Impact of COVID-19 on food security: Insights from Telangana, India

COVID-19undermines food security both directly, by disturbing food systems, and indirectly, through the impacts of lockdowns on household incomes and physical access to food especially in the developing nations. The International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) a telephonic survey based on a questionnaire developed by the NNEdPro Global Centre for Nutrition and Health, during July -August 2020 to understand the different perspectives of prevailing COVID-19crisis in urban, peri-urban, rural and tribal areas of Telangana, India. About 40 households were randomly selected for this survey covering urban, peri-urban, rural and tribal locations of Telangana. These households were recruited as respondents for previous surveys by ICRISAT for different projects. The NNEdPro survey questionnaire was adapted and translated into local language for better understanding of the surveyor as well as the participant and probe questions were added to elicit detailed information. Informed audio consent was undertaken through a secure mobile phone system and individual interviews were conducted to elicit data regarding the agriculture and food security situation during the COVID-19crisis in their respective locations. The recorded data were transcribed by enumerators and later translated into English language. Mixed responses evolved regarding agriculture and losses incurred during COVID-19crisis. In case of urban and peri-urban locations, information on agriculture, especially post-harvest losses, due to lack of access to markets was projected and the source of information was mostly through media such as television news, newspaper, and radio. In case of tribal areas, millets and cereals were procured by the government agricultural department at the farm gate and thereby no losses were incurred by farmers who grew cereals and millets. The farmers who grew vegetables incurred losses due to lack of transport to the nearby markets during the complete lockdown. As the vegetables are perishable goods, and due to shortage of labour for harvesting the produce, they incurred postharvest losses. Consumption of cereals and pulses distributed through the Public Distribution System (PDS) has increased at the household level in peri-urban areas. Consumption of fresh fruits and vegetables and spices has also increased in both urban and peri urban locations. There was no change in the number of meals consumed; quantity of meals was voluntarily reduced due to low physical activity and being confined to homes; home cooking was the most preferred way of cooking meals. Outside food and junk food were almost eliminated in the diets of the urban and peri-urban areas. In case of tribal areas, the adolescents and school age children lost their nutritious meals that were served either in their residential schools or midday meals in the government schools. There also emerged some differences between complete lockdown that was in place in late March and early April 2020 and the lockdown with fewer restrictions during June-July 2020. Similarly, the effect of food security at the household and individual level emerged differently across locations as well as during different periods

Shaping food environments to support sustainable healthy diets in low and middle-income countries

The global ambitions to end hunger, achieve food security and improved nutrition, and promote sustainable agriculture demand a complex transition of the current food environments for enabling sustainable healthy diets. The food environments in Low and Middle-Income Countries (LMICs) have been experiencing rapid and dynamic transitions across the globe, necessitating a system-level thinking and systemic approach to understand opportunities for improvement. There is a need for valid, reliable measures of food and nutrition environments for reorienting thinking and data collection toward determinants of food demand, especially the food environment components, which are critical to understand the transforming food systems. Food environment transformations are urgently required to provide consumers with more

Micronutrient-sensitive food value chains: A systematic review of intervention strategies and impact pathways to nutritional outcomes

Knowledge and evidence on how food value chains can deliver nutrition, especially micronutrients, are limited. A deeper understanding of the food value chains as part of agri-food systems approaches addressing hunger and malnutrition through agricultural development may provide pathways for nutrition and health outcomes.. This systematic review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to assess the broad topic of value chains and micronutrients, focusing on interventions and their related impact pathways. Impact pathway interventions improving micronutrient delivery and consumption were classified as production, accessibility, marketing, income, knowledge and behavioral, and finally, women’s empowerment pathways. However, the case study evidence on the micronutrient-sensitive value chains for nutritional outcomes is very scant. This review identified that making value chains micronutrient-sensitive requires a multi-stakeholder, integrated approach as a basis for concerted action among various stakeholders in terms of policy, research, strengthening partnerships and coordination, and information sharing. The review illustrates the scarcity of literature with a focus on the micronutrients in the context of food value chains and developing countries. The food value chain approach offers great potential to unpack the complexity of food systems and identify entry points and pathways for improving nutrition outcomes, especially the micronutrients. Additionally, this review identifies multiple entry points and calls for strong advocacy of nutrition-sensitive value chain approaches to combat hidden hunger

Assessing the rural food environment for advancing sustainable healthy diets: Insights from India

World agricultural production has seen significant growth in the past four decades, yet malnutrition remains a persistent problem, particularly in the global south and more so in the rural areas. Need for a holistic approach to food systems is becoming crucial in designing policies that support the transition to sustainable and healthy diets. The present study is aimed to understand the rural food environment in the Telangana state in southern India by analyzing the combination of external and personal factors affecting food choices, attitudes, and consumption behavior. We developed a scoring-based methodology to assess the external and personal domains and dimensions to understand the food environment. The results showed that rural households favored carbohydrate-rich food groups obtained mostly from their own production or subsidized sources. On the other hand, protein and micronutrient-rich food groups were neglected due to affordability and preference for taste, cultural factors, and the limitations of external food environment. The findings of this study provide a deeper understanding of the food environment in low and middle-income countries (LMICs) conext. By highlighting the interplay between agriculture, food environments, and nutrition outcomes, this study contributes to the ongoing effort to address the global malnutrition crisis and support the development of healthier and more sustainable food systems. These findings can be useful to guide policy actions towards achieving food security and nutrition in the rural regions where food environments are under rapid transitions in the LMICs

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Is diet partly responsible for differences in COVID-19 death rates between and within countries?

Correction: Volume: 10 Issue: 1 Article Number: 44 DOI: 10.1186/s13601-020-00351-w Published: OCT 26 2020Reported COVID-19 deaths in Germany are relatively low as compared to many European countries. Among the several explanations proposed, an early and large testing of the population was put forward. Most current debates on COVID-19 focus on the differences among countries, but little attention has been given to regional differences and diet. The low-death rate European countries (e.g. Austria, Baltic States, Czech Republic, Finland, Norway, Poland, Slovakia) have used different quarantine and/or confinement times and methods and none have performed as many early tests as Germany. Among other factors that may be significant are the dietary habits. It seems that some foods largely used in these countries may reduce angiotensin-converting enzyme activity or are anti-oxidants. Among the many possible areas of research, it might be important to understand diet and angiotensin-converting enzyme-2 (ACE2) levels in populations with different COVID-19 death rates since dietary interventions may be of great benefit.Peer reviewe

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362