Globalisation of agrifood systems and sustainable nutrition

Dynamic Progression of Hypertension and Diabetes in the Democratic Republic of Congo from 2019 to 2023

Introduction: The Democratic Republic of Congo (DRC) does not have national prevalence data for arterial hypertension (HTN) or diabetes (type I and II combined) to aid evidence-based decision-making, despite the assumption of epidemiological transition in low- and middle-income countries. The aim of this study was to estimate a proxy of prevalence for HTN and diabetes. Methodology: This study used routine monthly reported data pertaining to HTN and diabetes from the District Health Information Software 2 (DHIS2), spanning 2019-2023. Data underwent quality assessment and adjustments using standardization before analysis. Equity analyses were carried out at the national and sub-national levels. Epidemiological curves and maps were produced to analyze trends in the prevalence of HTN and diabetes among adults aged 18 and over. Permission to use the data was obtained from the regulatory authority. Results: Over five years, incidence of HTN increased from 13.23% (CI 95%: 13.22-13.24) to 15.23% (CI 95%: 15.22-15.24) (+15.1% relative increase), and diabetes rose from 2.73% (CI 95%: 2.72-2.74) to 3.345% (CI 95%: 3.34-3.35) (+16.3% relative increase), with provincial variations observed. Conclusions: In the DRC, hypertension and diabetes are advancing rapidly. Primary and preventative healthcare services and public health interventions must prioritize these diseases.

Which government policies to create sustainable food systems have the potential to simultaneously address undernutrition, obesity and environmental sustainability?

INTRODUCTION

A transformation of food systems is urgently needed, given their contribution to three ongoing and interlinked global health pandemics: (1) undernutrition and food insecurity, (2) obesity and non-communicable diseases (NCDs), and (3) climate change and biodiversity loss. As policymakers make decisions that shape food systems, this study aimed to identify and prioritise policies with double- or triple-duty potential to achieve healthier and more environmentally sustainable food systems.

METHODS

This study undertook a 4-step methodological approach, including (i) a compilation of international policy recommendations, (ii) an online survey, (iii) four regional workshops with international experts and (iv) a ranking for prioritisation. Policies were identified and prioritised based on their double- or triple-duty potential, synergies and trade-offs. Using participatory and transdisciplinary approaches, policies were identified to have double- or triple-duty potential if they were deemed effective in tackling two or three of the primary outcomes of interest: (1) undernutrition, (2) obesity/NCDs and (3) environmental degradation.

RESULTS

The desk review identified 291 recommendations for governments, which were merged and classified into 46 initially proposed policies. Based on the results from the online survey, 61% of those policies were perceived to have double- or triple-duty potential. During the workshops, 4 potential synergies and 31 trade-offs of these policies were identified. The final list of 44 proposed policies for healthier and more environmentally sustainable food systems created was divided into two main policy domains: 'food supply chains' and 'food environments'. The outcome with the most trade-offs identified was 'undernutrition', followed by 'environmental sustainability', and 'obesity/NCDs'. Of the top five expert-ranked food supply chain policies, two were perceived to have triple-duty potential: (a) incentives for crop diversification; (b) support for start-ups, and small- and medium-sized enterprises. For food environments, three of the top five ranked policies had perceived triple-duty potential: (a) affordability of healthier and more sustainable diets; (b) subsidies for healthier and more sustainable foods; (c) restrictions on children's exposure to marketing through all media.

CONCLUSION

This study identified and prioritised a comprehensive list of double- and triple-duty government policies for creating healthier and more environmentally sustainable food systems. As some proposed policies may have trade-offs across outcomes, they should be carefully contextualised, designed, implemented and monitored.

Food safety and dietary diversity in African urban cities: evidence from Ghana

BACKGROUND

Food safety is integral to food security and is increasingly becoming a significant concern in the urban areas of Africa, which are rapidly growing in population. In the case of Ghana, many urban households depend on traditional open-air markets for most of their food needs. However, these urban food markets also depend on domestic food supply chains, which are prone to risks, including poor hygiene and sanitation and weather seasonality. Food safety compliance has associated costs which increase the unit cost of food products. Thus, higher food price is a risk factor to food availability and accessibility-fundamental pillars of food security.

METHOD

We use food microbial data and food retail data from food market surveys in major cities in Ghana to assess the safety of selected fresh food commodities and how retailers handle the food products they sell. Additionally, based on a two-wave balanced panel household data, we used fixed effects Poisson and Correlated Random Effects (CRE) Probit models to estimate the effect of weather seasonality on the incidence of diarrhoea and urban household dietary diversity score (HDDS). A final sample of 609 households and 565 market respondents participated in the study.

RESULTS

Our findings show that selected food samples tested positive for Staphylococcus aureus and E.coli and had aflatoxin B1 levels above 5.0 ppb. Additionally, the household incidence of diarrhoea/vomiting, a proxy for food safety status, is higher in the dry season. In the dry season, the household incidence of diarrhoea/vomiting increases on average by a probability of 38% points compared to the rainy season. Regarding HDDS, the average HDDS is 7.3; however, we did not find the effect of seasonality on HDDS to be significant.

CONCLUSIONS

Although urban food availability and household dietary diversity are not challenges for many urban households, food safety is a challenge in the major food markets in Ghanaian cities and is associated with weather seasonality. Foods available in traditional open-air markets are not always safe for consumption, undermining households' food security. Weak enforcement of food safety regulations contributes to the food safety challenges in Ghanaian urban food markets.

Production Choices and Food Security: A Review of Studies Based on a Micro-Diversity Perspective

Given the 'subsistence' character of smallholder production, agricultural production diversification is often seen as an effective strategy for smallholders to improve their diets' diversity and nutritional status, yet the existing evidence remains inadequate. The study applies bibliometric data from the "Web of Science" database to synthesize 46 papers from developing countries to explore the relationship between production diversity, dietary diversity, and nutrition in smallholder households. The study identifies the most influential journals, authors, organizations, and countries and reveals research themes related to agricultural production and food security. This data analysis can help researchers target potential collaborators and access influential literature in agricultural production diversity and dietary diversity research. In addition, the results showed that agricultural production diversity potentially influences households' dietary diversity, with mixed results: Agricultural production diversification is the primary way to improve food and nutritional security among smallholder families with low socio-economic status, inaccessible transportation, and poverty; market access and trade have more potential to improve dietary diversity among smallholder households with well-developed markets and higher income levels; the significant measures of agricultural production diversity include Crop Counts, FGPD, SI, and SWDI; the significant measures of dietary diversity include HDDS and IDDS. This paper provides a roadmap for agricultural production and food security researchers by conducting a systematic review of the literature, summarizing some research methods and perspectives applicable to local socio-economic development.

Socioeconomic, demographic and geographic determinants of food consumption in Mexico

What people eat affects public health and human wellbeing, agricultural production, and environmental sustainability. This paper explores the heterogeneity of food consumption patterns in an ecologically and culturally diverse country. Using a latent class approach (which creates clusters of individuals with homogeneous characteristics), we analyse a food questionnaire (from the National Health and Nutrition Survey) applied across Mexico. We identify four clusters of food consumption (staple, prudent, high meat and low fruit) and find that belonging to these clusters is determined by socioeconomic, demographic (age, sex) and geographic (region, urban/rural) characteristics. Maize and pulses tend to constitute a larger proportion of the diet of poor, rural populations living in the south, while urban populations eat more varied foods, including ingredients whose production systems tend to exert more pressure on natural resources (for instance, meat). Despite the importance given in the literature to the Mexican gastronomy and its diverse traditional regional diets, we find that only 6% of the population adopts a food consumption pattern resembling the traditional Mexican diet. Instead, most of the Mexican population has a food consumption pattern resembling a western diet, which is problematic in terms of public health and environmental sustainability.

Critical Review of the Increasing Complexity of Access and Benefit-Sharing Policies of Genetic Resources for Genebank Curators and Plant Breeders-A Public and Private Sector Perspective

Plant breeders develop competitive, high-yielding, resistant crop varieties that can cope with the challenges of biotic stresses and tolerate abiotic stresses, resulting in nutritious food for consumers worldwide. To achieve this, plant breeders need continuous and easy access to plant genetic resources (PGR) for trait screening, to generate new diversity that can be built into newly improved varieties. International agreements such as the Convention on Biological Diversity (CBD), the International Treaty on Plant Genetic Resources for Food and Agriculture (ITPGRFA) and the Nagoya Protocol recognised the sovereign rights of countries over their genetic resources. Under the CBD/Nagoya Protocol, countries are free to establish specific national legislations regulating germplasm access and benefit-sharing to be negotiated bilaterally. Consequently, access to PGR became increasingly restricted and cumbersome, resulting in a decrease in germplasm exchange. The ITPGRFA attempted to ease this situation by establishing a globally harmonised multilateral system (MLS). Unfortunately, the MLS is (still) restricted to a limited number of food and forage crops, with very few vegetable crops. Easy and continuous access to genetic diversity combined with equitable and fair sharing of derived benefits is a prerequisite to breeding new varieties. Facilitated access contributes to sustainable crop production and food and nutrition security; therefore, access to and, consequently, use of PGRFA needs to be improved. Thus, the authors recommend, among others, expanding the scope of the ITPGRFA to include all PGRFA and making them and all related information accessible under a Standard Material Transfer Agreement (SMTA) combined, if necessary, with a subscription system or a seed sales tax. Such a transparent, functional and efficient system would erase legal uncertainties and minimise transaction costs for conservers, curators and users of genetic resources, thus aiding plant breeders to fulfil their mission.

The big food view and human health from the prospect of bio-manufacturing and future food

The "big food view" has attracted widespread attention due to the view of sustainable nutrition and human health as part of sustainable development. The "big food view" starts from better meeting the people's needs for a better life. While ensuring the supply of grain, the effective supply of meat, vegetables, fruits, aquatic products and other foods also should be guaranteed. Using cell factories to replace the traditional food acquisition methods, establishing a new model of sustainable food manufacturing, will greatly reduce the demand for resources in food production, and improve the controllability of food production and manufacturing, and effectively avoid potential food safety and health risks. Cell factories can provide key technologies and supporting methods for the biological manufacturing of important food components, functional food ingredients and important functional nutritional factors, realizing a safer, nutritious, healthy and sustainable way of food acquisition. The combination of cell factory technology and other technologies meets the people's new dietary demand, and also supports that sustainable nutrition and human health as part of sustainable development. This paper focuses on the big food view and human health from the prospect of bio-manufacturing and future food, which aims to better meet people's dietary needs for increasingly diversified, refined, nutritious and ecological food through diversified food manufacturing.

Functional Foods Acceptability: A Consumers' Survey on Bread Enriched with Oenological By-Products

In recent years, consumers have shown considerable attention to functional foods that can provide various benefits. At the same time, the awareness of the problem of waste generation from the agri-food supply chains has increased; thus, scholars and practitioners are devoting great attention to sustainable food waste management. Within the wine processing, the production phase generates by-products such as marc, grape seeds, stems, and wine lees. In most cases, these by-products are treated as waste rather than as a resource, creating environmental, economic, and social impacts related to their disposal. By contrast, the reuse of oenological by-products in food production can have several health benefits, since they are rich in functional molecules such as fibres, polyphenols, and vitamin E, and can also trigger a circular economy model. The aim of this research is to investigate the acceptance of consumers towards bread enriched with oenological by-products through the application of k-means clustering, providing insights on the characterisation of groups of consumers based on their specific features and declared attitudes. The results showed three different consumers' clusters, highlighting that the acceptance of this enriched bread is not influenced by the consumers' socio-economic features, but it is related to consumers' sensitivity. Therefore, target strategies should be put in place to inform consumers about the benefits associated with the consumption of bread enriched with oenological by-products.

Contribution of small-scale farmers to global food security: a meta-analysis

In this study, the impacts of small-scale farmers on food security enhancement were estimated in three dimensions of food availability, food access and food utilization. In the current study, a systematic review and meta-analysis have been performed to synthesize results from 75 original articles. It includes the pooling of data that quantitatively investigate whether or not causal links characterized in the original articles remain valid across a broader scope of the literature. The findings show that farmers who are small-scale in natural/physical capital would lead to higher median food production and agricultural productivity, compared with small-scale farmers in financial capital, at about 19% and 15%, respectively. Meta-regression results indicate that small-scale farmers in natural/physical capital have significantly positive effects on the average agricultural productivity, food income and biofortification. By contrast, farmers who are small-scale in financial capital have negative effects on food security. The influential role of these small-scale farmers should also be considered since food insecurity leads to socio-economic implications. Therefore, it is recommended to cultivate higher value crops, to participate in various income-generating activities such as fisheries and forestry, and to pay agricultural credits. The effect of the size of small-scale farmers on global food security is very useful for policymakers to plan for a world without hunger. © 2022 Society of Chemical Industry.

A Choice Experiment Model for Honey Attributes: Italian Consumer Preferences and Socio-Demographic Profiles

Honey production is currently experiencing a great deal of media attention, with many positive attributes of this hive product emerging. The purpose of the study is to investigate consumer preference and what key information informs people's purchase of honey. This study is based on consumer surveys and experimental evaluation. First of all, the relative importance assigned by consumers to 12 honey product attributes was defined by using the best-worst scaling (BWS) methodology. Secondly, the latent class analysis (LCA) was used to identify different honey consumers based on preferences. The findings demonstrate that "health aspects" and "organoleptic compound" are the main categories of information that consumers tend to research. The sample segmentation defined four different consumer clusters: people who value health, sustainability, organic sourcing and quality. Additionally, socio-demographic characteristics such as age, education level and profession also played a part on consumer choice and the characterisation of each cluster. This study can contribute to fostering good nutrition and improving sustainability within communities.

Access to Healthy Wheat and Maize Processed Foods in Mexico City: Comparisons across Socioeconomic Areas and Store Types

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16-69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

Sustainability Labels on Olive Oil: A Review on Consumer Attitudes and Behavior

Product labeling is a way to inform consumers and increase their awareness about sustainability attributes of products. It guarantees the use of specific production conditions, promotes market incentives and highlights environmental, social and/or ethical product attributes. This study provides a literature review of sustainability labels on olive oil including consumer attitudes and behavior towards this product. Results show that consumers have positive attitudes towards olive oil carrying sustainability labels and are willing to pay more for olive oil carrying those labels. However, the major drivers of this behavior are far from being related to sustainability. This insight jeopardizes the main objective of those labels and suggests more clarifications about the information delivered by them. More in-depth investigations are needed about the drivers of consumer behavior towards olive oil carrying sustainability labels.

Negotiating Unsustainable Food Transformations: Development, Middle Classes and Everyday Food Practices in Vietnam

Amidst calls for making food systems more sustainable, new unsustainable food transformations unfold alongside economic development. Explanations for unsustainable food transformations in emerging economies vary greatly, but there is widespread agreement that demand from new middle classes play a crucial role. Yet this demand is to a large extent co-created by systems of provision, and middle-class consumers are constantly navigating food transformations in a search for healthy and safe food. Focusing on Vietnam's dramatic food transformations, and combining attention to the political economy of food with a social practice approach to consumption, the paper zooms in on the how middle-class households in Hanoi negotiate the rapid transformations of food systems and food environments. The paper concludes that new thinking on sustainable food systems is urgently needed and argues that vital insights can be gained by studying food practices and their interaction with everyday geographies of consumption.

The effect of organic farming on water reusability, sustainable ecosystem, and food toxicity

Water is a fundamental necessity for people's well-being and the ecosystem's sustainability; however, its toxicity due to agrochemicals usage for food production leads to the deterioration of water quality. The poor water quality diminishes its reusability, thus limiting efficient water usage. Organic farming is one of the best ways that does not only reduce the deterioration of water quality but also decrease food toxicity. In organic farming, the crop is grown with no/less chemical usage. Besides, organic farming maintains biodiversity and reduces the anthropogenic footprint on soil, air, water, wildlife, and especially on the farming communities. Fields that are organically managed continuously for years have fewer pest populations and were attributed to increased biodiversity and abundance of multi-trophic interactions as well as to changes in plant metabolites. Fewer insect pests (pathogen vectors), in turn, would result in fewer crop diseases and increase crop production. This review highlights that organic farming may play a critical role in the reduction of pests and pathogens, which eventually would reduce the need for chemical reagents to protect crops, improving yield quality and water reusability.

Promoting Food Safety in Local Value Chains: The Case of Vegetables in Vietnam

Background: Food quality and safety concerns in low- and middle-income countries are often addressed using stringent standards and formal contracts between farmers and buyers. Many studies have investigated the welfare implications of these control mechanisms for small-scale farmers in modern value chains, including exports and supermarkets. Conversely, few studies have focused on the potential of certification and contracts to tackle food safety issues within local traditional value chains. Methods: This study uses a discrete choice experiment to explore the preferences of vegetable farmers (n = 301) in northern Vietnam for different types of certification schemes–including third-party certification and participatory guarantee systems–and contracts. Results: Farmers are willing to accept a 49% lower price per kilogram for their vegetables to enter into a contract with a buyer, provided that pesticide use restrictions are feasible and the buyer is fully committed and trustworthy. However, they are strongly averse to organic farming, as they would require a 40% premium per kilogram to produce organically. They would also request a 21% premium to accept selling to an unknown buyer. Farmers highly value contracts that entail large purchase quantities, long duration and pesticide provision. Although the estimated willingness-to-accept values may seem very large, they make sense in the context of highly perishable produce. Conclusion: Our findings urge both policy makers and researchers to not only focus on modern value chains but also on local traditional value chains to tackle food safety issues in low- and middle-income countries, as we show that farmers are willing to produce safe vegetables for the local market when trading with buyers under beneficial conditions.

Advances in Cereal Crop Genomics for Resilience under Climate Change

Adapting to climate change, providing sufficient human food and nutritional needs, and securing sufficient energy supplies will call for a radical transformation from the current conventional adaptation approaches to more broad-based and transformative alternatives. This entails diversifying the agricultural system and boosting productivity of major cereal crops through development of climate-resilient cultivars that can sustainably maintain higher yields under climate change conditions, expanding our focus to crop wild relatives, and better exploitation of underutilized crop species. This is facilitated by the recent developments in plant genomics, such as advances in genome sequencing, assembly, and annotation, as well as gene editing technologies, which have increased the availability of high-quality reference genomes for various model and non-model plant species. This has necessitated genomics-assisted breeding of crops, including underutilized species, consequently broadening genetic variation of the available germplasm; improving the discovery of novel alleles controlling important agronomic traits; and enhancing creation of new crop cultivars with improved tolerance to biotic and abiotic stresses and superior nutritive quality. Here, therefore, we summarize these recent developments in plant genomics and their application, with particular reference to cereal crops (including underutilized species). Particularly, we discuss genome sequencing approaches, quantitative trait loci (QTL) mapping and genome-wide association (GWAS) studies, directed mutagenesis, plant non-coding RNAs, precise gene editing technologies such as CRISPR-Cas9, and complementation of crop genotyping by crop phenotyping. We then conclude by providing an outlook that, as we step into the future, high-throughput phenotyping, pan-genomics, transposable elements analysis, and machine learning hold much promise for crop improvements related to climate resilience and nutritional superiority.

A global carbon and nitrogen isotope perspective on modern and ancient human diet

Stable carbon and nitrogen isotope analyses are widely used to infer diet and mobility in ancient and modern human populations, potentially providing a means to situate humans in global food webs. We collated 13,666 globally distributed analyses of ancient and modern human collagen and keratin samples. We converted all data to a common "Modern Diet Equivalent" reference frame to enable direct comparison among modern human diets, human diets prior to the advent of industrial agriculture, and the natural environment. This approach reveals a broad diet prior to industrialized agriculture and continued in modern subsistence populations, consistent with the human ability to consume opportunistically as extreme omnivores within complex natural food webs and across multiple trophic levels in every terrestrial and many marine ecosystems on the planet. In stark contrast, isotope dietary breadth across modern nonsubsistence populations has compressed by two-thirds as a result of the rise of industrialized agriculture and animal husbandry practices and the globalization of food distribution networks.

Effects of Modern Food Retailers on Adult and Child Diets and Nutrition

In many developing countries, food environments are changing rapidly, with modern retailers-such as supermarkets-gaining in importance. Previous studies have suggested that the rise of modern retailers contributes to overweight and obesity. Effects of modern retailers on dietary quality have not been analyzed previously due to the unavailability of individual-level dietary data. Here, we address this research gap with data from randomly selected households in Lusaka, Zambia. Anthropometric and food-intake data from 930 adults and 499 children were analyzed to estimate effects of purchasing food in modern retailers on body weight, height, and dietary quality while controlling for income and other confounding factors. The food expenditure share spent in modern retailers was found to be positively associated with overweight in adults, but not in children. For children, a positive association between expenditures in modern retailers and height was identified. Modern retailers contribute to higher consumption of ultra-processed foods and calories. But they also increase protein and micronutrient intakes among adults and children, mainly through higher consumption of meat and dairy. The findings underline that modern retailers can influence diets and nutrition in positive and negative ways. Differentiated regulatory policies are needed to shape food environments for healthy food choices and nutrition.

Prevalence of Overweight and Obesity among People Aged 18 Years and Over between 2013 and 2018 in Hunan, China

Background: Recent overweight and obesity prevalence data are lacking for China. Methods: Data were from provincially representative surveys conducted in 2013 and 2018 in Hunan Province, China. Overweight and obesity were defined according to the Chinese standard. Complex sampling weights were considered in statistical analyses. 95% confidence interval (95% CI) of rate was calculated. Results: The overall prevalence rate between 2013 and 2018 significantly increased from 20.81% (95% CI: 17.68–23.95) to 26.97% (95% CI: 23.48–30.45) for overweight and from 4.09% (95% CI: 3.21–4.96) to 7.13% (95% CI: 5.10–9.15) for obesity in Hunan Province of China, respectively. Urban residents and males had higher crude prevalence rates of overweight and obesity than rural residents and females in 2013 and in 2018. Notably, the peak age groups of overweight and obesity both became younger between 2013 and 2018. After controlling for Engel coefficient, level of education and frequency of physical exercise per week, the overweight prevalence significantly increased in urban males aged 65+ (adjusted OR: 1.52) and rural males aged 45–54 years (adjusted OR: 1.52) and 65+ (adjusted OR: 1.88) and the obesity prevalence rate rose significantly in many groups (urban males: 18–24 years, 25–34 years, 35–44 years and 55–64 years; urban females: 25–34 years, 35–44 years, 45–54 years; rural males: 18–24 years, 25–34 years; rural females: 35–44 years, 55–64 years), with adjusted OR varying from 1.56 to 5.52. Conclusion: The adult prevalence rates of overweight and obesity significantly increased between 2013 and 2018 in Hunan Province, China. The increasing prevalence rates and varying prevalence changes across groups warrantee further research and policy interventions.

Global drivers of food system (un)sustainability: A multi-country correlation analysis

At present, our ability to comprehend the dynamics of food systems and the consequences of their rapid 'transformations' is limited. In this paper, we propose to address this gap by exploring the interactions between the sustainability of food systems and a set of key drivers at the global scale. For this we compile a metric of 12 key drivers of food system from a globally-representative set of low, middle, and high-income countries and analyze the relationships between these drivers and a composite index that integrates the four key dimensions of food system sustainability, namely: food security & nutrition, environment, social, and economic dimensions. The two metrics highlight the important data gap that characterizes national systems' statistics-in particular in relation to transformation, transport, retail and distribution. Spearman correlations and Principal Component Analysis are then used to explore associations between levels of sustainability and drivers. With the exception of one economic driver (trade flows in merchandise and services), the majority of the statistically significant correlations found between food system sustainability and drivers appear to be negative. The fact that most of these negative drivers are closely related to the global demographic transition that is currently affecting the world population highlights the magnitude of the challenges ahead. This analysis is the first one that provides quantitative evidence at the global scale about correlations between the four dimensions of sustainability of our food systems and specific drivers.

Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms

Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.

Modernization of African Food Retailing and (Un)healthy Food Consumption

Food environments in Africa are changing rapidly, with modern retailers—such as supermarkets, hypermarkets, and fast-food restaurants—gaining in importance. Changing food environments can influence consumers’ food choices and dietary patterns. Recent research has suggested that the growth of supermarkets leads to more consumption of processed foods, less healthy diets, and rising obesity. However, relatively little is known about what type of consumers actually use modern supermarkets and to what extent. Moreover, focusing only on supermarkets may be misleading, as most consumers obtain their food from various modern and traditional retailers. We add to the literature by examining relationships between consumers’ socioeconomic status, use of different modern and traditional retailers, and dietary patterns. The analysis uses household survey data from urban Zambia. Results show that two-thirds of the households use modern and traditional retailers simultaneously, but that richer households are more likely than poorer ones to use supermarkets and hypermarkets. Use of modern retailers is positively associated with higher consumption of ultra-processed foods, after also controlling for income and other socioeconomic factors. However, the use of traditional stores and kiosks is also positively associated with the consumption of ultra-processed foods, suggesting that modern retailers are not the only drivers of dietary transitions.

Sustainability Matters: Consumer Acceptance of Different Vertical Farming Systems

Fresh produce within vertical farming systems grows vertically in different layers stacked atop each other, thus allowing for the efficient use of space. As the environment in vertical farming systems is completely controlled, neither sunlight nor soil is necessary. On the one hand, vertical farming may help to provide a healthy diet for the growing global population because it has a greater crop yield per square meter used than conventional farming; moreover, it can offer the opportunity to grow food in climatically disadvantaged areas. On the other hand, growth conditions may be perceived as unnatural and the entire vertical farming system as unsustainable. Therefore, understanding the consumers’ acceptance of vertical farming systems is important. This study is the first work to provide insights into consumers’ acceptance of three different vertical farming systems. Data are collected through an online survey of 482 consumers in Germany in February 2018. Drivers of consumer acceptance of vertical farming systems are identified through structural equation modelling. The results indicate that perceived sustainability is the major driver of consumer acceptance of vertical farming systems. The larger the system, the higher the likelihood that it will be considered as sustainable. Obviously, consumers perceive something like ecologies of scale.

How Do Fruit and Vegetable Markets Operate in Rural India? A Qualitative Study of the Impact of Supply and Demand on Nutrition Security

BACKGROUND

Diets in rural India are cereal based with low intakes of micronutrient-rich foods. The value chains for nutrition approach aims to study supply and demand of such foods. This may aid in development of interventions to improve diets and livelihoods.

OBJECTIVES

(1) To identify how fruit and vegetables are accessed, (2) to describe and map the structure of value chains for exemplar foods, (3) to understand how foods are priced, and (4) to explore factors that affect decisions about which crops are grown, marketed, and sold.

METHODS

After stakeholder consultation, we identified 2 fruits (mango and guava) and 2 vegetables (shepu and spinach) as exemplar foods. Criteria for these exemplar foods were that they should be known to participants and there should be variability in intakes. We held 24 interviews with value chain actors including farmers, wholesalers, and vendors of the exemplar foods. Data collection was stopped when no new information emerged. We used inductive thematic coding for our analysis.

RESULTS

The value chains for each of the exemplar foods were relatively simple and involved farmers, middlemen, and vendors at either city or village level. The main themes identified as being factors considered when making decisions about which foods to grow and sell were (1) farming resources and assets, (2) quality of produce, (3) environmental conditions, (4) financial factors, (5) transport availability, and (6) consumer demand.

CONCLUSIONS

There are opportunities to intervene within fruit and vegetable value chains to increase availability, affordability, and access to produce in rural India. Future research is required to determine which interventions will be feasible, effective, and acceptable to the community and other stakeholders.

Global supermarkets' corporate social responsibility commitments to public health: a content analysis

Background

Supermarkets have unprecedented political and economic power in the food system and an inherent responsibility to demonstrate good corporate citizenship via corporate social responsibility (CSR). The aim of this study was to investigate the world’s largest and most powerful supermarkets’ publically available CSR commitments to determine their potential impact on public health.

Methods

The world’s largest 100 retailers were identified using the Global Powers of Retailing report. Thirty-one supermarkets that published corporate reports referring to CSR or sustainability, in English, between 2013 and 2018, were included and thematically analysed.

Results

Although a large number of themes were identified (n = 79), and there were differences between each business, supermarket CSR commitments focused on five priorities: donating surplus food to charities for redistribution to feed the hungry; reducing and recovering food waste; sustainably sourcing specific ingredients including seafood, palm oil, soy and cocoa; governance of food safety; and growing the number of own brand foods available, that are made by suppliers to meet supermarkets’ requirements.

Conclusions

CSR commitments made by 31 of the world’s largest supermarkets showed they appeared willing to take steps to improve sustainable sourcing of specific ingredients, but there was little action being taken to support health and nutrition. Although some supermarket CSR initiatives showed promise, the world’s largest supermarkets could do more to use their power to support public health. It is recommended they should: (1) transparently report food waste encompassing the whole of the food system in their waste reduction efforts; (2) support healthful and sustainable diets by reducing production and consumption of discretionary foods, meat, and other ingredients with high social and environmental impacts; (3) remove unhealthful confectionery, snacks, and sweetened beverages from prominent in-store locations; (4) ensure a variety of minimally processed nutritious foods are widely available; and (5) introduce initiatives to make healthful foods more affordable, support consumers to select healthful and sustainable foods, and report healthful food sales as a proportion of total food sales, using transparent criteria for key terms.

The 2017 Garrod Lecture: Genes, guts and globalization

The widespread use of antibacterial drugs over the last 70 years has brought immense benefits to human health at the price of increasing drug inefficacy. Antibacterial agents have a strong selective effect in both favouring resistant strains and allowing particular species and families of bacteria to prosper, especially in the healthcare setting. Whilst important Gram-positive bacterial pathogens such as Staphylococcus aureus and Streptococcus pneumoniae caused concern over the last 20 years because of the spread of antibiotic-resistant strains, Enterobacteriaceae have become the biggest challenge. They have very efficient mechanisms for genetic exchange, as illustrated by the emergence and rapid spread of CTX-M β-lactamases and the carbapenemases. The unique epidemiology of Enterobacteriaceae, with substantial numbers colonizing the mammalian gut and subsequent release into and spread in the environment, presents a significant threat to human health because of the high levels of exposure for the whole community. The use of antimicrobials in agriculture combined with global movements of people, animals and food, arising from worldwide industrialization, generates a diversity and level of resistance not seen previously. Control will require globally coordinated interventions similar to those needed to ameliorate climate change.

The science of food security

We need to feed an estimated population in excess of 9 billion by 2050 with diminishing natural resources, whilst ensuring the health of people and the planet. Herein we connect the future global food demand to the role of agricultural and food science in producing and stabilising foods to meet the global food demand. We highlight the challenges to food and agriculture systems in the face of climate change and global megatrends that are shaping the future world. We discuss the opportunities to reduce food loss and waste, and recover produce that is currently wasted to make this the new raw ingredient supply for the food industry. Our systems-based perspective links food security to agricultural productivity, food safety, health and nutrition, processing and supply chain efficiency in the face of global and industry megatrends. We call for a collaborative, transdisciplinary approach to the science of food security, with a focus on enabling technologies within a context of social, market and global trends to achieve food and nutritional security.

Rural food security, subsistence agriculture, and seasonality

Many of the world's food-insecure and undernourished people are smallholder farmers in developing countries. This is especially true in Africa. There is an urgent need to make smallholder agriculture and food systems more nutrition-sensitive. African farm households are known to consume a sizeable part of what they produce at home. Less is known about how much subsistence agriculture actually contributes to household diets, and how this contribution changes seasonally. We use representative data from rural Ethiopia covering every month of one full year to address this knowledge gap. On average, subsistence production accounts for 58% of rural households' calorie consumption, that is, 42% of the calories consumed are from purchased foods. Some seasonal variation occurs. During the lean season, purchased foods account for more than half of all calories consumed. But even during the main harvest and post-harvest season, purchased foods contribute more than one-third to total calorie consumption. Markets are even more important for dietary quality. During all seasons, purchased foods play a much larger role for dietary diversity than subsistence production. These findings suggest that strengthening rural markets needs to be a key element in strategies to improve food security and dietary quality in the African small-farm sector.

Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya

BACKGROUND

While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people's health have not been analyzed up till now.

OBJECTIVE

This study investigates the effects of purchasing food in supermarkets on people's BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome.

DESIGN

This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality.

RESULTS

Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed.

CONCLUSIONS

Supermarkets and their food sales strategies seem to have direct effects on people's health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people's food choices.

The intricate connection between diet, microbiota, and cancer: A jigsaw puzzle

The microbial community has a decisive role in determining our health and disease susceptibility. Presumably, this is closely associated with the complex community network of bacteria, fungi, archaea and viruses that reside our guts. This dynamic ecosystem exists in a symbiotic relationship with its host and plays a fundamental role in the hosts' physiological functions. The microbial community is highly personalized and therefore exhibits a high degree of inter-individual variability, which is dependent on host specifics such as genetic background, physiology and lifestyle. Although the gut microbiota is shaped early on during birth, there are several factors that affect the composition of microbiota during childhood and adulthood. Among them diet appears to be a consistent and prominent one. The metabolic activity of bacteria affects food digestion, absorption, energy production, and immunity. Thus, definition of the microbiota composition and functional profiles in response to a particular diet may lead to critical information on the direct and indirect role/use of the bacterial community during health and disease. In this review, I discuss gut microbiota and its potential link to cancer with specific emphasis on metabolism and diet.

Economic Growth, Climate Change, and Obesity

Human and planetary health as well as economic growth are firmly interlinked and subject to complex interaction effects. In this paper, we provide an overview of interlinkages between economic growth, climate change, and obesity focusing on recent advances in the literature. In addition to empirical findings, we discuss different theoretical frameworks used to conceptualize these complex links and highlight policy options and challenges. We conclude that policies addressing both climate change and obesity simultaneously are particularly promising and often suitable for ensuring sustainable development.