The challenge of achieving basal energy, iron and zinc provision for home consumption through family farming in the Andes: a comparison of coverage through contemporary production systems and selected agricultural interventions

Background Child undernutrition is persistently high in the central Andes of Peru, and numerous smallholder households fail to meet their basic needs of energy, iron and zinc. Food-based approaches assume household-level nutrition can be improved following agricultural interventions. This study assesses for the first time whether current Andean production systems provide sufficient energy, iron and zinc output to meet household-level requirements and explores the likely effect of commonly promoted food-based approaches. Across four communities, we determined the crop and livestock production output for each household (n = 165) during one growing season. The household-level nutritional demand or input was calculated as a function of household composition and daily requirements of energy, iron and zinc as established by FAO/WHO. We examined five scenarios, current practice or status quo and four food-based interventions: (1) increased potato yield, (2) introduced biofortified potatoes, (3) promotion of guinea pigs and (4) a mixed strategy combining all of the above. Results Under status quo, 86, 62 and 76 % of households obtained sufficient production output to meet energy, iron and zinc requirements, respectively. Considering the three parameters simultaneously, 59 % of households were able to meet their energy, iron and zinc requirements. The total crop production among households provided more than the necessary energy, iron and zinc output to meet the demand of all 165 households. Yet, significant differences between households account for individual deficits or surpluses in household-level output–input balances. Potato (Solanum spp.), barley (Hordeum vulgare) and faba (Vicia faba) production was particularly significant in determining the energy, iron and zinc output. Livestock did not make a substantial contribution. The main difference between households with negative versus positive coverage, in terms of household-level production output from agriculture meeting demand (=input), was available cropping area given household size. None of the explored food-based interventions closed the energy, iron and zinc deficit from production among households with negative coverage. Conclusions The smallholder production systems analyzed are only partially capable of providing sufficient production output to cover household-level energy, iron and zinc demands. Of the four interventions examined, a mixed strategy holds most potential for reducing nutrition gaps. Particularly potato yield increases had a positive effect. The carrying capacity of high-altitude Andean farming systems is strained for households with limited land. Food-based approaches to nutrition under scenarios similar to those reported in this study are advised to balance agricultural interventions with options to enhance off-farm access to food

The Nutritional Contribution of Potato Varietal Diversity in Andean Food Systems: a Case Study

Potato is the backbone of agriculture and diets in high-altitude food systems of Peru, where farmers grow diverse varietal portfolios. Here we report on the role of diverse landraces and modern potato varieties in the Andean diet. The dry matter, energy, protein, iron and zinc content of 12 floury and 9 bitter landraces was determined. The contribution of varietal diversity to the dietary intake of energy, protein, iron and zinc was established during two contrasting periods of overall food availability. Results show that the potato and intraspecific diversity make an important contribution to nutrition. Most floury landraces contain higher concentrations of protein and iron compared to the reference value reported in the 2009 Peruvian food composition table for a boiled and peeled floury landrace. Traditional freeze-drying of bitter landraces doesn’t affect energy or iron concentrations, but reduces protein and zinc content considerably. Protein and iron contents in boiled chuño derived from the bitter landraces are lower compared to the mean value reported in the food composition table. The contribution of varietal diversity ideally needs to be taken into account when conducting nutrition studies in diversity hotspots like the Andes where potato is a main staple. The potato adds positively to the nutritional balance and the recommended requirements for energy, protein, iron and zinc of women and children. Floury landraces and modern varieties complement each other in light of seasonality, providing valuable nutrients during contrasting periods of the year. The potato thus contributes positively to food security. However, the overall diversity of the diet was found to be poor, resulting in micronutrient deficiencies. Options to strengthen food based approaches to attend undernutrition are discussed

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: An overview

Nutritional and developmental insults in the first few years of life have profound public health implications, including substantial contributions to neonatal, infant, and early childhood morbidity and mortality, as well as longer term impacts on cognitive development, school achievement, and worker productivity. Optimal development that can lead to the attainment of the individual's fullest potential therefore requires a combination of genetic capacity, adequate nutrition, psychosocial stimulation, and safe, clean physical environments. Researchers and policymakers have called for integrated child nutrition and development interventions for more than twenty years, yet there are only a handful of efficacy trials and even fewer examples of integrated interventions that have been taken to scale. While a critical component to the design of such interventions is formative research, there is a dearth of information in both the literature and policy arenas to guide this phase of the process. To move the field forward, this paper first provides an overview of formative research methods with a focus on qualitative inquiry, a description of the critical domains to be assessed (infant and young child feeding, responsive feeding, and child development), and currently available resources. Application of these methods is provided through a real-world case study—the design of an integrated nutrition and child development efficacy trial in Andhra Pradesh, India. Recommendations for next steps are discussed, the most important of which is the need for a comprehensive set of formative guidelines for designing locally tailored, culturally appropriate integrated interventions

Designing intervention prototypes to improve infant and young child nutrition in Peru: A participatory design study protocol

Introduction: Nutrition during the complementary feeding period (6–23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach. Methods and analysis: The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6–23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6–23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities. Ethics and dissemination: Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications

Farm-Level Agricultural Biodiversity in the Peruvian Andes Is Associated with Greater Odds of Women Achieving a Minimally Diverse and Micronutrient Adequate Diet

Abstract Background The extent to and mechanisms by which agricultural biodiversity may influence diet diversity and quality among women are not well understood. Objectives We aimed to 1) determine the association of farm-level agricultural biodiversity with diet diversity and quality among women of reproductive age in Peru and 2) determine the extent to which farm market orientation mediates or moderates this association. Methods We surveyed 600 households with the use of stratified random sampling across 3 study landscapes in the Peruvian Andes with diverse agroecological and market conditions. Diet diversity and quality among women were assessed by using quantitative 24-h dietary recalls with repeat recalls among 100 randomly selected women. We calculated a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, probability of adequacy (PA) of 9 micronutrients by using a measurement-error model approach, and mean PA (MPA; mean of PAs for all nutrients). Agricultural biodiversity was defined as a count of crop species cultivated by the household during the 2016–2017 agricultural season. Results In regression analyses adjusting for sociodemographic and agricultural characteristics, farm-level agricultural biodiversity was associated with a higher DDS (incidence rate ratio from Poisson regression: 1.03; P 60%: OR: 1.21; 95% CI: 1.10, 1.35). Farm market orientation did not consistently moderate these associations, and in path analyses we observed no consistent evidence of mediation of these associations by farm market orientation. Conclusions Farm-level agricultural biodiversity was associated with moderately more diverse and more micronutrient-adequate diets among Peruvian women. This association was consistent across farms with varying levels of market orientation, although agricultural biodiversity likely contributed to diets principally through subsistence consumption

The Biodiversity of Food and Agriculture (Agrobiodiversity) in the Anthropocene: Research Advances and a Conceptual Framework

Multiple knowledge systems are crucial to understand human-environment interactions of the biodiversity of agriculture and food systems (agrobiodiversity). This article synthesizes these knowledge systems to formulate the novel Agrobiodiversity Knowledge Framework comprised of four themes: (1) ecology and evolution; (2) governance; (3) food, nutrition, and health; and (4) global environmental and socioeconomic changes. Resulting characterization of these knowledge themes, joined with cross-theme integration, demonstrate advances of agrobiodiversity research, management, and policy amid the accelerated global environmental and socioeconomic transformations of the Anthropocene. Framework results guide the presentation of new data from the Agrobiodiversity, Food, and Nutrition project (AFN) in Peru. These results integrate an emphasis on factors of global change, including climate change. The combination of the new knowledge framework and project results is utilized to point toward future directions for research, policy, and management. The Agrobiodiversity Knowledge Framework is essential to address the transformative planetary challenges of the Anthropocene that include sustainable development with nutritional security, biodiversity conservation, social justice, climate change, and nutrient pollution. Strengthening the focus on and analysis of the complex human-environment interactions of biodiversity in agriculture and food is vital as a nexus of science, scholarship, management, and policy in the era of Earth systems dominated by human activity

¿Cómo alimentar a los niños? La práctica de conductas alimentarias saludables desde la infancia How to feed children? Healthy eating behaviors starting at childhood

Las intervenciones para prevenir la desnutrición o el exceso de peso en los niños se enfocan en la dieta, y dan poca atención a los comportamientos de las personas responsables de su cuidado. En sus primeros dos años los niños adoptan prácticas establecidas en su entorno y las conductas de sus cuidadores, los cuales constituyen patrones alimentarios que persistirán a lo largo de su vida. Así, los niños y sus cuidadores establecen una relación en que reconocen, interpretan y responden a las señales de comunicación verbal y no verbal. Alimentar al niño adoptando una conducta “responsiva” en la que los cuidadores proveen la dirección y estructura, y responden a los señales de hambre y saciedad de los niños, promueve la autorregulación y la responsabilidad de los niños para una alimentación sana. En este artículo, damos recomendaciones para incorporar la alimentación responsiva y modelar conductas alimentarias saludables en las intervenciones nutricionalesInterventions to prevent malnutrition or overweight in children focus on the diet, and give little attention to the behaviors of their caretakers. In their first two years of life, children adopt practices that are embedded in their environment and the behaviors of their caretakers, thus turning into nutrition patterns that will persist during their lifetimes. Therefore, children and caretakers establish a relationship in which they recognize, construe and respond to verbal and non verbal communication signs. Feeding a child by adopting a “responsive” behavior in which caretakers provide guidance and structure, and respond to children’s signs of hunger and satiety promotes self-regulation and children’s awareness of healthy nutrition. In this article, we give recommendations to include responsive nutrition and model healthy eating behaviors in nutritional intervention

¿Cómo alimentar a los niños? La práctica de conductas alimentarias saludables desde la infancia

Las intervenciones para prevenir la desnutrición o el exceso de peso en los niños se enfocan en la dieta, y dan poca atención a los comportamientos de las personas responsables de su cuidado. En sus primeros dos años los niños adoptan prácticas establecidas en su entorno y las conductas de sus cuidadores, los cuales constituyen patrones alimentarios que persistirán a lo largo de su vida. Así, los niños y sus cuidadores establecen una relación en que reconocen, interpretan y responden a las señales de comunicación verbal y no verbal. Alimentar al niño adoptando una conducta “responsiva” en la que los cuidadores proveen la dirección y estructura, y responden a los señales de hambre y saciedad de los niños, promueve la autorregulación y la responsabilidad de los niños para una alimentación sana. En este artículo, damos recomendaciones para incorporar la alimentación responsiva y modelar conductas alimentarias saludables en las intervenciones nutricionale

Estrategias empleadas por las madres durante el proceso de alimentación en niños de 6 a 24 meses de dos comunidades rurales de Lima, Perú

En: Revista Peruana de Medicina Experimental y de Salud Pública, Vol. 32, No. 3, pp. 440-448Objetivos. Conocer las estrategias de la madre durante el proceso de alimentación en niños de 6 a 24 meses de dos comunidades de Lima. Materiales y métodos. Estudio cualitativo, participaron 18 madres primíparas o multíparas de niños de 6-24 meses de edad, se empleó un muestreo intencionado por edad y paridad de la madre, se realizaron 36 observaciones directas y 12 entrevistas a profundidad. Análisis de datos inductivo, las categorías se agruparon por temas y por técnica, llegando a un consenso de los temas entre autores. Resultados. La comunicación verbal se vio marcadamente más en las madres multíparas. Se encontraron tres grandes temas; comunicación verbal madre-hijo, las madres multíparas fueron quienes utilizaron palabras afectivas durante la comida. Involucramiento y estrategias para dar de comer se vio caracterizado por la animación al niño a terminar la comida mediante, juegos y cantos que mostraron las madres multíparas con ayuda, algunas veces, de otros integrantes de la familia; sin embargo, no se obtuvo los mismos resultados por parte de las madres primíparas, ellas generalmente se tornaron represivas ante el rechazo de la comida. El contexto durante la comida, favorece a que el niño termine su comida. Conclusiones. Las estrategias utilizadas durante el tiempo de comida fueron variadas y parcializadas; predominantemente para las madres multíparas, actuando de una forma más activa y responsiva, sin embargo, las madres primíparas pueden llegar a actuar de una forma autoritaria cuando el menor se ensucia, juega y/o rechaza los alimentos