Let food be thy medicine:linking local food and health systems to address the full spectrum of malnutrition in low-income and middle-income countries

Hippocrates (fifth century BCE), the father of medicine and namesake of the Oath many medical students swear by to this day, was among the first to recognise the centrality of diet in disease prevention and treatment. In that Oath, the statement, ‘I will apply dietetic measures for the benefit of the sick according to my ability and judgement’, comes before statements about drugs and surgery. Unfortunately, the importance of diet and nutrition in medicine is lost in most discussions of health system reform today, especially in low-income and middle-income countries (LMICs).Moreover, few food system researchers and policymakers consider the myriad opportunities for improving health through forging partnerships between local food, agriculture and health systems.<br/

Challenges and opportunities for increasing the effectiveness of food reformulation and fortification to improve dietary and nutrition outcomes

Reformulation, a change to a food or beverage’s processing or composition, can reduce potentially harmful ingredients such as salt, added sugar, and saturated and trans fats or increase potentially beneficial ingredients or nutrients such as fiber, protein, and micronutrients. Poor nutrition and health outcomes of populations have stimulated programs and policies to reduce the intake of salt, added sugar, and unhealthy fats and increase healthy nutrients and ingredients to meet recommended targets of a healthy diet. Alongside promoting the consumption of whole, nutritious foods (e.g., fruits, vegetables, and whole grains), reformulation, including fortification of processed foods, has been utilized by food industry manufacturers to contribute to improving diets and aligning with national dietary guidelines. This paper summarizes a literature review and twenty semistructured interviews with experts on food product reformulation and fortification to highlight the challenges, limitations, and opportunities for increasing their effectiveness. While studies have shown that reformulation could have beneficial public health impacts, such as iodized salt, there are a dearth of rigorous evaluations, particularly for some types of reformulations. Importantly, some evidence suggests that ultra-processing has significant adverse health effects independently of nutrient adequacy. To improve population health, reformu­ lation should be complemented with a range of approaches, including food taxes and subsidies, public food procurement, restrictions on food advertising and marketing, front-of-pack labeling, and changes to food envi­ ronments that improve availability, affordability, and demand for whole and minimally processed foods

Diagnosing the performance of food systems to increase accountability toward healthy diets and environmental sustainability

To reorient food systems to ensure they deliver healthy diets that protect against multiple forms of malnutrition and diet-related disease and safeguard the environment, ecosystems, and natural resources, there is a need for better governance and accountability. However, decision-makers are often in the dark on how to navigate their food systems to achieve these multiple outcomes. Even where there is sufficient data to describe various elements, drivers, and outcomes of food systems, there is a lack of tools to assess how food systems are performing. This paper presents a diagnostic methodology for 39 indicators representing food supply, food environments, nutrition outcomes, and environmental outcomes that offer cutoffs to assess performance of national food systems. For each indicator, thresholds are presented for unlikely, potential, or likely challenge areas. This information can be used to generate actions and decisions on where and how to intervene in food systems to improve human and planetary health. A global assessment and two country case studies—Greece and Tanzania—illustrate how the diagnostics could spur decision options available to countries

Contribution of meat-free days, meat-free meals, and portion sizes to declines in meat consumption in the UK

Understanding behaviours driving recent declines in UK meat consumption is essential for achieving the Climate Change Committee’s 20% reduction target by 2030. This study explored trends in meat-eating days, daily meat-eating meal occasions, and portion size of meat from the National Diet and Nutrition Survey (2008/09-2018/19). Meat consumption was assessed using 4-day food diaries. Trends were assessed with Poisson and linear regression models, while decomposition analysis quantified relative contributions to overall reductions. Meat-eating days decreased from 3.27 (0.04) to 3.03 (0.05) (P &lt; 0.001), daily occasions decreased from 1.24 (0.02) to 1.13 (0.03) (P = 0.01), and portion size decreased from 85.8g (1.85) to 76.1g (1.78) (P &lt; 0.001). Reduction in portion size had the largest impact on total meat consumption (57%), followed by days (37%) and occasions (6%). Our findings suggest smaller meat portions significantly contributed to decreasing UK meat consumption. Dissecting these behaviours can inform interventions to reduce meat consumption, aligning with reduction targets

Micronutrient Deficiencies among Breastfeeding Infants in Tanzania

Infant mortality accounts for the majority of child deaths in Tanzania, and malnutrition is an important underlying cause. The objectives of this cross-sectional study were to describe the micronutrient status of infants in Tanzania and assess predictors of infant micronutrient deficiency. We analyzed serum vitamin D, vitamin B12, folate, and ferritin levels from 446 infants at two weeks of age, 408 infants at three months of age, and 427 mothers three months post-partum. We used log-Poisson regression to estimate relative risk of being deficient in vitamin D and vitamin B12 for infants in each age group. The prevalence of vitamin D and vitamin B12 deficiency decreased from 60% and 30% at two weeks to 9% and 13% at three months respectively. Yet, the prevalence of insufficiency at three months was 49% for vitamin D and 17% for vitamin B12. Predictors of infant vitamin D deficiency were low birthweight, urban residence, maternal education, and maternal vitamin D status. Maternal vitamin B12 status was the main predictor for infant vitamin B12 deficiency. The majority of infants had sufficient levels of folate or ferritin. Further research is necessary to examine the potential benefits of improving infants' nutritional status through vitamin D and B12 supplements.</p

You Say You Want a Data Revolution? Taking on Food Systems Accountability

Dramatic improvements in data availability and quality are needed to meet the challenge of monitoring and analyzing food systems, so that appropriate policies and actions to improve human and planetary health can be identified and data-informed accountability mechanisms put in place to strengthen food systems governance. Studying food systems is complex due to diverse actors and interlinking processes that operate on multiple spatial and temporal scales, and their multiple outcomes, which may be subject to hidden feedback mechanisms and tradeoffs. However, descriptive research to characterize food system components and make comparisons across geography, income groups, and population groups is an important foundation. The first part of this article details a series of critical data gaps and limitations that are currently hindering food systems learning and accountability, also comparing these gaps across regions and income groups. The second part of the article introduces the Food Systems Dashboard, a new data visualization tool that aims to improve access to and usage of food systems-related data, thus strengthening the data value chain and better informing policies and actions intended to improve diets, nutrition, livelihoods, and environmental sustainability

Home gardening improves dietary diversity, a cluster-randomized controlled trial among Tanzanian women

Homestead food production (HFP) programmes improve the availability of vegetables by providing training in growing nutrient-dense crops. In rural Tanzania, most foods consumed are carbohydrate-rich staples with low micronutrient concentrations. This cluster-randomized controlled trial investigated whether women growing home gardens have higher dietary diversity, household food security or probability of consuming nutrient-rich food groups than women in a control group. We enrolled 1,006 women of reproductive age in 10 villages in Pwani Region in eastern Tanzania, split between intervention (INT) and control (CON) groups. INT received (a) agricultural training and inputs to promote HFP and dietary diversity and (b) nutrition and public health counselling from agricultural extension workers and community health workers. CON received standard services provided by agriculture and health workers. Results were analysed using linear regression models with propensity weighting adjusting for individual-level confounders and differential loss to follow up. Women in INT consumed 0.50 (95% CI [0.20, 0.80], p = 0.001) more food groups per day than women in CON. Women in INT were also 14 percentage points (95% CI [6, 22], p = 0.001) more likely to consume at least five food groups per day, and INT households were 6 percentage points (95% CI [-13, 0], p = 0.059) less likely to experience moderate-to-severe food insecurity compared with CON. This home gardening intervention had positive effects on diet quality and food security after 1 year. Future research should explore whether impact is sustained over time as well as the effects of home garden interventions on additional measures of nutritional status.</p

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. Am J Clin Nutr 2020;00:1–10

There's an App for That:Development of an Application to Operationalize the Global Diet Quality Score

BACKGROUND: The global diet quality score (GDQS) is a simple, standardized metric appropriate for population-based measurement of diet quality globally.OBJECTIVES: We aimed to operationalize data collection by modifying the quantity of consumption cutoffs originally developed for the GDQS food groups and to statistically evaluate the performance of the operationalized GDQS relative to the original GDQS against nutrient adequacy and noncommunicable disease (NCD)-related outcomes.METHODS: The GDQS application uses a 24-h open-recall to collect a full list of all foods consumed during the previous day or night, and automatically classifies them into corresponding GDQS food group. Respondents use a set of 10 cubes in a range of predetermined sizes to determine if the quantity consumed per GDQS food group was below, or equal to or above food group-specific cutoffs established in grams. Because there is only a total of 10 cubes but as many as 54 cutoffs for the GDQS food groups, the operationalized cutoffs differ slightly from the original GDQS cutoffs.RESULTS: A secondary analysis using 5 cross-sectional datasets comparing the GDQS with the original and operationalized cutoffs showed that the operationalized GDQS remained strongly correlated with nutrient adequacy and was equally sensitive to anthropometric and other clinical measures of NCD risk. In a secondary analysis of a longitudinal cohort study of Mexican teachers, there were no differences between the 2 modalities with the beta coefficients per 1 SD change in the original and operationalized GDQS scores being nearly identical for weight gain (-0.37 and -0.36, respectively, P &lt; 0.001 for linear trend for both models) and of the same clinical order of magnitude for waist circumference (-0.52 and -0.44, respectively, P &lt; 0.001 for linear trend for both models).CONCLUSION: The operationalized GDQS cutoffs did not change the performance of the GDQS and therefore are recommended for use to collect GDQS data in the future.</p