The role of livestock products for nutrition in the first 1,000 days of life

Dietary patterns across the world are extremely diverse, with diets of most people in low- and middle-income countries being suboptimal from a nutritional standpoint. It is in these countries that the highest levels of undernutrition are recorded, with children being the most affected. Although stunting (i.e., children short for their age) rates are declining globally and regionally, significant disparities in such rates exist between and within countries. Moreover, the absolute number of stunted children in Africa continues to increase (Development Initiatives, 2018). Iron-deficient anemia has risen to 32.8% globally and nutrient intakes are typically deficient in poor settings. Poor people in poor countries often subsist on suboptimal diets based on cheap staples and have limited access to nutrient-dense foods such as pulses, fruit, or meat (Murphy and Allen, 2003; Thompson and Meerman, 2010; Muhihi et al., 2012). As a result of these circumstances, individuals do not receive sufficient nutrient intakes to sustain optimal well-being. Some research has shown that it is not unusual to begin feeding children livestock-derived food (particularly milk) before 6 mo of age when they should be exclusively breastfeeding (Micere et al., 2016). With that said, recent surveys confirmed that almost 40% of children above 6 mo living in informal settlements in peri-urban Nairobi did not consume cow’s milk daily. Furthermore, meat and other livestock-derived products were each eaten by less than 5% of these children and only in very small amounts (Grace et al., 2018). This is not an uncommon reality in Africa. Over the past decades, investments have been made to address the various forms of undernutrition present in many countries across the world. The shift from food security (access to enough food) to nutrition security (access to enough nutritious food) has prompted the development of interventions to increase nutrient intake. These interventions include food fortification as a means to improving the nutrient content of diets. Little attention has been given, however, to the specific role of livestock products such as meat, milk, and eggs (and their derived products) on nutrition and their potential to help achieve nutrition security goals. Media outlets in recent years, primarily in high-income countries, have increasingly been flooded with reports that are critical of the role of meat, in particular, and livestock-derived foods (e.g., milk and eggs), in general, as part of diets. Their environmental footprint, as well as their suggested negative effects on health, are ostensible arguments used to promote a shift to diets containing little to no animal-sourced foods. Environmental and sustainability concerns exist related to livestock production that require serious reflection relative to the evolution of farming systems and dietary patterns in industrialized countries (Willett et al., 2019). Underlying this may be more fundamental and immutable concerns over the use of animals (Perry and Grace, 2015). Nonetheless, in many low- and middle-income countries, the livestock sector is a key contributor to national economies (representing between 15% and 80% of agricultural domestic product) and represents a potential pathway out of poverty and an essential livelihood for millions of people (World Economic Forum, 2019). In countries where high volumes of livestock production accompany important undernutrition problems, it would represent a significant missed opportunity to not harvest livestock-derived food products to optimize the nutrition of the most vulnerable. This article will summarize the current state of knowledge on the role of livestock products for nutrition, with emphasis on the first 1,000 d of life for individuals living in low-income countries. The nutritional importance of livestock products, the evidence base for their impact on health and nutrition, and the major externalities concerned with their production will be considered

Leveraging human nutrition through livestock interventions: perceptions, knowledge, barriers and opportunities in the Sahel

The potential of livestock and animal-source foods (ASF) to improve nutrition of vulnerable households in the Sahel countries is large, but currently underutilised, despite the dependence of human nutrition on livestock in some areas. This study assesses the perceptions of the linkages between livestock and human nutrition interventions by West African implementers; the challenges faced; and the lessons learnt to significantly leverage nutrition in livestock interventions. Here, we report a qualitative study combining: 1) a formative research with semi-structured interviews of key informants [n = 36], and thematic analysis; and 2) a participatory work conducted during a regional workshop. Results were grouped to provide insights into several aspects: a) dietary, storage and preservation practices of ASF, b) livestock-human nutrition impact pathways, c) interventions with potential to improve nutrition, d) monitoring and evaluation, e) coordination issues, and f) knowledge gaps. Thirteen pathways were identified through which livestock impacts human nutrition, each presenting different trade-offs. About 79% of the participants of the workshop and working with livestock reported to never having monitored outcomes of attempts to improve human nutrition. Lessons learnt highlighted the importance of local ASF taboos and beneficiary targeting and identified promising interventions. The principal challenges identified were related to capacity-building, programming, or to funding issues. There was agreement among stakeholders on the importance of livestock and ASF to improve human nutrition, and on the prominent disconnect whereby livestock interventions often neglect human nutritional goals, due to the complexity of impact pathways and the multiple roles of livestock in livelihoods. Stronger collaboration among researchers and implementers could contribute to expanding the body of evidence. This compilation of insights could promote dialogue and guide further progress

The Importance of a food systems approach to low and middle income countries and emerging economies: a review of theories and its relevance for disease control and malnutrition

Our review explores the changing food production, distribution and consumption environment in low and middle-income countries and emerging economies as a basis for framing how to study food systems in order to address public health issues of food safety and nutrition. It presents the state of knowledge on existing food systems science and its use in terms of sustainable actions for food safety and public health. The review identifies a knowledge gap in food system mapping and governance, with value chain mapping of key commodities often missing. Despite a number of initiatives, the application of food systems methods is highly variable in scope and quality. Most analyses concentrate on specific commodities, rarely taking into account the need for a whole diet approach when looking at nutrition or the assessment of a range of infectious agents and their interactions when looking at food safety. Of the studies included in the review there is a growing observation of “informal” food systems, a term used inconsistently and one that requires revision. “Informal” food systems link to the formal sector to provide food security, yet with trade-offs between economic efficiencies and food safety. Efforts to improve food safety are hampered by inadequate food safety capacities and a lack of policy coherence leading to: inadequate investment; fragmented food quality control systems; weak or non-existent traceability mechanisms; weak foodborne disease surveillance; obsolete food regulation; and weak regulatory enforcement. In-depth food systems assessments can complement risk analysis to identify risky behaviors and understand institutional settings in order to improve codes of practice and enforcement. Methods for looking at food safety from a food systems perspective are emerging, yet existing nutrition and food systems science are not advancing sufficiently in response to nutritional public health problems. There is an urgency for improved understanding of the structure and drivers of the food systems, for better planning of changes that leads to nutrients access and healthy levels of eating. It is proposed that countries and international institutions provide an atlas of food system maps for the key commodities based on an agreed common methodology and developed by multidisciplinary teams

Aflatoxin exposure among young children in urban low-income areas of Nairobi and association with child growth

Populations in tropical and subtropical developing countries are exposed to largely uncontrolled levels of aflatoxins through food. These countries (especially in Africa and Asia) also present a high prevalence of stunting. Studies have reported an association between aflatoxin exposure and growth impairment in children but there is not yet conclusive evidence that aflatoxins are a significant cause of stunting in children, thus further research is warranted. In this cross-sectional study, 204 low-income households were randomly selected in two low-income areas of Nairobi, Kenya. Korogocho is a higher population density area and Dagoretti a lower population density area. We asked questions about household demographics and a 24-hour dietary recall was conducted in children aged 1–3 years. Child anthropometric measurements were also conducted. Height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ) and weight-for-height Z-scores (WHZ) were calculated for each child using World Health Organization (WHO) growth standards reference data. Samples of foods were taken from the household or from the retailer for analysis using competitive enzyme-linked immunosorbent assay (ELISA). Laboratory results for aflatoxin levels in the food samples collected were used to calculate the daily aflatoxin intake, according to the results from the dietary assessment. The study found 41% of children sampled had stunted growth. Boys were more stunted than girls (p=0.057) and Korogocho had more stunted children than Dagoretti (p=0.041). In all, 98% of food samples collected tested positive for aflatoxin and there was an average exposure to aflatoxins of 21.3 ng/kg bodyweight per day. Exposure to aflatoxin M1 (AFM1), location and sex were significantly associated with HAZ, with boys and children from Korogocho having lower HAZ, and AFM1 was negatively associated with HAZ (p=0.047), indicating that AFM1 was associated with stunting. There was no association between total aflatoxins (aflatoxin B [AFB] and aflatoxin G [AFG]) and HAZ, WAZ and WHZ. The study showed a high prevalence of malnutrition, especially stunting, in two low-income urban sites, and this was most pronounced in the high-density area. The reported association between AFM1 and stunted children indicates that more research is needed on the health impacts of this aflatoxin in growing children

Where food safety meets nutrition outcomes in livestock and fish value chains: a conceptual approach

There is increasing interest in the links between food safety and nutrition. Animal-source foods contribute to fulfilling important micronutrient requirements by supplying vitamin B12, high quality protein, iron, zinc, vitamin A of high bioavailability, riboflavin and calcium. However, high meat and dairy consumption may raise health concerns related to the risk of non-communicable diseases and food safety, especially if upscaling of livestock and fish value chains does not follow recommended hygiene and biosecurity practices. A recent report by the World Health Organisation indicates that food-borne diseases from animal-source foods constitutes an important health burden worldwide. Only a few studies explore nutrition outcomes and food-borne diseases simultaneously and integrative approaches may be difficult due to limited understanding of disciplinary paradigms. Here we propose a conceptual approach to integrate food safety and nutrition assessments in livestock and fish value chains combining knowledge from food sciences, public health, nutrition and economics. It offers six analytical dimensions with explanations of key disciplinary paradigms and methodological characteristics that can cause pitfalls for integration and provides recommendations for joint assessments. The insights arising from this work on methodology for interdisciplinary research can assist those who engage in collaboration to integrate food safety and nutrition research in livestock and fish value chains

The effect of participation in a pro-poor dairy development project on milk consumption among reproductive age women in rural Tanzania

Animal milk is an important contributor to women’s dietary diversity, especially among pastoral communities where access to diverse diets is limited. While there have been numerous large-scale milk development projects in East Africa, few examples of propoor milk collective action projects exist that focus on expanding milk production and consumption by women. This study reports cross-sectional findings on the association between participation in a pro-poor dairy development project and women’s milk consumption in rural Tanzania. Socio-demographic and health-related characteristics associated with milk consumption were assessed as well. The study utilized data from a sample of 272 women who participated in two surveys conducted in the Morogoro and Tanga regions of Tanzania in 2015. Chi-square and Cochran–Mantel–Haenszel analyses identified factors associated with whether milk was consumed in the previous 24-hour period. Analysis of variance (ANOVA) identified factors associated with frequency of milk consumption. Multivariable logistic regression was applied to estimate associations between program participation, socio-demographic, health characteristics, milk consumption behavior. Seventy-six percent of women reported drinking milk in the previous 24-hour period. The mean frequency of milk intake among the control group was 1.61 times 2.15 times among the intervention group. The adjusted odds of consuming any milk in the previous 24 hours were 16.1 (95% CI 1.72-150.44) times greater for Maasai than other tribes. Among Maasai, the adjusted odds of consuming milk 3-4 times per day compared to 1-2 times per day were 9.96 (95% CI 1.03 - 96.09) times greater for those in the dairy development group compared to the control. Among non-Maasai, the adjusted odds of consuming any milk in the prior 24 hours was 3.45 (95% CI 1.07- 11.05) times greater for those in the dairy development group compared to the control. Milk consumption was greatest among Maasai and communities with propoor dairy development programs. Findings suggest that participation in a Pro-poor agricultural intervention to improve milk production may improve women’s milk consumption and ultimately help to address rural poverty and improve household nutrition

Increased climate variability and sedentarization in Tanzania: Health and nutrition implications on pastoral communities of Mvomero and Handeni districts, Tanzania

African pastoralists are undergoing significant changes in livelihood strategies, from predominantly mobile pastoralism to agro-pastoralism in which both livestock raising and cultivation of crops are practiced, to agro- pastoralism combined with wage labor and petty trade. These changes often result in fixed settlements or a process known as sedentarization. Previous research indicates that sedentarization and increased climate vari-ability are prominent forces shaping livelihood opportunities and constraints in East Africa, but the effects of these co-occurring processes have yet to be investigated. This paper develops theory, using qualitative data collected in Morogoro and Tanga Regions of Tanzania, explaining the relationships between climate variability, pastoral sedentarization, livelihood outcomes, and resulting nutritional status. We observed that the co-occurring processes of increased climate variability and sedentarization among pastoralists in these regions have dramatic impacts on communities’ economic prosperity, health status, and nutritional outcomes. Due to risks associated with climate and sedentarization, land tenure policies that allow continued practice of highly mobile livelihood strategies, namely, legal recognition of collective land rights, should be adopted

Haptoglobin, alpha-thalassaemia and glucose-6-phosphate dehydrogenase polymorphisms and risk of abnormal transcranial Doppler among patients with sickle cell anaemia in Tanzania.

Transcranial Doppler ultrasonography measures cerebral blood flow velocity (CBFv) of basal intracranial vessels and is used clinically to detect stroke risk in children with sickle cell anaemia (SCA). Co-inheritance in SCA of alpha-thalassaemia and glucose-6-phosphate dehydrogenase (G6PD) polymorphisms is reported to associate with high CBFv and/or risk of stroke. The effect of a common functional polymorphism of haptoglobin (HP) is unknown. We investigated the effect of co-inheritance of these polymorphisms on CBFv in 601 stroke-free Tanzanian SCA patients aged <24 years. Homozygosity for alpha-thalassaemia 3·7 deletion was significantly associated with reduced mean CBFv compared to wild-type (β-coefficient -16·1 cm/s, P = 0·002) adjusted for age and survey year. Inheritance of 1 or 2 alpha-thalassaemia deletions was associated with decreased risk of abnormally high CBFv, compared to published data from Kenyan healthy control children (Relative risk ratio [RRR] = 0·53 [95% confidence interval (CI):0·35-0·8] & RRR = 0·43 [95% CI:0·23-0·78]), and reduced risk of abnormally low CBFv for 1 deletion only (RRR = 0·38 [95% CI:0·17-0·83]). No effects were observed for G6PD or HP polymorphisms. This is the first report of the effects of co-inheritance of common polymorphisms, including the HP polymorphism, on CBFv in SCA patients resident in Africa and confirms the importance of alpha-thalassaemia in reducing risk of abnormal CBFv

Transformation of animal agriculture should be evidence-driven and respectful of livestock’s benefits and contextual aspects

Response to a Letter to the Edito