current evidence and programmatic considerations

Funding Information: We are thankful to Ann Prentice for her critical review of the section ?Concerns in populations with low calcium intake.? The convenings of the Calcium Task Force and the development of this paper and its open access were supported by funding from The Children's Investment Fund Foundation to the Nutrition Science Program of the New York Academy of Sciences. Publisher Copyright: © 2022 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.Most low- and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500-mg doses/day). WHO recommends 1.5–2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low-dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost-effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron-containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food-based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.publishersversionpublishe

Gaps and priorities in assessment of food environments for children and adolescents in low- and middle-income countries

School-aged children and adolescents have complex interactions with their food environments—the point of engagement of individuals with the food system—and are influenced by a diversity of individual, household and organizational factors. Although a wide range of methods have been proposed to define, monitor and evaluate food environments, few are tailored to school-aged children and adolescents. Here, we interrogate published literature on food metrics and methodologies for the characterization of food environments for school-aged children and adolescents living in low- and middle-income counties. We identify key priority actions and potential indicators for better monitoring and evaluation to galvanize policymaking to improve the healthiness of these interactions, which are so crucial to future adult well-being

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries.

Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D 1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations

Establishing a Marine Conservation Baseline For the Insular Caribbean

Marine protected areas are a primary strategy for the conservation of marine habitats and species across the globe. In small island developing states, they often exceed their terrestrial counterparts in both number and area. To assess their effectiveness as a conservation measure over time, the accurate and up-to-date representation of marine protected areas through spatial and tabular data is imperative in order to establish baselines. Various regional and global agreements have set specific protection targets and these require spatial reporting on protected areas as an indicator of progress. For the insular Caribbean region, this study considers progress towards global Aichi Target 11 of the Convention on Biological Diversity which is to conserve at least 10% of coastal and marine areas, and progress towards the regional target of the Caribbean Challenge Initiative (CCI) to protect at least 20% of nearshore marine and coastal habitats , both aiming for a 2020 deadline. Progress towards these targets differs widely depending on the accuracy of the datasets and the methods used. In an effort to update the current baseline of protection within the insular Caribbean, multiple governments, the Nature Conservancy and the Caribbean Marine Protected Area Management Network and Forum collaborated to develop a single insular Caribbean protected area dataset with accurate boundary information and the best available ecoregional and political boundaries. This study represents the most in-depth and spatially accurate effort to date to determine marine protected area coverage in the insular Caribbean. It is found that some form of marine management has been designated for around 7.1% of our study area in the insular Caribbean; progress towards Aichi Target 11 averaged among sovereign states within the insular Caribbean stands at approximately 3.25% and only three of the 10 participating governments in the CCI have reached their 20% target. Ocean protection was further assessed across the 25 governments and the three marine ecoregions by four different marine zones. Recommendations are made on regional to global cooperation for data sharing and reporting on indicators, highlighting possible directions to fill marine conservation gaps in the insular Caribbean