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Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.

Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016. Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, International Labour Organisation, household surveys, and the Barro-Lee education dataset. From 1990 to 2016, remarkable shifts in adolescent health occurred. A decrease in disease burden in many countries has been offset by population growth in countries with the poorest adolescent health profiles. Compared with 1990, an additional 250 million adolescents were living in multi-burden countries in 2016, where they face a heavy and complex burden of disease. The rapidity of nutritional transition is evident from the 324·1 million (18%) of 1·8 billion adolescents globally who were overweight or obese in 2016, an increase of 176·9 million compared with 1990, and the 430·7 million (24%) who had anaemia in 2016, an increase of 74·2 million compared with 1990. Child marriage remains common, with an estimated 66 million women aged 20–24 years married before age 18 years. Although gender-parity in secondary school completion exists globally, prevalence of NEET remains high for young women in multi-burden countries, suggesting few opportunities to enter the workforce in these settings. Although disease burden has fallen in many settings, demographic shifts have heightened global inequalities. Global disease burden has changed little since 1990 and the prevalence of many adolescent health risks have increased. Health, education, and legal systems have not kept pace with shifting adolescent needs and demographic changes. Gender inequity remains a powerful driver of poor adolescent health in many countries. Australian National Health and Medical Research Council, and the Bill & Melinda Gates Foundation.

The diversity and quality of available and affordable foods vary vastly across income groups and countries, affecting adolescent food choices. 9 Those choices change with economic development, urbanisation, and shifts in the food industry and agriculture. [...]research on adolescent nutrition interventions and programmes has overwhelmingly emphasised single interventions, such as weekly iron folic acid supplementation, rather than the many drivers of adolescent food choice and nutritional status. 10 Adolescent food environments and nutrition are affected by factors at multiple levels and across sectors, including agriculture, food processing, retail, and marketing, through to the settings where adolescents are growing up. 12,13 Effective adolescent nutrition programmes will differ across food environments, but in all places strategies will need to be intersectoral, taking action across educational settings, social protection programmes, health services, food retailers, and in local communities and domestic households. 10,13,14 As this Series underlines, the most effective national policies will coordinate actions beyond health and nutrition to engage education, food manufacturing and marketing, and agriculture, with an emphasis on adolescents facing the greatest socioeconomic disadvantage. 9,10 Adolescents also have views on the food they eat that extend beyond the immediate effects on their health and wellbeing. Beyond government, multiple stakeholders, including the food industry, will need to take action to reverse the increased consumption of unhealthy, ultra-processed foods and help end adolescent malnutrition. 16 Despite calls for action, transnational food companies continue to influence and reframe national political debates on food regulation. 16 Social media allows direct marketing and influences community attitudes beyond national borders. 17 Given these increasingly transnational dimensions of the ultra-processed food industry, it is timely for WHO, the Food and Agriculture Organization of the UN, and their partners to revisit calls for global regulatory frameworks to assist governments in taking action. 16,18 Given the speed of nutritional change, there is perhaps no greater immediate threat to the health of adolescents.

Growing calls have emerged to reform existing global health governance (GHG) structures in response.1 2 Young people are ready to take action to ensure an equitable, inclusive and efficient future—because we are the future.3 4 Young people make up the world’s largest age demographic, with over 33% of the current population under the age of 20, and over 63% under the age of 40.5 Although there have been recent investments in youth leadership within GHG structures, the mainstreaming and institutionalisation of meaningful adolescent and youth engagement (MAYE) must be accelerated to unlock the youth potential needed to address pressing global health challenges.6 Coauthored by a team of seven young global health professionals from across the globe, this commentary maps current youth engagement structures within GHG, identifies gaps in existing practices and proposes mechanisms to strengthen existing structures. Within the research realm, the second Lancet Commission on Adolescent Health and Wellbeing brings a renewed commitment to establishing long-term, meaningful and equal youth partnerships. [...]The Lancet & Financial Times Commission on Governing Health Futures 2030: Youth voices still largely remain excluded on the global stage and in GHG decision-making processes. [...]many youth in low- and middle-income countries face intersectional barriers to engagement, including displacement, poverty and lack of connectivity.13 Despite most of the world’s youth residing in the Global South, those who are included in global health discourse are consistently from countries in the Global North.

To tackle these compounding challenges and take advantage of all that the 21st century has to offer, it will be necessary to draw on the power, ideas, and leadership capabilities of young people to reimagine and recreate a healthier, fairer, and just planet. Investments across adolescence—ie, the period between age 10 years and 24 years—will reap a triple dividend, with benefits for young people today, for the adults they will become, and for the next generation of children whom they will parent. Strengthen community systems that promote mental health and wellbeing Develop innovative approaches to address complex and emerging health threats in partnership with adolescents Against these advances, strikingly little progress has been made in reducing adolescent non-communicable diseases in every region of the world, with rises globally in obesity-related diseases and mental disorders in young people.

Protein-losing enteropathy entails an excessive loss of proteins in intestinal tract due to underlying primary or secondary pathologies. It is suspected in patients with chronic diarrhoea and peripheral oedema. Faecal alpha 1 antitrypsin clearance is the gold standard for diagnosis. Treatment includes a high-protein fat-modified diet, and replacements for micronutrients, electrolytes and vitamin deficiencies. Prognosis is variable depending on the underlying cause.

Tacrolimus, a topical calcineurin inhibitor (TCI) with immunomodulatory effects, is considered a viable treatment option for vitiligo. A consensus building exercise was undertaken to determine the role and clinical utility of topical tacrolimus in the management of vitiligo using input from experts in the field of dermatology. Seventeen experts collaborated to create consensus statements using a modified Delphi methodology. A questionnaire on effectiveness, safety and utility of topical tacrolimus in different types of vitiligo, duration, frequency, monotherapy and combination and other aspects was shared, and a concordance rate of 75% was preset to have consensus. A physical meeting was conducted to discuss statements, which did not achieve consensus. Amongst 34 statements derived from round one, consensus was not achieved for 9 statements. In the second round, consensus was achieved for 2/9 statements, hence in the physical meeting, discussion was done to reframe the remaining seven statements. Apart from these 34 statements, questions pertaining to \"Vitiligo: types and presentation in clinical practice\", where consensus was not intended, are presented as descriptive statements. Topical tacrolimus ointment has a favorable risk benefit profile to be used as one of the first-line agents for vitiligo. Combination of topical tacrolimus and narrow band Ultraviolet-B (NBUVB) was recommended as an effective treatment for non-segmental vitiligo. Recommended frequency of application was once or twice daily for optimal results. Apart from a transient burning sensation, topical tacrolimus has a favorable safety profile.