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Wallingford JK, de Pee S, Herforth AW, Kuri S, Bai Y, Masters WA. Measuring food access using least-cost diets: Results for global monitoring and targeting of interventions to improve food security, nutrition and health. GLOBAL FOOD SECURITY 2024; 41:100771. [PMID: 38957380 PMCID: PMC11215514 DOI: 10.1016/j.gfs.2024.100771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/01/2024] [Accepted: 05/15/2024] [Indexed: 07/04/2024]
Abstract
Benchmark diets using the most affordable locally available items to meet health and nutrition needs have long been used to guide food choice and nutrition assistance. This paper describes the result of recent innovations scaling up the use of such least-cost diets by UN agencies, the World Bank, and national governments for a different purpose, which is monitoring food environments and targeting systemic interventions to improve a population's access to sufficient food for an active and healthy life. Measuring food access using least-cost diets allows a clearer understanding of where poor diets are caused by unavailability or high prices for even the lowest-cost healthy foods, insufficient income or other resources to acquire those foods, or the use of other foods instead due to reasons such as time use and meal preparation costs, or cultural factors such as taste and aspirations. This paper reviews the data, methods and results that have led to official FAO and the World Bank adoption of cost and affordability metrics for global monitoring, and the parallel use of similar methods to guide interventions in country studies led by the World Food Programme with partner agencies across Africa, Asia and Latin America. We conclude by summarizing how increasing availability of food price data, matched to food composition and dietary requirements, allows analysts to use recently developed software tools for least-cost diet assessment to improve food access in a wide range of settings.
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Affiliation(s)
| | - Saskia de Pee
- Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA
- United Nations World Food Programme, Rome, Italy
| | - Anna W. Herforth
- Food Prices for Nutrition Project, Tufts University, Boston MA, USA
| | - Sabrina Kuri
- United Nations World Food Programme, Rome, Italy
| | - Yan Bai
- Development Data Group, The World Bank, Washington DC, USA
| | - William A. Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA
- Department of Economics, Tufts University, Medford MA, USA
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Korir J, Oldewage-Theron W, Mugambi G, Gichohi-Wainaina WN. Utilising emerging perspectives at the global and regional level to frame multisectoral nutrition governance landscape in Kenya. Public Health Nutr 2024; 27:e99. [PMID: 38504549 PMCID: PMC10993066 DOI: 10.1017/s1368980024000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/29/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Multisectoral nutrition governance (MNG) is a vital enabling determinant of improved nutrition outcomes. Despite this, it remains to be a complex phenomenon that lacks adequate understanding, especially in developing countries like Kenya. This narrative review aims to discuss the evolution of MNG, the current state of MNG, barriers and challenges, and based on these identify entry points for improvement within the complex governance structure in Kenya. DESIGN The Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to ensure rigorous and transparent identification of literature and interpretation. SETTING Kenya and developing countries with similar contexts. PARTICIPANTS The review included forty-five documents (peer-reviewed articles and grey literature) that reported on MNG in developing countries. RESULTS We acknowledge that MNG is a complex and evolving determinant of better nutrition outcomes. The paper highlights challenges Kenya and other developing countries face such as inadequate leadership, inadequate coordination, insufficient capacity, inadequate monitoring and evaluation systems, and limited financial resources, among others. For Kenya in particular, there is inadequate understanding of what MNG is and how it can be effectively operationalised and tracked. CONCLUSIONS To enhance understanding of MNG in Kenya, a country-specific assessment of MNG processes and impact outcomes using standard tools and defined metrics is vital. Such assessment will generate evidence of progress, successes, and challenges that will compel the government and stakeholders to invest more in multisectoral nutrition approaches to achieve its nutrition goals.
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Affiliation(s)
- Jacob Korir
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX79409, USA
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX79409, USA
| | - Gladys Mugambi
- Division of Health Promotion and Education, Ministry of Health, Nairobi, Kenya
| | - Wanjiku N Gichohi-Wainaina
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX79409, USA
- WorldFish, Jalan Batu Maung, 11960 Bayan Lepas, Penang, Malaysia
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3
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Geyik Ö, Hadjikakou M, Bryan BA. Climate-friendly and nutrition-sensitive interventions can close the global dietary nutrient gap while reducing GHG emissions. NATURE FOOD 2022; 4:61-73. [PMID: 37118573 DOI: 10.1038/s43016-022-00648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022]
Abstract
Sustainable food systems require malnutrition and climate change to be addressed in parallel. Here, we estimate the non-CO2 greenhouse gas emissions resulting from closing the world's dietary nutrient gap-that between country-level nutrient supply and population requirements-for energy, protein, iron, zinc, vitamin A, vitamin B12 and folate under five climate-friendly intervention scenarios in 2030. We show that improving crop and livestock productivity and halving food loss and waste can close the nutrient gap with up to 42% lower emissions (3.03 Gt CO2eq yr-1) compared with business-as-usual supply patterns with a persistent nutrient gap (5.48 Gt CO2eq yr-1). Increased production and trade of vegetables, eggs, and roots and tubers can close the nutrient gap with the lowest emissions in most countries-with ≤23% increase in total caloric production required for 2030 relative to 2015. We conclude that the world's nutrient gap could be closed without exceeding global climate targets and without drastic changes to national food baskets.
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4
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Koenen MF, Balvert M, Fleuren H. Bi-objective goal programming for balancing costs vs. nutritional adequacy. Front Nutr 2022; 9:1056205. [PMID: 36590216 PMCID: PMC9798409 DOI: 10.3389/fnut.2022.1056205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Linear programming (LP) is often used within diet optimization to find, from a set of available food commodities, the most affordable diet that meets the nutritional requirements of an individual or (sub)population. It is, however, not always possible to create a feasible diet, as certain nutritional requirements are difficult to meet. In that case, goal programming (GP) can be used to minimize deviations from the nutritional requirements in order to obtain a near feasible diet. With GP the cost of the diet is often overlooked or taken into account using the ε-constraint method. This method does not guarantee to find all possible trade-offs between costs and nutritional deficiency without solving many uninformative LPs. Methods We present a method to find all trade-offs between any two linear objectives in a dietary LP context that is simple, does not solve uninformative LPs and does not need prior input from the decision maker (DM). This method is a bi-objective algorithm based on the NonInferior Set Estimation (NISE) method that finds all efficient trade-offs between two linear objectives. Results In order to show what type of insights can be gained from this approach, two analyses are presented that investigate the relation between cost and nutritional adequacy. In the first analysis a diet with a restriction on the exact energy intake is considered where all nutrient intakes except energy are allowed to deviate from their prescription. This analysis is especially helpful in case of a restrictive budget or when a nutritionally adequate diet is either unaffordable or unattainable. The second analysis only relaxes the exact energy intake, where the other nutrients are kept within their requirements, to investigate how the energy intake affects the cost of a diet. Here, we describe in what situations the so-called more-for-less paradox takes place, which can be induced by requiring an exact energy intake. Conclusion To the best of our knowledge, we are the first to address how to obtain all efficient trade-offs of two linear objectives in a dietary LP context and how this can be used for analyses.
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Affiliation(s)
- Melissa F. Koenen
- Zero Hunger Lab, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands,Department of Econometrics and Operations Research, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands,*Correspondence: Melissa F. Koenen
| | - Marleen Balvert
- Zero Hunger Lab, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands,Department of Econometrics and Operations Research, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands
| | - Hein Fleuren
- Zero Hunger Lab, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands,Department of Econometrics and Operations Research, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands
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5
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de Pee S, Turowska Z. Retail prices track food and nutrition security. NATURE FOOD 2022; 3:306-307. [PMID: 37117567 DOI: 10.1038/s43016-022-00515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Saskia de Pee
- World Food Programme, Rome, Italy.
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
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Knight F, Bourassa MW, Ferguson E, Walls H, de Pee S, Vosti S, Martinez H, Levin C, Woldt M, Sethurman K, Bergeron G. Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors. Ann N Y Acad Sci 2022; 1513:170-191. [PMID: 35443074 PMCID: PMC9546113 DOI: 10.1111/nyas.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low‐ and middle‐income country case studies and used thematic analysis to understand the data. NMTs were mostly applied by international organizations to inform national government decision making. NMT applications contributed to enabling environments for nutrition and influenced program design and policy in most cases; however, this influence could be strengthened. Influence was shaped by processes for applying the NMTs; ownership of the analysis and data inputs, and capacity building in NMT methods, encouraged uptake. Targeting evidence generation at specific policy cycle stages promoted uptake; however, where advocacy capacity allowed, modeling was embedded ad hoc into emerging policy discussions and had broader influence. Meanwhile, external factors, such as political change and resource constraints of local partner organizations, challenged NMT implementation. Importantly, policy uptake was never the result of NMTs exclusively, indicating they should be nested persistently and strategically within the wider evidence and advocacy continuum, rather than being stand‐alone activities.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Walls
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia.,Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Kavita Sethurman
- Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- New York Academy of Sciences, New York, New York.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia
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7
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Di Prima S, Wright EP, Sharma IK, Syurina E, Broerse JE. Implementation and scale-up of nutrition-sensitive agriculture in low- and middle-income countries: a systematic review of what works, what doesn't work and why. GLOBAL FOOD SECURITY 2022. [DOI: 10.1016/j.gfs.2021.100595] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Knight F, Woldt M, Sethuraman K, Bergeron G, Ferguson E. Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries. Ann N Y Acad Sci 2021; 1509:145-160. [PMID: 34850396 PMCID: PMC9299870 DOI: 10.1111/nyas.14709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022]
Abstract
A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population‐specific food‐based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual‐level 24‐h recalls (24HRs). The 24HR data from 12‐ to 23‐month‐old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES‐ and 24HR‐defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food‐group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77–100% agreement), food sources of nutrients (71–100% agreement), and FBRs (80–100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12‐ to 23‐month‐old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,United Nations World Food Programme, Rome, Italy
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia
| | - Kavita Sethuraman
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,New York Academy of Sciences, New York, New York
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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9
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de Pee S, Hardinsyah R, Jalal F, Kim BF, Semba RD, Deptford A, Fanzo JC, Ramsing R, Nachman KE, McKenzie S, Bloem MW. Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia. Am J Clin Nutr 2021; 114:1686-1697. [PMID: 34477830 PMCID: PMC8574631 DOI: 10.1093/ajcn/nqab258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals. OBJECTIVES We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously. METHODS We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data. RESULTS The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously. CONCLUSIONS Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously.
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Affiliation(s)
- Saskia de Pee
- United Nations World Food Programme, Rome, Italy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | | | - Brent F Kim
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D Semba
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Deptford
- United Nations World Food Programme, Rome, Italy
| | - Jessica C Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca Ramsing
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shawn McKenzie
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin W Bloem
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Coile A, Wun J, Kothari MT, Hemminger C, Fracassi P, Di Dio D. Scaling up nutrition through multisectoral planning: An exploratory review of 26 national nutrition plans. MATERNAL & CHILD NUTRITION 2021; 17:e13225. [PMID: 34101997 PMCID: PMC8518575 DOI: 10.1111/mcn.13225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
With a growing consensus on the need to address malnutrition in a comprehensive and multisectoral way, there has been increased attention on the processes and factors for multisectoral nutrition planning to be successful. To guide countries, the Scaling Up Nutrition (SUN) Movement developed a checklist that defined characteristics of good national nutrition plans. This exploratory review used the framework of the Checklist to assess 26 national multisectoral nutrition plans (MSNPs) developed between 2014 and 2020. The MSNPs were assessed against a subset of 31 Checklist characteristics defined as basic plan components. Although the level of detail varied across the reviewed plans, the majority included core components that are important to facilitate effective planning and implementation, such as an assessment of the nutritional status and determinants of malnutrition for children under 5 years of age, a commitment to global recommendations related to reducing malnutrition, actions consistent with global evidence and responding to identified issues/gaps, governance arrangements to facilitate coordination, and identification of capacity-building needs/actions to support effective implementation. Common gaps across plans included risk analysis and mitigation, defined responsible agencies for each action, an assessment of the financial gap and defined mechanisms for financial tracking and resource allocation, and mechanisms to coordinate operational research. These findings provide a high-level, multi-country review of multisectoral nutrition planning that can support future policymakers, technical assistance providers and regional and global stakeholders to consider the foundational elements of and further validate and address common shortcomings in developing such a plan.
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Affiliation(s)
- Amanda Coile
- PATHWashingtonDistrict of ColumbiaUSA
- JSI Research and Training Institute Inc.ArlingtonVirginiaUSA
| | | | | | | | - Patrizia Fracassi
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
- Food and Agriculture Organization of the United NationsRomeItaly
| | - Debora Di Dio
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
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Fernández-Ríos A, Laso J, Campos C, Ruiz-Salmón I, Hoehn D, Cristóbal J, Batlle-Bayer L, Bala A, Fullana-I-Palmer P, Puig R, Aldaco R, Margallo M. Towards a Water-Energy-Food (WEF) nexus index: A review of nutrient profile models as a fundamental pillar of food and nutrition security. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 789:147936. [PMID: 34082212 DOI: 10.1016/j.scitotenv.2021.147936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
The Water-Energy-Food (WEF) nexus approach should be promoted as a tool for sustainable management of resources through the interconnection of these three fundamental pillars. Particularly, food security must ensure healthy and balanced diets for everyone, but selecting individual indicators to assess all slants covered by this element is not an easy task. Hence, the objective of this paper is two-fold, to review nutrient profiling (NP) models that allow to categorize foods and evaluate diets based on their nutritional quality, and to choose the most appropriate model to be used within a WEF nexus index. To address this issue, a total of 159 documents were assessed, appraising the geographic distribution, and time evolution of the publications, as well as the characteristics and potential applications of the NP systems. The review concludes that the NRF9.3. model is the most liable option to be used in a WEF nexus index, presenting the best characteristics by means of the definition of scores and thresholds, and the use of an 'across-the-board' criteria and a reference quantity of 100 kcal, alongside offering higher ability to assess diets and foods than the other competitive model (HEI) through the evaluation of nutrients to encourage instead of foods. A secondary outcome of the review is the identification of the NP models as a useful tool to enable institutions with information to establish policies in the field of public health and facilitating the decision-making process according to the current healthy claims.
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Affiliation(s)
- Ana Fernández-Ríos
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Jara Laso
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Cristina Campos
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Israel Ruiz-Salmón
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Daniel Hoehn
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Jorge Cristóbal
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Laura Batlle-Bayer
- UNESCO Chair in Life Cycle and Climate Change ESCI-UPF, Pg. Pujades 1, 08003 Barcelona, Spain
| | - Alba Bala
- UNESCO Chair in Life Cycle and Climate Change ESCI-UPF, Pg. Pujades 1, 08003 Barcelona, Spain
| | - Pere Fullana-I-Palmer
- UNESCO Chair in Life Cycle and Climate Change ESCI-UPF, Pg. Pujades 1, 08003 Barcelona, Spain
| | - Rita Puig
- Department of Computer Science and Industrial Engineering, University of Lleida (UdL), Pla de la Massa, 8, 08700 Igualada, Spain
| | - Rubén Aldaco
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain.
| | - María Margallo
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
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Abstract
Objective: Artisanal and small-scale mining (ASM) is a widespread livelihood in low- and middle-income countries; however, many in ASM communities face high levels of poverty and malnutrition. The food environments in ASM communities have non-agricultural rural characteristics that differ from those in urban and agricultural rural areas examined in much existing food environment literature. Design: We examine these complex external and personal food environments in ASM communities via a study using qualitative and quantitative methods. Market surveys and a cross-sectional household survey, plus qualitative mining site non-participant observations and in-depth structured interviews, were conducted in three waves. Setting: Eighteen study sites in ASM communities in northern Guinea. Participants: Surveys covered mothers in mining households with young children (n 613); in-depth interviews engaged caregivers of young children (n 45), food vendors (n 40) and young single miners (n 15); observations focused on mothers of young children (n 25). Results: The external food environment in these ASM communities combines widespread availability of commercially processed and staple-heavy foods with lower availability and higher prices for more nutritious, non-staple foods. Within the personal food environment, miners are constrained in their food choices by considerable variability in daily cash income and limited time for acquisition and preparation. Conclusions: We demonstrate that ASM communities have characteristics of both urban and rural populations and argue for greater nuance and appreciation of complexity in food environment research and resultant policy and programming.
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Beal T, White JM, Arsenault JE, Okronipa H, Hinnouho GM, Morris SS. Comprehensive Nutrient Gap Assessment (CONGA): A method for identifying the public health significance of nutrient gaps. Nutr Rev 2021; 79:4-15. [PMID: 33693909 PMCID: PMC7947985 DOI: 10.1093/nutrit/nuaa140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms. To fill this methodological gap, an approach called Comprehensive Nutrient Gap Assessment was created to enable use of existing evidence to assess the public health significance of nutrient gaps and identify evidence gaps. Comprehensive Nutrient Gap Assessment requires ≥ 2 experts in nutritional assessment but does not require primary data collection or secondary quantitative data analysis. It can be implemented relatively quickly with low costs, for specific countries and subnational regions, and updated on the basis of new data with minimal effort. The findings from a Comprehensive Nutrient Gap Assessment are easily interpretable by nontechnical decision makers yet include clear justification for technical audiences.
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Affiliation(s)
- Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
- Department of Environmental Science and Policy, University of California, Davis, California, USA
| | | | - Joanne E Arsenault
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Intake, Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Harriet Okronipa
- Institute for Global Nutrition, University of California , Davis, Davis, California, USA
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition , University of California , Davis, Davis, California, USA
- Helen Keller International, New York, New York, USA
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Ryckman T, Beal T, Nordhagen S, Chimanya K, Matji J. Affordability of nutritious foods for complementary feeding in Eastern and Southern Africa. Nutr Rev 2021; 79:35-51. [PMID: 33693913 PMCID: PMC7948081 DOI: 10.1093/nutrit/nuaa137] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Low intake of diverse complementary foods causes critical nutrient gaps in the diets of young children. Inadequate nutrient intake in the first 2 years of life can lead to poor health, educational, and economic outcomes. In this study, the extent to which food affordability is a barrier to consumption of several nutrients critical for child growth and development was examined in Ethiopia, Mozambique, South Africa, Tanzania, Uganda, and Zambia. Drawing upon data from nutrient gap assessments, household surveys, and food composition tables, current consumption levels were assessed, the cost of purchasing key nutritious foods that could fill likely nutrient gaps was calculated, and these costs were compared with current household food expenditure. Vitamin A is affordable for most households (via dark leafy greens, orange-fleshed vegetables, and liver) but only a few foods (fish, legumes, dairy, dark leafy greens, liver) are affordable sources of iron, animal-source protein, or calcium, and only in some countries. Zinc is ubiquitously unaffordable. For unaffordable nutrients, approaches to reduce prices, enhance household production, or increase household resources for nutritious foods are needed.
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Affiliation(s)
- Theresa Ryckman
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington DC, USA
- Department of Environmental Science and Policy, University of California, Davis, Davis, California, USA
| | | | - Kudakwashe Chimanya
- United Nations Children’s Fund, Regional Office for Eastern and Southern Africa, Nairobi, Kenya
| | - Joan Matji
- United Nations Children’s Fund, Regional Office for Eastern and Southern Africa, Nairobi, Kenya
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Ryckman T, Beal T, Nordhagen S, Murira Z, Torlesse H. Affordability of nutritious foods for complementary feeding in South Asia. Nutr Rev 2021; 79:52-68. [PMID: 33693914 PMCID: PMC7948078 DOI: 10.1093/nutrit/nuaa139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The high prevalence of stunting and micronutrient deficiencies among children in South Asia has lifelong health, educational, and economic consequences. For children aged 6-23 months, undernutrition is influenced by inadequate intake of complementary foods containing nutrients critical for growth and development. The affordability of nutrients lacking in young children's diets in Bangladesh, India, and Pakistan was assessed in this study. Using data from nutrient gap assessments and household surveys, household food expenditures were compared with the cost of purchasing foods that could fill nutrient gaps. In all 3 countries, there are multiple affordable sources of vitamin A (orange-fleshed vegetables, dark leafy greens, liver), vitamin B12 (liver, fish, milk), and folate (dark leafy greens, liver, legumes, okra); few affordable sources of iron and calcium (dark leafy greens); and no affordable sources of zinc. Affordability of animal-source protein varies, with several options in Pakistan (fish, chicken, eggs, beef) and India (fish, eggs, milk) but few in Bangladesh (eggs). Approaches to reduce prices, enhance household production, or increase incomes are needed to improve affordability.
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Affiliation(s)
- Theresa Ryckman
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
- Department of Environmental Science and Policy, University of California, Davis, Davis, California, USA
| | | | - Zivai Murira
- United Nations Children’s Fund, Regional Office for South Asia, Kathmandu, Nepal
| | - Harriet Torlesse
- United Nations Children’s Fund, Regional Office for South Asia, Kathmandu, Nepal
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Geyik O, Hadjikakou M, Karapinar B, Bryan BA. Does global food trade close the dietary nutrient gap for the world's poorest nations? GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100490] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leonard D, Buettner P, McDermott R, Makrides M. The iron content of healthy diets for one day for breastfed babies and young children. Nutr Diet 2021; 78:415-423. [PMID: 33594814 DOI: 10.1111/1747-0080.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS Early childhood anaemia due to iron deficiency is widespread in remote communities across northern Australia. Current recommendations for healthy food to complement breastfeeding at age 6 to 23 months include iron-rich and iron-enriched foods. An electronic nutrient analysis was undertaken to assess the iron content of hypothetical healthy diets for breastfed babies and young children aged 6 to 23 months in Australia, in comparison with their estimated requirements. METHODS Hypothetical diets for 1 day were developed that were consistent with the Foundation Diets for breastfed infants 6 to 12 months and for toddlers 13 to 23 months. Nutrient content was derived using the Australian Food Composition database in FoodWorks 10. The iron content of these two diets were compared with Estimated Average Requirements (EARs) and Recommended Dietary Intakes (RDIs) for iron for infants aged 7 to 12 months and children aged 1 to 3 years. RESULTS The iron content of the hypothetical diet for breastfed infants aged 6 to 12 months (5.8 mg) was less than the EAR (7 mg, 83%) and the RDI (11 mg, 53%). For young breastfed children aged 13 to 23 months, the iron content of the hypothetical diet was 4.4 mg; above the EAR (4 mg, 110%) but less than RDI (9 mg, 49%). CONCLUSIONS Breastfeeding has health and neurodevelopmental benefits for infants and young children that are particularly important in remote Australia where food insecurity and poor nutrition compromise health and wellbeing. Adequate iron intake is also important for neurodevelopment in early life but healthy diets for breastfed babies and young children may have insufficient iron content to meet requirements. The upcoming revision of the Australian Dietary Guidelines provides an opportunity to consider this issue.
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Affiliation(s)
- Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Petra Buettner
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Robyn McDermott
- Public Health Medicine, University of South Australia, Adelaide, South Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Adu‐Afarwuah S. Impact of nutrient supplementation on maternal nutrition and child growth and development in Sub-Saharan Africa: the case of small-quantity lipid-based nutrient supplements. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 3:e12960. [PMID: 33347727 PMCID: PMC7752123 DOI: 10.1111/mcn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/20/2019] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Micronutrient deficiencies remain common among women and children in Sub-Saharan Africa (SSA); in pregnant/lactating women, the intakes of essential fatty acids may also be low. Enriching home-prepared foods with small-quantity lipid-based nutrient supplements (SQ-LNSs) is a promising new strategy of delivering additional micronutrients, essential fatty acids and good quality protein to women and children. This narrative review aimed to examine the impact of SQ-LNSs supplementation among women and infants and young children in SSA, and to discuss the differential impact of SQ-LNS consumption across different settings. Papers reporting randomized trials conducted in SSA in which apparently healthy women and/or ≥6-mo-old children received SQ-LNSs were identified through electronic and manual searches. Prenatal SQ-LNS consumption reduced the prevalence of low gestational weight gain in Ghana when compared with multiple micronutrients supplementation, and was associated with poorer iron/hemoglobin status when compared with iron-plus-folic acid supplementation. SQ-LNSs received alone or as intervention package improved infant/child growth in two trials in Ghana and one trial each in Burkina Faso, Kenya, Zimbabwe and South Africa, but had no impact on growth in two trials in Malawi. SQ-LNSs supplementation improved motor development in Ghana, Burkina Faso, Malawi, Kenya, and South Africa, but had no impact on language, socio-emotional, and executive functions in Ghana and Malawi and on Griffiths' developmental scores in Malawi. SQ-LNSs may contribute to improving child growth in SSA. More research is needed to determine the iron level in SQ-LNSs effective for improving both maternal hemoglobin/iron status and birth outcomes.
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Affiliation(s)
- Seth Adu‐Afarwuah
- Department of Nutrition and Food ScienceUniversity of GhanaAccraGhana
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Bose I, Baldi G, Kiess L, de Pee S. The "Fill the Nutrient Gap" analysis: An approach to strengthen nutrition situation analysis and decision making towards multisectoral policies and systems change. MATERNAL AND CHILD NUTRITION 2019; 15:e12793. [PMID: 30698364 PMCID: PMC6767452 DOI: 10.1111/mcn.12793] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
Improved nutrition situation analysis can increase the understanding of the likely magnitude and main causes of the nutrient gap among a particular target group, for example, children under 2 or pregnant and lactating women, in a particular context. The World Food Programme, with input from University of California Davis, International Food Policy Research Institute, Epicentre, Harvard University, Mahidol University, Save the Children, and UNICEF, has developed a framework for strengthened nutrition situation analysis and decision making called the "Fill the Nutrient Gap" (FNG), which aims to support identification of strategies to increase availability, access, and choice of nutritious foods, to ultimately improve nutrient intake. The FNG engages stakeholders from different sectors throughout the analytical process to provide input and discuss findings to collectively identify and prioritize context-specific strategies. The FNG analysis contributes to better understanding the nutrition situation because it (a) focuses on the dietary intake side of the malnutrition framework and analyses in-depth the nutrient intake of different target groups; (b) linear programming is used in combination with review of secondary data to characterize barriers to nutrient intake, in particular to understand the availability, cost and affordability of nutritious diets for households and target groups with higher nutritional needs, and model potential interventions to improve them; (c) it links the nutrition situation analysis to decision making by providing an evidence base for decision makers to inform their strategies; (d) it facilitates multisectoral discussion on barriers to nutrient intake and enables a prioritization of context-specific strategies (both nutrition specific and sensitive) to improve the nutrition situation across food, health, and social protection systems.
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Affiliation(s)
- Indira Bose
- Nutrition Division, World Food Programme, Rome, Italy
| | - Giulia Baldi
- Nutrition Division, World Food Programme, Rome, Italy
| | - Lynnda Kiess
- Nutrition Division, World Food Programme, Rome, Italy
| | - Saskia de Pee
- Nutrition Division, World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Human Nutrition, Wageningen University, Wageningen, The Netherlands
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