Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes

Enhancing Human Health and Wellbeing through Sustainably and Equitably Unlocking a Healthy Ocean's Potential

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean's health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean's natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort.

Genetic Biofortification of Winter Wheat with Selenium (Se)

Wheat is one of the three most important cereals in the world, along with rice and maize. It serves as the primary food and source of energy for about 30-40% of the world's population. However, the low levels of micronutrients in wheat grains can lead to deficiencies of those micronutrients in people whose dietary habits are mostly based on cereals such as wheat. Apart from iron (Fe) and zinc (Zn), a lack of selenium (Se) is also one of the biggest problems in the world. The essentiality of Se has been confirmed for all animals and humans, and the lack of this micronutrient can cause serious health issues. Wheat dominates the world's cereal production, so it is one of the best plants for biofortification. Due to the fact that agronomic biofortification is not an economical or environmentally acceptable approach, genetic improvement of cereals such as wheat for the enhanced content of micronutrients in the grain represents the most efficient biofortification approach.

Mandatory large-scale food fortification programmes can reduce the estimated prevalence of inadequate zinc intake by up to 50% globally

Large-scale food fortification (LSFF) can increase dietary micronutrient intake and improve micronutrient status. Here we used food balance sheet data from the Food and Agriculture Organization of the United Nations to estimate current country-specific prevalences of inadequate zinc intake. We assessed the potential effects of improving existing LSFF programmes for cereal grains or implementing new programmes in 40 countries where zinc deficiency is a potential public health problem. Accounting for LSFF programmes as currently implemented, 15% of the global population (1.13 billion individuals) is estimated to have inadequate zinc intake. In countries where zinc deficiency is a potential public health problem, the implementation of high-quality mandatory LSFF programmes that include zinc as a fortificant would substantially increase the availability of zinc in the national food supply, reducing the estimated prevalence of inadequate zinc intake by up to 50% globally. Investments in strong LSFF programmes could have a substantial impact on population zinc status.

Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar

It is estimated that billions of people around the world are affected by micronutrient deficiencies. Madagascar is considered to be particularly nutritionally vulnerable, with nearly half of the population stunted, and parts of the country facing emergency, near famine-like conditions (IPC4). Although Madagascar is generally considered among the most undernourished of countries, empirical data in the form of biological samples to validate these claims are extremely limited. Our research drew data from three studies conducted between 2013-2020 and provided comprehensive biomarker profile information for 4,710 individuals from 30 communities in five different ecological regions during at least one time-point. Estimated prevalences of nutrient deficiencies and inflammation across various regions of rural Madagascar were of concern for both sexes and across all ages, with 66.5% of the population estimated to be deficient in zinc, 15.6% depleted in vitamin B12 (3.6% deficient), 11.6% deficient in retinol, and lower levels of iron deficiency (as indicated by 11.7% deficient in ferritin and 2.3% deficient assessed by soluble transferrin receptors). Beyond nutrient status biomarkers, nearly one quarter of the population (24.0%) exhibited chronic inflammation based on high values of α-1-acid glycoprotein, and 12.3% exhibited acute inflammation based on high values of C-reactive protein. There is an 8-fold difference between the lowest and highest regional observed prevalence of vitamin B12 deficiency, a 10-fold difference in vitamin A deficiency (based on retinol), and a 2-fold difference in acute inflammation (CRP) and deficiencies of zinc and iron (based on ferritin), highlighting strong geographical variations in micronutrient deficiencies across Madagascar.

Biofortification of Plant- and Animal-Based Foods in Limiting the Problem of Microelement Deficiencies-A Narrative Review

With a burgeoning global population, meeting the demand for increased food production presents challenges, particularly concerning mineral deficiencies in diets. Micronutrient shortages like iron, iodine, zinc, selenium, and magnesium carry severe health implications, especially in developing nations. Biofortification of plants and plant products emerges as a promising remedy to enhance micronutrient levels in food. Utilizing agronomic biofortification, conventional plant breeding, and genetic engineering yields raw materials with heightened micronutrient contents and improved bioavailability. A similar strategy extends to animal-derived foods by fortifying eggs, meat, and dairy products with micronutrients. Employing "dual" biofortification, utilizing previously enriched plant materials as a micronutrient source for livestock, proves an innovative solution. Amid biofortification research, conducting in vitro and in vivo experiments is essential to assess the bioactivity of micronutrients from enriched materials, emphasizing digestibility, bioavailability, and safety. Mineral deficiencies in human diets present a significant health challenge. Biofortification of plants and animal products emerges as a promising approach to alleviate micronutrient deficiencies, necessitating further research into the utilization of biofortified raw materials in the human diet, with a focus on bioavailability, digestibility, and safety.

The MED_EAT-IT approach: A modelling study to develop feasible, sustainable and nutritionally targeted dietary patterns based on the Planetary health diet

In 2019, the EAT-Lancet Commission introduced the Planetary Health Diet (PHD), a guide for creating 2500 kcal/day country-specific sustainable diets that promote health while reducing the environmental impact associated with food systems. The PHD was previously adapted to the Italian food context, resulting in the EAT-IT dietary pattern. However, this adaptation revealed several challenges in terms of nutritional adequacy, feasibility, and environmental impact. This study reports on strategies to improve the previous pattern and align it more closely with the Mediterranean Diet, resulting in the MED_EAT-IT pattern. The study also explores feasible strategies for adapting this pattern to different energy targets, enhancing its scalability and promoting personalized approaches. For the optimization of this pattern, a specific calculation tool was developed to introduce variation to the pattern, considering realistic and feasible serving sizes and frequency of consumption. This tool integrates a defined food ontology, food composition data, and two environmental impact metrics (Carbon and Water Footprint). To optimize nutritional adequacy, several adaptations of the amount within the different food groups were made, for instance by increasing cereals and animal source by 25.5% kcal/day and 36.2% kcal/day respectively compared to EAT-IT. The resulting 2500 kcal/die pattern meets all nutritional requirements except for vitamin D and does not hamper the possibility to limit environmental impact (Carbon Footprint increased only by 12.2% but Water Footprint decreased by 6.3%). Lower energy targets were achieved by modulating amounts of the different food groups to ensure nutritional adequacy. The strategies and tools proposed here could aid in optimizing dietary plans, evaluating their potential for environmental impact reduction, and identifying issues that could hinder their adoption. Furthermore, the analyses carried out pave the way for the potential future development of new or improved foods that may contribute to the optimization of nutritional and environmental impact of diets.

Targeting strategies of antenatal balanced energy and protein supplementation in Addis Ababa, Ethiopia: study protocol for a randomized effectiveness study

BACKGROUND

Antenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries.

METHODS

A randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies.

DISCUSSION

This study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women.

TRIAL REGISTRATION

ClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.

Dried Porous Biomaterials from Mealworm Protein Gels: Proof of Concept and Impact of Drying Method on Structural Properties and Zinc Retention

Dried porous materials can be found in a wide range of applications. So far, they are mostly prepared from inorganic or indigestible raw materials. The aim of the presented study was to provide a proof of concept for (a) the suitability of mealworm protein gels to be turned into dried porous biomaterials by either a combination of solvent exchange and supercritical drying to obtain aerogels or by lyophilization to obtain lyophilized hydrogels and (b) the suitability of either drying method to retain trace elements such as zinc in the gels throughout the drying process. Hydrogels were prepared from mealworm protein, subsequently dried using either method, and characterized via FT-IR, BET volume, and high-resolution scanning electron microscopy. Retention of zinc was evaluated via energy-dispersive X-ray spectroscopy. Results showed that both drying methods were suitable for obtaining dried porous biomaterials and that the drying method mainly influenced the overall surface area and pore hydrophobicity but not the secondary structure of the proteins in the gels or their zinc content after drying. Therefore, a first proof of concept for utilizing mealworm protein hydrogels as a base for dried porous biomaterials was successful and elucidated the potential of these materials as future sustainable alternatives to more conventional dried porous materials.

Impact of consuming an environmentally protective diet on micronutrients: a systematic literature review

BACKGROUND

A global move toward consumption of diets from sustainable sources is required to protect planetary health. As this dietary transition will result in greater reliance on plant-based protein sources, the impact on micronutrient (MN) intakes and status is unknown.

OBJECTIVE

Evaluate the evidence of effects on intakes and status of selected MNs resulting from changes in dietary intakes to reduce environmental impact. Selected MNs of public health concern were vitamins A, D, and B12, folate, calcium, iron, iodine, and zinc.

METHODS

We systematically searched 7 databases from January 2011 to October 2022 and followed the PRISMA guidelines. Eligible studies had to report individual MN intake and/or status data collected in free-living individuals from the year 2000 onward and environmental outcomes.

RESULTS

From the 10,965 studies identified, 56 studies were included, mostly from high-income countries (n = 49). Iron (all 56) and iodine (n = 20) were the most and least reported MNs, respectively. There was one randomized controlled trial (RCT) that also provided the only biomarker data, 10 dietary intake studies, and 45 dietary modeling studies, including 29 diet optimization studies. Most studies sought to reduce greenhouse gas emissions or intake of animal-sourced foods. Most results suggested that intakes of zinc, calcium, iodine, and vitamins B12, A, and D would decrease, and total iron and folate would increase in a dietary transition to reduce environmental impacts. Risk of inadequate intakes of zinc, calcium, vitamins A, B12 and D were more likely to increase in the 10 studies that reported nutrient adequacy. Diet optimization (n = 29) demonstrated that meeting nutritional and environmental targets is technically feasible, although acceptability is not guaranteed.

CONCLUSIONS

Lower intakes and status of MNs of public health concern are a potential outcome of dietary changes to reduce environmental impacts. Adequate consideration of context and nutritional requirements is required to develop evidence-based recommendations. This study was registered prospectively with PROSPERO (CRD42021239713).

Micronutrient inadequacy among lactating mothers in rural areas of North Mecha District, Amhara Region, Ethiopia

Background

Lactating mothers are frequently at risk for nutritional deficiencies due to the physiological requirements of lactation. Throughout the world, a significant number of lactating mothers have micronutrient intake inadequacy. Evidence on micronutrient intake during lactation is limited in rural Ethiopia. Therefore, this study aimed to determine micronutrient intake inadequacy and associated factors among lactating mothers.

Methods and materials

A community-based cross-sectional study was conducted from February 1 to 18, 2023, among lactating mothers in rural areas of the North Mecha District of Amhara Region, Northwest Ethiopia. A multistage sampling technique was used to select 449 study participants. An interviewer-administered questionnaire was employed to collect dietary intake data by using a single multiphasic interactive 24-h dietary recall. The NutriSurvey 2007 software and Ethiopia, Tanzania and Kenya food composition tables were used to calculate nutrient values for the selected 12 micronutrients. For the remainder of the analysis, SPSS version 25 was employed. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated by dividing all NAR values by the number of micronutrients computed to evaluate the nutrient intakes. A logistic regression analysis was conducted to determine the factors contributing to the overall micronutrient intake inadequacy, and statistical significance was determined at a p value <0.05.

Result

A total of 430 lactating mothers participated in the study, with a 96% response rate and a mean age of 29.46 ± 5.55 years. The overall prevalence of micronutrient intake inadequacy was 72.3% (95% CI: 67.9, 76.5). The odds of micronutrient intake inadequacy were 2.5 times higher among lactating mothers aged 18-25 years old as compared to mothers in the age group ≥36 years old (AOR = 2.52, 95% CI: 1.09, 5.83). Mothers with the educational status of unable to read and write and primary school incomplete were 3.5 (AOR = 3.49, 95% CI: 1.24, 9.83) and 3.6 (AOR = 3.56, 95% CI: 1.06, 11.99) times more likely to have micronutrient intake inadequacy than mothers with secondary school completed or above educational status, respectively. Mothers whose partner's occupation was other than farming were 3.3 times more likely to have micronutrient intake inadequacy as compared to mothers whose partners were engaged in farming (AOR = 3.32, 95% CI: 1.08, 10.27). Lactating mothers who were from food-insecure households were 83% more likely to have high micronutrient intake inadequacy as compared to lactating mothers from food-secure households (AOR = 1.83, 95% CI: 1.04, 3.23). Lactating mothers with nutrition-related unfavorable attitudes were 77% more likely to have inadequate intake of micronutrients compared to lactating mothers with favorable attitudes (AOR = 1.77, 95% CI: 1.07, 2.93).

Conclusion

The prevalence of micronutrient intake inadequacy among lactating mothers was high. Age of the mothers, educational status of the mothers, occupation of the partner, household food security, and nutrition-related attitude were significantly associated with micronutrient intake inadequacy. Community driven nutrition education and interventions are needed to address the high micronutrient intake inadequacy among lactating mothers in rural Ethiopia.

CRISPR/Cas system: A revolutionary tool for crop improvement

World's population is elevating at an alarming rate thus, the rising demands of producing crops with better adaptability to biotic and abiotic stresses, superior nutritional as well as morphological qualities, and generation of high-yielding varieties have led to encourage the development of new plant breeding technologies. The availability and easy accessibility of genome sequences for a number of crop plants as well as the development of various genome editing technologies such as zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs) has opened up possibilities to develop new varieties of crop plants with superior desirable traits. However, these approaches has limitation of being more expensive as well as having complex steps and time-consuming. The CRISPR/Cas genome editing system has been intensively studied for allowing versatile target-specific modifications of crop genome that fruitfully aid in the generation of novel varieties. It is an advanced and promising technology with the potential to meet hunger needs and contribute to food production for the ever-growing human population. This review summarizes the usage of novel CRISPR/Cas genome editing tool for targeted crop improvement in stress resistance, yield, quality and nutritional traits in the desired crop plants.

Adequacy and Distribution Equity of Nutrition Supplies across China

Procuring food enriched with diverse nutrients is pivotal for maintaining a robust immune system. However, the food system is now unprecedentedly globalized and faces challenges arising from climate change, pandemics, and political unrest. This study aims to illuminate the gap in exploring the adequacy and distribution equity of nutrition supplies in response to potential trade fluctuations and restrictions on agrifood within China's local agriculture endowments. Also, it seeks to identify the role of trade in contributing to these indices. Accordingly, we analyzed the distribution of nutrients in agrifood categories from production to consumption and assessed the adequacy and distribution equity of corresponding available nutrition supply from the local food provision system in terms of meeting residents' nutritional requirements, across China, and compared with those in the practical market. The local self-supply system showed that 12 out of 31 provinces have difficulty achieving an iron supply with 11% to 108% deficiencies. Except for iron, 52% (folate)-90% (vitamin B12) of agricultural output was available for diet provisioning nationwide. While food trade emerges as a crucial factor in enhancing secure and equitable nutrition supply, risks associated with micronutrient deficiencies necessitate careful consideration in current global circumstances. Our analysis explored a regional pool of nutrient information in supplements to the conventional food profile in China and could implicate better knowledge toward healthier food supplies and tailored improvements for achieving a resilient nutrition supply.

Influence of pre-treatment methods on quality indicators and mineral composition of plant milk from different sources of raw materials

BACKGROUND

Pre-treatment of plant materials is essential in producing plant-based products and can affect their various organoleptic and physicochemical characteristics. This work aimed to study the effect of pre-treatment of vegetable raw materials, namely ultrasonic processing and freezing of raw materials under various low-temperature conditions, to obtain multiple types of vegetable milk and determine their characteristics.

RESULTS

It is shown that by applying a certain kind of pre-treatment of vegetable raw materials it is possible to adjust organoleptic parameters and the content of solids, protein, fat, carbohydrates, fiber and mineral composition of various types of vegetable milk from soy, rice, oats, wheat, peas, buckwheat, pumpkin seeds and lentils. Ultrasound pre-treatment allows increasing of polyphenol content by an average of 15-20% for all types of plant milk, except for lentil milk. The results showed that ultrasound treatment for 3 min had the most significant effect on the overall acceptability for lentils, pumpkin, rice and pea milk. Pre-freezing at a temperature regime of -17 and -85 °C contributed to an increase in Fe, K, Zn, Ca, Mg, Si and P by an average of 30-100%, depending on the plant material.

CONCLUSION

Pre-treatment of vegetable raw materials, including freezing and ultrasonic treatment, can positively affect the macro- and micronutrient composition of plant milk. However, the effect may vary depending on the type of raw material and processing conditions. © 2023 Society of Chemical Industry.

Levels of stunting associated factors among under-five children in Ethiopia: A multi-level ordinal logistic regression analysis

INTRODUCTION

Stunting is a major public health problem affecting more than one-third of under five year's old children in Ethiopia. It has short and long (irreversible) consequences, including stunted growth, never reaching physical and cognitive potential, struggles in school, and increased morbidity and mortality due to infections. Though stunting is the leading cause of child mortality in Ethiopia, evidence is scarce on the prevalence and predictors of stunting among under-five years old children in Ethiopia. Therefore, this study aimed to estimate the prevalence and predictors of stunting severity among under-5 children in Ethiopia.

MATERIALS AND METHODS

This study was based on 2019 Mini-Ethiopian Demographic and Health Survey (EDHS) data. A weighted total sample of 4972 under-five years old children was included in the study. Height measurement was collected for each child. Anthropometric indicator, height-for-age was determined for children using World Health Organization growth standards (Z-scores for Height-for-Age (HAZ)) to asses stunting level. Given the ordinal nature of stunting and the hierarchical nature of EDHS data, a multilevel ordinal logistic regression model was applied. Brant test was used to check the proportional odds assumption, which was satisfied (P-value ≥0.05). Moreover, deviance was used for model comparison. For the multivariable analysis, variables with a p-value ≤0.2 in the bivariable analysis were considered. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported as associated factor to the severity levels of stunting in the multivariable multilevel proportional odds model.

RESULTS

The overall prevalence of stunting among under-5 children in Ethiopia was 35.7% [95% CI: 34.4%, 37.1%]. Of these, 12.1% were severely stunted, and 24.9% were moderately stunted. Being male [AOR = 0.83, 95% CI: 0.74, 0.93], children aged 6-23 months [AOR = 2.38, 95% CI: 1.84, 3.07], ≥ 24 months [AOR = 4.15, 95% CI: 3.26, 5.28], children whose maternal age 15-24 years [AOR = 0.73, 95% CI: 0.58, 0.92], children from the poorest, poorer, middle, and richer household wealth were [AOR = 1.84, 95% CI: 1.32, 2.57], [AOR = 1.66, 95% CI: 1.20, 2.31], [AOR = 1.78, 95% CI: 1.29, 2.44], and [AOR = 1.62, 95% CI: 1.20, 2.17], children whose maternal educational status of no formal education and primary education had [AOR = 1.90, 95% CI: 1.28, 2.82], [AOR = 1.78, 95% CI: 1.22, 2.60], Tigray [AOR = 2.95, 95% CI: 1.78, 4.86], Afar [AOR = 1.85, 95% CI: 1.11, 3.10], Amhara [AOR = 1.90, 95% CI: 1.14, 3.14] and Harari [AOR = 1.97, 95% CI: 1.20, 3.25]regions, low community maternal education [AOR = 0.76, 95% CI: 0.62, 0.92] were significantly associated with stunting severity levelling.

CONCLUSION

Stunting among children under five years of old in Ethiopia remains a major public health issue. Improving access to maternal education is related to appropriate child feeding practices and health, particularly in younger and uneducated mothers. Strengthening the family's wealth status is also recommended to reduce stunting. In addition, it is better to support strategies of preconception care for mothers during pregnancy to reduce stunting in the long term.

A Landscape of Micronutrient Dietary Intake by 15- to 65-Years-Old Urban Population in 8 Latin American Countries: Results From the Latin American Study of Health and Nutrition

BACKGROUND

Latin American countries have shifted from traditional diets rich in micronutrients to a Westernized diet rich in high energy-dense foods and low in micronutrients.

OBJECTIVE

This study aimed to determine the prevalence of adequate micronutrient intakes in urban populations of 8 Latin American countries.

METHOD

Micronutrient dietary intake data were collected from September 2014 to August 2015 from 9216 men and women aged 15.0 to 65.0 years living in urban populations of 8 Latin American countries. Dietary intake was collected using two 24-hour recalls on nonconsecutive days. Micronutrient adequacy of intake was calculated using the Estimated Average Requirement cut-off method.

RESULTS

In general terms, the prevalence of inadequate intake of thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium ranged from 0.4% to 9.9%. In contrast, the prevalence of inadequacy of pyridoxine, zinc, vitamin C, and vitamin A ranged from 15.7% to 51.5%. The nutrients with a critical prevalence of inadequacy were magnesium (80.5%), calcium (85.7%), and vitamin D (98.2%). The highest prevalence of inadequate intakes was observed in the low educational level, participants with overweight/obesity, in men, and varies according to socioeconomic status.

CONCLUSIONS

There is an urgent need to define direct regional actions and strategies in Latin America aimed at improving micronutrient adequacy, either through staple food fortification programs, agronomic biofortification, or food policies that facilitate economic access to micronutrient-rich foods.

Micronutrient gaps during the complementary feeding period in seven countries in Southeast Asia: A Comprehensive Nutrient Gap Assessment

The complementary feeding period is a critical stage of child development when micronutrient needs are high and challenging to meet. Understanding if specific micronutrient gaps exist during this period is critical for effective programming. A Comprehensive Nutrient Gap Assessment (CONGA) was conducted in seven countries in Southeast Asia to estimate gaps in micronutrients commonly lacking in the diets of children aged 6-23 months and to establish the certainty of available evidence for each identified gap. Sixty-eight evidence sources were identified during this analysis, and 310 micronutrient-specific data points were identified across all seven countries. Data points varied in recency, representativeness and evidence type. The CONGA methodology enabled the estimation of a gap burden rating for each micronutrient in each country, as well as a rating of their evidence certainty. Micronutrient gaps were identified in vitamin D, zinc and iron and a potential gap was identified in calcium during the complementary feeding period in the region. Evidence relevant to intake and deficiency of folate, vitamin B12 , thiamine, niacin, vitamin C and vitamin B6 was limited across the region. Proven strategies to address these gaps include increasing the availability and consumption of nutrient-dense foods, micronutrient supplementation, large-scale fortification of staple foods and condiments and point-of-use fortification through multiple micronutrient powders and fortified speciality foods. More recent data on micronutrient availability, intake and deficiency is urgently needed in Southeast Asia.

Examining energy and nutrient production across the different agroecological zones in rural Ethiopia using statistical methods

Poor-quality diets are of huge concern in areas where consumption is dominated by locally sourced foods that provide inadequate nutrients. In agroecologically diverse countries like Ethiopia, food production is also likely to vary spatially. Yet, little is known about how nutrient production varies by agroecology. Our study looked at the adequacy of essential nutrients from local production in the midland, highland, and upper highland agroecological zones (AEZs). Data were collected at the village level from the kebele agriculture office and at the farm and household levels through surveys in rural districts of the South Wollo zone, Ethiopia. Household data were acquired from 478 households, and crop samples were collected from 120 plots during the 2020 production year. Annual crop and livestock production across the three AEZs was converted into energy and nutrient supply using locally developed crops' energy and nutrient composition data. The total produced energy (kcal) met significant proportions of per capita energy demand in the highland and upper highland, while the supply had a 50% energy deficit in the midland. Shortfalls in per capita vitamin A supply decreased across the agroecological gradient from midland (46%) to upper highland (31%). The estimated shortfall in folate supply was significantly higher in the upper highlands (63%) and negligible in the highlands (2%). The risk of deficient iron and zinc supply was relatively low across all AEZs (<10%), but the deficiency risk of calcium was unacceptably high. Agroecology determines the choice of crop produced and, in this way, affects the available supply of energy and nutrients. Therefore, agroecological variations should be a key consideration when designing food system interventions dedicated to improving diets.

Thiamine deficiency disorders in women and children

Thiamine (vitamin B1) is available in common foods such as the outer husk of rice and is necessary for normal cardiovascular, neurological and metabolic processes. Thiamine deficiency is common in many parts of Asia and Africa, affecting up to a third or more of children and women of child-bearing age. The diagnosis is based on clinical suspicion, especially when noting heart failure in infants, encephalopathy in patients of any age, and peripheral neuropathy in older children and adults. Blood tests for whole-blood thiamine diphosphate (the quantity of biologically active thiamine present) and erythrocyte transketolase activity (the functional impact of thiamine) are not always readily available in areas where thiamine deficiency is common. Treatment is safe and effective, although dosing guidelines vary widely; 50 mg daily for 5 days is probably effective for treating acute thiamine deficiency disorders, and ongoing adequate thiamine intake is also needed. Prevention efforts depend on local and regional circumstances, including dietary diversification, food fortification, and/or supplementation of children and women at risk.Abbreviations: HIC: high-income countries; LMIC: low- and middle-income countries; MRI: magnetic resonance imaging; TDD: thiamine deficiency disorders.

Global food nutrients analysis reveals alarming gaps and daunting challenges

Eliminating both overt and hidden hunger is at the core of the global food and nutrition security agenda. Yet, the collective state of nutrition security at the population level is not known. Here we quantify food-based availability of 11 essential nutrients for 156 countries using a food production-consumption-nutrition model, followed by assessment of the nutrient availability status as a ratio of recommended intake. For the baseline year 2017, global per capita availability was adequate for calorie and protein but in severe deficit for vitamin A and calcium (intake ratios, <0.60, where 1.0 is adequate) and moderate deficit for vitamin B12 (intake ratio, 0.76). At the country level, more than half of the 156 countries were in various degrees of deficit for all nine micronutrients. Disparities across regions or countries were enormous. We explore intervention strategies from an agriculture-food system perspective and discuss the daunting challenges of addressing nutrition security broadly.

Climate change exacerbates nutrient disparities from seafood

Seafood is an important source of bioavailable micronutrients supporting human health, yet it is unclear how micronutrient production has changed in the past or how climate change will influence its availability. Here combining reconstructed fisheries databases and predictive models, we assess nutrient availability from fisheries and mariculture in the past and project their futures under climate change. Since the 1990s, availabilities of iron, calcium and omega-3 from seafood for direct human consumption have increased but stagnated for protein. Under climate change, nutrient availability is projected to decrease disproportionately in tropical low-income countries that are already highly dependent on seafood-derived nutrients. At 4 oC of warming, nutrient availability is projected to decline by ~30% by 2100 in low income countries, while at 1.5-2.0 oC warming, decreases are projected to be ~10%. We demonstrate the importance of effective mitigation to support nutritional security of vulnerable nations and global health equity.

Dietary protein recommendations to support healthy muscle ageing in the 21st century and beyond: considerations and future directions

This review explores the evolution of dietary protein intake requirements and recommendations, with a focus on skeletal muscle remodelling to support healthy ageing based on presentations at the 2023 Nutrition Society summer conference. In this review, we describe the role of dietary protein for metabolic health and ageing muscle, explain the origins of protein and amino acid (AA) requirements and discuss current recommendations for dietary protein intake, which currently sits at about 0⋅8 g/kg/d. We also critique existing (e.g. nitrogen balance) and contemporary (e.g. indicator AA oxidation) methods to determine protein/AA intake requirements and suggest that existing methods may underestimate requirements, with more contemporary assessments indicating protein recommendations may need to be increased to >1⋅0 g/kg/d. One example of evolution in dietary protein guidance is the transition from protein requirements to recommendations. Hence, we discuss the refinement of protein/AA requirements for skeletal muscle maintenance with advanced age beyond simply the dose (e.g. source, type, quality, timing, pattern, nutrient co-ingestion) and explore the efficacy and sustainability of alternative protein sources beyond animal-based proteins to facilitate skeletal muscle remodelling in older age. We conclude that, whilst a growing body of research has demonstrated that animal-free protein sources can effectively stimulate and support muscle remodelling in a manner that is comparable to animal-based proteins, food systems need to sustainably provide a diversity of both plant and animal source foods, not least for their protein content but other vital nutrients. Finally, we propose some priority research directions for the field of protein nutrition and healthy ageing.

Pollinator-dependent crops significantly contribute to diets and reduce household nutrient deficiencies in sub-Saharan Africa

Recent literature highlights the potential of animal pollinator-dependent (PD) crops in enhancing food and nutrition security, although there is a lack of detailed household-level estimates. In this study, we investigate the nutrient composition, productivity, and contribution of PD and pollinator-independent (PI) crops to household nutrition in four sub-Saharan African (SSA) countries. We also evaluate the impact of reallocating resources from PI crops to PD crops on nutrient deficiencies, utilizing nationally representative panel data from three waves and over 30,000 household-year observations. Our findings reveal that PD crops exhibit higher micronutrient content per unit, albeit with lower macronutrient content compared to PI crops. PI crops have higher yield of calories per hectare while PD crops have higher vitamin A yield per hectare. However, protein and iron yield for PD and PI crops varies across countries. PI crops predominantly contribute to macronutrients and iron, while PD crops significantly contribute to vitamin A production. Our econometric results demonstrate that increasing the cultivation of PD crops relative to PI crops reduces the prevalence of nutrient deficiencies and increases crop income without compromising macronutrients production. This suggests that greater investment in PD crop production can be an integral approach to achieving nutrition security in SSA.

The battle to achieve Sustainable Development Goal Two: The role of environmental sustainability and government institutions

The current period marked by addressing environmental sustainability challenges and the instability of government institutions has heightened the issue of food security, especially in developing countries as they work towards achieving Zero Hunger as highlighted in the Sustainable Development Goals. To assess the effect of environmental sustainability and government institutions on food security in West Africa with data from 1990 to 2021, two models have been deployed. The Generalized Method of Moments was deployed as the main model and while Two-Stage Least Squares was used as the robustness check. The findings of the study reveal that carbon emissions which represent environmental sustainability has no direct significant effect on food security, while government institutions has negative effect on food security. The study also reveals that income and urbanization promote food security, while renewable energy and population growth reduce food security. The findings of the study could be a reflection of the current political instability and attitude towards tackling carbon emissions mitigation in the region. Government institutions are encouraged to exercise authority without fear to implement policies that would encourage food security and restrict the use of high-emission technologies.

Biofortification of different maize cultivars with zinc, iron and selenium by foliar fertilizer applications

Fertilizer-based biofortification is a strategy for combating worldwide malnutrition of zinc (Zn), iron (Fe) and selenium (Se). Field experiments were conducted to investigate the effects of foliar treatments on concentrations of Zn, Fe, Se, N and bioavailability of Zn and Fe in grains of three maize cultivars grown at three locations. We compared the efficacy of ZnO nanoparticles (ZnO-NPs), Zn complexed chitosan nanoparticles (Zn-CNPs), conventional ZnSO4 and a cocktail solution (containing Zn, Fe and Se). All treatments were foliar-applied at rate of 452 mg Zn L-1, plus urea. Applying ten-fold less Zn (at rate of 45.2 mg Zn L-1) plus urea in the form of ZnO-NPs, Zn-CNPs, or ZnSO4 resulted in no increase, or a negligible increase, in grain Zn concentration compared with deionized water. By contrast, among the different Zn sources plus urea applied by foliar sprays, conventional ZnSO4 was the most efficient in improving grain Zn concentration. Furthermore, foliar application of a cocktail solution effectively improved grain concentrations of Zn, Fe, Se and N simultaneously, without a grain yield trade-off. For example, the average grain concentrations were simultaneously increased from 13.8 to 22.1 mg kg-1 for Zn, from 17.2 to 22.1 mg kg-1for Fe, from 21.4 to 413.5 ug kg-1 for Se and from 13.8 to 14.7 g kg-1 for N by foliar application of a cocktail solution. Because grain yield was significantly negatively correlated with grain nutrient concentrations, the magnitude of increase in grain concentrations of Zn and Fe was most pronounced in the maize cultivar with the lowest grain yield (Zhengdan958 grown in Linyi). Foliar application of a cocktail solution also significantly decreased the phytic acid (PA) concentration, ratios of PA/Fe and PA/Zn in grains, indicating an increased bioavailability of Fe and Zn for human health. In conclusion, we found that a foliar application of a cocktail solution including Zn, Fe, Se and N was most effective for biofortification, but that the grains with the lowest yield contained the greatest concentration of these elements. This finding highlights the need to breed maize varieties that are capable of achieving both high grain yield and high grain nutritional quality to address food security and human health challenges.

Comparative bioavailability of vitamins in human foods sourced from animals and plants

Vitamins are essential components of enzyme systems involved in normal growth and function. The quantitative estimation of the proportion of dietary vitamins, that is in a form available for utilization by the human body, is limited and fragmentary. This review provides the current state of knowledge on the bioavailability of thirteen vitamins and choline, to evaluate whether there are differences in vitamin bioavailability when human foods are sourced from animals or plants. The bioavailability of naturally occurring choline, vitamin D, vitamin E, and vitamin K in food awaits further studies. Animal-sourced foods are the almost exclusive natural sources of dietary vitamin B-12 (65% bioavailable) and preformed vitamin A retinol (74% bioavailable), and contain highly bioavailable biotin (89%), folate (67%), niacin (67%), pantothenic acid (80%), riboflavin (61%), thiamin (82%), and vitamin B-6 (83%). Plant-based foods are the main natural sources of vitamin C (76% bioavailable), provitamin A carotenoid β-carotene (15.6% bioavailable), riboflavin (65% bioavailable), thiamin (81% bioavailable), and vitamin K (16.5% bioavailable). The overview of studies showed that in general, vitamins in foods originating from animals are more bioavailable than vitamins in foods sourced from plants.

Contextual factors affecting the implementation of an anemia focused virtual counseling intervention for pregnant women in plains Nepal: a mixed methods process evaluation

BACKGROUND

Anemia is estimated to cause 115,000 maternal deaths each year. In Nepal, 46% of pregnant women have anemia. As part of an integrated anemia-prevention strategy, family engagement and counseling of pregnant women can increase compliance to iron folic acid tablets, but marginalized women often have lower access to these interventions. We implemented the VALID (Virtual antenatal intervention for improved diet and iron intake) randomized controlled trial to test a family-focused virtual counseling mHealth intervention designed to inclusively increase iron folic acid compliance in rural Nepal; here we report findings from our process evaluation research.

METHODS

We conducted semi structured interviews with 20 pregnant women who had received the intervention, eight husbands, seven mothers-in-laws and four health workers. We did four focus groups discussions with intervention implementers, 39 observations of counseling, and used routine monitoring data in our evaluation. We used inductive and deductive analysis of qualitative data, and descriptive statistics of monitoring data.

RESULTS

We were able to implement the intervention largely as planned and all participants liked the dialogical counseling approach and use of story-telling to trigger conversation. However, an unreliable and inaccessible mobile network impeded training families about how to use the mobile device, arrange the counseling time, and conduct the counseling. Women were not equally confident using mobile devices, and the need to frequently visit households to troubleshoot negated the virtual nature of the intervention for some. Women's lack of agency restricted both their ability to speak freely and their mobility, which meant that some women were unable to move to areas with better mobile reception. It was difficult for some women to schedule the counseling, as there were competing demands on their time. Family members were difficult to engage because they were often working outside the home; the small screen made it difficult to interact, and some women were uncomfortable speaking in front of family members.

CONCLUSIONS

It is important to understand gender norms, mobile access, and mobile literacy before implementing an mHealth intervention. The contextual barriers to implementation meant that we were not able to engage family members as much as we had hoped, and we were not able to minimize in-person contact with families. We recommend a flexible approach to mHealth interventions which can be responsive to local context and the situation of participants. Home visits may be more effective for those women who are most marginalized, lack confidence in using a mobile device, and where internet access is poor.

Growth in milk consumption and reductions in child stunting: Historical evidence from cross-country panel data

Agricultural and food policies are increasingly being tasked with doing more to improve the nutritional status of low-income populations, especially reductions in child stunting. Which specific food sectors warrant additional policy attention is less clear, although a growing body of research argues that increased animal-sourced food consumption in general, and increased dairy consumption specifically, can significantly reduce the risks of stunting, as well as deficiencies in micronutrients and high quality protein. However, experimental research on dairy's impacts on child growth in developing countries is very limited, and non-experimental evidence is confined to cross-sectional surveys. In this study we adopt a more macro lens by using a cross-country panel to show that increases in milk consumption over time are associated with large reductions in child stunting even after controlling for important confounding factors. Countries with high rates of stunting should therefore consider nutrition-sensitive strategies to increase dairy consumption among young children through both supply- and demand-side interventions.

Effect of iron-fortified jamun leather on the Asunra-induced anemia in Sprague Dawley rats

Introduction

Micronutrients such as minerals and vitamins are required in a minute quantity but play a pivotal role in the functioning of the body. Therefore, deficiency in one of them can lead to lethal health conditions. Iron deficiency anaemia is one of the most common micronutrient deficiencies across the world and is affecting women and children.

Methods

The present study aimed to investigate the anti-anaemic effect of fortified jamun leather on anaemia biomarkers and haematology in anaemic female Sprague Dawley rats. A total of 40 Sprague Dawley rats were used in 4 groups. Iron deficiency anaemia was induced by oral administration of the Asunra drug. The treatments were fed at two dosage levels i.e., 40 and 60% iron-fortified leather. All animals were treated for 60 days and the parameters including biochemical, and histopathology of the kidney and liver were examined.

Results

The experiment's findings showed that the group fed with iron-fortified leather (G₃) succeeded significantly (P < 0.05) in restoring the serum iron (98.68 ± 2.88 μg/dL), haemoglobin (12.41 ± 0.32 g/dL), ferritin (24.54 ± 1.98 ng/mL) and haematocrit levels (39.30 ± 1.66%) at the end of the 60 days period. Additionally, the treated group's mean values for transferrin and total iron binding capacity were lower than those of the anaemic rats, indicating an improvement in iron levels. The microscopic analysis revealed that treatments had no toxic effects on the kidney and liver tissues, except in the diseased group, which had necrosis and irregular cell structure.

Conclusion

Conclusively, iron-fortified jamun leather helped improve iron deficiency biomarkers and imparted a non-toxic effect on tissues in rats.

Socio-economic and food system drivers of nutrition and health transitions in The Gambia from 1990 to 2017

In common with many nations undergoing a nutrition transition, micronutrient deficiencies, undernutrition and overnutrition coexist in The Gambia. Addressing these challenges simultaneously would require transformational changes in the country's food system. However, the evidence base that would enable informed decision-making in the Gambian food system has been scant, despite several sources of routinely-collected data being available. This descriptive study brings together data from four open-access global databases on food supply, political, economic, and demographic variables, and nutrition and health between 1990 and 2017 to study potential leverage points for improvement in the food system. It compares trends in food supply and nutritional outcomes in The Gambia against regional and global averages, and identifies potential drivers taken from a food systems framework. The data show that, over the past three decades, total energy supply has increased, and obesity is rising quickly, but iron deficiency persists in a proportion of the population. Overall diet composition is poor, with lower availability of fruit and vegetables and higher supply of sugar and oils compared to regional and global averages. Domestic production is low for most food groups and so a high dependence on imports from other countries bridges the gap in terms of energy supply. Measures of economic development, particularly GDP, were positively related with supply of cereals and animal source foods over time, but no such relationship was observed with fruit and vegetable supply. Food system policy to improve nutrition and health outcomes in The Gambia needs to focus on improving the diversity of food supply - especially fruit and vegetables - and maximizing national domestic production to reduce reliance on food imports. The use of open-source global datasets can be feasible in exploring food system characteristics and trends at the national level and could be applied in other contexts.

Evolution of global food trade network and its effects on population nutritional status

Changes in food systems during the last decades fostered the establishment of global food networks based on exchanges between countries with different income levels. Recent studies explored configuration and factors associated with trade networks of specific food items during limited periods; however, there is lack of evidence on evolution of trade networks of foods for human consumption and its potential effects on population nutritional status. We present the evolution of the global trade network of foods for human consumption from 1986 to 2020, according to country income level, and we explore potential effects of country network centrality and globalization processes on the prevalence of overweight and obesity. Results show intensification of international food trade and globalization processes in the period of analysis with implications for population nutritional status worldwide.

Association of Pork (All Pork, Fresh Pork and Processed Pork) Consumption with Nutrient Intakes and Adequacy in US Children (Age 2-18 Years) and Adults (Age 19+ Years): NHANES 2011-2018 Analysis

Pork is a rich source of high-quality protein and select nutrients. The objective of this work was to assess the intakes of all pork (AP), fresh pork (FP) and processed pork (PP) and their association with nutrient intake and meeting nutrient recommendations using 24 h dietary recall data. Usual intake was determined using the NCI method and the percentage of the population with intakes below the Estimated Average Requirement, or above the Adequate Intake for pork consumers and non-consumers, was estimated. About 52, 15 and 45% of children and 59, 20 and 49% of adults were consumers of AP, FP and PP, respectively, with mean intakes in consumers of 47, 60 and 38 g/day for children and 61, 77 and 48 g/day for adults, respectively. Among consumers of AP, FP and PP, the intakes of copper, potassium, selenium, sodium, zinc, thiamine, niacin, vitamin B₆ and choline were higher (p < 0.05) and a higher (p < 0.05) proportion met nutrient recommendations for copper, potassium, zinc, thiamin and choline compared to non-consumers. There were additional differences (p < 0.05) in intakes and adequacies for other nutrients between consumers and non-consumers depending upon the age group and pork type. In conclusion, pork intake was associated with higher intakes and adequacies in children and adults for certain key nutrients.

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents' physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world's child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15-19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.

Nutrient intakes of pregnant and lactating women in Indonesia and Malaysia: Systematic review and meta-analysis

Introduction

Optimizing dietary intake during pregnancy and lactation is crucial to the growth and development of children and their lifelong health. We performed a systematic review and meta-analysis to describe the nutrient intakes of pregnant and lactating women in Indonesia and Malaysia, countries that are experiencing rapid nutrition transition in Southeast Asia.

Methods

We screened 2,258 studies published between January 1980 and March 2021. The nutrient intakes of pregnant and lactating women were quantitatively analyzed to calculate the percentage of adequacy using national recommended daily allowances or nutrient intakes (RDA/RNI) and estimated average requirements (EAR) for micronutrients. Standardized mean differences (SMD) between dietary intake and RDA/RNI were determined for selected nutrients.

Results

Fifty-three studies were included and showed that energy and macronutrient intakes among pregnant and lactating women in both countries were below the RDA/RNI. In addition, most studies reported that women failed to meet the EAR for vitamin D (&lt;70% EAR), vitamin E (&lt;50% EAR), and water-soluble vitamins (&lt;80% EAR) except for vitamin C and A among Malaysians. Moreover, calcium, potassium, and iron intakes of pregnant women were &lt;60% EAR in Indonesia and &lt;80% EAR in Malaysia. Phosphorus intake among pregnant women in both countries and sodium intake among Malaysian pregnant women exceeded 100% EAR. Indonesian lactating women had &lt;60% EAR for calcium and potassium intakes, while Malaysian women had more than 100% EAR. For 21 studies reporting overall protein intakes, the standard mean difference (SMD) was −2.26 (95% CI; −2.98, −1.54) below the RDA/RNI for pregnant women and −0.67 SMD (95% CI −15.7, −11.5) for lactating women. When the four studies from Malaysia were analyzed separately, protein intakes of pregnant women were above the RNI. Moreover, low intakes of vitamin D, vitamin C, calcium, and iron, but sufficient intakes in vitamin A, zinc, and phosphorus were observed in pregnant women in both countries.

Conclusion

Dietary intakes of energy, macronutrients, and micronutrients (vitamin D, vitamin E, water-soluble vitamins, calcium, and iron) of pregnant and lactating women in Indonesia and Malaysia were below the recommendations. Important heterogeneities were observed even between these two countries for specific essential nutrient intakes. Innovative research and targeted programs to address specific deficiencies should be prioritized.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021252204, identifier: CRD42021252204.

Global contributions of milk to nutrient supplies and greenhouse gas emissions

Globally, ruminant production systems used to synthesize meat and milk differ tremendously in terms of their efficiency, productivity, and environmental impacts. Regardless of this variability, milk has been repeatedly identified as an essential source of nutrients for humans. The objective of this work was to characterize global contributions of fluid milk to human food and nutrient supplies, greenhouse gas emissions, and water withdrawal. Data were leveraged from the United Nations Food and Agriculture Organization to estimate global supplies of agricultural products. Trade of agricultural products and waste of those products, along with use of human food for livestock feed were accounted for before estimating human nutrient supplies. The contributions of milk to human-edible nutrient supplies were then enumerated in terms of their proportion of total nutrients supplied by the agricultural system and in terms of the human population's requirement for that nutrient. We identified that fluid milk provides over 10% of consumable supplies of vitamin B₁₂, vitamin A, riboflavin, and calcium available for humans globally. In terms of human nutrient requirements, milk provides sufficient vitamin B₁₂ to meet the needs of over 60% of the global population, riboflavin to satisfy 50% of the population, and calcium and phosphorus for over 35% of the population. Compared with other foods, milk ranked among the highest in terms of nutrient-to-calorie ratio for numerous amino acids, phosphorus, calcium, and riboflavin. Conditional dependencies were identified between greenhouse gas emissions and ruminant milk and meat, but not between water withdrawal and milk production. When evaluating the trade-offs in nutrient use versus nutrient provision for producing milk or producing all ruminant products, the production of ruminants worldwide was associated with both net increases and net decreases of several key nutrients. Continued work focusing on strategies to reduce the environmental impact of milk production will improve the utility of milk for feeding the growing global population.

Dietary trends and the decline in male reproductive health

Over the twentieth century, male reproductive health has suffered a substantial decline, as evidenced by decreases in sperm counts and testosterone levels and increases in reproductive pathologies. At the same time, the prevalence of chronic diseases such as obesity, diabetes, and metabolic syndrome has risen dramatically. Metabolic and reproductive health are highly interconnected, suggesting that their respective trends are intertwined and, given the timeframe of such trends, environmental and not genetic factors are most likely to be the primary causes. Industrialization, which began in Europe in the mid-eighteenth century, has resulted in profound changes to our diet, lifestyle, and environment, many of which are causal factors in the rise in chronic diseases. Industrialization results in a nutrition transition from an agricultural unprocessed to a modern processed diet, incorporating increases in sugar, vegetable oils, ultra-processed foods, linoleic acid, trans-fats, and total energy. This dietary shift has incurred numerous adverse effects on metabolic and reproductive health, characterized by chronic inflammation, oxidative stress, and insulin resistance. Moreover, these effects appear to multiply across subsequent generations via epigenetic inheritance. Men's fertility is markedly affected by obesity and diabetes, with an increase in total energy via processed food intake arguably being the key factor driving the diabesity pandemic. In contrast, wholefoods rich in micronutrients and phytonutrients support male fertility and a healthy body weight. Therefore, men wanting to maximize their fertility should consider making positive dietary changes, such as replacing processed foods with unprocessed foods that support metabolic and reproductive health.

Pregnancy thiamine and riboflavin intake and the risk of gestational diabetes mellitus: A prospective cohort study

BACKGROUND

Thiamine and riboflavin deficiencies exist to varying degrees worldwide, especially in developing countries. Evidence regarding the association between thiamine and riboflavin intake and gestational diabetes mellitus (GDM) is scarce.

OBJECTIVES

We aimed to evaluate the association of thiamine and riboflavin intake during pregnancy, including dietary source and supplementation, with GDM risk in a prospective cohort study.

METHODS

We included 3036 pregnant women (923 in the first trimester and 2113 in the second trimester) from the Tongji Birth Cohort. A validated semi-quantitative food frequency questionnaire and a lifestyle questionnaire were used to assess thiamine and riboflavin intake from dietary source and supplementation, respectively. GDM was diagnosed using the 75 g 2-h oral glucose tolerance test at 24-28 weeks of gestation. A modified Poisson regression or logistic regression model was used to evaluate the association between thiamine and riboflavin intake and GDM risk.

RESULTS

Dietary intake of thiamine and riboflavin was at low levels during pregnancy. In the fully adjusted model, compared with participants in quartile 1 (Q1), those who had more total thiamine and riboflavin intake had a lower risk of GDM during the first trimester [thiamine: Q2: RR: 0.58 (95% CI: 0.34, 0.98); Q3: RR: 0.45 (95% CI: 0.24, 0.84); Q4: RR: 0.35 (95% CI: 0.17, 0.72), P for trend = 0.002; riboflavin: Q2: RR: 0.63 (95% CI: 0.37, 1.09); Q3: RR: 0.45 (95% CI: 0.24, 0.87); Q4: RR: 0.39 (95% CI: 0.19, 0.79), P for trend = 0.006]. This association was also observed during the second trimester. Similar results were observed for the association between thiamine and riboflavin supplement use but not dietary intake and GDM risk.

CONCLUSIONS

Higher intake of thiamine and riboflavin during pregnancy is associated with a lower incidence of GDM. This trial was registered at http://www.chictr.org.cn as ChiCTR1800016908.

Nutritional value of the marine fish in Bangladesh and their potential to address malnutrition: A review

Marine fish are good source of essential macro- and micronutrients and major food items in coastal areas in Bangladesh. However, there is no review that details the nutritional value of marine fish in Bangladesh. Therefore, this review focuses on the nutrient composition of marine fish in Bangladesh and how the marine fish can address common nutrient deficiencies among women and children. Nutrient composition data was collected through literature searching in databases and source, including PubMed, Web of Science, Google Scholar, ScienceDirect, WorldFish, and Bangladesh-based database Banglajol. Calculation was carried out to present how one serving marine fish could potentially meet the daily requirement of protein, iron, zinc, calcium, vitamin A, and docosahexaenoic acid (DHA) for pregnant and lactating women and children aged 6-23 months. A total of 97 entries covering nutrient composition analysis of 67 individual fish species were extracted from 12 articles published between 1993 and 2020. Included articles contained analysis of proximate composition, vitamins, minerals, fatty acids, and amino acid. Twelve minerals and nine vitamins were analyzed and reported. The average energy, protein, fat, and ash content per 100 g edible raw marine fish was 343.58 kJ, 16.76 g, 4.16 g, and 2.22 g, respectively. According to available data, marine fish are good sources of protein, zinc, calcium, and DHA. Pelagic small fish, which are mainly captured by artisanal small-scale fishers, had more nutritional value than other categories of fish. Furthermore, marine small fish were found more nutritious than commonly consumed freshwater fish types in Bangladesh, including major carps, introduced carps, and tilapia. Therefore, the study concludes that marine fish have high potential to address malnutrition in Bangladesh. There was scarcity of literature regarding the nutrient composition of marine fish in Bangladesh and in South Asia as a whole, so more comprehensive quality research in this area is recommended.

Spatial Distribution and Temporal Trends of Dietary Niacin Intake in Chinese Residents ≥ 5 Years of Age between 1991 and 2018

Limited knowledge exists on trends in niacin consumption and the prevalence of inadequate intakes in China. Understanding trends and the spatial distribution of the prevalence of inadequate niacin intake is crucial to identifying high-risk areas and sub-populations. The dietary intakes of niacin between 1991 and 2018 were analyzed using the China Health and Nutrition Survey (CHNS) data. The estimated average requirement cut point was applied to estimate inadequacy. The geographic information system's ordinary kriging method was used to estimate the spatial distribution of the prevalence of inadequate niacin intakes. However, between 1991 and 2018, the prevalence of inadequate niacin intake increased from 13.00% to 28.40% in females and from 17.75% to 29.46% in males. Additionally, the geographically significant clusters of high and low prevalence were identified and remained stable over almost three decades. The high prevalence of insufficient niacin intake was more pronounced in Henan and Shandong over 27 years. Further, effective and tailored nutrition interventions are required to address inadequate niacin intake in China.

Wild leafy vegetables: A potential source for a traditional Mediterranean food from Lebanon

Introduction

In Lebanon, wild leafy vegetables (WLVs) continue to be an essential component of people's diet. Nevertheless, little ethnobotanical research has addressed this important potential source for food and nutrition.

Methods

In this study, an ethnobotanical survey was carried out between 2018 and 2022 across 21 villages/towns involving 151 local informants by semi-structured interviews.

Results and discussion

A list of 158 plant species which was still gathered and consumed by traditional Lebanese communities was compiled. The species belonged to 21 families and the most diverse families were Asteraceae (77 species), Brassicaceae (22), and Apiaceae (11). Native species accounted for 147 of the cited species, five of which were endemics to Lebanon and Syria. According to the Relative Frequency of Citation (RFC) index, Anchusa azurea, Centaurea hyalolepis, Chondrilla juncea, Eruca vesicaria, Pseudopodospermum molle, Pseudopodospermum papposum, and Taraxacum sect. Taraxacum were reported for the first time among the top popular species. Basal rosettes were the main parts consumed both raw and/or cooked. Informants perceived a decline in availability primarily due to habitat loss and land degradation. According to the International Union for Conservation of Nature (IUCN), six of cited species were classified as globally threatened (EN or VU), five of which were narrow endemics. These species scored substantial RFC values. Findings indicate that WEVs of Lebanon offer a promising potential to support food diversity and dietary quality of traditional communities and that threatened endemic species present a high conservation priority. Future research on nutritional contents of these species and highly rated WLVs is recommended.

Maternal micronutrient disturbance as risks of offspring metabolic syndrome

Metabolic syndrome (MetS) is defined as a constellation of individual metabolic disturbances, including central obesity, hypertension, dyslipidemia, and insulin resistance. The established pathogenesis of MetS varies extensively with gender, age, ethnic background, and nutritional status. In terms of nutritional status, micronutrients are more likely to be discounted as essential components of required nutrition than macronutrients due to the small amount required. Numerous observational studies have shown that pregnant women frequently experience malnutrition, especially in developing and low-income countries, resulting in chronic MetS in the offspring due to the urgent and increasing demands for micronutrients during gestation and lactation. Over the past few decades, scientific developments have revolutionized our understanding of the association between balanced maternal micronutrients and MetS in the offspring. Examples of successful individual, dual, or multiple maternal micronutrient interventions on the offspring include iron for hypertension, selenium for type 2 diabetes, and a combination of folate and vitamin D for adiposity. In this review, we aim to elucidate the effects of maternal micronutrient intake on offspring metabolic homeostasis and discuss potential perspectives and challenges in the field of maternal micronutrient interventions.

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.

Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial

BACKGROUND

Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g).

METHODS

The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and 27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth.

RESULTS

The prevalence of adverse birth outcomes was: miscarriage: 5.0% [95% confidence interval (CI), 4.4, 5.7]; stillbirth: 2.3% (95% CI 1.9, 2.7); preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); and neonatal mortality: 31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births.

CONCLUSIONS

Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthened management of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles.

Safeguarding nutrients from coral reefs under climate change

The sustainability of coral reef fisheries is jeopardized by complex and interacting socio-ecological stressors that undermine their contribution to food and nutrition security. Climate change has emerged as one of the key stressors threatening coral reefs and their fish-associated services. How fish nutrient concentrations respond to warming oceans remains unclear but these responses are probably affected by both direct (metabolism and trophodynamics) and indirect (habitat and species range shifts) effects. Climate-driven coral habitat loss can cause changes in fish abundance and biomass, revealing potential winners and losers among major fisheries targets that can be predicted using ecological indicators and biological traits. A critical next step is to extend research focused on the quantity of available food (fish biomass) to also consider its nutritional quality, which is relevant to progress in the fields of food security and malnutrition. Biological traits are robust predictors of fish nutrient content and thus potentially indicate how climate-driven changes are expected to impact nutrient availability within future food webs on coral reefs. Here, we outline future research priorities and an anticipatory framework towards sustainable reef fisheries contributing to nutrition-sensitive food systems in a warming ocean.

Small pelagic fish supply abundant and affordable micronutrients to low- and middle-income countries

Wild-caught fish provide an irreplaceable source of essential nutrients in food-insecure places. Fishers catch thousands of species, yet the diversity of aquatic foods is often categorized homogeneously as 'fish', obscuring an understanding of which species supply affordable, nutritious and abundant food. Here, we use catch, economic and nutrient data on 2,348 species to identify the most affordable and nutritious fish in 39 low- and middle-income countries. We find that a 100 g portion of fish cost between 10 and 30% of the cheapest daily diet, with small pelagic fish (herring, sardine, anchovy) being the cheapest nutritious fish in 72% of countries. In sub-Saharan Africa, where nutrient deficiencies are rising, <20% of small pelagic catch would meet recommended dietary fish intakes for all children (6 months to 4 years old) living near to water bodies. Nutrition-sensitive policies that ensure local supplies and promote consumption of wild-caught fish could help address nutrient deficiencies in vulnerable populations.

Microgreens Biometric and Fluorescence Response to Iron (Fe) Biofortification

Microgreens are foods with high nutritional value, which can be further enhanced with biofortification. Crop biofortification involves increasing the accumulation of target nutrients in edible plant tissues through fertilization or other factors. The purpose of the present study was to evaluate the potential for biofortification of some vegetable microgreens through iron (Fe) enrichment. The effect of nutrient solution supplemented with iron chelate (1.5, 3.0 mg/L) on the plant's growth and mineral concentration of purple kohlrabi, radish, pea, and spinach microgreens was studied. Increasing the concentration of Fe in the medium increased the Fe content in the leaves of the species under study, except for radish. Significant interactions were observed between Fe and other microelements (Mn, Zn, and Cu) content in the shoots. With the increase in the intensity of supplementation with Fe, regardless of the species, the uptake of zinc and copper decreased. However, the species examined suggested that the response to Fe enrichment was species-specific. The application of Fe didn't influence plant height or fresh and dry weight. The chlorophyll content index (CCI) was different among species. With increasing fertilisation intensity, a reduction in CCI only in peas resulted. A higher dose of iron in the medium increased the fluorescence yield of spinach and pea microgreens. In conclusion, the tested species, especially spinach and pea, grown in soilless systems are good targets to produce high-quality Fe biofortified microgreens.

Evolution of energy and nutrient supply in Zambia (1961–2013) in the context of policy, political, social, economic, and climatic changes

An adequate supply of energy, micronutrients and macronutrients is essential to achieve food and nutrition security to prevent malnutrition. Socio-economic, political, and climatic events, however, can affect the supply of food and nutrients. We assessed country-level supply trends of food and nutrients and their sources within the context of policy changes and political, socio-economic and climatic events from 1961 to 2013 in Zambia. Due to the lack of national food consumption data, food supply data from the FAO food balance sheets, matched to food composition tables, were used to estimate the energy, macronutrient and micronutrient content of 264 food items available to Zambia. We calculated historical nutrient supplies based on demographic characteristics and population-level dietary requirements. Results showed that Zambia was nutrition insecure from 1961 to 2013 for key micronutrients vitamin A, folate, riboflavin, vitamin B12, calcium, zinc, iron, and energy-deficient from the late-1980s. The diet has not substantially changed over time, with maize being the dominant food source. However, refined energy-dense food has steadily increased in the diet coupled with a reduction in fibre. These nutrient supply and dietary pattern trends coincide with specific socio-economic, policy, political, and climatic events from the 1970s to the early-mid 2000s, such as population growth, maize subsidy and crop diversification policies, regime change and drought. This study shows how policy, political and climatic events have been central features shaping nutrient supplies and the consequences for nutrition security. The study provides a context to inform future food policies to improve food and nutrition security.

Genomic approaches for improving grain zinc and iron content in wheat

More than three billion people worldwide suffer from iron deficiency associated anemia and an equal number people suffer from zinc deficiency. These conditions are more prevalent in Sub-Saharan Africa and South Asia. In developing countries, children under the age of five with stunted growth and pregnant or lactating women were found to be at high risk of zinc and iron deficiencies. Biofortification, defined as breeding to develop varieties of staple food crops whose grain contains higher levels of micronutrients such as iron and zinc, are one of the most promising, cost-effective and sustainable ways to improve the health in resource-poor households, particularly in rural areas where families consume some part of what they grow. Biofortification through conventional breeding in wheat, particularly for grain zinc and iron, have made significant contributions, transferring important genes and quantitative trait loci (QTLs) from wild and related species into cultivated wheat. Nonetheless, the quantitative, genetically complex nature of iron and zinc levels in wheat grain limits progress through conventional breeding, making it difficult to attain genetic gain both for yield and grain mineral concentrations. Wheat biofortification can be achieved by enhancing mineral uptake, source-to-sink translocation of minerals and their deposition into grains, and the bioavailability of the minerals. A number of QTLs with major and minor effects for those traits have been detected in wheat; introducing the most effective into breeding lines will increase grain zinc and iron concentrations. New approaches to achieve this include marker assisted selection and genomic selection. Faster breeding approaches need to be combined to simultaneously increase grain mineral content and yield in wheat breeding lines.

Calcium status assessment at the population level: Candidate approaches and challenges

Inadequate dietary calcium intake is a global public health problem that disproportionately affects low- and middle-income countries. However, the calcium status of a population is challenging to measure, and there are no standard methods to identify high-risk communities even in settings with an elevated prevalence of a disease caused or exacerbated by low calcium intake (e.g., rickets). The calcium status of a population depends on numerous factors, including intake of calcium-rich foods; the bioavailability of the types of calcium consumed in foods and supplements; and population characteristics, including age, sex, vitamin D status, and genetic attributes that influence calcium retention and absorption. The aim of this narrative review was to assess candidate indicators of population-level calcium status based on a range of biomarkers and measurement methods, including dietary assessment, calcium balance studies, hormonal factors related to calcium, and health outcomes associated with low calcium status. Several promising approaches were identified, but there was insufficient evidence of the suitability of any single indicator to assess population calcium status. Further research is required to develop and validate specific indicators of calcium status that could be derived from the analysis of data or samples that are feasibly collected in population-based surveys.

Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys

BACKGROUND

Micronutrient deficiencies compromise immune systems, hinder child growth and development, and affect human potential worldwide. Yet, to our knowledge, the only existing estimate of the global prevalence of micronutrient deficiencies is from over 30 years ago and is based only on the prevalence of anaemia. We aimed to estimate the global and regional prevalence of deficiency in at least one of three micronutrients among preschool-aged children (aged 6-59 months) and non-pregnant women of reproductive age (aged 15-49 years).

METHODS

In this pooled analysis, we reanalysed individual-level biomarker data for micronutrient status from nationally representative, population-based surveys. We used Bayesian hierarchical logistic regression to estimate the prevalence of deficiency in at least one of three micronutrients for preschool-aged children (iron, zinc, and vitamin A) and for non-pregnant women of reproductive age (iron, zinc, and folate), globally and in seven regions using 24 nationally representative surveys done between 2003 and 2019.

FINDINGS

We estimated the global prevalence of deficiency in at least one of three micronutrients to be 56% (95% uncertainty interval [UI] 48-64) among preschool-aged children, and 69% (59-78) among non-pregnant women of reproductive age, equivalent to 372 million (95% UI 319-425) preschool-aged children and 1·2 billion (1·0-1·4) non-pregnant women of reproductive age. Regionally, three-quarters of preschool-aged children with micronutrient deficiencies live in south Asia (99 million, 95% UI 80-118), sub-Saharan Africa (98 million, 83-113), or east Asia and the Pacific (85 million, 61-110). Over half (57%) of non-pregnant women of reproductive age with micronutrient deficiencies live in east Asia and the Pacific (384 million, 279-470) or south Asia (307 million, 255-351).

INTERPRETATION

We estimate that over half of preschool-aged children and two-thirds of non-pregnant women of reproductive age worldwide have micronutrient deficiencies. However, estimates are uncertain due to the scarcity of population-based micronutrient deficiency data.

FUNDING

US Agency for International Development.