Achieving the Millennium Development Goals through mainstreaming nutrition: speaking with one voice.

At the most recent meeting of the Standing Committee on Nutrition of the UN system in Geneva in March of this year (2006) there was a dramatic shift in the tenor of the opening plenary session. Three very high-ranking officials of three of the largest implementing UN agencies (WHO UNICEF World Bank) along with WFP and FAO produced -- independently of one another -- a clear consistent message focusing on the importance of nutrition for development. In each case this was couched within the comparative advantage of each agency. It was also striking that none of the speakers came from a background of nutrition training -- one economist one public health physician one health economist and one development expert. All had been converted by enthusiastic nutrition colleagues within their particular agency and by long experience in many countries and an expanding evidence base. All referred to the same evidence base -- the Bellagio Child Survival Study Group and subsequent papers published not in nutrition or even public health journals but in medical journals (the Lancet and the British Medical Journal in particular) although the significance of this will not be discussed here. But all were somewhat perplexed as to why nutrition issues were not an automatic component of all national health and development programmes including within each agency. They had clearly used their considerable experience in the public sector to think this through especially the importance of having a common and consistent message. (excerpt

Impact of a Social Marketing Campaign Promoting Dark-green Leafy Vegetables and Eggs in Central Java,Indonesia

In order to work towards further reduction of vitamin A deficiency in central Java, Indonesia, a social marketing campaign promoting eggs and dark-green leafy vegetables was initiated in March 1996. The nutritional surveillance system (December 1995- December 1996) found the following. The campaign's messages were well noticed. Consumption of at least one egg in the past week increased from 80% to 92% in mothers and from 78% to 92% in children 1236 months old. It increased in all socio-economic groups and was independent of ownership of chickens. Most eggs had been purchased. The quantity of vegetables prepared increased from 93 to 111 g/person daily and most was purchased. Vitamin A intake increased from 335 to 371 RE/d for mothers and from 130 to 160 RE/d for children. Serum retinol levels increased after the start of the campaign, and were related to egg consumption and vitamin A intake. Because 1. data were collected in such a way that respondents were not aware of the link between data collected and the campaign, and 2. vitamin A status increased and was related to increased consumption of eggs and vitamin A intake, we conclude that the social marketing campaign was successful

Multiplayer Cost Games with Simple Nash Equilibria

Multiplayer games with selfish agents naturally occur in the design of distributed and embedded systems. As the goals of selfish agents are usually neither equivalent nor antagonistic to each other, such games are non zero-sum games. We study such games and show that a large class of these games, including games where the individual objectives are mean- or discounted-payoff, or quantitative reachability, and show that they do not only have a solution, but a simple solution. We establish the existence of Nash equilibria that are composed of k memoryless strategies for each agent in a setting with k agents, one main and k-1 minor strategies. The main strategy describes what happens when all agents comply, whereas the minor strategies ensure that all other agents immediately start to co-operate against the agent who first deviates from the plan. This simplicity is important, as rational agents are an idealisation. Realistically, agents have to decide on their moves with very limited resources, and complicated strategies that require exponential--or even non-elementary--implementations cannot realistically be implemented. The existence of simple strategies that we prove in this paper therefore holds a promise of implementability.Comment: 23 page

Are low tolerable upper intake levels for vitamin a undermining effective food fortification efforts?

Vitamin A deficiency (VAD) is a major health problem, particularly in low-resource countries, putting an estimated 125-130 million preschool-aged children at increased risk of morbidity and mortality from infectious diseases. Vitamin A supplementation reduces VAD and increases child survival; it is complemented by fortifying foods with vitamin A. Concern over increased risk of bone fracture associated with vitamin A intakes below the tolerable upper intake level (UL) among populations in affluent countries conflicts with the need to increase intakes in less developed countries, where populations are at greater risk of VAD and intakes are unlikely to reach the UL as diets include fewer foods containing retinol while vitamin A from carotenoids poses no risk of overdose. With the implementation of recently developed risk management tools, vitamin A can be used safely in food fortification, including point-of-use fortification in the context of supplementation among specific target groups in low-resource countrie

Relationship of homestead food production with night blindness among children below 5 years of age in Bangladesh

Abstract Objective To examine the relationship between homestead food production and night blindness among pre-school children in rural Bangladesh in the presence of a national vitamin A supplementation programme. Design A cross-sectional study. Setting A population-based sample of six rural divisions of Bangladesh assessed in the Bangladesh Nutrition Surveillance Project 2001-2005. Subjects A total of 158 898 children aged 12-59 months. Results The prevalence rates of night blindness in children among those who did and did not receive vitamin A capsules in the last 6 months were 0·07 % and 0·13 %, respectively. Given the known effect of vitamin A supplementation on night blindness, the analysis was stratified by children's receipt of vitamin A capsules in the last 6 months. Among children who did not receive vitamin A capsules in the last 6 months, the lack of a home garden was associated with increased odds of night blindness (OR = 3·16, 95 % CI 1·76, 5·68; P = 0·0001). Among children who received vitamin A capsules in the last 6 months, the lack of a home garden was not associated with night blindness (OR = 1·28, 95 % CI 0·71, 2·31; P = 0·4). Conclusions Homestead food production confers a protective effect against night blindness among pre-school children who missed vitamin A supplementation in rural Banglades

Affordability influences nutritional quality of seafood consumption among income and race/ethnicity groups in the United States

Background The 2020 US Dietary Guidelines for Americans recommend that the US population consume more seafood. Most analyses of seafood consumption ignore heterogeneity in consumption patterns by species, nutritional content, production methods, and price, which have implications for applying recommendations. Objectives We assessed seafood intake among adults by socioeconomic and demographic groups, as well as the cost of seafood at retail to identify affordable and nutritious options. Methods NHANES 2011–2018 dietary data (n = 17,559 total, n = 3285 eating seafood) were used to assess adult (≥20 y) intake of seafood in relation to income and race/ethnicity. Multivariable linear regression assessed the association between seafood consumption and income, adjusted for age, sex, and race/ethnicity, and the association between nutrients and seafood price, using Nielsen 2017–2019 retail sales data, adjusted for sales volume. Results Low-income groups consume slightly less seafood than high-income groups [low income: mean 120.2 (95% CI: 103.5, 137.2) g/wk; high income: 141.8 (119.1, 164.1) g/wk] but substantially less seafood that is high in long-chain n–3 (ω-3) PUFAs [lower income: 21.3 (17.3, 25.5) g/wk; higher income: 46.8 (35.4, 57.8) g/wk]. Intake rates, species, and production method choices varied by race/ethnicity groups and within race/ethnicity groups by income. Retail seafood as a whole costs more than other protein foods (e.g., meat, poultry, eggs, beans), and fresh seafood high in n–3 PUFAs costs more (P < 0.002) than fresh seafood low in n–3 PUFAs. Retail seafood is available in a wide range of price points and product forms, and some lower-cost fish and shellfish were high in n–3 PUFAs, calcium, iron, selenium, and vitamins B-12 and D. Conclusions New insights into the relation between seafood affordability and consumption patterns among income and ethnicity groups suggest that specific policies and interventions may be needed to enhance the consumption of seafood by different groups.publishedVersio

Value Chain Focus on Food and Nutrition Security

Value chains are not a new concept and many working in agriculture and business have been utilizing not only the concept, but have put value chains into practical use. Yet very little has been done to ensure nutrition is included and linked into the chain. This is likely a reflection of the cross-disciplinary nature of food value chains (FVCs). The analysis of FVC requires an understanding of nutrition, agriculture, food technology, economics, marketing, etc. However, the training received by nutritionists in these other areas is often insufficient. Because of this, there are still many unanswered questions that require research, more operational understanding and collaborative investigation. Nevertheless, FVCs for nutrition have a role to play in terms of identifying innovative ways to improve the availability, affordability and acceptability of nutritious foods both in the context of under- and overnutrition, and there is currently a push for conducting FVC analyses in an integrated manner with various stakeholders. This will require buy-in from various actors in the value chain and will need to target both supply and demand-side dynamics. There is likely a role for policy in terms of supporting actions along the FVC that can contribute to healthier consumption patterns; however, there is also a role for the private sector. Applying a business-lens to nutrition may help to identify opportunities for integrating nutrition into FVCs with the goal of increasing the availability, affordability and acceptability of nutritious foods for the population

The importance of food systems and the environment for nutrition

Global and local food system transformation is necessary in order to ensure the delivery of healthy, safe, and nutritious foods in both sustainable and equitable ways. Food systems are complex entities that affect diets, human health, and a range of other outcomes including economic growth, natural resource and environmental resiliency, and sociocultural factors. However, food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability. Although there has been increased focus on this topic in recent years, many gaps in our knowledge persist on the relation between environmental factors, food systems, and nutritional outcomes. In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation. Am J Clin Nutr 2020;00:1–10

Measuring Permissiveness in Parity Games: Mean-Payoff Parity Games Revisited

We study nondeterministic strategies in parity games with the aim of computing a most permissive winning strategy. Following earlier work, we measure permissiveness in terms of the average number/weight of transitions blocked by the strategy. Using a translation into mean-payoff parity games, we prove that the problem of computing (the permissiveness of) a most permissive winning strategy is in NP intersected coNP. Along the way, we provide a new study of mean-payoff parity games. In particular, we prove that the opponent player has a memoryless optimal strategy and give a new algorithm for solving these games.Comment: 30 pages, revised versio

Child malnutrition and mortality among families not utilizing adequately iodized salt

ABSTRACT Background: Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage. Objective: The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt. Design: Use of adequately iodized salt (ͧ30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia. Results: Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged 5 y was 3.3% compared with 4.2%, 5.5% compared with 7.1%, and 6.9% compared with 9.1%, respectively (P 0.0001 for all), in urban slums; among families who did not use adequately iodized salt, the respective values were 4.2% compared with 6.3%, 7.1% compared with 11.2%, and 8.5% compared with 13.3% (P 0.0001 for all) in rural areas. Families not using adequately iodized salt were more likely to have children who were stunted, underweight, and wasted. In multivariate analyses that controlled for potential confounders, low maternal education was the strongest factor associated with not using adequately iodized salt. Conclusion: In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged 5 y. Stronger efforts are needed to expand salt iodization in Indonesia. Am J Clin Nutr 2008;87:438 -44