Global dietary quality, undernutrition and non-communicable disease: a longitudinal modelling study

OBJECTIVES: To determine the relationship between global dietary energy availability and dietary quality, and nutrition-related health outcomes. // DESIGN: A worldwide longitudinal modelling study using country-level data. Data on total dietary energy availability and dietary energy from 10 distinct food groups (as a proxy for dietary quality) were obtained from the FAO Food Balance Sheets database. Indicators of development were abstracted from the World Bank's World Development Indicators database. Data on nutrition and health outcomes were taken from the WHO mortality database and major cross-country analyses. We investigated associations of energy availability from food groups and health and nutrition outcomes in the combined data set using mixed effects models, while adjusting for measures of development. // POPULATION: 124 countries over the period 1980–2009. // MAIN OUTCOME MEASURES: Prevalence of stunting in children under 5 years and mortality rate from ischaemic heart disease (IHD) in adults aged 55+ years. // RESULTS: From 1980 to 2009, global dietary energy availability increased, and rates of child stunting and adult IHD mortality declined. After adjustment for measures of development, increased total dietary energy availability was significantly associated with reduced stunting rates (−0.84% per 100 kcal increase in energy, 95% CI −0.97 to −0.72) and non-significantly associated with increased IHD mortality rates (by 4.2 deaths per 100 000/100 kcal increase, 95% CI −1.85 to 10.2). Further analysis demonstrated that the changing availability of energy from food groups (particularly fruit, vegetables, starchy roots, meat, dairy and sugar) was important in explaining the associations with health outcomes. // CONCLUSIONS: Our study has demonstrated that by combining large, publicly available data sets, important patterns underlying trends in diet-related health can be uncovered. These associations remain even after accounting for measures of development over a 30-year period. Further work and joined-up multisectoral thinking will be required to translate these patterns into policies that can improve nutrition and health outcomes globally

Interventions in Agriculture for Nutrition Outcomes: A Systematic Review Focused on South Asia

Research on the potential impact of interventions in agriculture on nutrition outcomes is of particular relevance in South Asia where agriculture-related activities are a major source of livelihoods for large sections of society and where the population suffers from one of the highest global burdens of malnutrition in all its forms. This systematic review aims to assess the strength of the available evidence that agricultural interventions have an impact on intermediate and final nutrition outcomes in India, Bangladesh, Nepal, Pakistan and Afghanistan. We searched five literature databases and reference lists of previous systematic reviews to identify peer-reviewed studies published between 2012 and 2017, detailing impacts of household- or farm-level agricultural interventions on nutritional outcomes in South Asia. We identified six intervention studies (reported in nine papers) conducted in Bangladesh (two studies), India (two studies) and Nepal (two studies). The majority of studies examined the impact of provision of seed, plants and training to increase home garden fruit and vegetable production with or without integrated poultry provision and training. Other studies evaluated the impact of livestock or aquaculture provision and training. Study designs and quality were mixed; heterogeneity across studies precluded formal meta-analysis. Interventions had a positive impact on intermediate outcomes on the pathway from agricultural intervention to nutritional or health status including dietary quality and dietary diversity of households and individuals (reported in seven papers). The evidence on the impact on final nutritional outcomes was mixed: one paper reported that home gardens with poultry reduced the odds of anaemia but there was no convincing evidence of an impact of agricultural interventions on child anthropometric measurement (reported in four papers). In recent years, the Leveraging Agriculture for Nutrition in South Asia (LANSA) research programme consortium has significantly expanded research on agricultural interventions for nutrition outcomes by conducting and commissioning a suite of formative and feasibility studies that have extended both the range and geographic location of interventions under study. This expanding body of research should, in the future, enable the identification of cost-effective interventions to enhance the impact of agricultural interventions sustainably to improve nutrition outcomes especially in women and children in South Asia

Factors influencing fruit and vegetable intake among urban Fijians: A qualitative study.

Low fruit and vegetable intake is an important risk factor for micronutrient deficiencies and non-communicable diseases, but many people worldwide, including most Fijians, eat less than the World Health Organization recommended amount. The present qualitative study explores factors that influence fruit and vegetable intake among 57 urban Fijians (50 women, 7 men) of indigenous Fijian (iTaukei) and South Asian (Indian) descent. Eight focus group discussions were held in and around Suva, Fiji's capital and largest urban area, which explored motivation for eating fruit and vegetables, understandings of links to health and disease, availability and sources, determinants of product choice, and preferred ways of preparing and eating fruit and vegetables. Data were analysed using thematic content analysis. Regardless of ethnicity, participants indicated that they enjoyed and valued eating fruit and vegetables, were aware of the health benefits, and had confidence in their cooking skills. In both cultures, fruit and vegetables were essential components of traditional diets. However, increasing preferences for processed and imported foods, and inconsistent availability and affordability of high-quality, low-priced, fresh produce, were identified as important barriers. The findings indicate that efforts to improve fruit and vegetable intake in urban Fijians should target the stability of the domestic fruit and vegetable supply and access

Nitrate and nitrite contamination in drinking water and cancer risk: A systematic review with meta-analysis

BACKGROUND: Pollution of water sources, largely from wide-scale agricultural fertilizer use has resulted in nitrate and nitrite contamination of drinking water. The effects on human health of raised nitrate and nitrite levels in drinking water are currently unclear. OBJECTIVES: We conducted a systematic review of peer-reviewed literature on the association of nitrate and nitrite in drinking water with human health with a specific focus on cancer. METHODS: We searched eight databases from 1 January 1990 until 28 February 2021. Meta-analyses were conducted when studies had the same exposure metric and outcome. RESULTS: Of 9835 studies identified in the literature search, we found 111 studies reporting health outcomes, 60 of which reported cancer outcomes (38 case-control studies; 12 cohort studies; 10 other study designs). Most studies were set in the USA (24), Europe (20) and Taiwan (14), with only 3 studies from low and middle-income countries. Nitrate exposure in water (59 studies) was more commonly investigated than nitrite exposure (4 studies). Colorectal (15 studies) and gastric (13 studies) cancers were the most reported. In meta-analyses (4 studies) we identified a positive association of nitrate exposure with gastric cancer, OR = 1.91 (95%CI = 1.09-3.33) per 10 mg/L increment in nitrate ion. We found no association of nitrate exposure with colorectal cancer (10 studies; OR = 1.02 [95%CI = 0.96-1.08]) or cancers at any other site. CONCLUSIONS: We identified an association of nitrate in drinking water with gastric cancer but with no other cancer site. There is currently a paucity of robust studies from settings with high levels nitrate pollution in drinking water. Research into this area will be valuable to ascertain the true health burden of nitrate contamination of water and the need for public policies to protect human health

Caste-based inequality in fruit and vegetables consumption in India

Objective: Fruit and vegetable (F&V) consumption is of central importance to many diet-related health outcomes. In India, caste is a major basis of socioeconomic inequality. Recent analysis shows that more disadvantaged “lower” castes consume less F&V than the rest. This article explores whether this consumption gap arises due to differential distribution of drivers of consumption such as income and education across castes, or whether behavioral differences or discrimination may be at play. Design: The Oaxaca-Blinder regression decomposition is applied to explain the gap in F&V consumption between “upper” castes and “lower” castes, using data from the 68th (2011-2012) round of the National Sample Survey Organization household survey. Results: Differences in the distribution of F&V drivers account for all of the 50 grams/person/day consumption gap between upper and lower castes. In particular, much of the gap is explained by income differential across castes. Conclusions: In the long run, India’s positive discrimination policies in education and employment that seek to equalize income across castes are also likely to help close the F&V consumption gap, leading to health benefits. In the medium run, interventions acting to boost lower caste income, such as cash transfers targeting lower castes, may be effective

Ympäristönmuutoksen vaikutukset hedelmien, pähkinöiden ja siementen satoihin ja ravitsemuskoostumukseen: systemaattinen kirjallisuustarkastelu

Background: Environmental changes are predicted to threaten human health, agricultural production and food security. Whilst their impact has been evaluated for major cereals, legumes and vegetables, no systematic evidence synthesis has been performed to date evaluating impact of environmental change on fruits, nuts and seeds (FN&S)-valuable sources of nutrients and pivotal in reducing risks of non-communicable disease. Methods: We systematically searched seven databases, identifying available published literature (1970-2018) evaluating impacts of water availability and salinity, temperature, carbon dioxide (CO2) and ozone (O-3) on yields and nutritional quality of FN&S. Dose-response relationships were assessed and, where possible, mean yield changes relative to baseline conditions were calculated. Results: 81 papers on fruits and 24 papers on nuts and seeds were identified, detailing 582 and 167 experiments respectively. A 50% reduction in water availability and a 3-4dS m(-1) increase in water salinity resulted in significant fruit yield reductions (mean yield changes: -20.7% [95%CI -43.1% to -1.7%]; and -28.2% [95%CI -53.0% to -3.4%] respectively). A 75%-100% increase in CO2 concentrations resulted in positive yield impacts (+37.8%; [95%CI 4.1% to 71.5%]; and 10.1%; [95%CI -30.0% to 50.3%] for fruits and nuts respectively). Evidence on yield impacts of increased O-3 concentrations and elevated temperatures (>25 degrees C) was scarce, but consistently negative. The positive effect of elevated CO2 levels appeared to attenuate with simultaneous exposure to elevated temperatures. Data on impacts of environmental change on nutritional quality of FN&S were sparse, with mixed results. Discussion: In the absence of adaptation strategies, predicted environmental changes will reduce yields of FN&S. With global intake already well-below WHO recommendations, declining FN&S yields may adversely affect population health. Adaptation strategies and careful agricultural and food system planning will be essential to optimise crop productivity in the context of future environmental changes, thereby supporting and safeguarding sustainable and resilient food systems.Peer reviewe

Can agricultural cultivation methods influence the healthfulness of crops for foods

The aim of the current study was to investigate if there are any health effects of long-term consumption of organically grown crops using a rat model. Crops were retrieved over two years from along-term field trial at three different locations in Denmark, using three different cultivation systems(OA, organic based on livestock manure; OB, organic based on green manure; and C, conventional with mineral fertilizers and pesticides)with two field replicates. The cultivation system had an impact on the nutritional quality, affecting γ-tocopherol, some amino acids, and fatty acid composition. Additionally, the nutritional quality was affected by harvest year and location. However, harvest year and location rather than cultivation system affected the measured health biomarkers. In conclusion, the differences in dietary treatments composed of ingredients from different cultivation systems did not lead to significant differences in the measured health biomarkers, except for a significant difference in plasma IgGl evels