Act now before Ukraine war plunges millions into malnutrition

Development of a standardized consensus lexicon for terms related to micronutrient programs

Inconsistent use of terminology among diverse stakeholders hinders effective communication in micronutrient programs, especially large-scale food fortification (LSFF) which involves stakeholders from different sectors. To align the terminology use, the Micronutrient Data Innovation Alliance (DInA) of the Micronutrient Forum (MNF) created a lexicon of terms related to LSFF and other micronutrient programs. The purpose of this lexicon is to establish a central repository of consensus definitions of key terms to facilitate communication among diverse stakeholders involved in micronutrient programs including public and private sectors, donor agencies, food industries, academic institutions, etc. This paper describes the methodology of lexicon development. Important terms related to micronutrient programs were compiled from multiple sources, including United Nations agencies, program implementation and technical support agencies, relevant websites, and scientific literature. The selection of terms was guided by key micronutrient interventions (fortification, supplementation, dietary diversification) and the program cycle (assessment, planning, implementation, monitoring and evaluation). Definitions of terms were identified from these references and checked for consistency across different sources. For terms with multiple definitions, a modified Delphi method was applied to harmonize the definitions. The first draft lexicon (n = 113 terms) was reviewed by six experts from the University of California, Davis (UCD) and MNF, and second draft (n = 115 terms) was shared with 24 global micronutrient experts for feedback. Fifty-four terms were found to have multiple definitions. Of which, minor modification was made for 12-terms with nominal difference and remaining 42-terms were shared with over 140 micronutrient-experts disseminated via an online survey through newsletters and emails to solicit experts' opinions on the most appropriate definition or a modified one. Nineteen legal terms and 83 micronutrient terms (n = 102 terms) were subsequently added. Overall, 39 experts from diverse areas of expertise (LSFF, micronutrient program planning and implementation, surveys and research, policy development, food industry regulations, food safety, and public health nutrition) participated in the online survey. The terms with >75% agreement among experts were considered as final, while the remaining were reviewed again by experts from UCD and MNF until consensus was reached on harmonized definitions. The current lexicon is available online at the DInA-website. and contains 217 terms and will be maintained as a "living document". The lexicon will facilitate the ability of key stakeholders of micronutrient programs to evaluate and compare program performance in order to make informed decisions on how to ensure future progress in reducing micronutrient deficiencies.

Food prices and the wages of the poor: A cost-effective addition to high-frequency food security monitoring

The affordability of nutritious food for "all people, at all times" is a critically important dimension of food security. Yet surprisingly, timely high-frequency indicators of food affordability are rarely collected in any systematic fashion despite price volatility emerging as major source of food insecurity in the 21st Century. The 2008 global food crisis prompted international agencies to invest heavily in monitoring domestic food prices in low and middle income countries (LMICs). However, food price monitoring is not sufficient for measuring changes in diet affordability; for that, one must also measure changes either in income or in an income proxy. We propose using the wages of unskilled workers as a cheap and sufficiently accurate income proxy, especially for the urban and rural non-farm poor. We first outline alternative measures of "food wage" indices, defined as wages deflated either by consumer food price indices or novel healthy diet cost indices. We then discuss the conceptual strengths and limitations of food wages. Finally, we examine patterns and trends in different types of real food wage series during well-known food price crises in Ethiopia (2008, 2011 and 2022), Sri Lanka (2022) and Myanmar (2022). In all these instances, food wages declined by 20-30%, often in the space of a few months. In Myanmar, the decline in real wages during 2022 closely matches declines in household disposable income. We strongly advocate tracking the wages of the poor as a timely, accurate and cost-effective means of monitoring food affordability for important segments of the world's poor.

Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development

Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.

Does acute malnutrition in young children increase the risk of treatment failure following artemisinin-based combination therapy? A WWARN individual patient data meta-analysis

BACKGROUND

The geographical, demographic, and socioeconomic distributions of malaria and malnutrition largely overlap. It remains unknown whether malnutrition affects the efficacy of WHO-recommended artemisinin-based combination therapies (ACTs). A previous systematic review was inconclusive as data were sparse and heterogeneous, indicating that other methodological approaches, such as individual patient data meta-analysis, should be considered. The objective of this study was to conduct such a meta-analysis to assess the effect of malnutrition (wasting and stunting) on treatment outcomes in children younger than 5 years treated with an ACT for uncomplicated falciparum malaria.

METHODS

We conducted a meta-analysis of individual patient data from studies identified through a systematic review of literature published between 1980 and 2018 in PubMed, Global Health, and Cochrane Libraries (PROSPERO CRD42017056934) and inspection of the WorldWide Antimalarial Resistance Network (WWARN) repository for ACT efficacy studies, including children younger than 5 years with uncomplicated falciparum malaria. The association of either acute (wasting) or chronic (stunting) malnutrition with day 42 PCR-adjusted risk of recrudescence (ie, return of the same infection) or reinfection after therapy was investigated using Cox regression, and with day 2 parasite positivity using logistic regression.

FINDINGS

Data were included from all 36 studies targeted, 31 from Africa. Of 11 301 eligible children in 75 study sites, 11·5% were wasted (weight-for-height Z score [WHZ] <-2), and 31·8% were stunted (height-for-age Z score [HAZ] <-2). Decrease in WHZ was associated with increased risk of day 2 positivity (adjusted odds ratio 1·12, 95% CI 1·05-1·18 per unit; p=0·0002), treatment failure (adjusted hazard ratio [AHR] 1·14, 95% CI 1·02-1·26, p=0·016), and reinfection after therapy (AHR 1·09, 1·04-1·13, p=0·0003). Children with milder wasting (WHZ -2 to -1) also had a higher risk of recrudescence (AHR 1·85, 1·29-2·65, p=0·0008 vs WHZ ≥0). Stunting was not associated with reduced ACT efficacy.

INTERPRETATION

Children younger than 5 years with acute malnutrition and presenting with uncomplicated falciparum malaria were at higher risk of delayed parasite clearance, ACT treatment failure, and reinfections. Stunting was more prevalent, but not associated with changes in ACT efficacy. Acute malnutrition is known to impact medicine absorption and metabolism. Further study to inform dose optimisation of ACTs in wasted children is urgently needed.

FUNDING

Bill & Melinda Gates Foundation.

TRANSLATION

For the French translation of the abstract see Supplementary Materials section.

A review of the impact of social disruptions on food security and food choice

At times of severe social disruption, be that war, conflict, pandemic, or economic downturn, both the availability and consumption of healthy dietary patterns can be adversely affected with any effects often outlasting the initial social disruption. For instance, when the COVID-19 pandemic hit and lockdown restrictions followed, households were reported to consume unhealthy diets. In some cases, this seemed to be a response to the situation and a coping mechanism. In contrast, in other cases, it was a consequence of limited food availability or access, with some communities finding that fresh foods became difficult to source due to the disruption in global supply chains. The example presented by the impact of conflict in Ukraine, which has also disrupted global food supply chains, at a macrolevel, food systems and at a microlevel, individual and community shows that food choices may respond to different global events in similar ways. Therefore, in this review, a range of events/disruptions are considered, beyond pandemics and wars, including climate disasters (e.g., fire, famine, and floods) that have been shown to impact food supply and consequently, food security. The importance of this can be seen as inadequate and nutritionally poor diets have a concomitant effect on health, which extends beyond the initial period of societal stress and disruption of food supply chains. Hence, the impact of such disruptions on consumer behavior which includes food choice needs to be corroborated. Therefore, this review aims to discuss the impact of such disruptions on consumer behavior and food choices. Additionally, this review provides some practical strategies that can be used to ensure the availability of healthy diets.

The Impact of Food-Shaping Techniques on Nutrition, Mealtime Experiences, and Quality of Life for Older Adults in Aged Care Settings: A Systematic Review

OBJECTIVE

Food-shaping methods, particularly for texture-modified foods, present numerous opportunities to improve the visual appeal of food and potentially the nutrition of older people with dysphagia (swallowing difficulty). This review appraises and synthesizes the evidence on the use of food-shaping methods to enhance nutrition in older adults with swallowing difficulties.

METHODS

In August 2022, five electronic databases (PubMed, CINAHL, Scopus, Cochrane Library, and Web of Science) were searched for original research related to the intersection of nutrition, food shaping, and older adults with swallowing difficulties. Characteristics of included studies were described and data from results and findings extracted for analysis across studies.

RESULTS

Eighteen studies met the inclusion criteria and encompassed a variety of settings, including aged care settings (n = 15) and food science laboratories (n = 3). Qualitative and quantitative findings demonstrated a variety of impacts of food shaping for the older adult with swallowing difficulty, including enhanced nutrition and wellbeing. The content themes identified across studies were: links between food shaping and nutrition, shaping food for individual choice, food shaping for enjoyment, a combination of supporting factors, collaborative inter-disciplinary teams and roles, and implementation aligns with local contexts.

CONCLUSION

With recent growth in research on food shaping, the body of studies reviewed identified an influence of food-shaping methods on the nutritional status of older adults with swallowing difficulties. Given the identified potential benefit of food shaping and attention to the visual appeal of food for older people, further research examining links between food shaping and nutrition are warranted.

Countries' vulnerability to food supply disruptions caused by the Russia-Ukraine war from a trade dependency perspective

Disruptions of key food and fertilizer exports from Russia and Ukraine have exposed many countries to challenges accessing some commodities since these countries' war began. We evaluated the short-term, external, and direct impacts of disruptions of six food commodities and three types of fertilizer supplies from Russia and Ukraine on food access for all trading partners of the two countries by applying a set of trade and socioeconomic indicators. We found that the external food supplies of 279 countries and territories were affected to varying degrees; 24 countries-especially Georgia, Armenia, Kazakhstan, Azerbaijan, and Mongolia-are extremely vulnerable because they depend almost entirely on a variety of food imports from Russia and Ukraine. Access to fertilizers was affected in 136 countries and territories, particularly Estonia (potassic fertilizer), Mongolia (nitrogenous fertilizers), Kazakhstan (mixed fertilizers), and Brazil, the United States, China, and India (all types of fertilizers). An integrated assessment of countries' import types, purchasing power parity per capita, and populations indicated that the Democratic Republic of the Congo, Ethiopia, Egypt, and Pakistan are most vulnerable to such supply disruptions. Development of research into diversification and decentralization strategies for food access is needed to guide stable food supply policies.

Breeding by intervening: Exploring the role of associations and deliberation in consumer acceptance of different breeding techniques

New plant breeding techniques may play an important role in improving food quality, global food security and sustainability. Previous breeding techniques have, however, met with substantial resistance from society. This study examined the role of associations and deliberation in the evaluation of breeding techniques. Breeding techniques studied included conventional breeding, gene-editing, genetic modification (cisgenesis and transgenesis), marker-assisted breeding and synthetic biology. By using focus group discussions that included individual tasks, we found that when participants relied on their spontaneous associations, gene-editing was evaluated similarly as genetic modification. However, after information provision and group discussion, gene-editing was preferred over genetic modification. Perceived naturalness was found to be the main reason for obtaining different levels of acceptance, not only between gene-editing and genetic modification but across all breeding techniques examined. These findings highlight the importance of associations and show that beliefs about naturalness remain crucial in understanding how consumers evaluate breeding techniques.

Transforming Nigerian Food Systems Through Their Backbones: Lessons From a Decade of Staple Crop Biofortification Programing

This article presents the evolution of the biofortification program in Nigeria over the last decade and the role of interdisciplinary research in informing cost-effective, efficient, and inclusive development; implementation; and scaling of this program. Launched in 2011 to improve Nigeria's food systems to deliver accessible and affordable nutrients through commonly consumed staples, the Nigeria biofortification program was implemented through an effective partnership between the CGIAR and public, private, and civil society sectors at federal, state, and local levels. By the end of 2021, several biofortified varieties of Nigeria's 2 main staples, namely cassava and maize, were officially released for production by smallholders, with several biofortified varieties of other key staples (including pearl millet, rice, and sorghum) either under testing or in the release pipeline. In 2021, the program was estimated to benefit 13 million Nigerians consuming biofortified cassava and maize varieties. The evidence on the nutritional impact, consumer and farmer acceptance, and cost-effective scalability of biofortified crops documented by the program resulted in the integration of biofortified crops in several key national public policies and social protection programs; private seed and food company products/investments, as well as in humanitarian aid.

Post-harvest ripening affects drying behavior, antioxidant capacity and flavor release of peach via alteration of cell wall polysaccharides content and nanostructures, water distribution and status

Effect of post-harvest ripening on cell wall polysaccharides nanostructures, water status, physiochemical properties of peaches and drying behavior under hot air-infrared drying was evaluated. Results showed that the content of water soluble pectins (WSP) increased by 94 %, while the contents of chelate-soluble pectins (CSP), Na₂CO₃-soluble pectins (NSP) and hemicelluloses (HE) decreased during post-harvest ripening by 60 %, 43 %, and 61 %, respectively. The drying time increased from 3.5 to 5.5 h when the post-harvest time increased from 0 to 6 days. Atomic force microscope analysis showed that depolymerization of hemicelluloses and pectin occurred during post-harvest ripening. Time Domain -NMR observations indicated that reorganization of cell wall polysaccharides nanostructure changed water spatial distribution and cell internal structure, facilitated moisture migration, and affected antioxidant capacity of peaches during drying. This leads to the redistribution of flavor substances (heptanal, n-nonanal dimer and n-nonanal monomer). The current work elucidates the effect of post-harvest ripening on the physiochemical properties and drying behavior of peaches.

Access to global wheat reserves determines country-level vulnerability to conflict-induced Ukrainian wheat supply disruption

The Russia-Ukraine conflict reduced global wheat supplies, yet the food security implications vary across countries. We identify a 39% decrease in Ukrainian wheat exports in 2022 resulting in >70% import losses in some of the countries most vulnerable to these disruptions, with substantial impacts felt in Egypt, Oman, Saudi Arabia, Libya, Mauritania, Yemen and Lebanon. Differential impacts are a function of access to capital and international trade, suggesting the need for policy measures to defuse the impending food crisis.

Predicting the Potential Impact of Emergency on Global Grain Security: A Case of the Russia-Ukraine Conflict

Global emergencies have a profound impact on exacerbating food insecurity, and the protracted Russia-Ukraine conflict has emerged as a significant driver of a global food crisis. Accurately quantifying the impact of this conflict is crucial for achieving sustainable development goals. The multi-indicator comprehensive evaluation approach was used to construct a grain security composite index (GSCI). Moreover, econometric model was used to predict the potential impacts of the conflict on global grain security in 2030 under two scenarios: with and without the "Russia-Ukraine conflict". The results conclude that global food prices reached unprecedented levels as a consequence of the conflict, leading to notable fluctuations in food prices, especially with a significant surge in wheat prices. The conflict had a negative impact on global grain security, resulting in a decline in grain security from 0.538 to 0.419. Predictions indicate that the influence of the conflict on global grain security will be substantially greater compared to the scenario without the conflict in 2023-2030, ranging from 0.033 to 0.13. Furthermore, grain security will first decrease and then increase under the sustained consequences of the conflict. The achievement of the 2030 sustainable development goals will encounter significant challenges in light of these circumstances.

Shock propagation from the Russia-Ukraine conflict on international multilayer food production network determines global food availability

Dependencies in the global food production network can lead to shortages in numerous regions, as demonstrated by the impacts of the Russia-Ukraine conflict on global food supplies. Here we reveal the losses of 125 food products after a localized shock to agricultural production in 192 countries and territories using a multilayer network model of trade (direct) and conversion of food products (indirect), thereby quantifying 10⁸ shock transmissions. We find that a complete agricultural production loss in Ukraine has heterogeneous impacts on other countries, causing relative losses of up to 89% in sunflower oil and 85% in maize via direct effects and up to 25% in poultry meat via indirect impacts. Whereas previous studies often treated products in isolation and did not account for product conversion during production, the present model considers the global propagation of local supply shocks along both production and trade relations, allowing for a comparison of different response strategies.

Harnessing the connectivity of climate change, food systems and diets: Taking action to improve human and planetary health☆

With climate change, the COVID-19 pandemic, and ongoing conflicts, food systems and the diets they produce are facing increasing fragility. In a turbulent, hot world, threatened resiliency and sustainability of food systems could make it all the more complicated to nourish a population of 9.7 billion by 2050. Climate change is having adverse impacts across food systems with more frequent and intense extreme events that will challenge food production, storage, and transport, potentially imperiling the global population’s ability to access and afford healthy diets. Inadequate diets will contribute further to detrimental human and planetary health impacts. At the same time, the way food is grown, processed, packaged, and transported is having adverse impacts on the environment and finite natural resources further accelerating climate change, tropical deforestation, and biodiversity loss. This state-of-the-science iterative review covers three areas. The paper's first section presents how climate change is connected to food systems and how dietary trends and foods consumed worldwide impact human health, climate change, and environmental degradation. The second area articulates how food systems affect global dietary trends and the macro forces shaping food systems and diets. The last section highlights how specific food policies and actions related to dietary transitions can contribute to climate adaptation and mitigation responses and, at the same time, improve human and planetary health. While there is significant urgency in acting, it is also critical to move beyond the political inertia and bridge the separatism of food systems and climate change agendas that currently exists among governments and private sector actors. The window is closing and closing fast.

Food fraud and mitigating strategies of UK food supply chain during COVID-19

Covid-19 had shown the vulnerability of the food supply chain and fraudsters may take advantage of the pandemic whilst the population needed a continuous supply of safe and quality food. The lack of monitoring and policing in the food supply chain may encourage fraudsters to upscale their operations. Previous studies had warned of a surge in fraudulent products due to COVID-19. This raised the question on whether food fraud had increased during the pandemic? This study aims to investigate food fraud during COVID-19 and how the food supply chain develops mitigating strategies against fraudulent activities. A mixed-method approach including survey and semi-structured interviews were conducted among UK food businesses. Two hundred and two agri-food businesses responded to the survey and 15 semi-structured interviews were conducted. The majority of the food businesses did not experience an increase of food fraud activities during COVID-19. Two thematic domains and ten sub-themes were identified from the data set. There was a heightened sense of anticipation and preparation for increased fraudulent activities during the pandemic. The main risk mitigating strategies included horizon scanning; developing and maintaining supplier relationship and assurance; understanding product characteristics, testing capabilities, conducting vulnerability assessments and training. Practical and cost-effective strategies for small and medium food businesses were recommended. This is the first empirical study on food fraud and mitigating strategies of the UK food supply chain during the pandemic. Our findings provide evidence for informing the policies and practices of the food regulatory authorities as well as best practices to protect the UK food supply chain against food fraud during exogenous shocks like COVID-19.

Aligning the Epidemiology of Malnutrition with Food Fortification: Grasp Versus Reach

Large-scale food fortification (LSFF) has been recognized as one of the most cost-effective interventions to improve the intake of vitamins and minerals and decrease the burden of micronutrient deficiency. Indeed, the simple addition of micronutrients to staple foods, such as wheat, maize and rice, or condiments, including salt and bouillon, has tremendous potential to impact malnutrition. However, most LSFF programs have been poorly designed and have not taken into consideration critical inputs, including current levels of nutrient inadequacy and per capita consumption of different food vehicles when deciding which nutrients to add and at what concentrations. LSFF programs, like some other nutrition interventions, also tend to have low coverage and reach and lack monitoring to measure this and course correct. These program design flaws have resulted in limited effectiveness and have made it difficult to determine how best to harmonize LSFF with other interventions to reduce micronutrient deficiencies, including efforts to enhance dietary diversity, biofortification and supplementation. Furthermore, LSFF has often been touted as a population-based intervention, but in fact has heterogenous effects among sub-groups, particularly those with limited access to or inability to afford fortified foods, as well as those with higher physiological requirements, such as pregnant and lactating women. This article focuses on these limitations and the concerted efforts underway to improve the collection, analysis, and use of data to better plan LSFF programs, track implementation, and monitor coverage and impact. This includes a more sophisticated secondary analysis of existing data, innovations to increase the frequency of primary data collection and programmatically relevant visualizations of data of sub-national estimates. These improvements will enable better use of data to target resources and programmatic efforts to reach those who stand to benefit most from fortification.

Trade policy announcements can increase price volatility in global food commodity markets

Many countries use trade policy to insulate their domestic markets from price volatility. However, there is a widespread concern that such policies-particularly export restrictions-may amplify global price volatility, adversely affecting other countries. Here, using an original dataset on trade policy announcements on wheat and maize encompassing the food price crises of 2007-2008 and 2010-2011, we show that the announcement of trade policy changes can increase global price volatility. This effect applies not only to export restrictions but also to import liberalization measures and is most pronounced when markets are tight (stocks are low). Policymakers should work towards increasing stock levels to mitigate price volatility effects of trade policy changes. When markets are tight, export restrictions and import liberalizations should be avoided.

Herbicide Use in the Era of Farm to Fork: Strengths, Weaknesses, and Future Implications

Climate change mitigation is a major concern of the European Union (EU). In 2019, the EU presented the European Green Deal (EGD), a new environmental strategy that aimed to neutralize climate change by 2050. Within its policy areas, the EGD included the Farm to Fork (F2F) Strategy that aims to reduce pesticide use by 50%, by 2030. This reduction was proposed due to the supposed negative effects of pesticides on the environment and its biota. Among the different pesticide groups (herbicides, fungicides, insecticides, etc.) though, herbicides are perhaps the hardest to reduce. This review aimed to shed light to any factors that might hinder the reduction of herbicide use; thus, the implementation of the Farm to Fork Strategy underlines some of its weaknesses and highlights key points of a viable herbicide reduction-related policy framework. The literature suggests that integrated weed management (IWM) consists perhaps the most suitable approach for the reduction of herbicides in the EU. Even though it is too soon to conclusively assess F2F, its success is not impossible.

Sustainable education and youth confidence as pillars of future civil society

While sustainability is at the centre of many government agendas, there is a great risk of entrusting strategic decisions to those lacking in sustainability expertise. It is therefore necessary to ensure that universities are the green engines of sustainable communities. The present study administered a questionnaire to students enrolled in a Management Engineering programme at an Italian university, to collect their perceptions of and opinions on sustainability and energy issues. Students completed the questionnaire twice: once prior to beginning and once at the end of term. The results showed that students held more sustainable attitudes at the end of term, and perceived sustainable education and youth confidence as the building blocks of future society. They also observed that decarbonisation of the Italian energy system and national energy independence would require the significant development of renewable systems and interventions to promote energy efficiency. In addition, they recognised subsidies for green production, energy communities, differentiated waste collection and professional skills training as crucial. The sustainable university should support younger generations by encouraging student engagement in real-world projects and the development of long-term, structured teacher-student relationships.

High energy and fertilizer prices are more damaging than food export curtailment from Ukraine and Russia for food prices, health and the environment

Higher food prices arising from restrictions on exports from Russia or Ukraine have been exacerbated by energy price rises, leading to higher costs for agricultural inputs such as fertilizer. Here, using a scenario modelling approach, we quantify the potential outcomes of increasing agricultural input costs and the curtailment of exports from Russia and Ukraine on human health and the environment. We show that, combined, agricultural inputs costs and food export restrictions could increase food costs by 60-100% in 2023 from 2021 levels, potentially leading to undernourishment of 61-107 million people in 2023 and annual additional deaths of 416,000 to 1.01 million people if the associated dietary patterns are maintained. Furthermore, reduced land use intensification arising from higher input costs would lead to agricultural land expansion and associated carbon and biodiversity loss. The impact of agricultural input costs on food prices is larger than that from curtailment of Russian and Ukrainian exports. Restoring food trade from Ukraine and Russia alone is therefore insufficient to avoid food insecurity problem from higher energy and fertilizer prices. We contend that the immediacy of the food export problems associated with the war diverted attention away from the principal causes of current global food insecurity.

Maternal and child nutrition in the Lives Saved Tool: Results of a recent update

Background

The Lives Saved Tool (LiST) is a mathematical modelling tool for estimating the survival, health, and nutritional impacts of scaling intervention coverage in low- and middle-income countries (LMICs). Various nutrition interventions are included in LiST and are regularly (and independently) reviewed and updated as new data emerge. This manuscript describes our latest in-depth review of nutrition evidence, focusing on intervention efficacy, appropriate population-affected fractions, and new interventions for potential inclusion in the LiST model.

Methods

An external advisory group (EAG) was assembled to review evidence from systematic reviews on intervention-outcome (I-O) pairs for women and children under five years of age. GRADE quality was assigned to each pair based on a LiST-specific checklist to facilitate consistent decisions during the consideration. For existing interventions with new information, the EAG was asked to recommend whether to update the default efficacy values and population-affected fractions. For the new interventions, the EAG decided whether there was sufficient evidence of benefit, and in affirmative cases, information on the efficacy and affected fraction values that could be used. Decisions were based on expert group consensus.

Results

Overall, the group reviewed 53 nutrition-related I-O pairs, including 25 existing and 28 new ones. Efficacy and population-affected fractions were updated for seven I-O pairs; three pairs were updated for efficacy estimates only, three were updated for population-affected fractions only; and nine new I-O pairs were added to the model, bringing the total of nutrition-related I-O pairs to 34. Included in the new I-O pairs were two new nutrition interventions added to LIST: zinc fortification and neonatal vitamin A supplementation.

Conclusions

For modelling tools like LiST to be useful, it is crucial to update interventions, efficacy and population-affected fractions as new evidence becomes available. The present updates will enable LiST users to better estimate the potential health, nutrition, and survival benefits of investing in nutrition.

The Russia-Ukraine war disproportionately threatens the nutrition security of developing countries

While the ongoing Russia-Ukraine war threatens global nutrition security, the magnitude and extent of its impact remain underexamined. Here we show that, with the lowest level of war duration, severity, sanction, and countries involved, the direct and indirect impacts of the war and sanctions could newly place 67.3 million people (roughly equals the total population of France) in undernourishment and 316.7 million people (roughly equals the total population of Bangladesh and Russia) suffering from extreme national food insecurity. Approximately 95% of the affected population are from developing countries, highlighting the vulnerability of food supply in these countries. Both the undernourished population and its inequality across countries will substantially grow, if war duration and severity increase. If the war is prolonged to early 2024, future agricultural growth cannot fully offset the negative impacts, and global hunger will still very likely exacerbate. We conclude that targeted measures should be placed in developing countries and their vulnerable populations to reconstruct a just, healthy, and environmentally sustainable food system.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43621-022-00112-8.

The Role of Alternative Crops in an Upcoming Global Food Crisis: A Concise Review

Achieving Food Security (FS) is perhaps our most challenging aspiration. Despite our best efforts, millions of people around the globe are malnourished or live with hunger. The state of the geo-political scene, as well as the COVID-19 pandemic, have recently brought forth fears of a Global Food Crisis (GFC). Here, we present the factors that threaten FS and could trigger a GFC, examine the potential of alternative crops (ACs) as a measure against an upcoming GFC, and highlight the key aspects of the ACs introduction process in new regions. ACs could enhance FS, yet their success is premised on the adoption of sustainable practices and the implementation of food strategies that aim to promote healthy consumer behaviours.

Ukraine's triple emergency: Food crisis amid conflicts and COVID-19 pandemic

Globally, both Russia and Ukraine play a key role in food production. Both countries are known for their meticulous positions in producing and exporting wheat, maize, sunflower seed oil, and cotton seed oil. Although the conflict between Russia and Ukraine has been going on for more than 5 years, the recent invasion of Russia in Ukraine has endangered food security in Ukraine during the COVID-19 pandemic. As COVID-19 cripples the healthcare infrastructure of Ukraine, food insecurity challenges the civilian population to migration. As the conflict intensitifes, damages to properties, loss of lives, rise of infectious diseases, incremental rise in energy prices, and fuel consumption are some of the possible consequences. This commentary aims to highlight the different ways in which access to food has been endangered, the implications that food crisis has on the world, and thus provide key recommendations on what needs to be addressed to mitigate the rising risks of the food crisis in the world.

Adoption of plant-based diets across Europe can improve food resilience against the Russia-Ukraine conflict

Crises related to extreme weather events, COVID-19 and the Russia-Ukraine conflict have revealed serious problems in global food (inter)dependency. Here we demonstrate that a transition towards the EAT-Lancet's planetary health diet in the European Union and the United Kingdom alone would almost compensate for all production deficits from Russia and Ukraine while yielding improvements in blue water use (4.1 Gm³ yr^-1), greenhouse gas emissions (0.22 GtCO₂e yr^-1) and carbon sequestration (17.4 GtCO₂e).

When the Pandemic Will Be Over: Lots of Hope and Some Concerns

The COVID-19 pandemic significantly threatened healthcare systems worldwide. The worst-hit population has been represented by older people with underlying chronic comorbidities, while children and adolescents developed mild or asymptomatic forms of the disease. However, certain medical conditions (i.e., obesity, respiratory, or neurological or immune disorders) may increase the risk for poor health outcomes even in young and middle-aged people. Beyond the direct negative effects of the infection, the pandemic posed several health challenges through an increase in psycho-social issues (i.e., anxiety, depression, fatigue, sleep alterations, loneliness, reduced assistance, and loss of income). Accordingly, the pandemic is negatively impacting the accumulation of the functional reserves of each individual, starting from early life. With the long-term effects of the pandemic to be seen in the coming years, clinicians must be prepared to manage such high clinical complexity of people they encounter, through the implementation of multidimensional and multidisciplinary interventions.

Development and validation of the food availability and related eating behaviors questionnaire: A stage 1 registered report

OBJECTIVE

Historically, eating disorder research has excluded marginalized and underserved populations, such as those with food insecurity (which also impacts higher numbers of Black/African American and Latinx communities). However, burgeoning research suggests an association between food insecurity and the development of eating disorder pathology. Examining patterns of food availability and related eating behaviors may elucidate the association between food insecurity and eating disorder pathology. However, to date, there are no comprehensive measures that accurately capture food availability patterns and related eating behaviors.

METHOD

In Study 1, 40 participants (20 adolescents, 20 adults) will respond to and provide qualitative feedback on the Food Availability and Related Eating Behaviors Questionnaire (FAREB-Q). In study 2, 50 participants (approximately 25 with and without food insecurity) will complete the FAREB-Q at two time-points, and respond to questions about food insecurity, disordered eating, and every day stress to assess the FAREB-Q's reliability and validity.

RESULTS

Results will clarify whether the FAREB-Q is a reliable and valid instrument that measures food availability and related eating behavior patterns.

DISCUSSION

The present study aims to develop, pilot, and examine the psychometric properties of the FAREB-Q, a self-report measure examining food availability and related eating behaviors in community populations.

PUBLIC SIGNIFICANCE

The novel FAREB-Q assesses food availability and related eating patterns in the general community. The FAREB-Q will be reviewed by experts in disordered eating, food insecurity, psychometric statisticians and piloted in the general public before being psychometrically evaluated in a larger sample. The FAREB-Q is anticipated to help elucidate the mechanisms linking food availability, food (in)security, disordered eating behaviors, and eating pathology.

Trade scenarios compensating for halted wheat and maize exports from Russia and Ukraine increase carbon emissions without easing food insecurity

The Russian invasion of Ukraine has destabilized global agricultural markets, triggering food price increases. We present scenarios of reduced exports and production affecting both countries that increase maize and wheat prices by up to 4.6% and 7.2%, respectively. Production expansion in other regions can partially compensate for export declines but may increase carbon emissions and will exacerbate ongoing global food security challenges.

Small and Medium Enterprises' Perspectives on Food Fortification Amid the Growing Burden of Malnutrition

The need for a profound food system transformation has never been greater. The growing burden of malnutrition has become the new normal, with two billion people who are overweight, over 140 million children under five who are stunted and over two billion people affected by hidden hunger. Food fortification has been recognized as a cost-effective strategy to address micronutrient deficiencies. Small and medium enterprises (SMEs) play a strategic role in the food supply chain in low- and middle-income countries, accounting for over 80% of food sales. It is therefore critical to create an enabling environment to facilitate SMEs' involvement in food fortification practices as a potential solution to tackle all forms of malnutrition. This review highlights SMEs' relevance as agents of change in the food system through food fortification practices and their indirect yet key role in producing nutritious, tasty and affordable foods. It discusses their challenges (e.g., access to long-term finance, sustainable technical assistance, limited capacity), presents solutions and discusses how different actors can help SMEs to overcome these challenges. Furthermore, it presents a relevant public-private partnership case study to demonstrate how SMEs can address the growing burden of malnutrition through food fortification practices, nutrient profiling schemes and demand generation.

Achieving the Sustainable Development Goals in the post-pandemic era

The COVID-19 pandemic continues to pose substantial challenges to achieving the Sustainable Development Goals (SDGs). Exploring systematic SDG strategies is urgently needed to aid recovery from the pandemic and reinvigorate global SDG actions. Based on available data and comprehensive analysis of the literature, this paper highlights ongoing challenges facing the SDGs, identifies the effects of COVID-19 on SDG progress, and proposes a systematic framework for promoting the achievement of SDGs in the post-pandemic era. Progress towards attaining the SDGs was already lagging behind even before the onset of the COVID-19 pandemic. Inequitable distribution of food-energy-water resources and environmental crises clearly threaten SDG implementation. Evidently, there are gaps between the vision for SDG realization and actual capacity that constrain national efforts. The turbulent geopolitical environment, spatial inequities, and trade-offs limit the effectiveness of SDG implementation. The global public health crisis and socio-economic downturn under COVID-19 have further impeded progress toward attaining the SDGs. Not only has the pandemic delayed SDG advancement in general, but it has also amplified spatial imbalances in achieving progress, undermined connectivity, and accentuated anti-globalization sentiment under lockdowns and geopolitical conflicts. Nevertheless, positive developments in technology and improvement in environmental conditions have also occurred. In reflecting on the overall situation globally, it is recommended that post-pandemic SDG actions adopt a "Classification-Coordination-Collaboration" framework. Classification facilitates both identification of the current development status and the urgency of SDG achievement aligned with national conditions. Coordination promotes domestic/international and inter-departmental synergy for short-term recovery as well as long-term development. Cooperation is key to strengthening economic exchanges, promoting technological innovation, and building a global culture of sustainable development that is essential if the endeavor of achieving the SDGs is to be successful. Systematic actions are urgently needed to get the SDG process back on track.

Impacts of the Russia-Ukraine War on Global Food Security: Towards More Sustainable and Resilient Food Systems?

As a conflict between two major agricultural powers, the Russia–Ukraine war has various negative socioeconomic impacts that are now being felt internationally and might worsen, notably, for global food security. If the war deepens, the food crisis will worsen, posing a challenge to many countries, especially those that rely on food imports, such as those in the Middle East and North Africa (MENA) region. Simultaneously, the war came at a bad time for global food markets because food prices were already high due to disruptions in the supply chain caused by the COVID-19 pandemic, strong global demand, and poor harvests in some countries. Understanding how conflict-related disruptions in global food and fertilizer markets might affect price and availability is critical for understanding the overall impact on global food security. Further, four months into the war, its implications for food security suggest that this review is timely, urgent, and highly needed. Accordingly, this paper aims to investigate the Russia–Ukraine war’s direct and indirect impact on global food security. The paper highlights that the war resulted in immediate and far-reaching cascading consequences on global food security: Ukrainian exports have stopped, conscription and population displacement have caused labor shortages, access to fertilizers is restricted, and future harvests are uncertain. First, Ukraine’s export capacity has been hampered. Secondly, conscription and population displacement caused labor shortages. Thirdly, access to vital agricultural products such as fertilizers is also constrained. The war may delay spring planting and winter crop harvesting. Further, the war has indirect and cascading effects. Indeed, rising fertilizer costs may reduce their use and crop yields. Moreover, as seen during the 2007–2008 food crisis, export restrictions and speculation are driving up international prices and worsening the situation. Furthermore, the war triggered a panic buying movement at country and individual levels. Finally, the war may jeopardize the implementation of the Sustainable Development Goals (SDGs), notably SDG 1 (No poverty), SDG 2 (Zero hunger), and DG 12 (Responsible consumption and production). However, the consequences of the war on food security are being exacerbated by a variety of underlying rigidities, vulnerabilities, and inefficiencies in global food systems. Accordingly, the transition toward healthy, equitable, and ecologically sustainable food systems must be strengthened by adopting urgent and long-term reforms and policies.

Role of foreign direct investments in agriculture, forestry and fishing in developing countries

The primary sector is vital for growth and sustainable development in emerging countries. The combined effects of COVID-19 and geopolitical uncertainty on capital flows are likely to have profound impacts on many developing countries. In particular, decreased capital inflows into agriculture will negatively affect food security and growth. However, there remain limited literature on the role of capital inflows in this sector. In this paper, we examine the role that foreign capital inflows play in the development of the agricultural, forestry and fishing sectors in developing countries. Specifically, we use the panel vector autoregression approach that accounts for endogeneity. Using data from sixteen developing economies, we find that there exists bidirectional causality between foreign direct investments in agriculture, forestry and fishing and value added in these sectors. These bidirectional relationships reflect a cyclical effect between FDI and value added in the agriculture, forestry and fishing. The effect of FDI on value added in agriculture, forestry and fishing remains positive for up to five years in our model. This implies FDI has a medium- to long-term positive impact on value added in agriculture, forestry and fishing. The implication of this result is that countries with currently high FDI transaction costs or that have a generally less conducive investment environment can improve agriculture by eliminating these obstacles. This is because FDIs can lead to improved technologies and technical expertise, practices, management and other systems that benefit the host countries.