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Background Understanding the burden and determinants of suicide during adolescence is key to achieving global health goals. We examined the prevalence and determinants of self-reported suicidal ideation and attempts among younger (13–15 years) and older adolescents (16–17 years). Methods Pooled prevalence estimates with 95% confidence interval, were calculated for suicide ideation and attempts for 118 surveys from 90 countries that administered the Global School-based Student Health Survey (GSHS) to adolescents (13–17 years of age) from 2003 to 2017. Indicators (including individual and social factors) associated with suicidal ideation and attempts were determined from multivariable linear regressions on key outcomes. Results The prevalence of suicidal ideation representing 397,299 adolescents (51.3% female) was significantly higher among girls than boys whereas attempts did not differ by age or sex. Being bullied, or having no close friends was associated with suicidal ideation among girls 13–15 years and 16–17 years, respectively. Among all boys, being in a fight and having no close friends was associated with suicidal ideation with the addition of serious injury for boys 13–15 years. Common to all younger adolescents was an association of suicide attempt with being bullied and having had a serious injury. Among young boys, having no close friends was an additional indicator for suicide attempt. Having no close friends was associated with suicide attempt in older adolescents with the addition to being bullied in older girls and serious injury in older boys. Conclusions Building positive social relationships with peers and avoiding serious injury appear key to suicide prevention strategies for vulnerable adolescents. Targeted programs by age group and sex for such indicators could improve mental health during adolescence in low and middle-income countries, given the diverse risk profiles for suicidal ideation and attempts.

To control the spread of COVID-19, mitigation strategies have been implemented globally, which may have unintended harmful effects on child and adolescent mental health. This study aims to synthesise the indirect mental health impacts on children and adolescents globally due to COVID-19 mitigation strategies. We included relevant reviews from MEDLINE, Embase, PsycINFO, LILACS, CINAHL, The Cochrane Library and Web of Science until January 2022 that examined the impact of COVID-19-related lockdown and stay-at-home measures on the mental health of children and adolescents. Data extraction and quality assessments were completed independently and in duplicate by BC and LH. A Measurement Tool to Assess Systematic Reviews-2 was used to assess the methodological quality. Eighteen systematic reviews, comprising 366 primary studies, found a pooled prevalence of 32% for depression (95% CI: 27 to 38, n=161 673) and 32% for anxiety (95% CI: 27 to 37, n=143 928) in children and adolescents globally following COVID-19 mitigation measures. Subgroup analyses also uncovered important differences for both depression and anxiety by World Health Organization regions with few studies from Africa and relative high burden of anxiety and depression in the Eastern Mediterranean region. Our findings reveal a high prevalence of depression and anxiety in children and adolescents during the COVID-19 pandemic, globally, compared with prepandemic estimates. These findings highlight the urgency for governments and policymakers to strengthen mental health systems in the COVID-19 recovery, especially in low-and middle-income countries where compounding psychological stress, access and affordability of care and discrepant reporting of mental health in this population remains a challenge. We also provide insight into how to alter mitigation strategies to reduce the unintended negative consequences for the health and well-being of children and adolescents in future pandemics. CRD42022309348.

Progress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. We review the current evidence base on the effectiveness of a variety of essential and emerging interventions that can be delivered from before conception until age 20 years to help children and adolescents not only survive into adulthood, but also to grow and develop optimally, support their wellbeing, and help them reach their full developmental potential. Although scaling up evidence-based interventions in children younger than 5 years might have the greatest effect on reducing child mortality rates, we highlight interventions and evidence gaps for school-age children (5–9 years) and the transition from childhood to adolescence (10–19 years), including interventions to support mental health and positive development, and address unintentional injuries, neglected tropical diseases, and non-communicable diseases.

Adolescence is a key developmental window of opportunity for nutrition promotion and cardiometabolic disease (CMD) prevention that can reap long-term significant health, economic and social advantages, however it is currently not a focus in the Developmental Origins of Health and Disease (DOHaD) framework. In this perspective, we argue that adolescence should be included in the DOHaD framework, by examining current evidence on the relationship between adolescent nutrition and risk factors for CMDs, physiological mechanisms, and potential interventions.

Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems. Growing rates of malnutrition, both under‐ and overnutrition, continue to threaten the South Asia region. Our study examined national policies, programmes, and data availability on nutrition interventions in eight South Asian countries. Results revealed a strong policy focus, but data gaps limit progress tracking. Multisectoral collaboration and strengthened nutrition data systems are required to overcome nutrition problems in the region. Key messages Most South Asian countries had several policies and programmes in place which considered or addressed nutrition interventions across the life course. Nationally representative surveys provide coverage data for evidence‐based recommendations to improve policy and programme actions. Significant coverage data gaps remain in nationally representative surveys around counselling during pregnancy, interventions targeted for newborns, infant, and young child feeding, and counselling on and identification and treatment of severe and moderate acute malnutrition. Mobilising political commitment and increasing multisectoral collaboration are required for an enabling environment in support of nutrition data systems in South Asia.

Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions. We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible. We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition. We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.

Cooking meals at home is often recommended as a strategy to consume a healthy diet and avoid ultra-processed foods and unhealthy dietary patterns. However, cooking has traditionally been a highly gendered activity, and as food environments, economies, and social norms evolve globally, understanding of cooking behaviors in different contexts is needed. We analyzed repeated cross-sectional data from 135 countries from the 2018–22 Gallup World Poll (n = 638 192). We conducted unadjusted and adjusted negative binomial regression models, overall and stratified by gender, to estimate differences over time and by five food system typologies in the mean number of days cooking and eating lunch and dinner at home per week. Across most food system typologies, mean number of days cooking but not eating meals at home gradually increased between 2018 and 2019, peaking in 2020 (among females) and 2021 (among males) and then declined in 2022, trending towards prepandemic levels. Adjusted for covariates, participants from emerging and diversifying food systems cooked meals at home 13% (95% CI: 1.10, 1.16, P < .001) more compared to participants in rural and traditional food systems. Compared to males, females cooked meals at home 214% more frequently (P < .001). Across the globe, COVID-19 shifted cooking behaviors and exacerbated preexisting gender disparities in frequency of cooking meals at home. Future research is needed to better understand the role of cooking behaviors in the nutrition transition at global, national, and local levels.

The global context has shifted dramatically since publication of the first EAT–Lancet Commission in 2019, with increased geopolitical instability, soaring food prices, and the COVID-19 pandemic exacerbating existing vulnerabilities and creating new challenges. However, food systems remain squarely centred at the nexus of food security, human health, environmental sustainability, social justice, and the resilience of nations. Actions on food systems strongly impact the lives and wellbeing of all and are necessary to progress towards goals highlighted in the Sustainable Development Goals, the Paris Agreement, and the Kunming–Montreal Global Biodiversity Framework. Although current food systems have largely kept pace with population growth, ensuring sufficient caloric intake for many, they are the single most influential driver of planetary boundary transgression. More than half of the world's population struggles to access healthy diets, leading to devastating consequences for public health, social equity, and the environment. Although hunger has declined in some regions, recent increases linked to expanding conflicts and emergent climate change impacts have reversed this positive trend. Obesity rates continue to rise globally, and the pressure exerted by food systems on planetary boundaries shows no signs of abating. In this moment of increasing instability, food systems still offer an unprecedented opportunity to build the resilience of environmental, health, economic, and social systems, and are uniquely placed to enhance human wellbeing while also contributing to Earth-system stability. This updated analysis builds upon the 2019 EAT–Lancet Commission, expanding its scope and strengthening its evidence base. The first Commission defined food group ranges for a healthy diet and identified the food systems' share of planetary boundaries. In this Commission, we add an analysis of the social foundations for a just food system, and incorporate new data and perspectives on distributive, representational, and recognitional justice, providing a global overview on equity in food systems. Substantial improvements in modelling capacity and data analysis allow for the use of a multimodel ensemble to project potential outcomes of a transition to healthy and sustainable food systems. The planetary health diet (PHD) remains a cornerstone of our recommendations and can be seen as a framework within which diverse and culturally appropriate diets can exist. Robust updated evidence reinforces a strong association with improved health outcomes, large reductions in all-cause mortality, and a substantial decline in the incidence of major diet-related chronic diseases. The reference PHD emphasises a balanced dietary pattern that is predominantly plant-based, with moderate inclusion of animal-sourced foods and minimal consumption of added sugars, saturated fats, and salt. Successful implementation of the PHD requires careful consideration of cultural contexts and the promotion of culturally appropriate and sustainable dietary traditions. This diversity of contexts, bounded by the PHD's reference values, represents substantial flexibility and choice across cultures, geographies, and individual preferences. However, when confronted by climate, biodiversity, health, and justice crises, transformation will require urgent and meaningful changes in our individual and collective behaviours and our culture of unhealthy, unjust, and unsustainable food production and consumption. For the first time, we quantify the global food systems' share of all nine planetary boundaries. These food system boundaries confirm that food is the single largest cause of planetary boundary transgressions, driving the transgression of five of the six breached boundaries. In addition, food systems exert a notable impact on the transgressed climate boundary and on the ocean acidification boundary. Unsustainable land conversion, particularly deforestation, remains a major driver of biodiversity loss and climate change, highlighting the need for zero conversion of all remaining intact ecosystems. Food systems account for the near totality of nitrogen and phosphorus boundary transgression, emphasising the improvements needed in nutrient management, efficient nutrient redistribution, and circular nutrient systems. The massive use of novel entities in food production, processing, and packaging (ranging from plastics to pesticides) remains a major concern but is alarmingly understudied. Our assessment of justice integrates three dimensions—distributive, representational, and recognitional—within a human rights framing that includes the rights to food, a healthy environment, and decent work. Analyses reveal important inequities in access to healthy diets, decent work conditions, and healthy environments, disproportionately affecting marginalised groups in low-income regions. We therefore propose nine social foundations that enable these rights to be met, and are able to assess the global status of six. Enabling access to, affordability of, and demand for healthy diets is paramount. Equally crucial is the right to live and work within a non-toxic environment and a stable climate system, as we recognise the profound impact of environmental degradation on human health and wellbeing. Furthermore, a living wage and meaningful representation would allow individuals to actively participate in building healthy, sustainable, and just food systems. However, nearly half of the world's population falls below these social foundations, undermining their ability to meet basic human rights. At the same time, the dietary patterns of most (6·9 billion people) of the world exert pressures that threaten further planetary boundary transgression. The destabilising effect of unhealthy overconsumption on the Earth's systems highlights the importance of viewing healthy diets not just as a human right, but also as a shared responsibility.

Background: Adolescence marks the transition from childhood to adulthood and is a critical period for the maturation of biological systems. Proper nutrition during adolescence supports growth and pubertal development. An imbalance of nutrients, along with early puberty onset, may contribute to the development of noncommunicable diseases (NCDs). To date, adolescence in the context of the Developmental Origins of Health and Disease (DOHaD) framework has not been explored; yet, it is imperative to understand the role of nutrition during this period. Research Objective: To summarize current evidence on the relationship between DOHaD, adolescent nutrition, including the food environment, and NCDs development. We discuss potential biological mechanisms, while considering sex differences. Methods: We searched PubMed with a combination of MeSH and keywords for prospective longitudinal or retrospective studies related to adolescence (10-19.9 years), puberty, nutrition, and NCDs. Our search was limited to relevant articles published after January 2000 to February 2023. Peer-reviewed literature derived from original scientific articles was eligible. Results: We identified seven studies, of which all were part of one of three prospective, longitudinal cohort studies based in Europe. Study publications ranged from 2001 to 2014 with the sample population varying from 195 to 262 participants, with an average of 14.2 years follow-up period. Overall, these studies suggested that high animal protein intake during adolescence is significantly associated with a higher adult fat-free mass index. As well, intake of high-glycemic index foods was associated with an increased risk of developing type 2 diabetes markers and inflammation in early adulthood. Discussion: Given the limited number of studies, future research is needed on this critical developmental window. Elevating adolescents as a central focus within multisectoral interventions and strategies is imperative for curtailing NCD risk factors across all life stages, thus advancing us closer to the fulfillment of the Sustainable Development Goals.