substantial economic returns on investment because of the newfound programmatic synergies and the decreased duplication of efforts that occur with integration (Alderman, Behrman et al. 2014; Pelletier and Neuman 2014). Leveraging existing resources and programs across sectors, regions and disciplines to foster integration yields greater cost-savings than investing in a single-component intervention. What is integration? The integration of nutrition and early child development refers to interventions that have both components delivered simultaneously to the same population, with the objective that they reinforce each other and are cost-effective (Grantham-McGregor, Fernald et al. 2014). Intervention activities happen concurrently and are integrated through funding and budget; organization and management; and place and mode of delivery (Briggs and Garner 2006). In the health system, integration is contrasted with the vertical delivery of interventions. By relying on parallel implementation, training and supervision, vertical delivery systems are prone to duplication of activities and resources (Msuya, 2004). Although vertical delivery systems may be appropriate in response to specific health issues that require expertise or an urgent response (Atun, Bennett et al. 2008), they have limited sustainability in promoting children’s health and development. Critical features of integration for early childhood development and nutrition interventions should include a joint design and delivery, the use of community-based delivery platforms and a focus on strengthening family care (Tomlinson, Rahman et al. 2014). 6 2 • The first 1000 days (from conception to age 24 months) are one of multiple sensitive periods in life where interventions can promote sustained growth and development. Findings suggest that the age at which to begin interventions should be based on what outcomes are targeted and what interventions are used. Early in life, adequate nutrition and consistent, responsive parenting promote brain development, social-emotional competencies and school-readiness (Wachs, Georgieff et al. 2014). • 3 Focus on the needs in early childhood for learning and nutrition by promoting high-quality family care Children’s growth and development can be enhanced by addressing the immediate and underlying causes of suboptimal nutrition. Long-lasting developmental gains require that maternal and child deficiencies are remedied and that positive parental feeding practices be fostered. Thus, there is a need for nutrition components to be delivered simultaneously with interventions that include responsive caregiving and early learning activities. Both should be attuned to unique individual and community needs (Yousafzai and Aboud 2014). • Factors that affect parenting- including individual knowledge, attitudes and beliefs, income, education, psychosocial wellbeing, support, and socio-cultural and environmental conditions- should be considered when designing an intervention (Bentley, Johnson et al. 2014; Zafar, Sikander et al. 2014). Adapt interventions to address the local capacities and constraints of families and communities • Natural interactions between families and children in their homes are important mechanisms for delivering integrated interventions to improve young children’s growth and psychosocial development. The setting and location of interventions should be adaptable to meet unique local needs. A combination of home and center-based delivery models can ensure a broad reach, while still recognizing and supporting the family’s role in promoting children’s wellbeing (Yousafzai, Rasheed et al. 2014). • Interventions that engage families are better able to overcome local challenges and barriers. Families are interested in their child’s development, and often find a provider’s interactive, conversational approach easier to accept than didactic methods (Fernandez-Rao, Hurley et al. 2014). An adaptable, family-based delivery strategy helps to identify and maintain existing positive childrearing and feeding practices (Yousafzai, Rasheed et al. 2014) and may help expose family members to the important effects of good nutrition and learning opportunities on children’s development and health (Tomlinson, Rahman et al. 2014). • Strong and sustained investment in the training and supervision of a skilled workforce to deliver integrated nutrition and child development services provides assurance that children will receive sufficient support to fulfill their development potentials (Yousafzai, Rasheed et al. 2014). Community health workers (CHWs) are on the frontline. Their interactions with families are an important determinant of the quality of support families receive for their caregiving tasks and the accessibility and coverage of support in the community (Tomlinson, Rahman et al. 2014). Opportunities to increase the capacity of CHWs include effective pre-service and in-service training, clearly defined integrated activities (Phuka, Maleta et al. 2014), and ongoing supervision and monitoring. 7 Every Child’s Potential: A Policy Brief 4 5 Identify the best practices and appropriate indicators in an integrated delivery of interventions through focused research and program evaluation • Empirical support for integration is strong, yet the continued measurement and communication of delivery processes can facilitate the scale-up of effective interventions. The reporting of the content, delivery strategy, training of providers, participation, and outcomes contribute to evaluating and improving the design and inputs to the program. These process indicators are crucial for identifying the most successful and feasible components and their relationship to children’s optimal development (Yousafzai and Aboud 2014). • A globally accepted set of measures and indicators is needed to ensure the successful evaluation of integrated interventions. An accepted set of indicators standardizes reporting procedures and allows for the comparison of effective components across locations. Research to validate specific outcome measures across cultures, countries and settings, especially those that can be applied to integrated interventions, can aid in identifying best practices (Frongillo, Tofail et al. 2014). • Indicators that address children’s development and growth enable stakeholders to track progress and advocate for action (DiGirolamo, Stansbery et al. 2014). Accepted measures can be used to operationalize an agenda for integration, providing policymakers with the necessary evidence for the allocation of resources that best promote children’s growth and development. 8 Mobilize the endorsements of leaders across intergovernmental and government agencies, nongovernmental organizations, and academia, and others in civil society to bring effective interventions to scale and sustain them • Promoting child growth and development represents a wide-ranging and complex challenge. Taking integrated interventions to scale requires that stakeholders support comprehensive, integrated care that addresses the physical and developmental needs of young children (Black and Dewey 2014). A clear agenda for integration must guide the decision-making, funding, and service delivery of a diverse set of public and private actors (Pelletier and Neuman 2014). • Horizontal coordination among sectors traditionally involved in child health ensures that development and nutrition services are integrated and not delivered in isolation (Britto, Yoshikawa et al. 2014; Tomlinson, Rahman et al. 2014). The identification of local leaders and the strengthening of their expertise are key aspects of building capacity for a more supportive policy environment (Yousafzai, Rasheed et al. 2014). Guidelines that establish roles and responsibilities and outline key processes for policymakers at the national level and local leaders can ensure more thorough coordination (Britto, Yoshikawa et al. 2014). • Partnerships among governments, NGOs, academicians and civil society offer the potential for scaling-up needed interventions (Britto, Yoshikawa et al. 2014). Just as the science of early childhood development and nutrition requires a consensus from multiple disciplines, the support of integrated interventions must also come from a wide array of stakeholders. These partnerships allow for the alignment of priorities, the pooling of limited resources, and access to the evidence base necessary to ensure effective scale-up. A Global Priority Remarkable progress has been made in the past decade toward the Millennium Development Goals – yet the statistics show that much more can be done to ensure optimal growth and development of the world’s children. The health sector has a unique responsibility because it has a significant opportunity to reach children and their families during sensitive periods for both growth and development. Evidence about the importance, design, delivery and sustainability of integrated services has reached a critical mass. The next step requires new partnerships and investment in large-scale programs. As 2015 approaches – the designated endpoint of the current Millennium Development Goals, researchers, policymakers and practitioners are confident that scientific advances in the two highly complementary fields of nutrition and child development can be applied to interventions that promote health and wellbeing, and can be incorporated into relevant policy worldwide. Integrated interventions can reach more children in need and achieve better outcomes than interventions that focus solely on one risk factor. Integrated programs offer governments and funders a unique opportunity for economy of effort and cost-effectiveness. Investments in integrated interventions promise an economic return that maximizes human capital and societal equity. Through investments in evidence-based integrated interventions, endorsements by stakeholders and supportive public policies we can ensure that all children worldwide have the opportunity to realize their developmental potential. What is scale-up? The “scale-up” of interventions refers to the increase in the proportion of a population receiving services, the increase in the range or type of services offered, and/or the process by which services are made sustainable and supported at a policy-level (Eaton, McCay et al. 2011). According to the WHO, scale-up entails “deliberate efforts to increase the impact of health service innovations successfully tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting basis” (Simmons, Fajans et al. 2007). Thinking about scaling-up as a process as opposed to an objective allows for the strategies that consider the political, resource and infrastructure environment that may be supportive, yet changing (Mangham and Hanson 2010). Throughout this policy brief, references to scale-up are used to encourage stakeholders to begin this process, working to meet the needs of impoverished children more effectively and stretch existing resources to benefit more children. 9 Every Child’s Potential: A Policy Brief References - “Every Child’s Potential”: Annals of the New York Academy of Sciences vol 1308 Alderman, H., J. R. Behrman, S. Grantham-McGregor, F. Lopez-Boo and S. Urzua (2014). Economic perspectives on integrating early child stimulation with nutritional interventions. pp 129-138. Ngure, F. M., B. M. Reid, J. H. Humphrey, M. N. Mbuya, G. Pelto and R. J. Stoltzfus (2014). Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. pp 118-128. Bentley, M. E., S. L. Johnson, H. Wasser, H. Creed-Kanashiro, M. Shroff, S. Fernandez Rao and M. Cunningham (2014). Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: an overview. pp 54-67. Pelletier, D. and M. J. Neuman (2014). Advancing the nutrition and early childhood development agenda: indicators and guidance. pp 232-244. Black, M. M. and K. G. Dewey (2014). Promoting equity through integrated early child development and nutrition interventions. pp 1-10. Britto, P. R., H. Yoshikawa, J. van Ravens, L. A. Ponguta, M. Reyes, S. Oh, R. Dimaya, A. M. Nieto and R. Seder (2014). Strengthening systems for integrated early childhood development services: a cross-national analysis of governance. pp 245-255. DiGirolamo, A. M., P. Stansbery and M. Lung’aho (2014). Advantages and challenges of integration: opportunities for integrating early childhood development and nutrition programming. pp 46-53. Phuka, J., K. Maleta, M. Thomas and M. Gladstone (2014). A job analysis of community health workers in the context of integrated nutrition and early child development. pp 183-191. Tomlinson, M., A. Rahman, D. Sanders, J. Maselko and M. J. Rotheram-Borus (2014). Leveraging paraprofessionals and family strengths to improve coverage and penetration of nutrition and early child development services. pp 162-171. Wachs, T. D., M. Georgieff, S. Cusick and B. S. McEwen (2014). Issues in the timing of integrated early interventions: contributions from nutrition, neuroscience, and psychological research. pp 89-106. Yousafzai, A. K. and F. Aboud (2014). Review of implementation processes for integrated nutrition and psychosocial stimulation interventions. pp 33-45. Fernandez-Rao, S., K. M. Hurley, K. M. Nair, N. Balakrishna, K. V. Radhakrishna, P. Ravinder, N. Tilton, K. B. Harding, G. A. Reinhart and M. M. Black (2014). Integrating nutrition and early child-development interventions among infants and preschoolers in rural India. pp 218-231. Yousafzai, A. K., M. A. Rasheed, B. Daelmans, S. Manji, C. Arnold, R. Lingam, J. Muskin and J. E. Lucas (2014). Capacity building in the health sector to improve care for child nutrition and development. pp 172-182. Frongillo, E. A., F. Tofail, J. D. Hamadani, A. M. Warren and S. F. Mehrin (2014). Measures and indicators for assessing impact of interventions integrating nutrition, health, and early childhood development. pp 68-88. Zafar, S., S. Sikander, Z. Haq, Z. Hill, R. Lingam, J. Skordis-Worrall, A. Hafeez, B. Kirkwood and A. Rahman (2014). Integrating maternal psychosocial well-being into a child-development intervention: the five-pillars approach. pp 107-117. Grantham-McGregor, S. M., L. C. H. Fernald, R. M. C. Kagawa and S. Walker (2014). Effects of integrated child development and nutrition interventions on child development and nutritional status. pp 11-32. All articles from Annals volume 1308 are available online for free at www.nyas.org/annals-1308 10 Other References Atun, R. A., S. Bennett and A. Duran (2008). When do vertical (stand-alone) programmes have a place in health systems?, World Health Organization. Mangham, L. J. and K. Hanson (2010). Scaling up in international health: what are the key issues? Health Policy and Planning 25(2): 85-96. Briggs, C. J. and P. Garner (2006). Strategies for integrating primary health services in middle-and low-income countries at the point of delivery. Cochrane Database Syst Rev 2. Msuya, J. (2004). Horizontal and vertical delivery of health services: what are the tradeoffs. Washington, DC: The World Bank. Eaton, J., L. McCay, M. Semrau, S. Chatterjee, F. Baingana, R. Araya, C. Ntulo, G. Thornicroft and S. Saxena (2011). Scale up of services for mental health in low-income and middle-income countries. The Lancet 378(9802): 1592-1603. Simmons, R., P. Fajans and L. Ghiron (2007). Scaling up health service delivery: from pilot innovations to policies and programmes, World Health Organization. 11 About Us The Sackler Institute for Nutrition Science The New York Academy of Sciences, in partnership with The Mortimer D. Sackler Foundation, established The Sackler Institute for Nutrition Science to create a coordinated effort to support and disseminate nutrition science research. The Sackler Institute for Nutrition Science is dedicated to advancing nutrition science research and knowledge, mobilizing communities, and translating this work into the field. The Sackler Institute is generating a coordinated network across sectors, disciplines, and geographies that promotes open communication; encourages exchange of information and resources; nurtures the next generation of scientists; and affects community intervention design and public policy changes. Visit us online at www.nyas.org/nutrition. The New York Academy of Sciences The New York Academy of Sciences is an independent, notfor-profit organization that since 1817 has been committed to advancing science, technology, and society worldwide. With 20,000 members in 100 countries, the Academy is creating a global community of science for the benefit of humanity. Please visit us online at www.nyas.org. Download All articles in Every Child’s Potential are available for free online on the website of the New York Academy of Sciences, please check www.nyas.org/Annals-1308. Stay Connected www.facebook.com/SacklerNutritionScience http://bit.nyas.org/sacklerlinkedin eAlerts: Visit www.nyas.org/Subscribe and select the Nutrition eNewsletter The Sackler Institute for Nutrition Science, The New York Academy of Sciences 7 World Trade Center, 250 Greenwich Street, FL 40, New York, NY 10007 | 212.298.8600