Impact of dietary shifts in India on greenhouse gas emissions, land use, water use, and food expenditure: a nationally-representative study

Background: Food production is a major driver of environmental change, while dietary risks are the leading cause of global disease burden. Studies suggest that adoption of healthy diets in high-income countries can provide environmental co-benefits. However, little is known about such options in low and middle-income countries. India is home to one-fifth of the global population, and experiencing complex nutritional challenges, alongside critical environmental pressures on its ability to produce food. This project assesses the potential for dietary change to improve health and diet-related environmental footprints in India. Methods and results: A systematic review assessed the sustainable dietary patterns studied in the literature, and their impacts on a range of environmental indicators, to understand which diets may lead to improved environmental and health outcomes. Adoption of sustainable diets is generally estimated to reduce environmental footprints, though large variations in reductions are seen across sustainable diet types. Following national dietary guidelines may be a relevant public health goal with both environmental and health benefits. A comparison was undertaken of a number of dietary intake data sources in India, examining relative differences in overall intake, and intake of key food groups, to better understand data suitability for sustainable diet analyses. The comparison highlighted the 2011-2012 National Sample Survey (NSS) household expenditure surveys as a relevant data source for the project, though data sources showed high variability in intake, particularly for a set of key nutrient-dense food groups. The NSS and environmental footprint data were matched to estimate the change in greenhouse gas (GHG) emissions, land use (LU), and water footprints (WFs) that may result from national adoption of healthy dietary guidelines, and contrasted this with a scenario of widespread uptake of “affluent” diets. A shift to healthy guidelines in India would result in a small increase in environmental footprints (4-5% for GHG emissions, LU and WFs), though this national result masked large variations among sub-samples; for example, healthy diet shifts among those who consume above recommended dietary energy could decrease emissions by 6-16% across the three environmental indicators. Shifts to affluent diets would result in large increases of about 19-36% across indicators. Lastly, differences in cost were assessed between observed healthy and lowerfootprint diets, and average diets with sufficient dietary energy (“adequate” diets). Overall, healthy diets with lower footprints were slightly more expensive than an adequate diet. Large variations were observed among sub-samples of the population: improved diets were particularly more expensive for lower-income individuals and rural residents, while cheaper, or had no difference in price, for individuals in the highest quartile of socioeconomic status, and for urban residents. Higher expenditure on improved diets was particularly associated with fruit and vegetables, and dairy. Conclusions: Achieving the critical public health goal of healthy diets while minimising diet-related environmental footprints in India may require three broad strategies: increasing the efficiency of agricultural production, alongside efforts to improve the affordability of healthy dietary change, and the active promotion of healthy and lower-footprint diets for those who can currently afford them

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

Roads to interdisciplinarity - working at the nexus among food systems, nutrition and health: 1st annual Agriculture, Nutrition and Health (ANH) Academy Week, Addis Ababa (Ethiopia), 20-24 June 2016

The development agenda over the next 15 years will be framed by the Sustainable Development Goals (SDGs), of which more than half relate either directly or indirectly to the agricultural sector, highlighting its importance in economic growth and development of low- and middle-income countries (LMICs) (FAO 2015). It is therefore imperative that agricultural systems are better understood, so that they may be strengthened and optimised to deliver outcomes in line with the SDGs. The interface between agriculture, nutrition and health is particularly multifaceted and complex, and the development of successful strategies will require an integrated and multi-sectoral approach (Dorward and Dangour 2012; Jones and Ejeta 2016). ‘Agri-health’ is an evolving paradigm seeking to unify research approaches and methodologies between agriculture and health. Research within the field encapsulates a broad range of disciplines, locations and actors, and aligns these into a common research agenda. In doing so, agri-health aims to transcend barriers imposed by the longstanding institutional and disciplinary silos. Much progress has been made in recent years in this regard (Harris et al. 2013; Kanter et al. 2014; Picchioni et al. 2015). However, more coordinated efforts are required to generate consensus and target strategic priorities amongst the many existing information gaps (Webb and Kennedy 2014). Understanding the linkages between complex issues such as globalisation, climate change, food systems, and evolving burdens of malnutrition is central to agri-health research. The Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH) was created in 2010 with a key focus on agri-health interdisciplinary research. LCIRAH includes experts from across the member colleges of the University of London: the London School of Hygiene and Tropical Medicine (LSHTM), the School of Oriental and African Studies (SOAS), and the Royal Veterinary College (RVC). The Agriculture, Nutrition and Health Academy (ANH Academy), was established in 2015 as a platform to facilitate learning, knowledge sharing, capacity building and collaborative partnerships among the growing global community of researchers, practitioners and policy makers working within agri-health. It was developed with support from the Innovative Metrics and Methods for Agriculture and Nutrition Actions (IMMANA) research programme,Footnote1 led by LCIRAH and Tufts University, in partnership with the CGIAR Programme on Agriculture for Nutrition and Health (A4NH). Within this scope, the ANH Academy hosts an annual ANH Academy Week, building on the legacy of five agri-health research conferences organised by LCIRAH; as well as events and activities coordinated under the CGIAR A4NH. The inaugural ANH Academy Week took place in Addis Ababa, Ethiopia, in June 2016 and included two days of interactive ‘learning labs’ (training sessions on skills and methods across a broad range of disciplines in agri-health), followed by a three-day research conference. The conference included a mix of abstract-driven sessions, round table discussions, and keynote speeches from across the spectrum of agriculture, nutrition and health disciplines, and a wide range of countries. Hawkes et al. (2012) developed a conceptual framework (Fig. 2, hereafter referred to as the Framework), outlining the key pathways through which agriculture may affect nutritional status in Low and Middle Income Countries (LMICs), as well as broader drivers of these pathways. Drawing on this Framework, this paper aims to provide an analytical synthesis of the ANH Academy week by mapping the research and debates presented during the conference

Dietary patterns and non-communicable disease risk in Indian adults: secondary analysis of Indian Migration Study data.

OBJECTIVE: Undernutrition and non-communicable disease (NCD) are important public health issues in India, yet their relationship with dietary patterns is poorly understood. The current study identified distinct dietary patterns and their association with micronutrient undernutrition (Ca, Fe, Zn) and NCD risk factors (underweight, obesity, waist:hip ratio, hypertension, total:HDL cholesterol, diabetes). DESIGN: Data were from the cross-sectional Indian Migration Study, including semi-quantitative FFQ. Distinct dietary patterns were identified using finite mixture modelling; associations with NCD risk factors were assessed using mixed-effects logistic regression models. SETTING: India. SUBJECTS: Migrant factory workers, their rural-dwelling siblings and urban non-migrants. Participants (7067 adults) resided mainly in Karnataka, Andhra Pradesh, Maharashtra and Uttar Pradesh. RESULTS: Five distinct, regionally distributed, dietary patterns were identified, with rice-based patterns in the south and wheat-based patterns in the north-west. A rice-based pattern characterised by low energy consumption and dietary diversity ('Rice & low diversity') was consumed predominantly by adults with little formal education in rural settings, while a rice-based pattern with high fruit consumption ('Rice & fruit') was consumed by more educated adults in urban settings. Dietary patterns met WHO macronutrient recommendations, but some had low micronutrient contents. Dietary pattern membership was associated with several NCD risk factors. CONCLUSIONS: Five distinct dietary patterns were identified, supporting sub-national assessments of the implications of dietary patterns for various health, food system or environment outcomes

Guidelines for Modeling and Reporting Health Effects of Climate Change Mitigation Actions.

BACKGROUND: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers. OBJECTIVE: The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions. METHODS: An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies. RESULTS: The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting. DISCUSSION: This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice. https://doi.org/10.1289/EHP6745

Guidelines for Modeling and Reporting Health Effects of Climate Change Mitigation Actions

Background: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers. Objective: The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions. Methods: An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies. Results: The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting. Discussion: This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice

Efficacious Intermittent Dosing of a Novel JAK2 Inhibitor in Mouse Models of Polycythemia Vera

A high percentage of patients with the myeloproliferative disorder polycythemia vera (PV) harbor a Val617→Phe activating mutation in the Janus kinase 2 (JAK2) gene, and both cell culture and mouse models have established a functional role for this mutation in the development of this disease. We describe the properties of MRLB-11055, a highly potent inhibitor of both the WT and V617F forms of JAK2, that has therapeutic efficacy in erythropoietin (EPO)-driven and JAK2V617F-driven mouse models of PV. In cultured cells, MRLB-11055 blocked proliferation and induced apoptosis in a manner consistent with JAK2 pathway inhibition. MRLB-11055 effectively prevented EPO-induced STAT5 activation in the peripheral blood of acutely dosed mice, and could prevent EPO-induced splenomegaly and erythrocytosis in chronically dosed mice. In a bone marrow reconstituted JAK2V617F-luciferase murine PV model, MRLB-11055 rapidly reduced the burden of JAK2V617F-expressing cells from both the spleen and the bone marrow. Using real-time in vivo imaging, we examined the kinetics of disease regression and resurgence, enabling the development of an intermittent dosing schedule that achieved significant reductions in both erythroid and myeloid populations with minimal impact on lymphoid cells. Our studies provide a rationale for the use of non-continuous treatment to provide optimal therapy for PV patients

Assessing national nutrition security

Funding: The author(s) received no specific funding for this work. JIM and SW acknowledge funding from the Scottish Government’s Rural and Environment Science Analytical Services Strategic Research Programme. HC acknowledges funding from the Fondation Daniel & Nina Carasso. This work contributes to the Belmont Forum/FACCE-JPI funded DEVIL project (Natural Environment Research Council grant number NE/M021327/1) (JIM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD