Epigenetics involve studying heritable phenotype changes driven by gene expression modifications rather than the DNA sequence itself. There is a clear link between epigenetics and: microbiome, nutrition (diet and breast milk), and parental life history. The hub's work focuses to:

1) Go beyond the simple height for age definition to develop better methods for defining and identifying stunting types based on epigenetic states.

2) Develop epigenetic markers that can be used to identify children and
pregnancies already on the pathway to stunting to prioritise early intervention.

3) Develop interventions that can be used to ameliorate or reverse the effects of stunting based on an understanding of epigenetic changes and predict the ability of stunted children to respond to specific interventions based on biological stunting type.

4) Prevent stunting by developing strategies to avoid it before it occurs based on understanding the antecedents and their effect on the underlying epigenetic and biological pathways that lead to different stunting types.

There are three distinct phases to consider when addressing factors contributing to functional stunting in the first 1000 days of a child's life: pregnancy, breastfeeding during the first six months, and complementary feeding.

Each phase has overlapping and independent drivers and risk factors. Understanding the complex, interacting and dynamic systems that influence nutrition – requires interdisciplinary thinking encompassing data from the biological to food/health systems, social environments, and values.

We are collecting: dietary, anthropometric and cognitive data; samples of saliva, stool, hair, blood, breastmilk and food; and questionnaire or observational data on food, social and economic environments.

This rich data set will allow an in-depth analysis of functional stunting and its impacts across the life cycle. It will be conducted across three countries using standardised techniques to enhance generalisability.

Right after birth, children start to experience rapid colonization by microorganisms from their mothers and the surrounding environment. The child develops a symbiotic relationship with their microbes, the presence of which contributes to how a person fights disease, digests food, and may even impact their psychological processes.

Diseases and malnutrition in the first 1000 days can affect the colonization of the infant's gut microbiota and delay its maturation.

Our work focuses on several potential mechanisms that involve the microbiome. They include the ability to modify the function of the immune system, the enhancement of energy availability from diet and the capacity to out-compete harmful pathogens. The hub focuses to:

1. Identify whether microbiome “signatures” are associated with subsequent stunting outcomes.

2. Identify whether there are microbiome “signatures” in newborns that predict later physical, cognitive and health trajectory characteristics of stunting and stunting type.

3. Assess the combinatorial effect of nutritional exposures, food and the home environment, epigenetics, gut health, and parasites on key microbiome states.

4. Assess the effect of the synbiotic interventions in Senegal on the microbiome and relate any observed differences post-intervention to the stunting outcome.

5. Utilise this greater understanding of underlying biological mechanisms to inform future development of interventions that can be used to prevent, ameliorate or reverse stunting and other adverse clinical outcomes.

The hub's work focuses to:

1) Go beyond the simple height for age definition to develop better methods of defining and identifying stunting type based on gut health status

2) Develop gut health biomarkers that can be used to identify children already on the pathway to stunting to prioritise early intervention

3) Develop interventions that can be used to ameliorate or reverse the effects of stunting based on an understanding of impairments in gut health

4) Develop strategies to prevent stunting based on an understanding of the role of poor gut health as an antecedent that leads to different stunting types

The food systems workstream aims to design a food environment metric that identifies levers for interventions in the food system and food environment. The metric will be designed for policymakers and researchers to inform the design of interventions.

The home environment workstream focuses on water, sanitation and hygiene (WASH) practices as they play a crucial role in people living in resource-limited countries. They can potentially reduce stunting and overlap significantly with other Hub workstreams, such as animal-source foods and gut health. The focus so far has been on the behavioural determinants of infant feeding practices, hygiene and caregiving practices, and the domestic environment.

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The shared values workstream contributes to the Hub by framing the study in a culturally appropriate way. It aims to improve understanding of local values-based perceptions of matters relating directly or indirectly to child stunting. It wants to strengthen the abilities of the members of the Hub to work together more effectively, intersubjectively, and in a state of ongoing learning and respect.

To finish, it plays a crucial role in building local research capacity. The workstream is particularly cross-cutting as it runs through all the components of the whole child approach. It helps the project to articulate the undefined shared values of groups of people in the local sites, guiding the formative research of several strands for planning, improving and analysing legacies.

The education and cognition workstream of the Hub looks into how childhood stunting affects neurocognitive development and how learning environments could be modified to support early learning and child development.

There are four potential child-level measures to consider - cognition, social-emotional development, oracy skills, and motor development - alongside environmental factors - professionals and classroom interactions.

Our work is focused on engaging families with children under the age of five to understand their current domestic food hygiene practices, specifically in regard to the preparation, storage, and feeding of complementary and snack foods, as well as their access and utilization of child health services and WASH infrastructure. Our objectives are as follows:

1. To gain an understanding of the behaviours of caretakers of children under five related to child feeding (including exclusive breastfeeding), food hygiene, childcare, and utilization of child health and development services.

2. To explore the individual, household, social, and environmental determinants of food hygiene, WASH, childcare, and healthcare-seeking behaviours.

3. To document the larger contextual drivers influencing current and improved behaviours, including gender, life stage, urban/rural, family composition, government policy, etc.

4. To utilize these findings to identify barriers and opportunities for improving domestic food hygiene, child feeding, WASH, caregiving, and childcare/development services that the GCRF Action Against Stunting Hub can address.

As a partner in public engagement, Science Made Simple leads the science messaging of the hub, fully committed to collaborating closely with research teams in various countries. The team works to develop messages to align closely with schools, communities, and policymakers to raise awareness of about hub's work and highlight the expected outcomes of the scientific research conducted by the Hub. They also actively promote interdisciplinarity across the various research teams within the Hub to help connect different research areas.