High food prices and the global financial crisis have reduced access to nutritious food and worsened nutritional status and health

The global magnitude and temporal trend of hypertensive heart disease burden attributable to high sodium intake from 1990 to 2021

BACKGROUND

The relationship between high sodium intake (HSI) and hypertensive heart disease (HHD) has been confirmed. However, notable regional disparities exist in implementing effective measures to control sodium intake. This study was carried out to estimate the spatiotemporal trends in the burden of HHD attributable to HSI.

METHODS

Data obtained from the Global Burden of Disease Study 2021 were analyzed, considering factors such as age, gender, year, and region. Joinpoint regression analysis was applied to investigate the temporal trends in the HHD burden resulting from HSI over the past 32 years.

RESULTS

From 1990 to 2021, the global cases of HHD increased significantly annually. The age-standardized prevalence rates showed a slow gradual increase. However, both the age-standardized death and disability-adjusted life-year (DALY) rates decreased. Specifically, HSI was responsible for 29.2% of total HHD deaths and 30.4% of total DALYs in 1990 but only 22.8% of total HHD deaths and 23.4% of total DALYs in 2021. A greater burden from HSI exposure was observed among men, older adults and people living in middle and low sociodemographic index (SDI) countries and regions. Moreover, over the 32-year period, Guam and Colombia demonstrated the highest reduction in age-standardized death and DALY rates, respectively.

CONCLUSION

Globally, the age-standardized burden of HHD due to HSI has demonstrated a decline. Although some areas have effectively managed this issue, it remains a challenge in specific areas. Hence, it is crucial to examine and implement the strategies adopted by successful nations to further mitigate this burden.

Perceived influences of fruit and vegetable consumption among Indian adolescents - A qualitative inquiry

BACKGROUND

Fruits and vegetables are primary sources of vitamins and minerals that may alleviate the risk of chronic illnesses. However, Indian adolescents consume inadequate amounts of fruits and vegetables, with less than 10% meeting recommendations. Micronutrient deficiencies are a major public health problem in India. For example, the prevalence of iron-deficiency anemia and Vitamin A deficiency in adolescents is 28.5% and 14.4%, respectively. To promote fruit and vegetable consumption among Indian adolescents, we need to identify the factors which may influence the consumption. The aim of this qualitative inquiry was to explore perceived influences of fruit and vegetable consumption among Indian adolescents.

METHODS

Using purposive sampling, adolescents aged 10-19 years were recruited from two public and two private (independent) schools in Varanasi, India. Face-to-face interviews along with the 'draw and tell' technique were used for data collection. Interviews were conducted in English as well as in Hindi depending on the preferences of the adolescents. The conversations were digitally recorded and transcribed verbatim. The transcribed data were subjected to thematic analysis. Data were coded inductively, and themes were extracted using NVivo software program.

RESULTS

A total of 58 adolescents (53% female; 74% urban) with mean age 13.6 years completed the interviews. Nine major themes and associated sub-themes emerged, including: (i) Sensory properties (i.e., taste, color, flavor, texture); (ii) Health and immunity; (iii) Allergy; (iv) Home food environment (i.e., influence of mothers, availability and accessibility of fruits and vegetables); (v) Cost; (vi) Food preparation; (vii) Influence of peers; (viii) School food environment; (ix) Proclivity for energy-dense, nutrient-poor foods and beverages.

CONCLUSIONS

The emerging themes and sub-themes show that multiple factors are likely to affect fruit and vegetable consumption in adolescents, aligning with literature on adolescent fruit and vegetable consumption in international settings. Behavioral interventions should be designed to create enabling environments to encourage fruit and vegetable consumption in Indian adolescents by removing barriers at the individual, household, and community levels, thereby reducing the enduring prevalence of micronutrient deficiencies.

COVID-19 and shifting food preferences: A panel study among Chilean students

The COVID-19 pandemic had a profound impact on various aspects of life. This study aims to investigate whether the COVID-19 pandemic changed food preferences, focusing on cost perceptions, environmental factors, and health attributes. We conducted a panel study with self-administered online surveys among undergraduate students in Chile, both before and during the first wave of the pandemic. Each survey included a discrete choice experiment (DCE) to elicit food preferences. Using mixed logit models, our analysis shows that during the COVID-19 pandemic, sensitivity to cost, preference for foods with low environmental impact, and preference for vitamin-rich foods increased. These changes in preferences can be attributed to individuals' perceived health risks. These findings suggest that the pandemic increased awareness of sustainable and healthy food choices, with important implications for promoting these choices during global crises.

The Effects of Subsidies for Healthy Foods on Food Purchasing Behaviors, Consumption Patterns, and Obesity/Overweight: A Systematic Review

CONTEXT

Taxing unhealthy foods and drinks is an essential measure against the double burden of malnutrition that affects every nation worldwide. In turn, subsidizing the consumption of healthy foods can also be a critical measure for changing the population's behavior and improving health indicators.

OBJECTIVE

A systematic review was conducted of food subsidies and their potential impact on food purchases, consumption, overweight/obesity, and changes in body mass index (BMI).

DATA SOURCES

The PubMed, Embase, LILAC, Scientific Electronic Library Online, and Google Scholar databases were searched to identify studies investigating the effects of subsidies on the amount of food purchased, food consumption, caloric intake, nutrient intake, and their impact on overweight, obesity, and BMI changes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

DATA EXTRACTION

Two investigators independently performed data screening, extraction, and quality assessment.

RESULTS

Of the 6135 studies screened, 149 were read in full and 18 were included in this systematic review. Most studies investigated the effects of subsidy scenarios on food purchases and observed increases in fruit and vegetable (F&V) purchases when these were subsidized. In randomized controlled studies, subsidized healthy foods were purchased more often. However, when the subsidy was suspended, F&V consumption decreased. Although quasi-experimental studies have demonstrated increased F&V consumption due to subsidies, some studies showed increased saturated fat and sodium intake. Only 2 studies evaluated the relationship between subsidies and obesity, yielding conflicting results.

CONCLUSION

Although the subsidies appear to encourage purchase and consumption of healthier foods, enhancing the quality and diversity of dietary choices, the removal of subsidies can lead to a decline in the consumption of healthier foods. Additionally, their impact on obesity and BMI remains uncertain and requires further research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration by the number CRD42023442122.

Validation of the food inflation impact on consumer behavior scale: a comparative measurement instrument with focus on food security

This study aimed to compare the change in consumer behaviour in the face of high inflation with respect to food security in the Turkish population by developing a 3-factor The Impact of Food Inflation on Consumer Behaviour (IFI-ConB) scale. Item generation and expert evaluation, item purification by preliminary application, and final administration were conducted. The moderate to severe food insecure individuals exhibited a higher inflation impact score on food consumption patterns, food shopping behaviours, and food purchasing motives factors compared to secure to mild insecure individuals. A positive correlation was found between the inflation impact score by IFI-ConB and the price motive for food choice. The primary food choice motive was health among the secure to mild insecure individuals, while for the moderate to severe food insecure individuals, it was price. The findings indicate that food insecure individuals are more affected by high food inflation compared to food secure individuals.

The effects of food affordability on life expectancy in emerging countries

The relationship between food prices and life expectancy in emerging countries has significant implications for public health and socioeconomic development in these regions. This study examines this relationship using a dataset of 120 emerging economies over the period 2000–2021, employing the dynamic panel threshold and system generalized method of moments (GMM) models. Our findings reveal a nonlinear inverted U‐shaped relationship where beyond a specific threshold, higher food prices tend to shorten life expectancy. We also reveal the disproportionate burden placed on low‐income countries when food prices rise, in comparison to middle‐income countries and highlight the profound impact of economic disparities on public health. Moreover, we identify several channels through which food prices affect life expectancy. Specifically, we reveal that income, undernutrition, and mental health disorders represent potential mediating factors affecting food prices–life expectancy nexus. We also shed light on the severe implications of economic crises on public health, emphasizing the close connection between economic events and indicators of human health. These insights have direct implications for policymakers, offering valuable guidance in the context of fluctuating food prices.

Diet affordability: a key dimension in the assessment of sustainable food systems and healthy diets

A promulgated global shift toward a plant-based diet is largely in response to a perceived negative environmental impact of animal food production, but the nutritional adequacy and economic implications of plant-sourced sustainable healthy dietary patterns need to be considered. This paper reviews recent modeling studies using Linear Programming to determine the respective roles of animal- and plant-sourced foods in developing a least-cost diet in the United States and New Zealand. In both economies, least-cost diets were found to include animal-based foods, such as milk, eggs, fish, and seafood, to meet the energy and nutrient requirements of healthy adults at the lowest retail cost. To model a solely plant-based least-cost diet, the prevailing costs of all animal-sourced foods had to be increased by 1.1 to 11.5 times their original retail prices. This led to the inclusion of fortified plant-based foods, such as fortified soymilk, and a plant-based diet that was considerably (34-45%) more costly. The first-limiting essential nutrients were mostly the vitamins and minerals, with special focus on pantothenic acid, zinc, and vitamin B-12, when transitioning from an animal- and plant-containing least-cost diet to a plant-only based least-cost diet. Modeled least-cost diets based on contemporary food costs include animal-sourced foods, at least for developed high-income US and NZ food economies, and potentially for developing low- and middle-income countries, such as Indonesia. Modeling of least-cost diets that consist exclusively of plant-based foods is feasible, but at a higher daily diet cost, and these diets are often close to limiting for several key nutrients. Diet affordability, as a key dimension of sustainable healthy diets, and the respective economic roles of animal- and plant-sourced foods need to be considered.

Food Insecurity in Greece and across the Globe: A Narrative Literature Review

Food insecurity comprises a major global public health threat, as its effects are detrimental to the mental, physical, and social aspects of the health and well-being of those experiencing it. We performed a narrative literature review on the magnitude of global food insecurity with a special emphasis on Greece and analyzed the major factors driving food insecurity, taking into consideration also the effect of the COVID-19 pandemic. An electronic search of international literature was conducted in three databases. More than 900 million people worldwide experience severe food insecurity, with future projections showing increasing trends. Within Europe, Eastern and Southern European countries display the highest food insecurity prevalence rates, with Greece reporting a prevalence of moderate or severe food insecurity ranging between 6.6% and 8% for the period 2019-2022. Climate change, war, armed conflicts and economic crises are major underlying drivers of food insecurity. Amidst these drivers, the COVID-19 pandemic had a profound impact on food insecurity levels around the globe, through halting economic growth, disrupting food supply chains and increasing unemployment and poverty. Tackling food insecurity through addressing its key drivers is essential to any progress towards succeeding the Sustainable Development Goal of "Zero Hunger".

Predicting the short and long term effects of food price inflation, armed conflicts, and climate variability on global acute malnutrition in Somalia

BACKGROUND

Malnutrition poses a substantial challenge in Somalia, impacting approximately 1.8 million children. This critical issue is exacerbated by a multifaceted interplay of factors. Consequently, this study seeks to examine the long-term and short-term effects of armed conflicts, food price inflation, and climate variability on global acute malnutrition in Somalia.

METHODS

The study utilized secondary data spanning from January 2015 to December 2022, sourced from relevant databases. Two distinct analytical approaches were employed to comprehensively investigate the dynamics of global acute malnutrition in Somalia. Firstly, dynamic autoregressive distributed lag (ARDL) simulations were applied, allowing for a nuanced understanding of the short and long-term effects of armed conflicts, food price inflation, and climate variability on malnutrition. Additionally, the study employed kernel-based regularized least squares, a sophisticated statistical technique, to further enhance the robustness of the findings. The analysis was conducted using STATA version 17.

RESULTS

In the short run, armed conflicts and food price inflation exhibit positive associations with global acute malnutrition, particularly in conflict-prone areas and during inflationary periods. Moreover, climatic variables, specifically temperature and rainfall, demonstrate positive associations. It is important to note that temperature lacks a statistically significant relationship with global acute malnutrition in the short run. In the long run, armed conflicts and food price inflation maintain persistent impacts on global acute malnutrition, as confirmed by the dynamic ARDL simulations model. Furthermore, both temperature and rainfall continue to show positive associations with global acute malnutrition, but it is worth noting that temperature still exhibits a non-significant relationship. The results from kernel-based regularized least squares were consistent, further enhancing the robustness of the findings.

CONCLUSIONS

Increased armed conflicts, food price inflation, temperature, and rainfall were associated with increased global acute malnutrition. Strategies such as stabilizing conflict-prone regions, diplomatic interventions, and peace-building initiatives are crucial, along with measures to control food price inflation. Implementing climate adaptation strategies is vital to counter temperature changes and fluctuating rainfall patterns, emphasizing the need for resilience-building. Policymakers and humanitarian organizations can leverage these insights to design targeted interventions, focusing on conflict resolution, food security, and climate resilience to enhance Somalia's overall nutritional well-being.

Determinants associated with low dietary diversity among migrants to Morocco: a cross sectional study

Low dietary diversity (LDD) is prevalent among vulnerable populations, posing a morbidity risk. Few studies have been conducted on the dietary diversity of migrants. The objectives of this study are to determine the prevalence of LDD among migrants in Morocco and the risk factors associated with it. In the Oriental region, we conducted a cross-sectional study with migrants between November and December 2021. The sampling method used was convenience sampling. A face-to-face, structured questionnaire was used to collect sociodemographic, behavioral, and clinical data. We calculated a dietary diversity score based on a 24-h food recall and assessed food intake. The risk factors associated with LDD were identified using multivariate logistic regression. A total of 445 migrants was enrolled. The prevalence of LDD was 31.7%. Risk factors associated with LDD were: being homeless (adjusted Odds Ratio (AOR) of 6.32; CI% [3.55-11.25]), a lack of social support (AOR of 2.30; CI% [1.33-03.98]), and low monthly income (AOR of 8.21; CI% [3.39-19.85]). Public policies must focus on social and environmental determinants. Nutrition training programs should be set up for the migrant population.

A review of the dietary diversity and micronutrient adequacy among the women of reproductive age in low- and middle-income countries

The dietary quality of women of reproductive age (WRA) is particularly important during preconception, conception, and pregnancy for themselves and their offspring. Poorly diversified diets resulting in inadequate micronutrient consumption may have adverse effects on their health. This narrative review summarizes the findings of studies reporting on dietary diversity and micronutrient intake by WRA in low- and middle-income countries (LMICs). Studies on WRA aged 15-49 years in LMICs, with a sample size of more than 150, report dietary diversity and multiple micronutrient intake based on 24-h dietary recall/food weighed record/food frequency questionnaire, and published between January 2011 and June 2021 were included. The results were compared to the Food and Agriculture Organization (FAO) recommended cut-off for dietary diversity and the Indian Council of Medical Research (ICMR) recommended age- and sex-specific estimated average requirements (EARs) for micronutrient intake. This review includes 35 articles, of which 21 focused on dietary diversity and 14 on micronutrient intake. The results showed that WRA in LMICs had inadequate dietary diversity, with mean food group consumption of only 3.0-4.84, and around 42.3%-90% of women consumed inadequately diversified diets (<5 food groups). Additionally, most studies found that WRA did not consume adequate amounts of essential micronutrients, particularly calcium, iron, zinc, vitamin A, thiamin, riboflavin, folate, and vitamin B12. However, the intake of vitamin C, niacin, and vitamin B6 was above the required levels. In conclusion, this review highlights the common inadequacy of dietary diversity and multiple micronutrient intake among WRA in most LMICs. Effective measures involving improving dietary diversity, food fortification with micronutrients, and supplementation programs could help improve the dietary quality and intake of optimal micronutrients by women in LMICs.

Factors associated with inadequate dietary diversity among adolescent girls in Hurumu Woreda High School, Oromia Region, Southwest Ethiopia

Background

Inadequate diet among adolescent girls leads to anatomical and physiological disturbances which will contribute to the vicious intergenerational cycle of malnutrition. However, only a few studies are available in Ethiopia on dietary diversity among adolescent girls who are attending school.

Objective

The objective of this study is to assess factors associated with inadequate dietary diversity among high school adolescent girls in Hurumu Woreda, Southwest Ethiopia, 2022.

Methods

An institution-based cross-sectional study was conducted among 374 high school adolescent girls from 3 May 2022 to 12 June 2022 and selected by using simple random sampling techniques. Data were collected through face-to-face interviews using structured questionnaires. Epi-data version 4.6.0 was used to enter the data, which were then exported to SPSS version 26 for analysis. Simple binary and multivariable logistic regressions were performed to identify factors associated with inadequate dietary diversity.

Results

In this study, the magnitude of inadequate dietary diversity among adolescent girls was 62.6% [95% CI: 57.5-66.5]. Living with more than five family members (AOR = 1.8, 95% CI: 1.16-3.44), consumption of sweet foods/beverages (AOR = 2.2, 95% CI: 1.07-3.41), poor nutritional knowledge (AOR = 2.5, 95% CI: 1.48-3.89), and poor household wealth tercile (AOR = 2.8, 95% CI: 1.44-5.12) were significantly associated with inadequate dietary diversity.

Conclusion

Living with more than five family members, poor household wealth status, consumption of sweet foods/beverages, family size, and poor nutritional knowledge were factors significantly associated with inadequate dietary diversity. Hence, nutrition education, the use of family planning methods, and securing income-generating activities should be implemented.

Nutrition transition, double burden of malnutrition, and urbanization patterns in secondary cities of Bangladesh, Kenya and Rwanda

BACKGROUND

By 2050, approximately 68% of the global population will live in cities, but nutrition data on urban populations of low- and middle-income countries are scarce. Fast growing secondary cities, combining characteristics and hurdles of urban and rural settings, are hotspots for the double burden of malnutrition. The Nutrition in City Ecosystems (NICE) project focuses on 6 secondary cities in Bangladesh, Kenya and Rwanda, to improve health and nutrition, and reduce poverty. To assess the baseline situation and guide future interventions, food insecurity, dietary diversity, nutrition status, and food production and purchasing patterns were explored.

METHODS

In a cross-sectional study design, data were collected from urban and peri-urban households of Dinajpur and Rangpur in Bangladesh, Bungoma and Busia in Kenya, and Rubavu and Rusizi in Rwanda. Approximately 1200 households, in neighborhoods prone to malnutrition, were involved from April to June 2021. We assessed Household Food Insecurity Access Score (HFIAS), both current and before COVID-19, Household Dietary Diversity Score (HDDS), Minimum Dietary Diversity for Women (MDD-W), anthropometric measurements, household and socioeconomic information, and questions related to food production and consumer behavior. Further we collected secondary data on low birthweight and anemia during pregnancy.

RESULTS

All cities experienced a substantial increase in food insecurity during the COVID-19 pandemic. Stunting rates in children under 5 years varied among the cities and ranged from 7.8% in Busia to 46.6% in Rubavu, while half of adult women were overweight (between 42.1% in Rusizi and 55.8% in Bungoma). Furthermore, many women did not consume an adequately diverse diet (MDD-W < 5 for 29.3% in Bangladesh, 47.5% in Kenya, and 67.0% in Rwanda), however many of the urban and peri-urban households were engaged in farming (58-78%).

CONCLUSIONS

The double burden of malnutrition is high in secondary cities and the COVID-19 pandemic has exacerbated levels of food insecurity. Demand for, and access to, an affordable healthy diverse diet that comprises local, nutritious, and agroecologically produced foods present a pathway for overcoming the complex challenges of malnutrition.

Food price perception, food and beverage marketing and the nutritional status of children 6-24 months in Obunga slums, Kisumu Kenya: a cross-sectional study

BACKGROUND

Malnutrition is a significant problem in Africa. In Kenya, 26% of under-fives are stunted; slums are the hardest hit. Obunga slum has the highest prevalence at 40%.

METHODS

A cross-sectional study was adopted; simple random sampling techniques were used to identify 189 eligible households in the Obunga slum with children between 6-24 months. An interviewer-administered questionnaire collected data on food price perceptions and food and beverage marketing. An anthropometric data collection form gathered information on the children's height, weight and age. Scores for stunting, wasting and underweight were generated based on WHO Z-Score cut-off points. Binary logistic regression identified the relationship between food price perceptions, food and beverage marketing and the nutritional status of children between 6-24 months in Obunga slums.

RESULTS

Prevalence of wasting was 3.2%, stunting was 27.0%, underweight was at 7.4%, while overweight was at 13%. Food price perceptions: An increase in fruits prices was significantly associated with wasting (Adjusted O.R. = 10. 82, C.I. = 1.10-106.77, P < 0.05) and underweight (Adjusted O.R. = 5.44, C.I. = 1.35-21.61, P < 0.05). Food & Beverage Marketing: Feeding children on commercially produced complementary food products and commercially produced food was significantly associated with wasting at an (Adjusted O.R. = 7.82, C.I. = 1.29-47.46, p < 0.05, and adjusted O.R. = 5.96, C.I. = 1.06-33.60, p < 0.05) respectively. Stunting was significantly associated with listening/reading or watching advertisements on commercial food products (Crude O.R. = 0.49, C.I. = 0.24-0.998, p < 0.05.). Watching food-related adverts on television (Adjusted O.R. = 0.38 C.I. = 0.146- 0.10) and watching marketing on commercial foods (Adjusted O.R. = 0.21, C.I. = 0.07-0.61) and watching television (Adjusted O.R. = 9.30, C.I. = 2.31-37.40). While watching food-related adverts on television was associated with being underweight (Adjusted O.R. = 18.68 and at C.I. = 1.22-286.89).

CONCLUSION

The price perceptions of fruits, feeding children commercially produced food products and complementary foods, and Watching food-related adverts on television; had an impact on the nutritional status of children. Thus, a longitudinal study would be needed to understand the long-term effect of food prices and food and beverage marketing on nutritional status.

Assessing the Progress of the Philippine Plan of Action for Nutrition From 1974 to 2022: A Narrative Review

BACKGROUND

Malnutrition remains a public health burden in the Philippines, with the country struggling to meet global nutrition targets.

OBJECTIVE

This study aims to review the Philippine Plan of Action for Nutrition (PPAN) and its progress in addressing malnutrition in the Philippines.

METHODS

A narrative literature review of the PPAN and its implementation from 1974 to 2022 was conducted, including an analysis of relevant data on the nutrition status and programs for Filipinos.

RESULTS

The study found that the PPAN has been largely supportive in addressing malnutrition in the Philippines over the years. However, obstacles hindering the achievement of its nutrition-related goals have been identified. Challenges include inadequate coordination of programs at the local level, concerns regarding data quality, and insufficient training of personnel involved in implementing the PPAN. The results also indicate that the country has made limited progress toward achieving the global nutrition targets set by the Sustainable Development Goals 2030.

CONCLUSION

This study highlights the need to revisit and refine the PPAN to respond to the changing nature of malnutrition in the country. Recommendations to address the remaining gaps in the planning, implementing, and monitoring of the PPAN are discussed. Finally, the paper offers some valuable insights from the experiences of the PPAN that can be applied to other countries facing comparable nutrition contexts.

The volatility of beef and lamb prices in Türkiye: The role of COVID-19, livestock imports, and energy prices

This study examines the volatility of beef and lamb prices in Türkiye, as food price inflation compromises the food security of low- and middle-income households. The inflation is the result of a rise in energy (gasoline) prices leading to an increase in production costs, together with a disruption of the supply chain by the COVID-19 pandemic. This study is the first to comprehensively explore the effects of multiple price series on meat prices in Türkiye. Using price records from April 2006 through February 2022, the study applies rigorous testing and selects the VAR(1)-asymmetric BEKK bivariate GARCH model for empirical analysis. The beef and lamb returns were affected by periods of livestock imports, energy prices, and the COVID-19 pandemic, but those factors influenced the short- and long-term uncertainties differently. Uncertainty was increased by the COVID-19 pandemic, but livestock imports offset some of the negative effects on meat prices. To improve price stability and assure access to beef and lamb, it is recommended that livestock farmers be supported through tax exemptions to control production costs, government assistance through the introduction of highly productive livestock breeds, and improving processing flexibility. Additionally, conducting livestock sales through the livestock exchange will create a price information source allowing stakeholders to follow price movements in a digital format and their decision-making.

Nutrition in City Ecosystems (NICE): Protocol of a multi-sectoral development project to improve food and nutrition security of secondary city populations in Bangladesh, Kenya and Rwanda

Background

Secondary cities tend to be better linked with local food systems than primate cities, acting as important platforms to trade agricultural produce with rural surrounding. COVID-19, conflicts and climate change continue to expose inefficiencies in food systems and have further exacerbated malnutrition, calling for substantial food systems transformations. However, tackling current food systems' challenges requires new approaches to ensure food and nutrition security. Nutritious and agroecologically produced food offer the potential to transform food systems by improving diets and alleviating pressure on the environment, as well as by creating jobs and reducing poverty. This paper describes the design of a project by a Swiss public-private consortium to improve food and nutrition security and to reduce poverty in city ecosystems in six secondary cities in Bangladesh, Kenya and Rwanda through governance/policy and supply and demand side interventions.

Methods

The Nutrition in City Ecosystems (NICE) project promotes well-balanced nutrition for city populations through interdisciplinary agricultural, food, and health sector collaborations along city-specific value chains. Adopting a transdiciplinary systems approach, the main interventions of NICE are (i) advocacy and policy dialogue, (ii) building of decentralized institutional capacity in multi-sectoral collaborations, (iii) support of data-driven planning, coordination and resource mobilization, (iv) anchoring of innovations and new approaches in city-level partnerships, (v) capacity building in the agricultural, retail, health and education sectors, as well as (vi) evidence generation from putting policies into practice at the local level. NICE is coordinated by in-country partners and local offices of the Swiss public-private consortium partners.

Discussion

The NICE project seeks to contribute to urban food system resilience and enhanced sustainable nutrition for city populations by (A) strengthening urban governance structures involving key stakeholders including women and youth, (B) generating income for producers along the supply chain, (C) triggering change in producers' and consumers' behavior such that nutritious and agroecologically produced foods are both in demand as well as available and affordable in urban markets, and (D) allowing a scale up of successful approaches to other national and international cities and city networks.

Age at menarche, environmental stress, and social inequality: Evidence from Poland in the 1930s-1950s

OBJECTIVE

To address the relationship between socioeconomic factors and age of menarche among Polish women born and reared in periods that varied considerably in environmental stresses: the Great Depression of the 1930s, the interval of World War II, and the interval of communist rule following World War II through the 1950s.

METHODS

The data set included information on age at menarche and socioeconomic status (SES) of 718 women born during the Great Depression (n = 182), WWII (n = 189), and post-WWII through the 1950s (n = 347). A structured semi-parametric statistical model (generalized additive model [GAM] class) was used for analysis. An ANOVA-like linear model was used to test for marginal effects of SES-related factors and their interactions together with nonparametric seasonal effect.

RESULTS

The influence of period of birth, month of birth, region of early childhood, and father's education, and the interaction between period of birth and father's education on age at menarche were statistically significant. During the economic crisis and the interval of WWII, differences in ages at menarche between the extreme categories of father's education were marked. The differences in ages at menarche between women from the lowest and highest social groups were markedly reduced among women born during the post-war interval. In addition, women born in February-March attained menarche earlier than women born in September-October.

CONCLUSIONS

Unpredictable conditions associated with the economic crisis and war conditions had a stronger impact on age at menarche among women from families of lower SES compared to women from better economic circumstances. Individuals born and reared in low SES conditions likely suffered more severe deterioration across the spectrum of the standard of living and quality of life compared to those with a higher SES.

Global evidence of the exposure-lag-response associations between temperature anomalies and food markets

Recent years have witnessed a landmark shift in global food prices due to the frequency of extreme weather events caused by temperature anomalies as well as the overlapping risks of COVID-19. Notably, the threat posed by temperature anomalies has spread beyond agricultural production to all aspects across food supply and demand channels, further amplifying volatility in food markets. Exploring trends in global food prices will give nations early warning signs to ensure the stability of food market. Accordingly, we utilize the Distributed Lag Non-Linear Model (DLNM) to simultaneously establish the exposure-lag-response associations between global temperature anomalies and food price returns in two dimensions: "Anomaly Degree" and "Response Time". Meanwhile, we also examine the cumulative lagged effects of temperature anomalies in terms of different quantiles and lag times. Several conclusions have been drawn. First, global food price returns will continue to decrease when the average temperature drops or rises slightly. While it turns up once the average temperature rises more than 1.1 °C. Second, major food commodities are more sensitive to temperature changes, and their price returns may also trend in a directional shift at different lags, with the trend in meat price being more particular. Third, food markets are more strongly affected in the case of extreme temperature anomalies. Many uncertainties still exist regarding the impact of climate change on food markets, and our work serves as a valuable reference for international trade regulation as well as the creation of dynamic climate risk hedging strategies.

Determinants of dietary diversity among children 6-23 months: a cross-sectional study in three regions of Haiti

BACKGROUND

The prenatal, perinatal, postnatal and nutritional (A3PN) support study was a 4-year initiative aimed to reduce maternal mortality in Haiti. A cross-sectional study was developed to collect the baseline data for evaluation purposes of the A3PN. This study aimed to determine the factors contributing to dietary diversity (DD) in Haitian children aged 6-23 months.

METHODS

A cross-sectional study during two seasons (the lean season and the harvest season) was carried out in Haiti to assess the DD of children and their mothers using non-quantitative 24-h recalls. Indicators of DD were minimum dietary diversity for children (MDD-C) and minimum dietary diversity for women (MDD-W). Mid-upper arm circumference was measured in women and children, and food security was assessed using the Household Hunger Scale. Focus groups were also conducted to gain a better understanding of the quantitative findings.

RESULTS

Only 7.3% of the children included in this study met the MDD-C. Factors associated with MDD-C were the season (odds ratio [OR]: 0.141 [0.039-0.513]), land ownership or rental (OR: 4.603 [1.233-17.188]), maternal education (OR: 0.092 [0.011-0.749]), the mother's responsibility for the main or secondary source of income for the household (OR: 2.883 [1.030-8.069]) and her DD (OR: 5.690 [1.916-16.892]). Focus groups revealed the existence of various food restrictions.

CONCLUSIONS

The results indicated that the low prevalence of MDD-C in three regions of study in Haiti is indicative of a serious public health concern that might be further aggravated by local food taboos. They also suggest that to fight against hunger, it is necessary to focus on women's well-being.

The Portuguese economic crisis is associated with socioeconomic and sex disparities on children's health-related behaviors and obesity: A cross-sectional study

OBJECTIVES

Our objective was to examine the relationship between the 2008 and 2015 economic crisis and children's physical activity (PA) outcomes, eating behaviors and obesity prevalence, while considering sex inequalities and familial socioeconomic status.

METHOD

This is a cross-sectional study, including data collected in 2016/2017 among 5134 children aged 6-11 years (mean age: 8.11 ± 1.24; 50.0% boys). Children's height, weight, and waist circumference were objectively measured. Children's sleep- and screen-time, participation in organized sports, and specific dietary habits were reported parental-reported using a standardized questionnaire. An economic crisis impact score, with data from 10 indicators of economic needs in the family, was used to characterize the crisis' impact.

RESULTS

First, the prevalence of overweight and obesity was higher in children whose families had a higher impact of the crisis. Second, children's intake of fruit and high-fat food, screen-time, sleep-time, and participation in organized sports differed according to the level of impact of the economic crisis. Third, the association between health-related behaviors and the impact of the economic crisis was stronger for girls compared to boys.

CONCLUSION

Our findings give us an indication of how economic crises may drive changes in health outcomes.

Poor diet quality evaluated with the China Healthy Diet Index in Chinese tuberculosis patients

OBJECTIVE

The purpose of this study was to compare and evaluate the diet quality of tuberculosis patients and healthy adults by using the China Healthy Diet Index (CHDI) and to provide guidance for the diet of tuberculosis patients in the future.

METHODS

A case-control study of 1241 patients and 1241 healthy individuals matchedfor sex and age. The CHDI was used to score the overall diet quality of patients in the casegroup and the control group.

RESULTS

The CHDI score of tuberculosis patients was 61.61 and that of healthy controls was 63.97. After adjustment for confounders, participants with >80 on CHDI were 73.5% less likely to develop tuberculosis than participants with <51 (OR: 0.265, 95% CI: 0.086, 0.813, p < 0.05). In the original model, the CHDI scores in the highest range were inversely associated with tuberculosis risk compared with the lowest range (OR: 0.687, 95% CI: 0.420,1.122, p < 0.001). After adjusting for confounders, the CHDI score was significantly associated with a reduced risk of tuberculosis (OR: 0.265, 95% CI: 0.086, 0.813, p < 0.001). After adjusting for confounders, a high-quality diet was positively correlated with anti-tuberculosis treatment outcomes (OR:0.957, 95% CI: 0.918,0.998, p = 0.039).

CONCLUSION

Compared with healthy adults, tuberculosis patients have poor diet quality with unreasonable diet structure. The insufficient intake of whole grains, vegetables, beans, aquatic products, meat and eggs and the excessive intake of pure energy food and solid fat suggests that the dietary structure of tuberculosis patients was unreasonable. This study provides an idea of the diet structure of tuberculosis patients.

Using Household Expenditure Surveys for Comparable and Replicable Nutritional Analysis: Evidence from México

In this study, we explore how to use household expenditures and income surveys (HEIS) to provide replicable and comparable measures of nutrients availability at the population level. Our method formalizes the common practice in the literature and consists of three steps: identification of relevant food categories, pairing of food contents food groups in HEIS data, and calculation of the typical amount of nutrients by food group. We illustrate the usage of the method with Mexican data and provide a publicly available data set to readily convert food purchases into six nutrients: calories, proteins, vitamins A and C, iron, and zinc. We perform a descriptive analysis of the evolution of nutrients intake among Mexican households between 2008 and 2020, considering differences by income level. Our results reflect the effect of the COVID-19 pandemic on nutrient availability in Mexican households, mainly driven by a substantial reduction in the expenditure in food consumed away from home, although for most nutrients the trend was stable over most of the period.

Food spending in the United States during the first year of the COVID-19 pandemic

The COVID-19 pandemic brought about a significant increase in the unemployment rate and a decline in consumer income. At the same time, the public health responses to the pandemic, such as lockdowns and business closures, disrupted the food supply chain. These pandemic-driven changes could lead to a shift in food spending behaviors and potentially exacerbate the food insecurity situation. Leveraging the nationally representative dataset from the 2017-2020 consumer expenditure surveys, we employ a two-part model to assess the changes in weekly household spending on total food, food-at-home (FAH), and food-away-from-home (FAFH) between the pre-pandemic and pandemic period in the United States. Our finding shows a predicted marginal decline in FAFH expenditure by 33.7% but an increase in FAH spending by 6.9% during the pandemic. The increase in FAH spending could not fully offset the decrease in FAFH spending, leading to a decline in total food spending by 12.6%. The results could provide a basis for future studies on food insecurity, nutrient intake, and healthy consumption during the pandemic.

Association of Household Food Insecurity With Dietary Intakes and Nutrition-Related Knowledge, Attitudes, and Practices Among School-Aged Children in Gaza Strip, Palestine

Background

The present study aimed to determine the association of household food insecurity with dietary intakes and nutrition-related knowledge, attitudes, and practices (KAP) among school-aged children.

Methods

This cross-sectional study was conducted among a representative sample of school-aged children. A total of 380 children and their parents were selected from all Gaza strip governorates, using a random sampling method. The demographic and socioeconomic characteristics; the Radimer/Cornell food security scale; two non-consecutive days of 24-h dietary recall; anthropometric measurements; and the Food and Agriculture Organization KAP-questionnaire (Module 3) were employed. Statistical analysis was performed using SPSS version 25.

Results

About 71.6% of school-aged children were household food-insecure, while 28.4% were household food-secure. Significant associations were found between living area, educational level, household monthly income, weight for age and BMI for age z-scores, underweight, malnutrition status, intakes of protein, iron, vitamin D, and zinc among household food-secure, and household food-insecure. After adjustment for confounding variables, having nutrition-related adequate KAP were associated with lower odds of being food-insecure household [OR = 0.519, 95% (CI = 0.320–0.841)], [OR = 0.510, 95% CI = (0.315–0.827)], and [OR = 0.466, 95% CI = (0.285–0.763), P < 0.05 for all], respectively.

Conclusions

Low socioeconomic status, low anthropometric indices, poor dietary intakes may be associated with a high level of food-insecurity; while having nutrition-related adequate KAP may be protective against food-insecurity among school-aged children.

Evaluating the regional risks to food availability and access from land-based climate policies in an integrated assessment model

Mitigating greenhouse gas emissions is necessary to reduce the overall negative climate change impacts on crop yields and agricultural production. However, certain mitigation measures may generate unintended consequences to food availability and food access due to both land use competition and economic burden of mitigation. Integrated assessment models (IAM) are generally used to evaluate these policies; however, currently these models may not capture the importance of income and food prices for hunger and overall economic wellbeing. Here, we implement a measure of food security that captures the nutritional and economic aspects as the total expenditures on staple foods divided by income and weighted by total caloric consumption in an IAM, the global change analysis model (GCAM4.0). We then project consumer prices and our measure of food security along the shared socioeconomic pathways. Sustained economic growth underpins increases in caloric consumption and lowering expenditures on staple foods. Strict conservation policies affect food accessibility in a larger number of developing countries, whereas the negative effects of pricing terrestrial emissions are more concentrated on the poor in Sub-Saharan Africa, by substantially replacing their cropland with forests and affecting the production of key staples.

Moderators of Food Insecurity and Diet Quality in Pairs of Mothers and Their Children

Research has suggested that maternal diet and characteristics may influence the diet of offspring during childhood. The present cross-sectional study aimed to assess the influence of distinct maternal characteristics and the diet quality of mothers on the prevalence of household food insecurity (FI) and the diet quality of children. A total of 179 mother–child pairs were recruited from two primary schools in the metropolitan area of Thessaloniki. The children were aged between 10 and 12 years old. Diet quality was assessed as the level of adherence to the Mediterranean diet (MD), with the use of the KIDMED for the children and the MedDietScore for the mothers. The household FI and the social and demographic characteristics of the mothers were also recorded, and anthropometric measures of both the mothers and their children were collected. Approximately ¼ (26.3%) of the pairs reported some degree of FI, with a greater prevalence (64.7%) within single-mother families. Moreover, FI affected the level of maternal MD adherence (p = 0.011). On the other hand, FI was decreased in households with a greater maternal educational level (OR: 0.25; 95% CI: 0.10–0.63) and conjugal family status (OR: 0.15; 95% CI: 0.87–0.52). Maternal adherence to the MD was inversely related to the respective adherence of their offspring (OR: 0.93; 95% CI: 0.86–0.997), suggesting that during periods of financial constraints, maternal diet quality is compromised at the expense of affording a better diet for the minors in the family.

Infant Mortality and Inflation in China: Based on the Mixed Frequency VAR Analyses

Reducing neonatal mortality is an important goal in the Sustainable Development Goals (SDGs), and with the outbreak of the new crown epidemic and severe global inflation, it is extremely important to explore the relationship between inflation and infant mortality. This paper investigates the causal relationship between inflation and infant mortality using a mixed frequency vector autoregressive model (MF-VAR) without any filtering procedure, along with impulse response analysis and forecast misspecification variance decomposition, and compares it with a low frequency vector autoregressive model (LF-VAR). We find that there is a causal relationship between inflation and infant mortality, specifically, that is inflation increases infant mortality. Moreover, the contribution of CPI to IMR is greater in the forecast error variance decomposition in the MF-VAR model compared to the LF-VAR model, indicating that CPI has stronger explanatory power for IMR in mixed-frequency data. The results of the study have important implications for China and other developing countries in reducing infant mortality and achieving the Sustainable Development Goals (SDGs). Policymakers should focus on inflation as a macroeconomic variable that reduces the potential negative impact of inflation on infant mortality. The results of the analysis further emphasize the importance of price stability in the context of global inflation caused by the outbreak of the coronavirus pandemic outbreak.

Household food insecurity, maternal nutrition, environmental risks and infants' health outcomes: protocol of the IMPALA birth cohort study in Uganda

INTRODUCTION

In low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of societies remains a major concern in LMICs. Biomass fuel use for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that early life nutritional and environmental exposures and their effect on infant lung function are important; however, data from sub-Saharan Africa are scarce.

AIM

To estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity.

METHODS AND ANALYSIS

Pregnant women will be recruited in an existing Health and Demographic Surveillance Site in South-West Uganda. Household food insecurity, sources and uses of energy, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. Primary health outcomes will be infant lung function determined by tidal breath flow and volume analysis at 6-10 weeks of age. Infant weight and length will also be collected.A household Food Consumption Score and Minimum Dietary Diversity for Women (MDD-W) indicator will be constructed. The involved cost of dietary diversity will be estimated based on MDD-W. The association between household level and mothers' food access indicators and infant lung function will be evaluated using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of households' environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models.

ETHICS AND DISSEMINATION

Ethical approvals have been obtained from Liverpool School of Tropical Medicine (18-059), the Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and Technology (SS 4846). Study results will be shared with participants, policy-makers, other stakeholders and published in peer-reviewed journals.

Comparative metabolomic and transcriptomic analysis reveals a coexpression network of the carotenoid metabolism pathway in the panicle of Setaria italica

BACKGROUND

The grains of foxtail millet are enriched in carotenoids, which endow this plant with a yellow color and extremely high nutritional value. However, the underlying molecular regulation mechanism and gene coexpression network remain unclear.

METHODS

The carotenoid species and content were detected by HPLC for two foxtail millet varieties at three panicle development stages. Based on a homologous sequence BLAST analysis, these genes related to carotenoid metabolism were identified from the foxtail millet genome database. The conserved protein domains, chromosome locations, gene structures and phylogenetic trees were analyzed using bioinformatics tools. RNA-seq was performed for these samples to identify differentially expressed genes (DEGs). A Pearson correlation analysis was performed between the expression of genes related to carotenoid metabolism and the content of carotenoid metabolites. Furthermore, the expression levels of the key DEGs were verified by qRT-PCR. The gene coexpression network was constructed by a weighted gene coexpression network analysis (WGCNA).

RESULT

The major carotenoid metabolites in the panicles of DHD and JG21 were lutein and β-carotene. These carotenoid metabolite contents sharply decreased during the panicle development stage. The lutein and β-carotene contents were highest at the S1 stage of DHD, with values of 11.474 μg /100 mg and 12.524 μg /100 mg, respectively. Fifty-four genes related to carotenoid metabolism were identified in the foxtail millet genome. Cis-acting element analysis showed that these gene promoters mainly contain 'plant hormone', 'drought stress resistance', 'MYB binding site', 'endosperm specific' and 'seed specific' cis-acting elements and especially the 'light-responsive' and 'ABA-responsive' elements. In the carotenoid metabolic pathways, SiHDS, SiHMGS3, SiPDS and SiNCED1 were more highly expressed in the panicle of foxtail millet. The expression of SiCMT, SiAACT3, SiPSY1, SiZEP1/2, and SiCCD8c/8d was significantly correlated with the lutein content. The expression of SiCMT, SiHDR, SiIDI2, SiAACT3, SiPSY1, and SiZEP1/2 was significantly correlated with the content of β-carotene. WGCNA showed that the coral module was highly correlated with lutein and β-carotene, and 13 structural genes from the carotenoid biosynthetic pathway were identified. Network visualization revealed 25 intramodular hub genes that putatively control carotenoid metabolism.

CONCLUSION

Based on the integrative analysis of the transcriptomics and carotenoid metabonomics, we found that DEGs related to carotenoid metabolism had a stronger correlation with the key carotenoid metabolite content. The correlation analysis and WGCNA identified and predicted the gene regulation network related to carotenoid metabolism. These results lay the foundation for exploring the key target genes regulating carotenoid metabolism flux in the panicle of foxtail millet. We hope that these target genes could be used to genetically modify millet to enhance the carotenoid content in the future.

Assessment of the obesogenic environment in primary schools: a multi-site case study in Jakarta

BACKGROUND

Childhood overweight and obesity have increasingly been recognized as a significant global public health crisis, including in Asia. This study aimed to assess the obesogenic environment in primary schools in Jakarta, Indonesia.

METHODS

A qualitative, multi-site, case study design was used to capture different elements of the school environment and policies related to obesity, with a focus on nutrition and physical activity. An adaptation of the Primary School Environmental Assessment tool was used. Six primary schools in Jakarta were purposively selected based on their location, socioeconomic status, and type (public or private). In addition to direct observation at each school, interviews were conducted with the principal, physical education teacher, canteen staff, street food vendors, and students.

RESULTS

Among the six schools, two were private and four were public. The most popular foods consumed by students were unhealthy, such as deep-fried foods and sugar-sweetened beverages. Students had easy and constant access to unhealthy foods, whereas only limited variation of healthy foods were available in the school canteen. Some schools also allowed the student to have access to street food vendors. School policies related to healthy eating and physical activities had been implemented, mainly in the form of teaching these topics as part of the school curriculum. However, promotion of healthy eating and physical activities by the schools was still limited.

CONCLUSIONS

This study showed the usefulness of the Primary School Environmental Assessment tool in identifying obesogenic factors in urban area of Indonesia. Effective implementation of guidelines to foster good nutritional practices and healthy lifestyles at school should be prioritized to improve the health and nutritional status of the students.

Consumer experiences of food environments during the Covid-19 pandemic: Global insights from a rapid online survey of individuals from 119 countries

This study investigates consumer experiences of food environments and food acquisition practices during the Covid-19 pandemic. Our rapid assessment online survey featured a convenience sample of 2015 individuals from 119 countries, spanning Western Europe, North America, Latin America, Asia-Pacific, and Africa. Data collection took place in April 2020 during the second month of the pandemic. Participants were recruited via existing networks of the United Nations System Standing Committee on Nutrition, through social media, and by snowballing. The majority of participants were female (71.9%), from low- and middle-income countries (51.0%), and working in nutrition or healthcare (39.3%). Qualitative thematic analysis and descriptive statistics reveal a series of common global experiences related to food availability and accessibility, food prices and affordability, food acquisition practices, and food preparation and consumption. The importance of community food participation, food sharing, and resource allocation are highlighted, along with increasing awareness of healthy diets and food waste. We identify ten synergistic policy entry points to: 1) build resilient and equitable food environments resistant to stresses and shocks; 2) harness positive dietary-related behaviors manifested during the pandemic; and, 3) mitigate the projected nutrition crisis and promote sustainable healthy diets for all.

Evolving Patterns of Nutritional Deficiencies Burden in Low- and Middle-Income Countries: Findings from the 2019 Global Burden of Disease Study

Low- and middle-income countries (LMICs) suffered the most from nutritional deficiencies (NDs). Although decades of efforts have reduced it, little is known about the changing trajectory of ND burden in LMICs. By extracting data of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we calculated indicators of incidence and disability-adjusted life years (DALYs) to measure the burden of NDs and its main subcategories in LMICs, including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, dietary iron deficiency, and other nutritional deficiencies by sex, age and spatial patterns. In LMICs, ND incidence still increased in the age group 15+ born before 2005, especially in males. The effort of reducing the DALYs of NDs has generated a strong decline in per age group. In the main subcategories of NDs, protein-energy malnutrition incidence in males age 45+ born before 1970 still increased. Despite vitamin A deficiency incidence and dietary iron deficiency, DALYs strongly experienced decreases over three decades while still remaining at the heaviest level in 2019, especially in females and children under 5 years. The top largest tendency estimates occurred in Mali' females and Bhutan' males. Zimbabwe was the only country with increased DALYs rate tendency in both sexes.

Dietary Diversity of Women across Agricultural Seasons in the Kapchorwa District, Uganda: Results from a Cohort Study

Small-holder farm households in developing countries mainly depend on rain-fed agriculture activities, thus seasonality affects eating habits and contributes to micronutrient deficiencies. This study assessed women’s dietary diversity score (WDDS) across three agricultural seasons in the Kapchorwa District, Uganda. In each season, 445 women with under five-year-old children from small-holder farm households were interviewed on socio-demographic characteristics as well as dietary practices between May 2016 and January 2017. Linear regression models estimated differences in WDDS across seasons. The mean WDDS at the lean, harvest and post-harvest seasons was 4.33 ± 1.21, 4.63 ± 1.30 and 4.36 ± 1.21, respectively. Mean WDDS was higher in urban regions across all seasons. Women in urban regions generated more income through off-farm activities, had better access to markets and consumed significantly more ‘meat, poultry and fish’ (p < 0.001), dairy products (p < 0.05), ‘vitamin A-rich fruits and vegetables’ (p < 0.001) and ‘other vegetables’ (p < 0.001) during the lean season, whilst rural women ate more dark green leafy vegetables (p < 0.001) during the same period. Poorer households in the rural setting were more likely to be affected by seasonally limited food availability and accessibility. Hence, strengthening the linkages between market participation, agricultural activities, improved food storage and preservation techniques and dietary intake is recommended.

Public Health-Based Policy on Stunting Prevention in Pati Regency, Central Java, Indonesia

BACKGROUND: In Indonesia, the Law on Long-Term Development Goals and the implementing regulations, namely the Health Law and the Food Law and their implementing regulations have stipulated nutritional adequacy for all ages including toddlers to prevent stunting. However, stunting still occurs, including in Pati Regency, Central Java Province. AIM: This research aims to know and evaluate the stunting program from the Pati Regency, Province of Central Java, Indonesia and to found the solution. METHODS: This is empirical (non-doctrinal) legal research which aims to analyze the public health-based local government policy in tackling the stunting problem in Pati Regency. RESULTS: The results of the study indicate that there are eight stages of convergence actions from the public health-based local government policies to accelerate stunting prevention in the Pati Regency. However, the stunting prevention policy as a form of legal protection for children has not succeeded in reducing the stunting prevalence rate in this regency. CONCLUSION: The conclusion of this research is beneficial to become an input for the Pati Regency Government, Central Java Provincial Government in formulating and evaluating stunting prevention policies in their areas.

COVID-19 and women's nutrition security: panel data evidence from rural India

In response to the COVID-19 pandemic, India implemented a stringent nationwide lockdown. Although food value chains and allied activities were exempted from the lockdown, there were widespread disruptions in food access and availability. Using two panel-datasets, we distinguish the pandemic's impact on non-staples versus staples in relation to household food availability and women's diet diversity at the national, state, and district levels in four economically backward districts of Uttar Pradesh (Maharajganj), Bihar (Munger), and Odisha (Kandhamal and Kalahandi). Both the primary and secondary data indicate a decline in household food expenditures and women's dietary diversity in May 2020 compared to May 2019, particularly for non-staples like meats, eggs, vegetables and fruits. This occurred despite special PDS, direct benefit transfer, and ration from aanganwadis rations reaching 80%, 50%, and 30% of surveyed households, respectively. While national and state-level expenditures recovered to the pre-lockdown levels by June 2020, the district-level expenditures did not recover. Our findings contribute to the growing body of evidence of women's disproportionate vulnerability to economic shocks, the impact of a staple grain focused safety net program, and restricted markets on the access and availability of diverse nutritious foods. This paper makes a case for policy reforms towards PDS diversification to include nutrition-rich foods and market reforms to remove supply-side bottlenecks and expansion of direct benefit transfers for healthy food access. We also highlight the importance of gender-responsive safety nets and their increased coverage for improving intrahousehold nutritional disadvantages.

Global variation in the cost of a nutrient-adequate diet by population group: an observational study

BACKGROUND

Nutrient deficiencies limit human development and could be caused by the high cost of locally available foods needed to meet nutrient requirements. We aimed to identify the populations whose nutrient needs are most difficult to meet with existing global food systems.

METHODS

In this observational study, we used the International Comparison Program 2017 collection of global food prices to measure cost per day and cost per calorie of meeting nutrient needs, based on least-cost diets within upper and lower bounds for energy and 20 nutrients for healthy populations across 20 demographic groups in 172 countries. We then analysed the composition of these least-cost diets by food groups to estimate how the affordability of foods for meeting nutrient needs varied by age, sex, and reproductive status.

FINDINGS

In 2017, the global median of diet costs per day was US$2·32 (IQR 1·95-2·76), with cost highest for adolescent boys aged 14-18 years at $2·72 (2·31-3·15). For females, median cost was highest for adolescents aged 14-18 years during pregnancy and lactation at $2·64 (2·29-3·15), exceeding the cost for adult men aged 19-30 years. The global median of diet cost per 1000 kcal was $0·94 (IQR 0·80-1·12), and was higher for females throughout the life course than for males, peaking for adolescent girls aged 9-13 years ($1·17 [95% CI 1·15-1·19]) and women older than 70 years ($1·18 [1·17-1·19]). Diet costs were most sensitive to requirements for calcium, iron, zinc, and vitamins C and E, as well as the upper bounds on carbohydrates and sodium. Total diet costs per day did not vary significantly with national income; however, in high-income countries, the composition of least-cost diets included more animal-source foods, whereas in low-income countries, diets with more pulses, nuts and seeds, and fruits and vegetables provided the most affordable way to meet nutrient requirements.

INTERPRETATION

Diets with adequate nutrients were unaffordable for many demographic groups, especially women and girls. These results could help to guide agriculture and food policy or transfer programmes to support populations at risk of inadequate intake.

FUNDING

The Bill & Melinda Gates Foundation and UKAid.

Coştei Hydrographic Diversion Node, a Historical Environment Quality and Biological Resources Accessibility Game Changer; Anthropogenic Induced Problems and Sustainable Solutions ‒ An Ichthyologic Perspective

26 fish species were affected by the Coştei historical diversion hydrotechnical system build in 1758. In order to mitigate the negative effects produced by this hydrotechnical work on the fish, a migration system, of nature-like meandering by pass type was proposed. The dimensions of this channel and the slope of about 2% allow fish, and other aquatic organisms to move upstream and downstream of the spillway.

Reverse thinking: taking a healthy diet perspective towards food systems transformations

Food systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.

Stunting Prevention Policy as a Form of Child Health Rights Legal Protection

AIM: The objectives of this research are to reveal and to analyze the stunting prevention policy as a form of legal protection for children’s health rights (HR). METHODS: This type of research is a normative legal research approach to the legislation approach and conceptual approach. RESULTS: The results of the study show that stunting prevention policy as a form of legal protection for child HR has not been able to reduce the number of stunting. The high prevalence of stunting as evidence of the government’s failure in legal protection against the problem of malnutrition. Ignoring children’s rights is a form of HR violations committed by the state. CONCLUSION: Need to regulate the law related to stunting as a manifestation of state responsibility in upholding children’s rights. Prevention and handling of stunting are carried out holistically in various sectors with commitment and synergy between the central/regional government, parents, family, and community.

Elucidating the Macroeconomic Determinants of Undernourishment in South Asian Countries: Building the Framework for Action

Undernourishment is a big challenge for humanity across the world. Considering the significance of reducing undernourishment, the current study focuses on exploring the macroeconomic determinants of undernourishment in the South Asian panel. The study employed econometric models that are more robust to underpin cross-sectional dependency and heterogeneity in a panel data set. The overall findings reveal that an increase in food production increases undernourishment and infer that food availability at the national level is insufficient to reduce undernourishment unless poor people also had economic and physical access to food. In the case of economic growth and governance, the results are negatively significant in some countries. The results infer that GDP and quality of governance are nuanced in declining the rate of undernourishment in some countries, while in other countries where the results are found insignificant, the government should seek other interventions to curtail the prevalence of undernourishment. Unexpectedly, an increase in food prices lessens the undernourishment in developing countries that reflect that food prices might transform the dietary patterns of poor people from nutrient-rich foods to nutrient-poor staples, thus lead to undernourishment reduction but trigger overweight and obesity alongside. In conclusion, the results depict that policymakers should devise strategies keeping in view fundamental aspects of the country to reduce undernourishment.

Understanding Pathways Between Agriculture, Food Systems, and Nutrition: An Evidence and Gap Map of Research Tools, Metrics, and Methods in the Last 10 Years

New tools, metrics, and methods in agriculture, food systems, and nutrition (A&N) research proliferated in the decade following the 2007-2008 food price crisis. We map these developments across themes derived from conceptual A&N pathways and expert consultations. We created an interactive Evidence and Gap Map (EGM) from a systematic search of published and gray literature since 2008, following Campbell Collaboration guidelines. We retrieved over 30,000 reports from published literature databases, and individually searched 20 online repositories. We systematically screened 24,359 reports by title and/or abstract, 1577 by full report, and included 904 eligible reports. The EGM consists of rows of thematic domains and columns of types of tools, metrics, and methods, as well as extensive coding applied as filters. Each cell of the map represents research surrounding a type of tool, metric, or method within a given theme. Reports in each cell are grouped by stage of development, which expand to a corresponding bibliography. Users can filter EGM reports by various characteristics. The 4 most populated domains were: diets, nutrition, and health; primary food production; water, sanitation, and hygiene; and environment and sustainability. The 4 most common types of metrics, methods, and tools were: diet metrics; footprint analysis (especially water); technology applications; and network or Bayesian analysis. Gaps represent areas of few or no reports of innovation between 2008 and 2018. There were gaps in reports and innovations related to: power or conflicts of interest; food environments; markets; private sector engagement; food loss and waste; conflict; study design and system-level tools, metrics, and methods. The EGM is a comprehensive tool to navigate advances in measurement in A&N research: to highlight trends and gaps, conduct further synthesis and development, and prioritize the agenda for future work. This narrative synthesis accompanies the EGM, which can be found at https://www.anh-academy.org/evidence-and-gap-map.

The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries

The economic crisis and food and health system disruptions related to the COVID-19 pandemic threaten to exacerbate undernutrition in low- and middle-income countries (LMICs). We developed pessimistic, moderate and optimistic scenarios for 2020-2022 and used three modelling tools (MIRAGRODEP, the Lives Saved Tool and Optima Nutrition) to estimate the impacts of pandemic-induced disruptions on child stunting, wasting and mortality, maternal anaemia and children born to women with a low body mass index (BMI) in 118 LMICs. We estimated the cost of six nutrition interventions to mitigate excess stunting and child mortality due to the pandemic and to maximize alive and non-stunted children, and used the human capital approach to estimate future productivity losses. By 2022, COVID-19-related disruptions could result in an additional 9.3 million wasted children and 2.6 million stunted children, 168,000 additional child deaths, 2.1 million maternal anaemia cases, 2.1 million children born to women with a low BMI and US$29.7 billion in future productivity losses due to excess stunting and child mortality. An additional US$1.2 billion per year will be needed to mitigate these effects by scaling up nutrition interventions. Governments and donors must maintain nutrition as a priority, continue to support resilient systems and ensure the efficient use of new and existing resources.

Short-term impacts of COVID-19 on food security and nutrition in rural Guatemala: Phone-based farm household survey evidence

This article examines the short-term effects of the COVID-19 lockdown on food security and nutrition in rural Guatemala. We rely on a comprehensive panel dataset of 1,824 small agricultural households collected over two survey rounds, on November-December 2019 and May-June 2020. We place special emphasis on changes in agricultural and nonagricultural income sources, including remittances, and changes in dietary diversity, including consumption of animal source foods (ASF) and fruits and vegetables (F&V). We find that COVID-19 affected the incomes, food security, and dietary patterns of households, with a decrease in ASF diversity and an increase in F&V diversity, and an overall net decrease in dietary diversity across all food groups. Dietary diversity among women in reproductive age, however, remained unchanged, and increased among children under 2 years old. Interestingly, households with relatively higher incomes appear to have reduced their dietary diversity to a larger extent than lower income ones, as well as households located in communities with more severe access restrictions. The focus of the study in a region with a high prevalence of poverty and chronic malnutrition provides an important perspective into the consequences of the lockdown in complex rural contexts with vulnerable populations and contributes to inform eventual recovery measures.

Impacts of the 2008 Great Recession on dietary intake: a systematic review and meta-analysis

Background

The 2008 Great Recession significantly impacted economies and individuals globally, with potential impacts on food systems and dietary intake. We systematically reviewed evidence on the impact of the Great Recession on individuals’ dietary intake globally and whether disadvantaged individuals were disproportionately affected.

Methods

We searched seven databases and relevant grey literature through June 2020. Longitudinal quantitative studies with the 2008 recession as the exposure and any measure of dietary intake (energy intake, dietary quality, and food/macronutrient consumption) as the outcome were eligible for inclusion. Eligibility was independently assessed by two reviewers. The Newcastle Ottawa Scale was used for quality and risk of bias assessment. We undertook a random effects meta-analysis for changes in energy intake. Harvest plots were used to display and summarise study results for other outcomes. The study was registered with PROSPERO (CRD42019135864).

Results

Forty-one studies including 2.6 million people met our inclusion criteria and were heterogenous in both methods and results. Ten studies reported energy intake, 11 dietary quality, 34 food intake, and 13 macronutrient consumption. The Great Recession was associated with a mean reduction of 103.0 cal per adult equivalent per day (95% Confidence Interval: − 132.1, − 73.9) in high-income countries (5 studies) and an increase of 105.5 cal per adult per day (95% Confidence Interval: 72.8, 138.2) in middle-income countries (2 studies) following random effects meta-analysis. We found reductions in fruit and vegetable intake. We also found reductions in intake of fast food, sugary products, and soft drinks. Impacts on macronutrients and dietary quality were inconclusive, though suggestive of a decrease in dietary quality. The Great Recession had greater impacts on dietary intake for disadvantaged individuals.

Conclusions

The 2008 recession was associated with diverse impacts on diets. Calorie intake decreased in high income countries but increased in middle income countries. Fruit and vegetable consumption reduced, especially for more disadvantaged individuals, which may negatively affect health. Fast food, sugary products, and soft drink consumption also decreased which may confer health benefits. Implementing effective policies to mitigate adverse nutritional changes and encourage positive changes during the COVID-19 pandemic and other major economic shocks should be prioritised.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01125-8.

Prevalence and predictors of birth preparedness and complication readiness in the Kassena-Nankana district of Ghana: an analytical cross-sectional study

OBJECTIVES

To assess birth preparedness and complication readiness (BPACR) and associated factors among mothers who had given birth in the past 12 months prior to the study.

DESIGN

An analytical cross-sectional study.

SETTING

The study was carried out in the rural areas of Kassena-Nankana district located in the Upper East Region of Ghana.

PARTICIPANTS

The study population comprised 600 postpartum women who had delivered within the last 12 months prior to the study.

PRIMARY OUTCOME MEASURE

The primary outcome measure was BPACR.

RESULTS

The prevalence of BPACR among recently delivered women was very low as less than 15% were able to mention at least three of the five basic components of birth preparedness/complication readiness that were fulfilled. After adjustment for confounding effect using multivariable logistic regression analysis, high educational level (adjusted OR (AOR)=3.40 (95% CI: 1.88 to 6.15)), better knowledge about obstetric danger signs during pregnancy (AOR=4.88 (95% CI: 2.68 to 8.90)), older women (≥35 years) (AOR=2.59 (95% CI: 1.11 to 6.02)), women of low household wealth index (AOR=4.64 (95% CI: 1.97 to 10.91)) and women who received lower content of antenatal care services (AOR=3.34 (95% CI: 1.69 to 6.60)) were significant predictors of BPACR.

CONCLUSION

This study concludes that BPACR practices were low. High educational attainment of the woman, having adequate knowledge about obstetric danger signs during pregnancy, older women (≥35 years) and women of low household wealth index were significant predictors of BPACR. The predictors identified should be given high priority by health authorities in addressing low prevalence of BPACR.

Determinants of dietary diversity and its relationship with the nutritional status of pregnant women

There is little information regarding factors that determine dietary diversity among pregnant women in Ghana. The present study, therefore, sought to assess the independent predictors of dietary diversity and its relationship with nutritional status of pregnant women in the Northern Region of Ghana. The present study was an analytical cross-sectional survey involving 423 pregnant women in different stages of gestation. The 24-h dietary recall method was used to assess minimum dietary diversity for women (MDD-W), and nutritional status was assessed using mid-upper arm circumference (MUAC) measurements. Binary logistic regression was performed to assess the association between maternal dietary diversity and maternal thinness and a P value of <0⋅05 was considered statistically significant. Of the 423 women, 79⋅9 % (95 % CI 76⋅1, 83⋅7) met the MDD-W and the prevalence of undernutrition among the pregnant women was 26⋅0 %. The analysis showed that women of low household wealth index were 48 % less likely (AOR 0⋅52, CI 0⋅31, 0⋅88) of meeting the MDD-W, whereas women from households of poor food insecurity were 88 % less likely (AOR 0⋅12, CI 0⋅05, 0⋅27) of achieving the MDD-W. Women of low household size were three times more likely of meeting the MDD-W (AOR 3⋅07, CI 1⋅13, 8⋅39). MDD-W was not associated with maternal underweight during pregnancy. In conclusion, the results of the present study showed that food insecurity and not low MDD-W, associated with mothers' thinness (underweight) during pregnancy in peri-urban setting of Northern Ghana.

The importance of food systems and the environment for nutrition

Global and local food system transformation is necessary in order to ensure the delivery of healthy, safe, and nutritious foods in both sustainable and equitable ways. Food systems are complex entities that affect diets, human health, and a range of other outcomes including economic growth, natural resource and environmental resiliency, and sociocultural factors. However, food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability. Although there has been increased focus on this topic in recent years, many gaps in our knowledge persist on the relation between environmental factors, food systems, and nutritional outcomes. In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation.