The true cost of food: a preliminary assessment

Ensuring sustainable food systems requires vastly reducing their environmental and health costs while making healthy and sustainable food affordable to all. One of the central problems of current food systems is that many of the costs of harmful foods are externalized, i.e., are not reflected in market prices. At the same time, the benefits of healthful foods are not appreciated. Due to externalities, sustainable and healthy food is often less affordable to consumers and less profitable for businesses than unsustainable and unhealthy food. Externalities and other market failures lead to unintended consequences for present and future generations, destroying nature and perpetuating social injustices such as underpay for workers, food insecurity, illness, premature death and other harms. We urgently need to address the fundamental causes of these problems. This chapter sets out the results of an analysis to determine the current cost of externalities in food systems and the potential impact of a shift in diets to more healthy and sustainable production and consumption patterns. The current externalities were estimated to be almost double (19.8 trillion USD) the current total global food consumption (9 trillion USD). These externalities accrue from 7 trillion USD (range 4–11) in environmental costs, 11 trillion USD (range 3–39) in costs to human life and 1 trillion USD (range 0.2–1.7) in economic costs. This means that food is roughly a third cheaper than it would be if these externalities were included. More studies are needed to quantify the costs and benefits of food systems that would support a global shift to more sustainable and healthy diets. However, the evidence presented in this chapter points to the urgent need for a system reset to account for these ‘hidden costs’ in food systems and calls for bold actions to redefine the incentives for producing and consuming healthier and more sustainable diets. The first step to correct for these ‘hidden costs’ is to redefine the value of food through true-cost accounting (TCA) so as to address externalities and other market failures. TCA reveals the true value of food by making the benefits of affordable and healthy food visible and revealing the costs of damage to the environment and human health 3

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Risk of climate-related impacts on global rangelands – a review and modelling study

Climate change threatens the ability of global rangelands to provide food, support livelihoods and deliver important ecosystems services. The extent and magnitude of potential impacts are however poorly understood. In this study, we review the risk of climate impacts along the rangeland systems food supply chain. We also present results from biophysical modelling simulations and spatial data analyses to identify where and to what extent rangelands may be at climatic risk. Although a quantification of the net impacts of climate change on rangeland production systems is beyond the reach of our current understanding, there is strong evidence that there will be impacts throughout the supply chain, from feed and animal production to processing, storage, transport, retailing and human consumption. Regarding grazing biomass production, this study finds that mean herbaceous biomass is projected to decrease across global rangelands between 2000 and 2050 under RCP 8.5 (-4.7%), while inter- (year-to-year) and intra- (month-to-month) annual variabilities are projected to increase (+21.3% and +8.2%, respectively). These averaged global estimates mask large spatial heterogeneities, with 74% of global rangeland area projected to experience a decline in mean biomass, 64% an increase in inter-annual variability and 54% an increase in intra-annual variability. The potentially most damaging vegetation trends for livestock production (i.e., simultaneous decreases in mean biomass and increases in inter-annual variability) are projected to occur in rangeland communities that are currently the most vulnerable (here, with the lowest livestock productivities and economic development levels and with the highest projected increases in human population densities). Large uncertainties remain as to climate futures and the exposure and responses of the interlinked human and natural systems to climatic changes over time. Consequently, adaptation choices will need to build on robust methods of designing, implementing and evaluating detailed development pathways, and account for a wide range of possible futures