1
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Smith MR, Myers SS. Do Global Dietary Nutrient Datasets Associate with Human Biomarker Assessments? A Regression Analysis. Am J Clin Nutr 2024; 119:69-75. [PMID: 37898436 DOI: 10.1016/j.ajcnut.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND To assess the state and trends of global nutrition, our best tools are nationally representative assessments using human biomarker assays, yet these are expensive and logistically challenging. We instead often rely on more easily produced global nutrient datasets-measures of nutrients provided by the diet-as a proxy for nutritional intake and deficiency, due to their greater geographic and temporal coverage. However, the accuracy of global nutrient datasets is questionable. OBJECTIVE We aimed to test whether estimates of inadequate dietary intake derived from existing global nutrient datasets reliably associate with biophysical deficiency. DESIGN We performed linear regressions of estimates of inadequate dietary nutrient intake derived from three global nutrient datasets-Global Dietary Database, Global Nutrient Database, and Global Expanded Nutrient Supply (GENuS) model-against the existing suite of nationally representative biomarker survey data for three key nutrients of global concern in two vulnerable demographic groups: zinc, folate, and vitamin A in females of childbearing age; and zinc and vitamin A in children younger than 5 y. RESULTS We found significant associations (P < 0.1) for only 3 of 22 regressions between global nutrition datasets and biophysical deficiency: zinc for females of childbearing age from GENuS and Global Dietary Database, and zinc for children under 5 y from GENuS. Folate and vitamin A show no reliable relationship between nutrient datasets and independent biomarker surveys. Applying the successful models for zinc to the accompanying full datasets yield estimates of global zinc deficiency of 31%-37% for these demographic groups. CONCLUSIONS We found that few estimates of nutritional inadequacy from global dietary datasets are associated with more direct measures of biophysical deficiency from biomarker studies. Researchers and policymakers must be cautious when applying global nutrient datasets to questions of global health and use them for limited applications.
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Affiliation(s)
- Matthew R Smith
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Samuel S Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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2
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Krech R, Abdelaziz FB, McCartney G, Myers SS, Boarini R, Valentine N, de Leeuw E, Smith JA, Herriot M, Williams C. The Geneva Charter-Realising the potential of a well-being society. Health Promot J Austr 2023; 34:272-275. [PMID: 37104508 DOI: 10.1002/hpja.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
| | | | | | | | - Romina Boarini
- OECD Centre for Well-Being, Inclusion, Sustainability and Equal Opportunity (WISE), Paris, France
| | | | - Evelyne de Leeuw
- HUE (Healthy Urban Environments) Collaboratory, Maridulu Budyari Gumal, Sydney, New South Wales, Australia
| | - James A Smith
- Rural and Remote Health, Flinders University, Darwin, Northern Territory, Australia
| | - Michele Herriot
- Health Promotion Consulting, Adelaide, South Australia, Australia
| | - Carmel Williams
- Centre for Health in All Policies Research Translation, SAHMRI and University of Adelaide, Adelaide, South Australia, Australia
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3
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Smith MR, Mueller ND, Springmann M, Sulser TB, Garibaldi LA, Gerber J, Wiebe K, Myers SS. Pollinator Deficits, Food Consumption, and Consequences for Human Health: A Modeling Study. Environ Health Perspect 2022; 130:127003. [PMID: 36515549 PMCID: PMC9749483 DOI: 10.1289/ehp10947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Animal pollination supports agricultural production for many healthy foods, such as fruits, vegetables, nuts, and legumes, that provide key nutrients and protect against noncommunicable disease. Today, most crops receive suboptimal pollination because of limited abundance and diversity of pollinating insects. Animal pollinators are currently suffering owing to a host of direct and indirect anthropogenic pressures: land-use change, intensive farming techniques, harmful pesticides, nutritional stress, and climate change, among others. OBJECTIVES We aimed to model the impacts on current global human health from insufficient pollination via diet. METHODS We used a climate zonation approach to estimate current yield gaps for animal-pollinated foods and estimated the proportion of the gap attributable to insufficient pollinators based on existing research. We then simulated closing the "pollinator yield gaps" by eliminating the portion of total yield gaps attributable to insufficient pollination. Next, we used an agriculture-economic model to estimate the impacts of closing the pollinator yield gap on food production, interregional trade, and consumption. Finally, we used a comparative risk assessment to estimate the related changes in dietary risks and mortality by country and globally. In addition, we estimated the lost economic value of crop production for three diverse case-study countries: Honduras, Nepal, and Nigeria. RESULTS Globally, we calculated that 3%-5% of fruit, vegetable, and nut production is lost due to inadequate pollination, leading to an estimated 427,000 (95% uncertainty interval: 86,000, 691,000) excess deaths annually from lost healthy food consumption and associated diseases. Modeled impacts were unevenly distributed: Lost food production was concentrated in lower-income countries, whereas impacts on food consumption and mortality attributable to insufficient pollination were greater in middle- and high-income countries with higher rates of noncommunicable disease. Furthermore, in our three case-study countries, we calculated the economic value of crop production to be 12%-31% lower than if pollinators were abundant (due to crop production losses of 3%-19%), mainly due to lost fruit and vegetable production. DISCUSSION According to our analysis, insufficient populations of pollinators were responsible for large present-day burdens of disease through lost healthy food consumption. In addition, we calculated that low-income countries lost significant income and crop yields from pollinator deficits. These results underscore the urgent need to promote pollinator-friendly practices for both human health and agricultural livelihoods. https://doi.org/10.1289/EHP10947.
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Affiliation(s)
- Matthew R. Smith
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nathaniel D. Mueller
- Department of Ecosystem Science and Department of Soil and Crop Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Marco Springmann
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Environmental Change Institute and Oxford Martin Programme on the Future of Food, University of Oxford, Oxford, UK
| | - Timothy B. Sulser
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Lucas A. Garibaldi
- Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Universidad Nacional de Río Negro, Miter 630, San Carlos de Bariloche, Río Negro, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural. Mitre 630, CP 8400, San Carlos de Bariloche, Río Negro, Argentina
| | - James Gerber
- Institute on the Environment, University of Minnesota, Saint Paul, Minnesota, USA
| | - Keith Wiebe
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Samuel S. Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Harvard University Center for the Environment, Cambridge, Massachusetts, USA
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Cadeddu C, Pivor J, Jevtic M, Faerron C, Zjalic D, Lombardi GS, Myers SS, Ricciardi W. Planetary health education: a cornerstone for international sustainable public health deals. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
As stated in The Lancet Public Health editorial, “No public health without planetary health”, the future health of the planet and human health are inextricably linked. For this reason, global citizens, practitioners, and professionals, especially those involved in Public Health, must be equipped to address and understand the field of Planetary Health (PH), which looks at the complex connections associated with disruptions to natural systems and resulting impacts on human health. Strategies aimed at incorporating PH education into high schools and academic curricula are required to build capacity for future national and local PH leadership. One of the most relevant tools used to achieve these goals is the PH Education Framework, designed by the Planetary Health Alliance (PHA). This framework considers five foundational domains as essential for PH knowledge, values, and practice, and has been currently applied by different institutions involved in PH. The Italian Institute for PH (IIPH) applied this framework to a school-based project for education in urban health, which will be better described in the workshop presentation. The PH Education Framework domains were used for the development of four interactive sessions oriented to raise students’ interest on the topic and stimulate active participation during and after the intervention, also with simple pro-environmental behaviours. The experience was shown to be fruitful for Public Health residents as well, who were deeply involved in and led the interactive sessions held in the high school. By means of a qualitative assessment, residents demonstrated to have increased their self-confidence, knowledge and leadership skills in PH. Further research and applications of the PH Education Framework are needed in order to increase evidence and awareness in PH and strengthen PH collaboration in Europe and beyond.
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Affiliation(s)
- C Cadeddu
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
- Italian Institute for Planetary Health , Rome, Italy
| | - J Pivor
- Planetary Health Alliance , Cambridge, USA
- Harvard TH Chan School of Public Health , Boston, USA
- Harvard University Center for the Environment , Cambridge, USA
| | - M Jevtic
- Faculty of Medicine, University of Novi Sad , Novi Sad, Serbia
- EUPHA-ENV
| | - C Faerron
- Planetary Health Alliance , Cambridge, USA
- Harvard TH Chan School of Public Health , Boston, USA
- Harvard University Center for the Environment , Cambridge, USA
| | - D Zjalic
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
- Italian Institute for Planetary Health , Rome, Italy
| | - GS Lombardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
- Italian Institute for Planetary Health , Rome, Italy
| | - SS Myers
- Planetary Health Alliance , Cambridge, USA
- Harvard TH Chan School of Public Health , Boston, USA
- Harvard University Center for the Environment , Cambridge, USA
| | - W Ricciardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
- Italian Institute for Planetary Health , Rome, Italy
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5
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Garibaldi LA, Gomez Carella DS, Nabaes Jodar DN, Smith MR, Timberlake TP, Myers SS. Exploring connections between pollinator health and human health. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210158. [PMID: 35491592 DOI: 10.1098/rstb.2021.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Despite recent advances in understanding the role of biodiversity in ecosystem-service provision, the links between the health of ecosystem-service providers and human health remain more uncertain. During the past decade, an increasing number of studies have argued for the positive impacts of healthy pollinator communities (defined as functionally and genetically diverse species assemblages that are sustained over time) on human health. Here, we begin with a systematic review of these impacts, finding only two studies that concomitantly quantified aspects of pollinator health and human health. Next, we identify relevant research relating to four pathways linking pollinator health and human health: nutrition, medicine provisioning, mental health and environmental quality. These benefits are obtained through improved pollination of nutritious crops and an estimated approximately 28 000 animal-pollinated medicinal plants; the provisioning of pollinator-derived products such as honey; the maintenance of green spaces and biocultural landscapes that improve mental health; and cleaner air, water and food resulting from pollinator-centred initiatives to reduce agrochemical use. We suggest that pollinator diversity could be a proxy for the benefits that landscapes provide to human health. This article is part of the theme issue 'Natural processes influencing pollinator health: from chemistry to landscapes'.
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Affiliation(s)
- Lucas A Garibaldi
- Universidad Nacional de Río Negro, Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Río Negro, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Río Negro, Argentina
| | - Dulce S Gomez Carella
- Universidad Nacional de Río Negro, Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Río Negro, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Río Negro, Argentina
| | - Diego N Nabaes Jodar
- Universidad Nacional de Río Negro, Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Río Negro, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural, Río Negro, Argentina
| | - Matthew R Smith
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115 MA, USA
| | - Thomas P Timberlake
- School of Biological Sciences, University of Bristol, 24 Tyndall Avenue, Bristol, BS8 1TQ UK
| | - Samuel S Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115 MA, USA.,Harvard University Center for the Environment, Cambridge, 02138 MA, USA
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6
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Affiliation(s)
- Matthew R Smith
- Department of Environmental Health Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Samuel S Myers
- Department of Environmental Health Harvard T. H. Chan School of Public Health, Boston, MA, USA
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7
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Timberlake TP, Cirtwill AR, Baral SC, Bhusal DR, Devkota K, Harris‐Fry HA, Kortsch S, Myers SS, Roslin T, Saville NM, Smith MR, Strona G, Memmott J. A network approach for managing ecosystem services and improving food and nutrition security on smallholder farms. People and Nature 2022. [DOI: 10.1002/pan3.10295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
| | - Alyssa R. Cirtwill
- Department of Agricultural Sciences University of Helsinki Helsinki Finland
| | | | - Daya R. Bhusal
- Central Department of Zoology Institute of Science and Technology Tribhuvan University Kathmandu Nepal
| | - Kedar Devkota
- Faculty of Agriculture, Agriculture and Forestry University Chitwan Nepal
| | - Helen A. Harris‐Fry
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | - Susanne Kortsch
- Department of Agricultural Sciences University of Helsinki Helsinki Finland
| | - Samuel S. Myers
- Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA USA
| | - Tomas Roslin
- Department of Agricultural Sciences University of Helsinki Helsinki Finland
| | | | - Matthew R. Smith
- Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA USA
| | - Giovanni Strona
- Department of Agricultural Sciences University of Helsinki Helsinki Finland
| | - Jane Memmott
- School of Biological Sciences University of Bristol Bristol UK
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8
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Affiliation(s)
- Samuel S Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA 02138, USA.
| | - Jeremy I Pivor
- Planetary Health Alliance, Harvard T H Chan School of Public Health, Boston, MA 02138, USA
| | - Antonio M Saraiva
- Institute of Advanced Studies and Polytechnic School, University of São Paulo, São Paulo, Brazil
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9
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Iyer HS, DeVille NV, Stoddard O, Cole J, Myers SS, Li H, Elliott EG, Jimenez MP, James P, Golden CD. Sustaining planetary health through systems thinking: Public health's critical role. SSM Popul Health 2021; 15:100844. [PMID: 34179331 PMCID: PMC8213960 DOI: 10.1016/j.ssmph.2021.100844] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 01/07/2023] Open
Abstract
Understanding and responding to adverse human health impacts of global environmental change will be a major priority of 21st century public health professionals. The emerging field of planetary health aims to face this challenge by studying and promoting policies that protect the health of humans and of the Earth's natural systems that support them. Public health, drawing on its experience of guiding policies to improve population health, has contributed to planetary health's development. Yet, few public health practitioners are familiar with planetary health's systems-oriented approaches for understanding relationships between economic development, environmental degradation, and human health. In this narrative review, we present key planetary health concepts and show how systems thinking has guided its development. We discuss historical approaches to studying impacts of economic development on human health and the environment. We then review novel conceptual frameworks adopted by planetary health scientists to study and forecast impacts of policies that influence human health and Earth's natural systems at varying spatiotemporal scales. We conclude by presenting examples of how applying the "Doughnut" model (an economic framework where the needs of people are met without overshooting the world's ecological limits) could guide policies for promoting health co-benefits to humans and natural systems.
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Affiliation(s)
- Hari S. Iyer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, USA,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA,Corresponding author. Division of Population Sciences Dana-Farber Cancer Institute, USA.
| | - Nicole V. DeVille
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, USA
| | - Olivia Stoddard
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Jennifer Cole
- Geography Department, Royal Holloway University of London and Royal United Services Institute, London, United Kingdom
| | - Samuel S. Myers
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Huichu Li
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Elise G. Elliott
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, USA,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Marcia P. Jimenez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA,Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | - Peter James
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA,Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | - Christopher D. Golden
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
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10
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Madzorera I, Jaacks L, Paarlberg R, Herforth A, Bromage S, Ghosh S, Myers SS, Masters WA, Fawzi WW. Food Systems as Drivers of Optimal Nutrition and Health: Complexities and Opportunities for Research and Implementation. Curr Dev Nutr 2021; 5:nzab062. [PMID: 34084996 PMCID: PMC8166275 DOI: 10.1093/cdn/nzab062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023] Open
Abstract
The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems-on pathways, value chains, and development and validation of metrics of diet quality-is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.
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Affiliation(s)
- Isabel Madzorera
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lindsay Jaacks
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Robert Paarlberg
- Harvard Kennedy School of Public Policy and Governance, Cambridge, MA, USA
| | - Anna Herforth
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sabri Bromage
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Shibani Ghosh
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA, USA
| | - Samuel S Myers
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - William A Masters
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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11
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Blakstad MM, Danaei G, Tadesse AW, Damerau K, Bellows AL, Canavan CR, Bliznashka L, Zack R, Myers SS, Berhane Y, Fawzi WW. Life expectancy and agricultural environmental impacts in Addis Ababa can be improved through optimized plant and animal protein consumption. Nat Food 2021; 2:291-298. [PMID: 37118473 DOI: 10.1038/s43016-021-00264-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/17/2021] [Indexed: 04/30/2023]
Abstract
In Ethiopia, children and adults face a double burden of malnutrition, with undernutrition and stunting coexisting with non-communicable diseases. Here we use a framework of comparative risk assessment, local dietary surveys and relative risks from large observational studies to quantify the health and environmental impacts of meeting adult and child recommended daily protein intakes in urban Addis Ababa. We find that plant-based foods, especially legumes, would have the lowest environmental impact and substantially increase life expectancy in adults, while animal-source proteins could be beneficial for children. This context-specific approach-accounting for regional constraints and trade-offs-could aid policymakers in developing culturally appropriate, nutritionally adequate and sustainable dietary recommendations.
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Affiliation(s)
- Mia M Blakstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amare W Tadesse
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerstin Damerau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Vocational Education and Work Studies, Technische Universität Berlin, Berlin, Germany
| | - Alexandra L Bellows
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rachel Zack
- The Greater Boston Food Bank, Boston, MA, USA
| | - Samuel S Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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12
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Affiliation(s)
- Howard Frumkin
- Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Samuel S Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA 02115, USA.
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13
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Damerau K, Davis KF, Godde C, Herrero M, Springmann M, Bhupathiraju SN, Myers SS, Willett W. India has natural resource capacity to achieve nutrition security, reduce health risks and improve environmental sustainability. Nat Food 2020; 1:631-639. [PMID: 37128104 DOI: 10.1038/s43016-020-00157-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/01/2020] [Indexed: 05/03/2023]
Abstract
Sustainable development of India's food system must ensure a growing population is fed while minimizing both widespread malnutrition and the environmental impacts of food production. After assessing current adequacy of nutrient supplies at the national level, associated natural resource use (land, fresh water) and greenhouse gas (GHG) emissions, we apply an integrated subnational environmental and nutritional optimization approach to explore resource constraints that might limit the achievement of national food self-sufficiency goals. We find that India currently has the capacity to produce sufficient amounts of nutritious foods, supplying vitamins and minerals that would mostly exceed requirements. Regional cropland use could be reduced by up to 50%, water demand by up to 65% and combined resource inputs by up to 40% while still supporting adequate nutrition. Associated GHG emissions would decline by 26-34% and could possibly be sequestered in agroforestry systems. Such dietary shifts could lower the number of diet-related premature deaths by 14-30%. Achieving these potential gains, however, would require a major transition from current production and consumption patterns, particularly of refined cereals, to free-up resources for more traditional and nutritious foods.
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Affiliation(s)
| | - Kyle Frankel Davis
- Department of Geography and Spatial Sciences, University of Delaware, Newark, DE, USA
- Department of Plant and Soil Sciences, University of Delaware, Newark, DE, USA
- Data Science Institute, Columbia University, New York, NY, USA
| | - Cécile Godde
- Commonwealth Scientific and Industrial Research Organisation, St Lucia, Queensland, Australia
| | - Mario Herrero
- Commonwealth Scientific and Industrial Research Organisation, St Lucia, Queensland, Australia
| | | | | | - Samuel S Myers
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Walter Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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14
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Abstract
BACKGROUND India has made important strides in reducing nutritional deficiencies over the past several decades. However, for micronutrients such as zinc, previous studies have suggested a worsening situation, contrary to most other dietary indicators. Adding to this burden, higher carbon dioxide (CO2) levels of 550 ppm, projected to potentially occur within decades, could reduce the zinc content of many staple crops. OBJECTIVE To assess the historical prevalence of inadequate zinc intake, as well as to estimate the future prevalence attributable to rising CO2. METHODS Seven household food consumption surveys between 1983 and 2012 were used to calculate total dietary zinc, phytate, and absorbable zinc intakes and to assess the prevalence of historic inadequacy in zinc intake. The added nutritional effect of elevated CO2 on zinc intake is then modeled. RESULTS Prevalence of inadequate absorbable zinc intake has increased from 17.1% (15.3%-19.0%) in 1983 to 24.6% (22.3%-27.1%) in 2011-12, corresponding to an additional 82 million people consuming inadequate zinc than would have otherwise if 1983 rates had persisted. These increases in inadequacy have been driven by a relatively constant zinc intake being increasingly insufficient to meet a 5% growth in zinc requirements due to the aging of the population. Reaching 550 ppm CO2 by 2050 could potentially increase the prevalence of inadequate zinc intake by another 3.9 percentage points (2.1-5.8), corresponding to 65 million additional people having inadequate zinc intake. CONCLUSIONS The persistently worsening trend for zinc-opposite most other measures of human nutrition-shows that it may pose an ongoing risk unless addressed.
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Affiliation(s)
- Matthew R Smith
- 1 Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ruth DeFries
- 2 Department of Ecology, Evolution, and Environmental Biology, Columbia University, New York, NY, USA
| | | | - Suparna Ghosh-Jerath
- 4 Indian Institute of Public Health-Delhi, Public Health Foundation of India, Delhi NCR, India
| | - Samuel S Myers
- 1 Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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Golden CD, Shapero A, Vaitla B, Smith MR, Myers SS, Stebbins E, Gephart JA. Impacts of Mainstream Hydropower Development on Fisheries and Human Nutrition in the Lower Mekong. Front Sustain Food Syst 2019. [DOI: 10.3389/fsufs.2019.00093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Park CS, Vogel E, Larson LM, Myers SS, Daniel M, Biggs BA. The global effect of extreme weather events on nutrient supply: a superposed epoch analysis. Lancet Planet Health 2019; 3:e429-e438. [PMID: 31625515 DOI: 10.1016/s2542-5196(19)30193-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 09/07/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND To date, the effects of extreme weather events on nutrient supply within the population have not been quantified. In this study, we investigated micronutrient, macronutrient, and fibre supply changes during 175 extreme weather events within 87 countries in the year that a major extreme weather event occurred, with a targeted focus on low-income settings. METHODS We collected data from the International Disasters Database and the Global Expanded Nutrient Supply model for the period 1961-2010, and applied superposed epoch analysis to calculate the percentage change in nutrient supply during the year of an extreme weather event relative to its historical context. We composited globally and by subgroup (EU, landlocked developing countries, least developed countries, low-income food deficit countries, and net food-importing developing countries). Lastly, we reported nutrient supply changes in terms of recommended dietary allowance for children aged 1-3 years. FINDINGS Globally, all micronutrient supplies had a modest negative percentage change during the year of an extreme weather event; of these effects, those that reached an α=0·05 significance level included calcium, folate, thiamin, vitamin B6, and vitamin C, with nutrient supply changes ranging from -0·40 to -1·73% of the average supply. The effect of an extreme weather event was especially magnified among landlocked developing countries and low-income food deficit countries, with significant nutrient supply changes ranging from -1·61 to -7·57% of the average supply. Furthermore, the observed nutrient supply deficits in landlocked developing countries constituted a large percentage (ranging from 1·95 to 39·19%) of what a healthy child's sufficient average dietary intake should be. INTERPRETATION The global effects of extreme weather events on nutrient supply found in this study are modest in isolation; however, in the context of nutrient needs for healthy child development in low-income settings, the effects observed are substantial. FUNDING Australian-American Fulbright Commission.
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Affiliation(s)
- Caro S Park
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, VIC, Australia; Australian-German Climate and Energy College, University of Melbourne, Parkville, VIC, Australia; Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Elisabeth Vogel
- Australian-German Climate and Energy College, University of Melbourne, Parkville, VIC, Australia
| | - Leila M Larson
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, VIC, Australia
| | - Samuel S Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA
| | - Mark Daniel
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia; Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Beverley-Ann Biggs
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
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17
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Golden CD, Borgerson C, Rice BL, Allen LH, Anjaranirina EJG, Barrett CB, Boateng G, Gephart JA, Hampel D, Hartl DL, Knippenberg E, Myers SS, Ralalason DH, Ramihantaniarivo H, Randriamady H, Shahab-Ferdows S, Vaitla B, Volkman SK, Vonona MA. Cohort Description of the Madagascar Health and Environmental Research-Antongil (MAHERY-Antongil) Study in Madagascar. Front Nutr 2019; 6:109. [PMID: 31428615 PMCID: PMC6690017 DOI: 10.3389/fnut.2019.00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/01/2019] [Indexed: 12/19/2022] Open
Abstract
The Madagascar Health and Environmental Research-Antongil (MAHERY-Antongil) study cohort was set up in September 2015 to assess the nutritional value of seafood for the coastal Malagasy population living along Antongil Bay in northeastern Madagascar. Over 28 months of surveillance, we aimed to understand the relationships among different marine resource governance models, local people's fish catch, the consumption of seafood, and nutritional status. In the Antongil Bay, fisheries governance takes three general forms: traditional management, marine national parks, and co-management. Traditional management involves little to no involvement by the national government or non-governmental organizations, and focuses on culturally accepted Malagasy community practices. Co-management and marine national parks involve management support from either an non-govermental organization (NGO) or the national government. Five communities of varying governance strategies were enrolled into the study including 225 households and 1031 individuals whose diets, resource acquisition strategies, fisheries and agricultural practices, and other social, demographic and economic indicators were measured over the span of 3 years. Clinical visits with each individual were conducted at two points during the study to measure disease and nutritional status. By analyzing differences in fish catch arising from variation in governance (in addition to intra-annual seasonal changes and minor inter-annual changes), the project will allow us to calculate the public health value of sustainable fisheries management approaches for local populations. There is hope that coastal zones that are managed sustainably can increase the productivity of fisheries, increasing the catch of seafood products for poor, undernourished populations.
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Affiliation(s)
- Christopher D. Golden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Madagascar Health and Environmental Research, Maroantsetra, Madagascar
| | - Cortni Borgerson
- Madagascar Health and Environmental Research, Maroantsetra, Madagascar
- Department of Anthropology, Montclair State University, Montclair, NJ, United States
| | - Benjamin L. Rice
- Madagascar Health and Environmental Research, Maroantsetra, Madagascar
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Lindsay H. Allen
- ARS Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA, United States
- Department of Nutrition, University of California, Davis, Davis, CA, United States
| | | | - Christopher B. Barrett
- CH Dyson School of Applied Economics & Management, Cornell University, Cornell, NY, United States
| | - Godfred Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jessica A. Gephart
- National Center for Socio-Environmental Synthesis (SESYNC), Annapolis, MD, United States
| | - Daniela Hampel
- ARS Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA, United States
- Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Daniel L. Hartl
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | | | - Samuel S. Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Dera H. Ralalason
- Service de District de la Santé Publique de Maroantsetra, Ministère de la Santé Publique d'Analanjirofo, Maroantsetra, Madagascar
| | | | | | - Setareh Shahab-Ferdows
- ARS Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA, United States
| | - Bapu Vaitla
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah K. Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Infectious Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, United States
- College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, MA, United States
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18
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Marlier ME, Liu T, Yu K, Buonocore JJ, Koplitz SN, DeFries RS, Mickley LJ, Jacob DJ, Schwartz J, Wardhana BS, Myers SS. Fires, Smoke Exposure, and Public Health: An Integrative Framework to Maximize Health Benefits From Peatland Restoration. Geohealth 2019; 3:178-189. [PMID: 32159040 PMCID: PMC7007093 DOI: 10.1029/2019gh000191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 05/08/2023]
Abstract
Emissions of particulate matter from fires associated with land management practices in Indonesia contribute to regional air pollution and mortality. We assess the public health benefits in Indonesia, Malaysia, and Singapore from policies to reduce fires by integrating information on fire emissions, atmospheric transport patterns, and population exposure to fine particulate matter (PM2.5). We use adjoint sensitivities to relate fire emissions to PM2.5 for a range of meteorological conditions and find that a Business-As-Usual scenario of land use change leads, on average, to 36,000 excess deaths per year into the foreseeable future (the next several decades) across the region. These deaths are largely preventable with fire reduction strategies, such as blocking fires in peatlands, industrial concessions, or protected areas, which reduce the health burden by 66, 45, and 14%, respectively. The effectiveness of these different strategies in mitigating human health impacts depends on the location of fires relative to the population distribution. For example, protecting peatlands through eliminating all fires on such lands would prevent on average 24,000 excess deaths per year into the foreseeable future across the region because, in addition to storing large amounts of fuel, many peatlands are located directly upwind of densely populated areas. We also demonstrate how this framework can be used to prioritize restoration locations for the Indonesian Peatland Restoration Agency based on their ability to reduce pollution exposure and health burden. This scientific framework is publicly available through an online decision support tool that allows stakeholders to readily determine the public health benefits of different land management strategies.
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Affiliation(s)
- Miriam E. Marlier
- The RAND CorporationSanta MonicaCAUSA
- Department of Ecology, Evolution, and Environmental BiologyColumbia UniversityNew YorkNYUSA
| | - Tianjia Liu
- Department of Earth and Planetary SciencesHarvard UniversityCambridgeMAUSA
| | - Karen Yu
- School of Engineering and Applied SciencesHarvard UniversityCambridgeMAUSA
| | - Jonathan J. Buonocore
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMAUSA
| | - Shannon N. Koplitz
- Department of Earth and Planetary SciencesHarvard UniversityCambridgeMAUSA
| | - Ruth S. DeFries
- Department of Ecology, Evolution, and Environmental BiologyColumbia UniversityNew YorkNYUSA
| | - Loretta J. Mickley
- School of Engineering and Applied SciencesHarvard UniversityCambridgeMAUSA
| | - Daniel J. Jacob
- Department of Earth and Planetary SciencesHarvard UniversityCambridgeMAUSA
- School of Engineering and Applied SciencesHarvard UniversityCambridgeMAUSA
| | - Joel Schwartz
- Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMAUSA
| | | | - Samuel S. Myers
- Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMAUSA
- Harvard University Center for the EnvironmentHarvard UniversityCambridgeMAUSA
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19
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Affiliation(s)
| | - Samuel S Myers
- Planetary Health Alliance, Boston, MA, 02115, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Christopher D Golden
- Planetary Health Alliance, Boston, MA, 02115, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
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20
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Fisher B, Herrera D, Adams D, Fox HE, Gallagher L, Gerkey D, Gill D, Golden CD, Hole D, Johnson K, Mulligan M, Myers SS, Naidoo R, Pfaff A, Rasolofoson R, Selig ER, Tickner D, Treuer T, Ricketts T. Can nature deliver on the sustainable development goals? Lancet Planet Health 2019; 3:e112-e113. [PMID: 30904104 DOI: 10.1016/s2542-5196(18)30281-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 10/23/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Brendan Fisher
- Rubenstein School of Environment and Natural Resources, University of Vermont, Burlington, VT, USA; Gund Institute for Environment, University of Vermont, Burlington, VT, USA.
| | - Diego Herrera
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA
| | - Diane Adams
- Department of Marine and Coastal Sciences, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Helen E Fox
- National Geographic Society, Washington, DC, USA
| | - Louise Gallagher
- Institute for Sciences of the Environment, University of Geneva, Switzerland
| | - Drew Gerkey
- School of Language, Culture and Society, Oregon State University, Corvalis, OR, USA
| | - David Gill
- National Socio-Environmental Synthesis Center, Annapolis, MD, USA
| | - Christopher D Golden
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Harvard University, Cambridge, MA, USA
| | - David Hole
- Environmental Defence Fund, Washington, DC, USA; Betty and Gordon Moore Center for Science, Conservation International, Crystal City, VA, USA
| | - Kiersten Johnson
- United States Agency for International Development, Bureau for Food Security Washington, DC, USA; United States Department of Agriculture Foreign Agricultural Service, Washington, DC, USA
| | | | - Samuel S Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Harvard University, Cambridge, MA, USA
| | - Robin Naidoo
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA; World Wildlife Fund, Washington, DC, USA
| | - Alexander Pfaff
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | | | | | | | - Timothy Treuer
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA; Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Taylor Ricketts
- Rubenstein School of Environment and Natural Resources, University of Vermont, Burlington, VT, USA; Gund Institute for Environment, University of Vermont, Burlington, VT, USA
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21
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Almada A, Myers SS, Golden CD, Burke KS, Luby SP. Planetary Health Alliance 2019 call for abstracts. Lancet Planet Health 2019; 3:e111. [PMID: 30777733 DOI: 10.1016/s2542-5196(19)30022-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Affiliation(s)
| | - Samuel S Myers
- Planetary Health Alliance, Cambridge, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA
| | - Christopher D Golden
- Planetary Health Alliance, Cambridge, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Woods Institute for the Environment, Stanford University, Stanford, CA, USA
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22
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Golden CD, Anjaranirina EJG, Fernald LCH, Hartl DL, Kremen C, Milner DA, Ralalason DH, Ramihantaniarivo H, Randriamady H, Rice BL, Vaitla B, Volkman SK, Vonona MA, Myers SS. Cohort Profile: The Madagascar Health and Environmental Research (MAHERY) study in north-eastern Madagascar. Int J Epidemiol 2018; 46:1747-1748d. [PMID: 29040632 DOI: 10.1093/ije/dyx071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher D Golden
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Harvard University Center for the Environment, Cambridge, MA, USA.,Madagascar Health and Environmental Research (MAHERY), Maroantsetra, Madagascar
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, CA, USA
| | - Daniel L Hartl
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Claire Kremen
- Department of Environmental Science, Policy and Management, University of California, Berkeley, CA, USA
| | | | - Dera H Ralalason
- Ministère de la Santé Publique d'Analanjirofo, Service de District de la Santé Publique de Maroantsetra, Madagascar
| | | | - Hervet Randriamady
- Madagascar Health and Environmental Research (MAHERY), Maroantsetra, Madagascar
| | - Benjamin L Rice
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Bapu Vaitla
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sarah K Volkman
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Infectious Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,School of Nursing and Health Sciences, Simmons College, Boston, MA, USA
| | | | - Samuel S Myers
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Harvard University Center for the Environment, Cambridge, MA, USA
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23
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Vaitla B, Collar D, Smith MR, Myers SS, Rice BL, Golden CD. Predicting nutrient content of ray-finned fishes using phylogenetic information. Nat Commun 2018; 9:3742. [PMID: 30254265 PMCID: PMC6156416 DOI: 10.1038/s41467-018-06199-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 08/24/2018] [Indexed: 01/07/2023] Open
Abstract
Human food and nutrition security is dependent on marine ecosystems threatened by overfishing, climate change, and other processes. The consequences on human nutritional status are uncertain, in part because current methods of analyzing fish nutrient content are expensive. Here, we evaluate the possibility of predicting nutrient content of ray-finned fishes using existing phylogenetic and life history information. We focus on nutrients for which fish are important sources: protein, total fat, omega-3 and omega-6 fatty acids, iron, zinc, vitamin A, vitamin B12, and vitamin D. Our results show that life history traits are weak predictors of species nutrient content, but phylogenetic relatedness is associated with similar nutrient profiles. Further, we develop a method for predicting the nutrient content of 7500+ species based on phylogenetic relationships to species with known nutrient content. Our approach is a cost-effective means for estimating potential changes in human nutrient intake associated with altered access to ray-finned fishes. Humans increasingly depend on seafood for nutrition, but nutrient content is unknown for the vast majority of fish species. Here, the authors use phylogenetic analyses and data imputation to predict the nutrient content of fish that are under-studied but that could be of future dietary importance.
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Affiliation(s)
- Bapu Vaitla
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - David Collar
- Department of Organismal & Environmental Biology, Christopher Newport University, One Avenue of the Arts, Newport News, VA, 23606, USA
| | - Matthew R Smith
- Department of Environmental Health, Harvard TH Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Samuel S Myers
- Department of Environmental Health, Harvard TH Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA.,Harvard University Center for the Environment, Harvard University, 26 Oxford St, 4th Floor, Cambridge, MA, 02138, USA
| | - Benjamin L Rice
- Department of Organismic and Evolutionary Biology, Harvard University, 26 Oxford St, Cambridge, MA, 02138, USA
| | - Christopher D Golden
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, 665 Huntington Ave, Boston, MA, 02115, USA.,Department of Environmental Health, Harvard TH Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA
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24
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Affiliation(s)
- Sara B Stone
- Planetary Health Alliance, Cambridge, MA 02138, USA.
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25
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Abstract
The impact of human activities on our planet's natural systems has been intensifying rapidly in the past several decades, leading to disruption and transformation of most natural systems. These disruptions in the atmosphere, oceans, and across the terrestrial land surface are not only driving species to extinction, they pose serious threats to human health and wellbeing. Characterising and addressing these threats requires a paradigm shift. In a lecture delivered to the Academy of Medical Sciences on Nov 13, 2017, I describe the scale of human impacts on natural systems and the extensive associated health effects across nearly every dimension of human health. I highlight several overarching themes that emerge from planetary health and suggest advances in the way we train, reward, promote, and fund the generation of health scientists who will be tasked with breaking out of their disciplinary silos to address this urgent constellation of health threats. I propose that protecting the health of future generations requires taking better care of Earth's natural systems.
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Affiliation(s)
- Samuel S Myers
- Department of Environmental Health, The Harvard T.H. Chan School of Public Health, Boston, MA, USA; Planetary Health Alliance, Harvard University Center for the Environment, Cambridge, MA, USA.
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26
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Affiliation(s)
- Sara B Stone
- Planetary Health Alliance, Cambridge, MA 02139, USA
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27
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Myers SS, Golden CD, Almada AA, Grant L. Planetary health research in 2018: a call for abstracts. Lancet Planet Health 2017; 1:e306. [PMID: 29628161 DOI: 10.1016/s2542-5196(17)30135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Samuel S Myers
- Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA.
| | - Christopher D Golden
- Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA
| | - Amalia A Almada
- Harvard University Center for the Environment, Cambridge, MA, USA
| | - Liz Grant
- Global Health Academy, University of Edinburgh, Edinburgh, UK
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Medek DE, Schwartz J, Myers SS. Estimated Effects of Future Atmospheric CO2 Concentrations on Protein Intake and the Risk of Protein Deficiency by Country and Region. Environ Health Perspect 2017; 125:087002. [PMID: 28885977 PMCID: PMC5783645 DOI: 10.1289/ehp41] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND Crops grown under elevated atmospheric CO2 concentrations (eCO2) contain less protein. Crops particularly affected include rice and wheat, which are primary sources of dietary protein for many countries. OBJECTIVES We aimed to estimate global and country-specific risks of protein deficiency attributable to anthropogenic CO2 emissions by 2050. METHODS To model per capita protein intake in countries around the world under eCO2, we first established the effect size of eCO2 on the protein concentration of edible portions of crops by performing a meta-analysis of published literature. We then estimated per-country protein intake under current and anticipated future eCO2 using global food balance sheets (FBS). We modeled protein intake distributions within countries using Gini coefficients, and we estimated those at risk of deficiency from estimated average protein requirements (EAR) weighted by population age structure. RESULTS Under eCO2, rice, wheat, barley, and potato protein contents decreased by 7.6%, 7.8%, 14.1%, and 6.4%, respectively. Consequently, 18 countries may lose >5% of their dietary protein, including India (5.3%). By 2050, assuming today's diets and levels of income inequality, an additional 1.6% or 148.4 million of the world's population may be placed at risk of protein deficiency because of eCO2. In India, an additional 53 million people may become at risk. CONCLUSIONS Anthropogenic CO2 emissions threaten the adequacy of protein intake worldwide. Elevated atmospheric CO2 may widen the disparity in protein intake within countries, with plant-based diets being the most vulnerable. https://doi.org/10.1289/EHP41.
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Affiliation(s)
- Danielle E Medek
- Department of Environmental Health, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
- Waitemata District Health Board , Takapuna, Auckland, New Zealand
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
| | - Samuel S Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
- Harvard University Center for the Environment , Cambridge, Massachusetts, USA
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29
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Abstract
Concern has been spreading across scientific disciplines that the pervasive human transformation of Earth's natural systems is an urgent threat to human health. The simultaneous emergence of "GeoHealth" and "Planetary Health" signals recognition that developing a new relationship between humanity and our natural systems is becoming an urgent global health priority-if we are to prevent a backsliding from the past century's great public health gains. Achieving meaningful progress will require collaboration across a broad swath of scientific disciplines as well as with policy makers, natural resource managers, members of faith communities, and movement builders around the world in order to build a rigorous evidence base of scientific understanding as the foundation for more robust policy and resource management decisions that incorporate both environmental and human health outcomes.
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Affiliation(s)
- Amalia A. Almada
- Planetary Health AllianceHarvard University Center for the EnvironmentCambridgeMassachusettsUSA
| | - Christopher D. Golden
- Planetary Health AllianceHarvard University Center for the EnvironmentCambridgeMassachusettsUSA
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachussettsUSA
| | - Steven A. Osofsky
- Planetary Health AllianceCornell UniversityIthacaNew YorkUSA
- Department of Population Medicine and Diagnostic SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | - Samuel S. Myers
- Planetary Health AllianceHarvard University Center for the EnvironmentCambridgeMassachusettsUSA
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachussettsUSA
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Myers SS, Smith MR, Guth S, Golden CD, Vaitla B, Mueller ND, Dangour AD, Huybers P. Climate Change and Global Food Systems: Potential Impacts on Food Security and Undernutrition. Annu Rev Public Health 2017; 38:259-277. [PMID: 28125383 DOI: 10.1146/annurev-publhealth-031816-044356] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Great progress has been made in addressing global undernutrition over the past several decades, in part because of large increases in food production from agricultural expansion and intensification. Food systems, however, face continued increases in demand and growing environmental pressures. Most prominently, human-caused climate change will influence the quality and quantity of food we produce and our ability to distribute it equitably. Our capacity to ensure food security and nutritional adequacy in the face of rapidly changing biophysical conditions will be a major determinant of the next century's global burden of disease. In this article, we review the main pathways by which climate change may affect our food production systems-agriculture, fisheries, and livestock-as well as the socioeconomic forces that may influence equitable distribution.
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Affiliation(s)
- Samuel S Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115; , , , .,Harvard University Center for the Environment, Cambridge, Massachusetts 02138;
| | - Matthew R Smith
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115; , , ,
| | - Sarah Guth
- Harvard University Center for the Environment, Cambridge, Massachusetts 02138;
| | - Christopher D Golden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115; , , , .,Harvard University Center for the Environment, Cambridge, Massachusetts 02138;
| | - Bapu Vaitla
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115; , , ,
| | - Nathaniel D Mueller
- Department of Earth and Planetary Sciences, Harvard University, Cambridge, Massachusetts 02138; , .,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts 02138
| | - Alan D Dangour
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom;
| | - Peter Huybers
- Harvard University Center for the Environment, Cambridge, Massachusetts 02138; .,Department of Earth and Planetary Sciences, Harvard University, Cambridge, Massachusetts 02138; ,
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Myers SS, Golden CD, Almada AA, Osofsky SA, Pongsiri MJ. Research in planetary health: a call for abstracts. Lancet 2016; 388:2070. [PMID: 27968736 DOI: 10.1016/s0140-6736(16)32054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Samuel S Myers
- Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA.
| | - Christopher D Golden
- Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA
| | - Amalia A Almada
- Harvard University Center for the Environment, Cambridge, MA, USA
| | - Steven A Osofsky
- Cornell University College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Bayles BR, Brauman KA, Adkins JN, Allan BF, Ellis AM, Goldberg TL, Golden CD, Grigsby-Toussaint DS, Myers SS, Osofsky SA, Ricketts TH, Ristaino JB. Ecosystem Services Connect Environmental Change to Human Health Outcomes. Ecohealth 2016; 13:443-449. [PMID: 27357081 DOI: 10.1007/s10393-016-1137-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/18/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Brett R Bayles
- Institute on the Environment, University of Minnesota-Twin Cities, 1954 Buford Avenue, St. Paul, MN, 55108, USA.
| | - Kate A Brauman
- Institute on the Environment, University of Minnesota-Twin Cities, 1954 Buford Avenue, St. Paul, MN, 55108, USA
| | | | - Brian F Allan
- Department of Entomology, University of Illinois, Urbana, IL, USA
| | - Alicia M Ellis
- Gund Institute for Ecological Economics, University of Vermont, Burlington, VT, USA
| | - Tony L Goldberg
- Global Health Institute, University of Wisconsin, Madison, WI, USA
| | - Christopher D Golden
- Department of Environmental Health, Harvard School of Public Health, Cambridge, MA, USA
- Center for the Environment, Harvard University, Cambridge, MA, USA
- Wildlife Health and Health Policy Program, Wildlife Conservation Society, New York, NY, USA
| | | | - Samuel S Myers
- Department of Environmental Health, Harvard School of Public Health, Cambridge, MA, USA
- Center for the Environment, Harvard University, Cambridge, MA, USA
| | - Steven A Osofsky
- Wildlife Health and Health Policy Program, Wildlife Conservation Society, New York, NY, USA
| | - Taylor H Ricketts
- Gund Institute for Ecological Economics, University of Vermont, Burlington, VT, USA
| | - Jean B Ristaino
- Department of Plant Pathology, North Carolina State University, Raleigh, NC, USA
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Golden CD, Allison EH, Cheung WWL, Dey MM, Halpern BS, McCauley DJ, Smith M, Vaitla B, Zeller D, Myers SS. Nutrition: Fall in fish catch threatens human health. Nature 2016; 534:317-20. [PMID: 27306172 DOI: 10.1038/534317a] [Citation(s) in RCA: 344] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christopher D Golden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health; and associate director of the Planetary Health Alliance at the Harvard University Center for the Environment, Harvard University, Cambridge, Massachusetts, USA
| | - Edward H Allison
- School of Marine and Environment Affairs at the University of Washington, Seattle, Washington, USA
| | - William W L Cheung
- Changing Ocean Research Unit; and director of the Nippon Foundation-Nereus Program, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, Canada
| | - Madan M Dey
- Aquaculture/Fisheries Center of Excellence, University of Arkansas at Pine Bluff, Pine Bluff, Arkansas, USA
| | - Benjamin S Halpern
- Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Douglas J McCauley
- Department of Ecology, Evolution and Marine Biology, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Matthew Smith
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Bapu Vaitla
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Dirk Zeller
- Sea Around Us, Global Fisheries Cluster, University of British Columbia, Vancouver, Canada
| | - Samuel S Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health; and director of the Planetary Health Alliance at the Harvard University Center for the Environment, Harvard University, Cambridge, Massachusetts, USA
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Smith MR, Micha R, Golden CD, Mozaffarian D, Myers SS. Global Expanded Nutrient Supply (GENuS) Model: A New Method for Estimating the Global Dietary Supply of Nutrients. PLoS One 2016; 11:e0146976. [PMID: 26807571 PMCID: PMC4726504 DOI: 10.1371/journal.pone.0146976] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/23/2015] [Indexed: 11/18/2022] Open
Abstract
Insufficient data exist for accurate estimation of global nutrient supplies. Commonly used global datasets contain key weaknesses: 1) data with global coverage, such as the FAO food balance sheets, lack specific information about many individual foods and no information on micronutrient supplies nor heterogeneity among subnational populations, while 2) household surveys provide a closer approximation of consumption, but are often not nationally representative, do not commonly capture many foods consumed outside of the home, and only provide adequate information for a few select populations. Here, we attempt to improve upon these datasets by constructing a new model--the Global Expanded Nutrient Supply (GENuS) model--to estimate nutrient availabilities for 23 individual nutrients across 225 food categories for thirty-four age-sex groups in nearly all countries. Furthermore, the model provides historical trends in dietary nutritional supplies at the national level using data from 1961-2011. We determine supplies of edible food by expanding the food balance sheet data using FAO production and trade data to increase food supply estimates from 98 to 221 food groups, and then estimate the proportion of major cereals being processed to flours to increase to 225. Next, we estimate intake among twenty-six demographic groups (ages 20+, both sexes) in each country by using data taken from the Global Dietary Database, which uses nationally representative surveys to relate national averages of food consumption to individual age and sex-groups; for children and adolescents where GDD data does not yet exist, average calorie-adjusted amounts are assumed. Finally, we match food supplies with nutrient densities from regional food composition tables to estimate nutrient supplies, running Monte Carlo simulations to find the range of potential nutrient supplies provided by the diet. To validate our new method, we compare the GENuS estimates of nutrient supplies against independent estimates by the USDA for historical US nutrition and find very good agreement for 21 of 23 nutrients, though sodium and dietary fiber will require further improvement.
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Affiliation(s)
- Matthew R. Smith
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Renata Micha
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Christopher D. Golden
- Center for Health and the Global Environment, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Samuel S. Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard University Center for the Environment, Cambridge, Massachusetts, United States of America
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Abstract
BACKGROUND Anthropogenic declines of animal pollinators and the associated effects on human nutrition are of growing concern. We quantified the nutritional and health outcomes associated with decreased intake of pollinator-dependent foods for populations around the world. METHODS We assembled a database of supplies of 224 types of food in 156 countries. We quantified nutrient composition and pollinator dependence of foods to estimate the size of possible reductions in micronutrient and food intakes for different national populations, while keeping calorie intake constant with replacement by staple foods. We estimated pollinator-decline-dependent changes in micronutrient-deficient populations using population-weighted estimated average requirements and the cutpoint method. We estimated disease burdens of non-communicable, communicable, and malnutrition-related diseases with the Global Burden of Disease 2010 comparative risk assessment framework. FINDINGS Assuming complete removal of pollinators, 71 million (95% uncertainty interval 41-262) people in low-income countries could become newly deficient in vitamin A, and an additional 2.2 billion (1.2-2.5) already consuming below the average requirement would have further declines in vitamin A supplies. Corresponding estimates for folate were 173 million (134-225) and 1.23 billion (1.12-1.33). A 100% decline in pollinator services could reduce global fruit supplies by 22.9% (19.5-26.1), vegetables by 16.3% (15.1-17.7), and nuts and seeds by 22.1% (17.7-26.4), with significant heterogeneity by country. In sum, these dietary changes could increase global deaths yearly from non-communicable and malnutrition-related diseases by 1.42 million (1.38-1.48) and disability-adjusted life-years (DALYs) by 27.0 million (25.8-29.1), an increase of 2.7% for deaths and 1.1% for DALYs. A 50% loss of pollination services would be associated with 700,000 additional annual deaths and 13.2 million DALYs. INTERPRETATION Declines in animal pollinators could cause significant global health burdens from both non-communicable diseases and micronutrient deficiencies. FUNDING Winslow Foundation, Bill & Melinda Gates Foundation.
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Affiliation(s)
- Matthew R Smith
- Harvard T H Chan School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Gitanjali M Singh
- Tufts University, Friedman School of Nutrition Science & Policy, Boston, MA, USA
| | - Dariush Mozaffarian
- Tufts University, Friedman School of Nutrition Science & Policy, Boston, MA, USA
| | - Samuel S Myers
- Harvard T H Chan School of Public Health, Department of Environmental Health, Boston, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA.
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Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, Horton R, Mace GM, Marten R, Myers SS, Nishtar S, Osofsky SA, Pattanayak SK, Pongsiri MJ, Romanelli C, Soucat A, Vega J, Yach D. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. Lancet 2015; 386:1973-2028. [PMID: 26188744 DOI: 10.1016/s0140-6736(15)60901-1] [Citation(s) in RCA: 956] [Impact Index Per Article: 106.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sarah Whitmee
- Centre for Biodiversity and Environment Research, University College London, London, UK.
| | - Andy Haines
- London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Anthony G Capon
- International Institute for Global Health, United Nations University, Federal Territory of Kuala Lumpur, Malaysia
| | | | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Howard Frumkin
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Peng Gong
- Center for Earth System Science, Tsinghua University, Beijing, China
| | - Peter Head
- The Ecological Sequestration Trust, London, UK
| | | | - Georgina M Mace
- Centre for Biodiversity and Environment Research, University College London, London, UK
| | - Robert Marten
- London School of Hygiene & Tropical Medicine, London, UK; The Rockefeller Foundation, New York, NY, USA
| | - Samuel S Myers
- Center for the Environment, Harvard University, Cambridge, MA, USA; Harvard T.H. Chan School of Public Health, Islamabad, Pakistan
| | | | | | - Subhrendu K Pattanayak
- Sanford School of Public Policy and Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | | | | | - Jeanette Vega
- The National Chilean Public Health Insurance Agency, Santiago, Chile
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Myers SS, Wessells KR, Kloog I, Zanobetti A, Schwartz J. Effect of increased concentrations of atmospheric carbon dioxide on the global threat of zinc deficiency: a modelling study. Lancet Glob Health 2015. [PMID: 26189102 DOI: 10.1016/s2214-109x(15)00093-95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Increasing concentrations of atmospheric carbon dioxide (CO2) lower the content of zinc and other nutrients in important food crops. Zinc deficiency is currently responsible for large burdens of disease globally, and the populations who are at highest risk of zinc deficiency also receive most of their dietary zinc from crops. By modelling dietary intake of bioavailable zinc for the populations of 188 countries under both an ambient CO2 and elevated CO2 scenario, we sought to estimate the effect of anthropogenic CO2 emissions on the global risk of zinc deficiency. METHODS We estimated per capita per day bioavailable intake of zinc for the populations of 188 countries at ambient CO2 concentrations (375-384 ppm) using food balance sheet data for 2003-07 from the Food and Agriculture Organization. We then used previously published data from free air CO2 enrichment and open-top chamber experiments to model zinc intake at elevated CO2 concentrations (550 ppm, which is the concentration expected by 2050). Estimates developed by the International Zinc Nutrition Consultative Group were used for country-specific theoretical mean daily per-capita physiological requirements for zinc. Finally, we used these data on zinc bioavailability and population-weighted estimated average zinc requirements to estimate the risk of inadequate zinc intake among the populations of the different nations under the two scenarios (ambient and elevated CO2). The difference between the population at risk at elevated and ambient CO2 concentrations (ie, population at new risk of zinc deficiency) was our measure of impact. FINDINGS The total number of people estimated to be placed at new risk of zinc deficiency by 2050 was 138 million (95% CI 120-156). The people likely to be most affected live in Africa and South Asia, with nearly 48 million (32-63) residing in India alone. Global maps of increased risk show significant heterogeneity. INTERPRETATION Our results indicate that one heretofore unquantified human health effect associated with anthropogenic CO2 emissions will be a significant increase in the human population at risk of zinc deficiency. Our country-specific findings can be used to help guide interventions aimed at reducing this vulnerability. FUNDING Bill & Melinda Gates Foundation, Winslow Foundation.
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Affiliation(s)
- Samuel S Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Cambridge, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA.
| | - K Ryan Wessells
- Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Cambridge, MA, USA
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Myers SS, Wessells KR, Kloog I, Zanobetti A, Schwartz J. Effect of increased concentrations of atmospheric carbon dioxide on the global threat of zinc deficiency: a modelling study. Lancet Glob Health 2015; 3:e639-45. [PMID: 26189102 DOI: 10.1016/s2214-109x(15)00093-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing concentrations of atmospheric carbon dioxide (CO2) lower the content of zinc and other nutrients in important food crops. Zinc deficiency is currently responsible for large burdens of disease globally, and the populations who are at highest risk of zinc deficiency also receive most of their dietary zinc from crops. By modelling dietary intake of bioavailable zinc for the populations of 188 countries under both an ambient CO2 and elevated CO2 scenario, we sought to estimate the effect of anthropogenic CO2 emissions on the global risk of zinc deficiency. METHODS We estimated per capita per day bioavailable intake of zinc for the populations of 188 countries at ambient CO2 concentrations (375-384 ppm) using food balance sheet data for 2003-07 from the Food and Agriculture Organization. We then used previously published data from free air CO2 enrichment and open-top chamber experiments to model zinc intake at elevated CO2 concentrations (550 ppm, which is the concentration expected by 2050). Estimates developed by the International Zinc Nutrition Consultative Group were used for country-specific theoretical mean daily per-capita physiological requirements for zinc. Finally, we used these data on zinc bioavailability and population-weighted estimated average zinc requirements to estimate the risk of inadequate zinc intake among the populations of the different nations under the two scenarios (ambient and elevated CO2). The difference between the population at risk at elevated and ambient CO2 concentrations (ie, population at new risk of zinc deficiency) was our measure of impact. FINDINGS The total number of people estimated to be placed at new risk of zinc deficiency by 2050 was 138 million (95% CI 120-156). The people likely to be most affected live in Africa and South Asia, with nearly 48 million (32-63) residing in India alone. Global maps of increased risk show significant heterogeneity. INTERPRETATION Our results indicate that one heretofore unquantified human health effect associated with anthropogenic CO2 emissions will be a significant increase in the human population at risk of zinc deficiency. Our country-specific findings can be used to help guide interventions aimed at reducing this vulnerability. FUNDING Bill & Melinda Gates Foundation, Winslow Foundation.
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Affiliation(s)
- Samuel S Myers
- Department of Environmental Health, Harvard T H Chan School of Public Health, Cambridge, MA, USA; Harvard University Center for the Environment, Cambridge, MA, USA.
| | - K Ryan Wessells
- Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Cambridge, MA, USA
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Del Gobbo LC, Khatibzadeh S, Imamura F, Micha R, Shi P, Smith M, Myers SS, Mozaffarian D. Assessing global dietary habits: a comparison of national estimates from the FAO and the Global Dietary Database. Am J Clin Nutr 2015; 101:1038-46. [PMID: 25788002 PMCID: PMC4409685 DOI: 10.3945/ajcn.114.087403] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 02/20/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Accurate data on dietary habits are crucial for understanding impacts on disease and informing policy priorities. Nation-specific food balance sheets from the United Nations FAO provided the only available global dietary estimates but with uncertain validity. OBJECTIVES We investigated how FAO estimates compared with nationally representative, individual-based dietary surveys from the Global Dietary Database (GDD) and developed calibration equations to improve the validity of FAO data to estimate dietary intakes. DESIGN FAO estimates were matched to GDD data for 113 countries across the following 9 major dietary metrics for 30 y of data (1980-2009): fruit, vegetables, beans and legumes, nuts and seeds, whole grains, red and processed meats, fish and seafood, milk, and total energy. Both absolute and percentage differences in FAO and GDD mean estimates were evaluated. Linear regression was used to evaluate whether FAO estimates predicted GDD dietary intakes and whether this prediction varied according to age, sex, region, and time. Calibration equations were developed to adjust FAO estimates to approximate national dietary surveys validated by using randomly split data sets. RESULTS For most food groups, FAO estimates substantially overestimated individual-based dietary intakes by 74.5% (vegetables) and 270% (whole grains) while underestimating beans and legumes (-50%) and nuts and seeds (-29%) (P < 0.05 for each). In multivariate regressions, these overestimations and underestimations for each dietary factor further varied by age, sex, region, and time (P < 0.001 for each). Split-data set calibration models, which accounted for country-level covariates and other sources of heterogeneity, effectively adjusted FAO estimates to approximate estimates from national survey data (r = 0.47-0.80) with small SEs of prediction (generally 1-5 g/d). CONCLUSIONS For all food groups and total energy, FAO estimates substantially exceeded or underestimated individual-based national surveys of individual intakes with significant variation depending on age, sex, region, and time. Calibration models effectively adjusted the comprehensive, widely accessible FAO data to facilitate a more-accurate estimation of individual-level dietary intakes nationally and by age and sex.
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Affiliation(s)
- Liana C Del Gobbo
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Shahab Khatibzadeh
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Fumiaki Imamura
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Renata Micha
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Peilin Shi
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Matthew Smith
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Samuel S Myers
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Dariush Mozaffarian
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
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Abstract
Despite suggestions that animal pollinators are crucial for human nutritional health, no studies have actually tested this claim. Here, we combined data on crop pollination requirements, food nutrient densities, and actual human diets to predict the effects of pollinator losses on the risk of nutrient deficiency. In four developing countries and across five nutrients, we found that 0 to 56% of populations would become newly at risk if pollinators were removed. Increases in risk were most pronounced for vitamin A in populations with moderate levels of total nutrient intake. Overall, the effects of pollinator decline varied widely among populations and nutrients. We conclude that the importance of pollinators to human nutrition depends critically on the composition of local diets, and cannot be reliably predicted from global commodity analyses. We identify conditions under which severe health effects of pollinator loss are most likely to occur.
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Affiliation(s)
- Alicia M. Ellis
- Gund Institute for Ecological Economics, University of Vermont, 617 Main St., Burlington, VT 05405, United States of America
| | - Samuel S. Myers
- Harvard School of Public Health, Department of Environmental Health, 401 Park Drive, Room 404-M, Boston, MA 02215, United States of America
- Harvard University Center for the Environment, 24 Oxford St, Room 307, Cambridge, MA 02138, United States of America
| | - Taylor H. Ricketts
- Gund Institute for Ecological Economics, University of Vermont, 617 Main St., Burlington, VT 05405, United States of America
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41
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Myers SS, Zanobetti A, Kloog I, Huybers P, Leakey ADB, Bloom A, Carlisle E, Dietterich LH, Fitzgerald G, Hasegawa T, Holbrook NM, Nelson RL, Ottman MJ, Raboy V, Sakai H, Sartor KA, Schwartz J, Seneweera S, Tausz M, Usui Y. Increasing CO2 threatens human nutrition. Nature 2014; 510:139-42. [PMID: 24805231 PMCID: PMC4810679 DOI: 10.1038/nature13179] [Citation(s) in RCA: 475] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/24/2014] [Indexed: 11/09/2022]
Abstract
Dietary deficiencies of zinc and iron are a substantial global public health problem. An estimated two billion people suffer these deficiencies, causing a loss of 63 million life-years annually. Most of these people depend on C3 grains and legumes as their primary dietary source of zinc and iron. Here we report that C3 grains and legumes have lower concentrations of zinc and iron when grown under field conditions at the elevated atmospheric CO2 concentration predicted for the middle of this century. C3 crops other than legumes also have lower concentrations of protein, whereas C4 crops seem to be less affected. Differences between cultivars of a single crop suggest that breeding for decreased sensitivity to atmospheric CO2 concentration could partly address these new challenges to global health.
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Affiliation(s)
- Samuel S. Myers
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
- Harvard University Center for the Environment, Cambridge, MA, USA
| | - Antonella Zanobetti
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Itai Kloog
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
- The Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Peter Huybers
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
| | - Andrew D. B. Leakey
- Department of Plant Biology and Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Arnold Bloom
- Department of Plant Sciences, University of California at Davis, Davis, CA, USA
| | - Eli Carlisle
- Department of Plant Sciences, University of California at Davis, Davis, CA, USA
| | - Lee H. Dietterich
- University of Pennsylvania, Department of Biology, Philadelphia, PA, USA
| | - Glenn Fitzgerald
- Department of Environment and Primary Industries, Horsham, Victoria, Australia
| | - Toshihiro Hasegawa
- National Institute for Agro-Environmental Sciences, Tsukuba, Ibaraki, Japan
| | - N. Michele Holbrook
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Randall L. Nelson
- USDA-Agricultural Research Service, Soybean/Maize Germplasm, Pathology, and Genetics Research Unit, Dept. of Crop Sciences, University of Illinois, Urbana, IL, USA
| | - Michael J Ottman
- School of Plant Sciences, University of Arizona, Tucson, AZ, USA
| | - Victor Raboy
- USDA Agricultural Research Service, Aberdeen, Idaho, USA
| | - Hidemitsu Sakai
- National Institute for Agro-Environmental Sciences, Tsukuba, Ibaraki, Japan
| | | | - Joel Schwartz
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Saman Seneweera
- Department of Agriculture and Food Systems, Melbourne School of Land and Environment, The University of Melbourne, Creswick, Victoria, Australia
| | - Michael Tausz
- Department of Forest & Ecosystem Science, Melbourne School of Land and Environment, The University of Melbourne, Creswick, Victoria, Australia
| | - Yasuhiro Usui
- National Institute for Agro-Environmental Sciences, Tsukuba, Ibaraki, Japan
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Affiliation(s)
- Kent H Redford
- Archipelago Consulting, P.O. Box 4750, Portland, ME, 04112, U.S.A..
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Abstract
Global climate change threatens the health of hundreds of millions of people. While much has been written about the direct impacts of climate change on health as a result of more severe storms, more intense heat stress, changes in the distribution of infectious disease, and reduced air quality, we are concerned that the indirect impacts of a disrupted climate system may be orders of magnitude more important in terms of the human suffering they cause. Because these indirect effects will result from changes in biophysical systems, which are inherently complex, there is significant uncertainty about their magnitude, timing, and location. However, the uncertainty that shrouds this issue should not be cause for complacency; rather it should serve as an organizing principle for adaptation to its ill effects.
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Myers SS, Lynn J. Patients with eventually fatal chronic illness: their importance within a national research agenda on improving patient safety and reducing medical errors. J Palliat Med 2002; 4:325-32. [PMID: 11596543 DOI: 10.1089/109662101753123931] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In September 2000, the Quality Interagency Coordination (QuIC) Task Force invited the RAND Center to Improve Care of the Dying and Americans for Better Care of the Dying to testify at its National Summit on Medical Errors and Patient Safety Research. In their testimony, the organizations urged the QuIC to consider the special vulnerability and needs of individuals at the end of life in crafting their research agenda. Patients at the end of life are particularly vulnerable to medical errors and other lapses in patient safety for three reasons: (1) substantially increased exposure to medical errors; (2) more serious effects from errors because they cannot protect themselves from risks and have less reserve with which to overcome the effects; and (3) pervasive patterns of care that run counter to well-substantiated evidence-based practices. A national research agenda on preventing medical errors and increasing patient safety must include a focus on how to improve shortcomings affecting these vulnerable patients. The QuIC's preliminary research agenda, released in October 2000, included patients coming to the end of life. The Agency for Healthcare Research and Quality, the lead federal agency for researching patient safety and medical errors, released between November 2000 and April 2001 six Requests for Applications for research into medical errors.
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Affiliation(s)
- S S Myers
- RAND Center to Improve Care of the Dying, Arlington, Virginia, USA.
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Abstract
OBJECTIVE Direct HIV testing of individual injecting drug users is not always feasible. As an alternative, we have evaluated the sensitivity and specificity of several techniques for detecting HIV-1-specific products in used syringes. DESIGN Polymerase chain reaction (PCR) and antibody-capture assays were compared using syringes prepared with blood from HIV-1-positive and -negative individuals. METHODS PCR sensitivity was maximized, enabling detection of single copies of HIV-1-specific proviral DNA. The limits of detection from used syringes were determined for PCR by diluting extracts and correlated to CD4+ cell counts. Similarly, limits of detection were determined for enzyme immunoassays (EIA) and Western blot. RESULTS All techniques were highly specific, although with PCR false-positives were detected occasionally. EIA proved more sensitive than Western blot in detecting needles containing HIV-1-infected individuals' blood. Even after prolonged storage of syringes at room temperature, EIA was equal to or better than PCR as an HIV-1 detection technique. The most sensitive method for detecting HIV-1 was the viral-based EIA when the recommended predilution step was omitted. CONCLUSIONS EIA proved preferable to PCR because of their higher sensitivity, absence of false-positives and easier sample preparation and analysis.
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Affiliation(s)
- S S Myers
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510
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Heimer R, Myers SS, Cadman EC, Kaplan EH. Detection by polymerase chain reaction of human immunodeficiency virus type 1 proviral DNA sequences in needles of injecting drug users. J Infect Dis 1992; 165:781-2. [PMID: 1552214 DOI: 10.1093/infdis/165.4.781] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Affiliation(s)
- S S Myers
- Yale University School of Medicine, New Haven
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Myers SS. Child abuse and the military community. Mil Med 1979; 144:23-5. [PMID: 105315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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