Can common dietary assessment methods be better designed to capture the nutritional contribution of neglected, forest, and wild foods to diets?

Food systems are the primary cause of biodiversity loss globally. Biodiversity and specifically, the role that wild, forest and neglected and underutilised species (NUS) foods might play in diet quality is gaining increased attention. The narrow focus on producing affordable staples for dietary energy has contributed to largely homogenous and unhealthy diets. To date, evidence to quantify the nutritional contribution of these biodiverse foods is limited. A scoping review was conducted to document the methods used to quantify the contribution of wild, forest and NUS foods. We found 37 relevant articles from 22 different countries, mainly from Africa (45%), the Americas (19%), and Asia (10%). There were 114 different classifications used for the foods, 73% of these were specifically related to wild or forest foods. Most dietary assessments were completed using a single day qualitative or quantitative 24 h open recall (n = 23), or a food frequency questionnaire (n = 12). There were 18 different diet related indicators used, mainly nutrient adequacy (n = 9) and dietary diversity scores (n = 9). Often, no specific nutritionally validated diet metric was used. There were 16 studies that presented results (semi) quantitatively to measure the contribution of wild, forest or NUS foods to dietary intakes. Of these, 38% were aggregated together with broader classifications of 'traditional' or 'local' foods, without definitions provided meaning it was not possible to determine if or to what extend wild, forest of NUS foods were included (or not). In almost all studies there was insufficient detail on the magnitude of the associations between wild, forest or NUS foods and dietary energy or nutrient intakes or the (qualitative) diet recall methodologies that were used inhibited the quantification of the contribution of these foods to diets. A set of six recommendations are put forward to strengthen the evidence on the contribution of wild, NUS, and forest foods to human diets.

Assessing Biodiversity Conditions in Cocoa Agroforests with a Rapid Assessment Method: Outcomes from a Large-Scale Application in Ghana

Cocoa fields in West Africa traditionally kept other tree species to provide shade for cocoa trees and obtain food and other products. Measuring other trees is paramount to monitoring environmental conditions in cocoa agroforests, but it has been difficult to apply at a large scale. This study presents the results of a rapid assessment method applied in Ghana, developed to measure non-cocoa tree characteristics based on easily observed parameters using sample surveys and mapping tools. We collected data from over 8700 cocoa farms and evaluated their biodiversity performance based on 6 indicators classified according to recommended thresholds to benefit biodiversity conditions. Our results show that species richness, shade cover, and potential for tree succession have the lowest proportions of fields with the recommended levels, with variations among regions and districts. The methodological procedure allowed us to identify priority areas and indicators falling behind desirable thresholds, which can inform training and management approaches regarding biodiversity-friendly practices in cocoa fields tailored to the needs of the farmers. The analysis procedure was developed with open-access automated routines, allowing for easy updates and replication to other areas, as well as for other commodities, enabling comparisons at different spatial scales and contributing to monitoring biodiversity over time.

Vegetables for Healthy Diets in Low- and Middle-Income Countries: A Scoping Review of the Food Systems Literature

Background:

Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches.

Methods:

This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps.

Results:

We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is also a research gap on the impacts of different policy and practice interventions (13% of articles) to enable greater vegetable consumption.

Conclusions:

Food system studies necessarily drew on multiple disciplines, methods and metrics to describe, analyze, and diagnose parts of the system. More work is needed across disciplines, across contexts, and across the food system, including understanding interventions and trade-offs, and impacts and change for diets particularly of marginalized population groups. Filling these gaps in knowledge is necessary in order to work toward healthy vegetable-rich diets for everyone everywhere.

Improving Food Systems: A Participatory Consultation Exercise to Determine Priority Research and Action Areas in Viet Nam

With increased burden of malnutrition on global health, there is a need to set clear and transparent priorities for action in food systems at a global and local level. While priority settings methods are available for several adjacent domains, such as nutrition and health policies, setting priorities for food system research has not been documented and streamlined. The challenges involve food systems' multisector, multi-stakeholder and multi-outcome nature. Where data exists, it is not easy to aggregate data from across food system dimensions and stakeholders to make an informed analysis of the overall picture of the food system, as well as current and potential food system trade-offs to inform research and policy. Once research priorities are set, they risk staying on paper and never make their ways to concrete outputs and outcomes. In this paper, we documented and assessed the inclusive process of setting research priorities for a local food system, taking Vietnamese food systems as a case study. From this exercise, we examined how priority setting for food systems research could learn from and improve upon earlier priority setting research practices in other domains. We discussed the lessons for research and policies in local food systems, such as the need for a concrete follow-up plan accompanying the priority setting process.

Dietary agrobiodiversity for improved nutrition and health outcomes within a transitioning indigenous Solomon Island food system

Indigenous food systems of Pacific Small Island Developing Countries contain vast biological and cultural diversity. However, a nutrition transition is underway, characterized by shifts away from traditional diets in favour of imported and modern foods, contributing to some of the highest rates of obesity and Diabetes Type 2 Mellitus in the world. Using a mixed method approach, this study aimed to assess dietary agrobiodiversity’s relationship with nutrition indicators related to diet quality and anthropometrics within the context of the rural and Indigenous food system of Baniata village, located in the Western Province of Solomon Islands (Melanesia). A secondary aim was to evaluate the contribution of agrobiodiversity from the local food system to diet quality. A comprehensive nutrition survey was administered to the women primarily responsible for cooking of randomly selected households (n = 30). Additionally, 14 participatory focus group discussions captured the historical narrative of food system transitions, were hosted over a period of seven days, and included men, women and youth. Dietary intakes of the participants were reported below the estimated average requirement (EAR) for several essential nutrients, including protein (53%), calcium (96.6%), vitamin B1 (86.6%), vitamin B2 (80%), vitamin A (80%), zinc (40%) and fibre (77%). Focus group participants built a timeline of key historical and climatic transitions perceived to be drivers of dietary shifts away from traditional foods and towards imported and processed foods. Participants identified 221 species and varieties of agrobiodiverse foods available for cultivation or wild collection. Based on 24 h diet recalls, 87 were found to be utilised. Participants who consumed foods of a wider diversity of species richness had a higher probability of achieving recommended nutrition intakes and a lower body fat percentage (r2 = 0.205; p = 0.012). Our results suggest a nutrition transition is underway, and strategies harnessing traditional knowledge of nutrient-dense, agrobiodiverse foods can help improve food and nutrition security.

Assessing Diet Quality of Indigenous Food Systems in Three Geographically Distinct Solomon Islands Sites (Melanesia, Pacific Islands)

Indigenous Solomon Islanders, like many living in Pacific Small Island Developing States (PSIDS), are currently experiencing the global syndemic-the combined threat of obesity, undernutrition, and climate change. This mixed-method study aimed to assess nutrition transitions and diet quality by comparing three geographically unique rural and urban indigenous Solomon Islands populations. Participants in rural areas sourced more energy from wild and cultivated foods; consumed a wider diversity of foods; were more likely to meet WHO recommendations of >400g of non-starchy fruits and vegetables daily; were more physically active; and had significantly lower body fat, waist circumference, and body mass index (BMI) when compared to urban populations. Urban populations were found to have a reduced ability to self-cultivate agri-food products or collect wild foods, and therefore consumed more ultra-processed foods (classified as NOVA 4) and takeout foods, and overall had less diverse diets compared to rural populations. Clear opportunities to leverage traditional knowledge and improve the cultivation and consumption of underutilized species can assist in building more sustainable and resilient food systems while ensuring that indigenous knowledge and cultural preferences are respected.

Uptake and impact of priority setting exercises in nutrition research publications

OBJECTIVE

To assess how priority setting exercises for nutrition research are considered in publication.

DESIGN

Cross-sectional design.

SETTINGS

First, a citation analysis of priority setting exercises found in nutrition research until 2019 was conducted. The reasons for citation were extracted from the text of citing papers and the reasons were defined as: (i) acting on the research questions identified as priorities, (ii) acknowledging the priority setting exercise, (iii) using the same method, or (iv) previous knowledge to support evidence. Second, a survey with authors of the priority setting exercises was done to understand priority setters' perspectives on the impact and satisfaction of their work.

PARTICIPANTS

Twenty-one priority setting exercise papers were included. In all, 434 citing papers were found, of which 338 were considered in the citation analysis. A sample of 17 authors representing 13 priority setting exercise papers completed the impact and satisfaction survey.

RESULTS

Half of the priority setting exercise papers were published by 2013. After excluding self-citations (n = 60), the priority setting papers had on average 18 citations. Priority setting exercises had a median of 1 (IQR = 0-1) citing manuscript that acted on the recommendations produced from priority setting exercises. Authors of the priority setting exercises expressed a desire for increased uptake of the results of the priority setting exercises by funding agencies. Key barriers for uptake were identified as challenges in involving stakeholders and the general public for participation in the priority setting exercise.

CONCLUSIONS

Priority settings exercises are important efforts to guide nutrition research toward effective allocation of resources. However, there seems to be a limited consideration of these priority setting exercises in research papers.

A model-based exploration of farm-household livelihood and nutrition indicators to guide nutrition-sensitive agriculture interventions

Assessing progress towards healthier people, farms and landscapes through nutrition-sensitive agriculture (NSA) requires transdisciplinary methods with robust models and metrics. Farm-household models could facilitate disentangling the complex agriculture-nutrition nexus, by jointly assessing performance indicators on different farm system components such as farm productivity, farm environmental performance, household nutrition, and livelihoods. We, therefore, applied a farm-household model, FarmDESIGN, expanded to more comprehensively capture household nutrition and production diversity, diet diversity, and nutrient adequacy metrics. We estimated the potential contribution of an NSA intervention targeting the diversification of home gardens, aimed at reducing nutritional gaps and improving livelihoods in rural Vietnam. We addressed three central questions: (1) Do ‘Selected Crops’ (i.e. crops identified in a participatory process) in the intervention contribute to satisfying household dietary requirements?; (2) Does the adoption of Selected Crops contribute to improving household livelihoods (i.e. does it increase leisure time for non-earning activities as well as the dispensable budget)?; and (3) Do the proposed nutrition-related metrics estimate the contribution of home-garden diversification towards satisfying household dietary requirements? Results indicate trade-offs between nutrition and dispensable budget, with limited farm-household configurations leading to jointly improved nutrition and livelihoods. FarmDESIGN facilitated testing the robustness and limitations of commonly used metrics to monitor progress towards NSA. Results indicate that most of the production diversity metrics performed poorly at predicting desirable nutritional outcomes in this modelling study. This study demonstrates that farm-household models can facilitate anticipating the effect (positive or negative) of agricultural interventions on nutrition and the environment, identifying complementary interventions for significant and positive results and helping to foresee the trade-offs that farm-households could face. Furthermore, FarmDESIGN could contribute to identifying agreed-upon and robust metrics for measuring nutritional outcomes at the farm-household level, to allow comparability between contexts and NSA interventions.

A cross-disciplinary mixed-method approach to understand how food retail environment transformations influence food choice and intake among the urban poor: Experiences from Vietnam

Nutrition insecurity among urban poor in modernizing Asian metropolises is a critical issue. It is well recognized that in urban Asia the poor are food insecure. Across Asia the food retail environment is transforming rapidly, in which supermarkets increasingly replace traditional food vending, like markets and street vendors that the urban poor depend upon. The question is, how these transformations impact the diets of the urban poor? What drives their food choice? What are their daily shopping practices and how does that affect their dietary intake? To investigate this, we developed a cross-disciplinary nutrition and social practices study with a sequential quantitative-qualitative mixed-method design. Building on empirical evidence from Hanoi, Vietnam, the study links (i) food choice and measured dietary intake, with (ii) food retail environment, through (iii) food shopping practices and preferences of 400 women of reproductive age within the context of (iv) their transformative urban lifestyles. Methods included are a retail census with GPS coordinates to map the food retail environment, a household survey, a 24-h diet recall, multi-generation household interviews and shopping trips. We demonstrate that integrated sociological and nutritional perspectives are productive in rapidly generating evidence to comprehend the complex trade-offs between food safety and nutrition in everyday food consumption practices. We describe and reflect on our theoretical mix of dietary intake and social practices research, and our holistic mixed method approach which besides combining quantitative and qualitative methods, also voices the urban poor first hand.

Dietary species richness as a measure of food biodiversity and nutritional quality of diets

Biodiversity is key for human and environmental health. Available dietary and ecological indicators are not designed to assess the intricate relationship between food biodiversity and diet quality. We applied biodiversity indicators to dietary intake data from and assessed associations with diet quality of women and young children. Data from 24-hour diet recalls (55% in the wet season) of n = 6,226 participants (34% women) in rural areas from seven low- and middle-income countries were analyzed. Mean adequacies of vitamin A, vitamin C, folate, calcium, iron, and zinc and diet diversity score (DDS) were used to assess diet quality. Associations of biodiversity indicators with nutrient adequacy were quantified using multilevel models, receiver operating characteristic curves, and test sensitivity and specificity. A total of 234 different species were consumed, of which <30% were consumed in more than one country. Nine species were consumed in all countries and provided, on average, 61% of total energy intake and a significant contribution of micronutrients in the wet season. Compared with Simpson's index of diversity and functional diversity, species richness (SR) showed stronger associations and better diagnostic properties with micronutrient adequacy. For every additional species consumed, dietary nutrient adequacy increased by 0.03 (P < 0.001). Diets with higher nutrient adequacy were mostly obtained when both SR and DDS were maximal. Adding SR to the minimum cutoff for minimum diet diversity improved the ability to detect diets with higher micronutrient adequacy in women but not in children. Dietary SR is recommended as the most appropriate measure of food biodiversity in diets.