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

The macro-economic effects of health co-benefits associated with climate change mitigation strategies

The UK government has specific targets for greenhouse gas (GHG) emission reduction to lower the risk of dangerous climate change. Strategies to reduce GHG emissions are sometimes perceived as expensive and difficult to implement but previous work has demonstrated significant potential health co-benefits from ‘Active Travel and low carbon driving’, ‘Housing Insulation/Ventilation’, and ‘Healthy Diet’ scenarios which may be attractive to policymakers. Here a Computable General Equilibrium model is used to assess the financial effects of such health co-benefits on the wider economy including changes in labour force, social security payments and healthcare costs averted. Results suggest that for all scenarios the financial impacts of the health co-benefits will be positive and increased active travel in particular is likely to make a substantial contribution, largely due to health care costs averted. Strategies to reduce GHG emissions and improve health are likely to result in substantial and increasing positive contributions to the economy which may offset some potential economic costs and thereby be seen more favourably in times of economic austerity

B-Vitamins and fatty acids in the prevention and treatment of Alzheimer's disease and dementia: A systematic review

The increasing worldwide prevalence of dementia is a major public health concern. Findings from some epidemiological studies suggest that diet and nutrition may be important modifiable risk factors for development of dementia. In order to evaluate the strength of the available evidence of an association of dietary factors with dementia including Alzheimer's disease (AD), we systematically searched relevant publication databases and hand-searched bibliographies up to end July 2007. We included prospective cohort studies which evaluated the association of nutrient levels with the risk of developing dementia and randomized intervention studies examining the treatment effect of nutrient supplementation on cognitive function. One hundred and sixty studies, comprising ninety one prospective cohort studies and sixty nine intervention studies, met the pre-specified inclusion criteria. Of these, thirty-three studies (19 cohort and 14 randomized controlled trials) investigated the effects of folate, B-vitamins, and levels of homocysteine (a biomarker modifiable through B-vitamin supplementation) or fish/fatty acids and are the focus of the present report. Some observational cohort studies indicated that higher dietary intake or elevated serum levels of folate and fish/fatty acids and low serum levels of homocysteine were associated with a reduced risk of incident AD and dementia, while other studies reported no association. The results of intervention studies examining the effects of folic acid or fatty acid supplementation on cognitive function are inconsistent. In summary, the available evidence is insufficient to draw definitive conclusions on the association of B vitamins and fatty acids with cognitive decline or dementia, and further long-term trials are required

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

Multidimensional characterization of global food supply from 1961 to 2013

Food systems are increasingly globalized and interdependent, and diets around the world are changing. To characterize national food supplies and how they have changed can inform food policies that ensure national food security, support access to healthy diets and enhance environmental sustainability. Here we analysed data for 171 countries on the availability of 18 food groups from the United Nations Food and Agriculture Organization to identify and track multidimensional food supply patterns from 1961 to 2013. Four predominant food-group combinations were identified that explained almost 90% of the cross-country variance in food supply: animal source and sugar, vegetable, starchy root and fruit, and seafood and oilcrops. South Korea, China and Taiwan experienced the largest changes in food supply over the past five decades, with animal source foods and sugar, vegetables and seafood and oilcrops all becoming more abundant components of the food supply. In contrast, in many Western countries the supply of animal source foods and sugar declined. Meanwhile, there was remarkably little change in the food supply in countries in the sub-Saharan Africa region. These changes led to a partial global convergence in the national supply of animal source foods and sugar, and a divergence in those of vegetables and of seafood and oilcrops. Our analysis generated a novel characterization of food supply that highlights the interdependence of multiple food types in national food systems. A better understanding of how these patterns have evolved and will continue to change is needed to support the delivery of healthy and sustainable food system policies

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