Current Developments in Nutrition最新文献

Background

To monitor trends toward healthy and sustainable diets, there is a need for feasible survey tools, with cross-cultural validity, low-cost, and low-expertise requirements.

Objectives

The objective of this research was to develop a method to gather data suitable for monitoring diet quality in the general population (women and men of all ages) that is feasible within multitopic surveys, low burden for both enumerators and respondents, valid at population level, and that captures the information necessary for understanding diet quality at global and local levels.

Methods

A literature review was conducted to identify constructs of diet quality with existing consensus, indicators with existing global demand, and methods that may be feasible and valid. Results were presented to a technical advisory group for debate, resulting in consensus on a set of constructs to be measured, desired indicators, viable data collection platforms, and an approach for testing and piloting.

Results

Food group-based indicators and 24-h recall period were selected as the most feasible and valid approach for population-level monitoring. A 29-item Diet Quality Questionnaire (DQQ) was developed, where each yes/no question asks about the consumption of a distinct food group on the previous day or night. The food groups were selected for the purpose of deriving indicators to capture the constructs for which there was consensus: nutrient adequacy, and protection against noncommunicable diseases, including both positive and negative risk factors.

Conclusions

The DQQ is low cost and feasible to administer in existing large-scale surveys, overcoming barriers to diet data collection that have precluded the routine monitoring of diet quality in the past. This novel approach has now been used across >85 countries in the Gallup World Poll and other surveys, generating the first nationally representative available datasets on Minimum Dietary Diversity for Women and complementary diet quality indicators.

Current food systems fail to provide equity, sustainability, and positive health outcomes, thus underscoring the critical need for their transformation. Intervening in food environments holds substantial promise for contributing to this much-needed transformation. Despite scholars and practitioners often recognizing the necessity for bottom–up approaches, there is a dearth of empirical investigations evaluating the potential of these approaches to contribute to food system transformations in low- and middle-income countries (LMICs). Our study aimed to address this research gap, providing a unique perspective in this regard. Drawing on evidence from two co-creation case studies conducted with small-scale informal fruit and vegetable vendors and poor consumers in Vietnam and Nigeria from January 2020 to December 2021, we explored the relevance of bottom–up community-engaged co-creation processes in intervening within LMICs’ food retail environments. Employing a mixed-methods approach that includes quantitative surveys, qualitative interviews, participatory workshops, and focus group discussions, we demonstrated that bottom–up co-creation processes involving marginalized socioeconomic groups can generate retail-level innovations that are tailored to informal retail contexts, whereas remaining aligned with established top–down theories and literature pertaining to food environments and healthy diets. We provided empirical evidence highlighting how both vendors and consumers respond positively to the co-created innovations. Expanding upon our results, we offered methodological insights applicable to interventions targeted at food environments in LMICs, and considerations for future research or development initiatives in this domain. Our findings revealed the capacity of vulnerable stakeholders to actively engage in public health initiatives and contribute to developing innovative solutions that are context-specific and conducive to the adoption of healthier dietary practices. These results confirm the potential of bottom–up, co-creation, real-world interventions within informal settings to contribute toward fostering inclusive transformation of food systems.

There is a high level of concern about the possible influence of commercial organizations on food-related research and professional bodies, including regulatory and advisory panels. This has contributed to an increased emphasis on the declaration and management of conflicts of interest (CoI) in the reporting, evaluation, and application of research in nutrition science. However, common perceptions of CoI in nutrition, and procedures for declaring and managing these, often lack intellectual rigor and consistency. This commentary highlights 3 main issues related to CoI in nutrition, particularly the emphasis on industry-related CoI relative to other sources of conflict and bias. 1) Considerations of CoI in nutrition are largely limited to financial or collaborative links to the food industry, disregarding other important sources of influence such as intellectual allegiances or nonindustry financial and professional incentives. 2) Associations with industry incur ad hominem, often punitive stigmatization of individuals and their research, and inappropriate downgrading or exclusion of evidence. This disproportionately affects expertise in the food and agricultural sciences, in which commercial collaborations are widely encouraged. 3) These practices and related approaches to managing CoI are applied without due consideration of the nature of the conflicts and activities involved, the qualifications of individuals, or the availability of other, objective methods and guidance for assessing research quality and risks of bias. Overall, recognition of the nature and range of CoI in nutrition and approaches to their identification and management lack consistency and balance. A singular and strict focus specifically on industry-related CoI may paradoxically exacerbate rather than mitigate imbalance and bias in the field. This commentary outlines the underlying issues and the need for more comprehensive and nuanced approaches to the assessment, reporting, and management of CoI in nutrition.

Background

Limited research exists on the specific approaches and behavior change techniques (BCT) used in nutrition-sensitive agriculture (NSA) programs and their effects on diet diversity.

Objectives

We aimed to describe nutrition-related social behavior change (SBC) in the context of NSA and quantify the effectiveness of different SBC components of NSA programs in improving diet diversity.

Methods

We searched PubMed, Embase, Web of Science, the International Food Policy and Research Institute repository, and Agricola for articles published between 2000 and 2023. We identified the agricultural activities each project used as a pathway to improved nutrition (ag-nutrition pathways), identified SBC approaches used by each project, and coded BCTs using validated coding protocols. Effectiveness ratios (ERs) were calculated to assess pathways, approaches, and BCTs in relation to dietary diversity outcomes (minimum diet diversity for children, child dietary diversity score, and women’s dietary diversity).

Results

Of 65 included NSA interventions, the most used agriculture-to-nutrition pathways included 1) agricultural production for home consumption (n = 61); 2) women’s empowerment (n = 36); and 3) agricultural income (n = 37) pathways. The most used SBC approaches were interpersonal communication (IPC, n = 59) and community-based approaches (n = 53). Frequently used BCTs included “instructions on how to perform the behavior” (n = 65), “social support (unspecified)” (n = 43), and using a “credible source” (n = 43). The increased production for the home consumption pathway, IPC approach, and the BCT “behavioral practice” had high ERs for diet diversity outcomes.

Conclusions

Although the agricultural production for home consumption pathway to improved nutrition had the highest ERs for diet diversity, other pathways, such as income generation and reducing wastage, hold promise and require additional investigation. The most commonly applied BCTs focused on information dissemination; however, participatory BCTs related to behavioral demonstration, and behavioral practice had higher ERs. Findings indicate a need to test less frequently utilized SBC components to determine effectiveness.

This trial was registered at PROSPERO (=https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179016) as CRD42020179016.

Background

Despite progress in improving living standards and reduced poverty, food insecurity and malnutrition remain a significant issue worldwide. Childhood is a critical time for the intake of protein to support physical and cognitive growth, including animal-source foods like eggs which can effectively mitigate stunting in low- and middle-income countries. In Malawi, high malnutrition rates among women and children represent a significant public health challenge, but high-quality sources such as eggs remain costly, scarce, and rarely consumed by children in Malawi. The Egg Hub model, identified and piloted by local agri-food entrepreneurs and the Sight and Life Foundation in Malawi, tackles the obstacles faced by smallholder farmers, working to increase egg production, enhance availability, and improve consumption within rural communities by supporting small-scale farmers transition from unsustainable and unproductive backyard rearing to small-scale farm through access to high-quality inputs, training, loans, and a guaranteed market for their eggs.

Objectives

This paper provides a detailed account of the implementation of the pilot of the Egg Hub Model in Malawi including the demand creation process, the impact of the model on producers, consumers, and operators, and the social, economic, and environmental sustainability aspects of the model.

Methods

Qualitative and quantitative surveys (n = 217 consumers) were used for demand creation and qualitative surveys were used with 15 retailers to determine egg sales. With 16 farmers and the egg hub operator, business metrics, including profits and loss records, were analyzed.

Results

The pilot of the Egg Hub model in Malawi supported 85 farmers to triple their egg production, allowing their communities to purchase eggs at prices reduced by 40%, benefiting an estimated number of 180,000 rural poor. Egg consumption among the target population increased from an average of 2 to 9 eggs/month and led to reduced egg wastage and better biosecurity, reducing the risk of children’s exposure to chicken feces and infections. The achievements of this Egg Hub in Malawi allowed the model to be replicated in Ethiopia, Peru, and Brazil, producing 40 million eggs annually and benefiting more than half a million consumers.

Conclusion

The Egg Hub model is a comprehensive and scalable solution to increase egg supply, address malnutrition and food insecurity, and improve livelihoods. The advantages include centralizing key activities through a community-centered approach, empowering female farmers, increasing access to a highly nutritious food, and economic benefits for farmers and their communities.

Background

Micronutrient deficiencies are a major problem among children in northern Ghana. Available local foods and existing plant-based dietary patterns among children are insufficient to meet children’s nutrients requirements. Aside enhancing diets with animal source foods, most of which are expensive for rural households, entomophagy, which is culturally accepted, appears to be a great alternative.

Objectives

This study aimed to 1) document the types of insects commonly consumed and the reasons for or against entomophagy in the study area, 2) document the reasons for adding or not adding insects to household meals, and 3) determine the nutrient contribution of community-based insects in children's food.

Methods

Both qualitative and quantitative research methods were concurrently applied in this exploratory study (N = 392 individuals; 6 focus group discussions) in northern Ghana.

Results

Termites, crickets, grasshoppers, and caterpillars were recognized as the most prevalent edible insects in communities. These insects were largely consumed by children but presently only included in household meals by a few households. Individual, sociocultural, sensory characteristics of insects, climate, and economic aspects were cited as grounds for and against entomophagy. Existing community-based children’s diets were unable to meet the acceptable recommended nutrient intake (RNI; within a given age and gender group, the RNI is the amount of a nutrient ingested daily that would meet the needs of almost all healthy individuals in that group) level of all nutrients under consideration, especially for zinc, vitamin B-12, folate, and fat. Inclusion of community-based edible insects increased the RNI levels for all 11 micronutrients considered and met children’s zinc, vitamin B-12, folate, and fat requirements.

Conclusions

Community-based insects demonstrate a great potential for meeting micronutrients needs of children in the research setting. Future research is required to improve households’ adoption of community-based insects as part of household meals and to make insects accessible to households.

Background

Women of reproductive age are at elevated risk of iron deficiency (ID) and anemia; in the United States, those of Hispanic/Latino background are at especially high risk. Causes of ID and anemia and variations in risk within Hispanic/Latino women of reproductive age are not well described.

Objectives

To characterize ID and anemia and their risk factors/markers in Hispanic/Latina women.

Methods

Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were used. HCHS/SOL enrolled participants in 2008–2011 at 4 sites: Bronx, Chicago, Miami, and San Diego; 5386 were non-pregnant women ages 18–49 y. Primary outcomes were ID (ferritin <30 μg/L) and anemia (hemoglobin <12 g/dL). Predictors were background/heritage, Short Acculturation Scale for Hispanics scores, years lived in the United States, and interview language, diet summarized in the Alternate Healthy Eating Index 2010, sociodemographic covariates, and study site. Main analyses used survey log binomial regressions adjusted for age, site, and smoking.

Results

Almost half (42%) of participants were of Mexican background, 15% of Cuban background, and <15% each were of Puerto Rican, Dominican, Central American, or South American background. ID prevalence was 34.4% overall but differed by site-background pairings. The lowest and highest prevalence were 26% and 42% among women of Cuban background in Miami and women of Mexican background in Chicago, respectively. Anemia prevalence was 16% and ranged from 8.9% (Central American background/Miami) to 22% (Dominican background/Bronx). Acculturation, sociodemographic, and diet variables examined did not explain observed prevalence differences by site/background.

Conclusions

Prevalence of ID and anemia were high among HCHS/SOL women and differed by field center and background. These differences highlight the importance of characterizing nutritional risk by background within Hispanic/Latino women.

The hormonally active form of vitamin D, 1,25-Dihydroxyvitamin D3 [1,25(OH)₂D₃], has been associated with neuroprotective effects in the brain, but has been difficult to measure in human brain tissue because of its low concentration. The aim of this study was to develop and validate a sensitive method to quantify 1,25(OH)₂D₃ in the human brain. Prior to analysis by the LC-MS/MS, the samples were derivatized with 4-phenyl-1,2,4-triazoline-3,5-dione. The method showed good linearity of 1,25(OH)₂D₃ over the physiological range (R² = 0.9998). The limit of detection was 2.5 pg/g, >10 times lower than the previously reported limit of detection. The average 1,25(OH)₂D₃ concentrations in 3 regions of human brain tissue samples were: anterior watershed 30.7 pg/g; mid-temporal cortex 19.2 pg/g; and cerebellum 18.5 pg/g. This validated method to quantify 1,25(OH)₂D₃ in human brain tissue can be applied to obtain information about its presence in various regions of the human brain associated with neurodegenerative diseases.

Background

There is currently no cogent set of standards to guide the design, implementation and evaluation of nutrition social and behavior change (SBC), including for nutrition-sensitive agriculture (NSA).

Objectives

We aimed to capture, consolidate, and describe SBC core principles and practices (CPPs), reflecting professional consensus, and to offer programmatic examples that illustrate their application for NSA projects in low- and middle-income countries.

Methods

We conducted a narrative review following a 4-step iterative process to identify and describe SBC CPPs. We first reviewed general SBC frameworks and technical documents and developed a preliminary list of CPPs and their definitions. Following review and feedback from 8 content experts, we revised the CPPs, incorporating the panel’s feedback, and conducted a more specific search of the peer-reviewed and gray literature. We presented a revised draft of the CPPs to 26 NSA researchers, practitioners, and implementers at the 2022 Agriculture, Nutrition and Health Academy annual conference. We then conducted a focused review of each CPP, and 3 content experts rereviewed the final draft.

Results

We reviewed ∼475 documents and resources resulting in a set of 4 core principles: 1) following a systematic, strategic method in designing, implementing, and evaluating SBC activities; 2) ensuring design and implementation are evidence-based; 3) grounding design and implementation in theory; and 4) authentically engaging communities. Additionally, we identified 11 core practices and mapped these to the different stages in the SBC design, implementation, and evaluation cycle. Detailed descriptions, illustrative examples and resources for implementation are provided for each CPP.

Conclusions

An explicit set of CPPs for SBC can serve as a guide for design, research, implementation, and evaluation of nutrition and NSA programs; help standardize knowledge sharing and production; and contribute to improved quality of implementation. Broader consultation with SBC practitioners and researchers will further consensus on this work.