Micronutrient deficiencies account for an estimated one million premature deaths annually, and for some nations can reduce gross domestic product
by up to 11%, highlighting the need for food policies ...that focus on improving nutrition rather than simply increasing the volume of food produced
. People gain nutrients from a varied diet, although fish-which are a rich source of bioavailable micronutrients that are essential to human health
-are often overlooked. A lack of understanding of the nutrient composition of most fish
and how nutrient yields vary among fisheries has hindered the policy shifts that are needed to effectively harness the potential of fisheries for food and nutrition security
. Here, using the concentration of 7 nutrients in more than 350 species of marine fish, we estimate how environmental and ecological traits predict nutrient content of marine finfish species. We use this predictive model to quantify the global spatial patterns of the concentrations of nutrients in marine fisheries and compare nutrient yields to the prevalence of micronutrient deficiencies in human populations. We find that species from tropical thermal regimes contain higher concentrations of calcium, iron and zinc; smaller species contain higher concentrations of calcium, iron and omega-3 fatty acids; and species from cold thermal regimes or those with a pelagic feeding pathway contain higher concentrations of omega-3 fatty acids. There is no relationship between nutrient concentrations and total fishery yield, highlighting that the nutrient quality of a fishery is determined by the species composition. For a number of countries in which nutrient intakes are inadequate, nutrients available in marine finfish catches exceed the dietary requirements for populations that live within 100 km of the coast, and a fraction of current landings could be particularly impactful for children under 5 years of age. Our analyses suggest that fish-based food strategies have the potential to substantially contribute to global food and nutrition security.
Vitamin D has well‐defined classical functions related to calcium metabolism and bone health but also has non‐classical effects that may influence other aspects of health. There has been considerable ...recent interest in the role of vitamin D on outcomes related to pregnancy and young child health but few efforts have been made to systematically consolidate this evidence to inform the research and policy agenda for low‐income countries. A systematic review was undertaken to identify intervention and observational studies of vitamin D supplementation, intake or status (25‐hydroxy‐vitamin D) during pregnancy on perinatal and infant health outcomes. Data from trials and observational studies isolating the effect of vitamin D supplementation and intake were extracted and study quality was evaluated. Meta‐analysis was used to pool effect estimates. We identified five randomised trials with outcomes of relevance to our review. All had small sample size and dosage amount, duration and frequency varied as did the ability to correct deficiency. Pooled analysis of trials using fixed‐effects models suggested protective effects of supplementation on low birthweight (three trials, risk ratio (RR) = 0.40 95% confidence interval (CI) 0.23, 0.71) and non‐significant but suggestive effects of daily supplementation on small‐for‐gestational age (two trials, RR = 0.67 0.40, 1.11). No effect on preterm delivery (<37 weeks) was evident (two trials, RR = 0.77 0.35, 1.66). Little evidence from trials exists to evaluate the effect of vitamin D supplementation during pregnancy on maternal, perinatal or infant health outcomes. Based on both trials and observational studies, we recommend that future research explore small‐for‐gestational age, preterm delivery, pre‐eclampsia, and maternal and childhood infections, as outcomes of interest. Trials should focus on populations with a high prevalence of vitamin D deficiency, explore the relevance of timing of supplementation, and the dosage used in such trials should be sufficient to correct deficiency.
Achieving Sustainable Development Goal 2 of zero hunger and malnutrition by 2030 will require dietary shifts that include increasing the consumption of nutrient dense foods by populations in low- and ...middle-income countries. Animal source foods are known to be rich in a number of highly bioavailable nutrients that otherwise are not often consumed in the staple-food based diets of poorer populations throughout the world. Fish is the dominant animal source food in many low- and middle-income countries in the global south and is available from both fisheries and aquaculture. Consumers often perceive that wild caught fish have higher nutritional value than fish produced through aquaculture, and this may be true for some nutrients, for example omega-3 fatty acid content. However, there is potential to modify the nutritional value of farmed fish through feeds and through production systems, illustrated by the common practice of supplementing omega-3 fatty acids in fish diets to optimize their fatty acid profile. This manuscript reviews the evidence related to fish feeds and the nutritional composition of fish with respect to a number of nutrients of interest to human health, including iron, zinc, vitamins A and D, selenium, calcium, and omega-3 fatty acids, with low- and middle-income country populations in mind. In general, we find that the research on fortification of fish diet particularly with vitamins and minerals has not been directed toward human health but rather toward improvement of fish growth and health performance. We were unable to identify any studies directly exploring the impact of fish feed modification on the health of human consumers of fish, but as nutrition and health rises in the development agenda and consumer attention, the topic requires more urgent attention in future feed formulations.
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.
Dietary diversity can play an important role in providing essential nutrients for both mother and fetus during pregnancy. This study aimed to assess the factors associated with dietary diversity ...during pregnancy in the western hill region of Nepal.
A cross-sectional study of 327 pregnant women was conducted in an urban municipality of Baglung district in the western hill region of Nepal. A semi-structured questionnaire was used to collect information on household demographic and socioeconomic status, food taboos, household food security status, nutrition-related knowledge in pregnancy, and women's empowerment. Women consuming ≥5 of 10 food groups in the past 24 hours were defined as consuming a diverse diet using the Minimum Dietary Diversity Score for Women (MDD-W) tool. Bivariate and multivariate logistic regression was used to estimate crude odds ratio (cOR) and adjusted odds ratios (aOR) and 95% confidence intervals (CIs) to understand factors associated with dietary diversity.
Almost 45% (95% CI: 39.6-50.4) of the participants did not consume a diverse diet and the mean dietary diversity score was 4.76 ± 1.23. Multivariable analysis revealed that women with greater empowerment (aOR = 4.3, 95% CI: 1.9-9.9), from wealthier households (aOR = 5.1, 95% CI: 2.7-9.3), joint families (aOR = 2.7, 95% CI: 1.4-5.1), employment (aOR = 2.2, 95% CI: 1.2-4.1), and had adequate nutrition knowledge (aOR: 1.9, 95% CI 1.1-3.4) had higher odds of dietary diversity.
Along with socioeconomic status, women's empowerment and nutrition knowledge were modifiable risk factors that should be considered as targets for programs to improve women's health during pregnancy.
The 2015 earthquake in Nepal caused massive damages and triggered relief activities to minimize human suffering. The post-earthquake nutrition and food security situation in the hardest hit areas ...remains uncertain.
Two national cross-sectional surveys were conducted in 2014 and 2016 among households (HH) with pre-school aged children or newly married women. Of the 21 village development committees (VDCs) included in this sample, 7 fell within "earthquake-affected" areas. This paper presents data from 982 HH, 1015 women, and 883 children from 2014 and 1056 HH, 1083 women, and 998 children from 2016 living in these areas, with longitudinal overlap of about 55%. Prevalence estimates and 95% confidence intervals were calculated, and logistic regression was used to calculate p-values, both using robust estimates of standard errors to account for clustering.
From 2014 to 2016, child wasting (weight-for-height z score <-2) fell from 4.5% (95% CI 3.3%- 6.1%) to 2.1% (1.4%- 3.1%) and food insecurity (assessed using the household food insecurity access scale) dropped from 17.6% (11.7%- 25.6%) to 12.4% (6.9%- 21.2%). Child stunting prevalence remained similar at both time-points. Improvements were also evident in dietary diversity and breastfeeding indicators.
Nutrition and food security conditions remained comparable or improved one year after the earthquake despite evidence of structural and other damage. Livelihood resilience to shocks and/or effective nutrition, food or health interventions may have helped buffer the impact on nutrition, although this hypothesis requires further exploration.
Little is known of the usual food intakes of rural adolescents in South Asia. This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 ...years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. Latent class analysis was used to assign individuals to dietary patterns based on class membership probabilities. The following five dietary patterns (class membership probabilities) were identified: (1) “least diverse” (0.20); (2) “traditional” (0.28); (3) “low vegetable/low fish” (0.23), (4) “moderately high meat” (0.20); and (5) “most diverse” (0.09). The least diverse pattern had the lowest median consumption of most foods and traditional had a relatively higher intake of most vegetables and fish. The most diverse pattern consumed both healthy and processed foods much more often than other patterns. The two most diverse patterns (4 and 5) were associated with higher socioeconomic status, body mass index, height‐for‐age Z‐score, and male gender, and the least diverse pattern showed inverse associations with these characteristics. The most diverse pattern may represent an early wave of the nutrition transition in rural Bangladesh.
This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. These were then used to generate dietary patterns.
Vitamin A (VA) deficiency during pregnancy is common in low‐income countries and a growing number of intervention trials have examined the effects of supplementation during pregnancy on maternal, ...perinatal and infant health outcomes. We systematically reviewed the literature to identify trials isolating the effects of VA or carotenoid supplementation during pregnancy on maternal, fetal, neonatal and early infant health outcomes. Meta‐analysis was used to pool effect estimates for outcomes with more than one comparable study. We used GRADE criteria to assess the quality of individual studies and the level of evidence available for each outcome. We identified 23 eligible trials of which 17 had suitable quality for inclusion in meta‐analyses. VA or beta‐carotene (βC) supplementation during pregnancy did not have a significant overall effect on birthweight indicators, preterm birth, stillbirth, miscarriage or fetal loss. Among HIV‐positive women, supplementation was protective against low birthweight (<2.5 kg) risk ratio (RR) = 0.79 95% confidence interval (CI) 0.64, 0.99, but no significant effects on preterm delivery or small‐for‐gestational age were observed. Pooled analysis of the results of three large randomised trials found no effects of VA supplementation on neonatal/infant mortality, or pregnancy‐related maternal mortality (random‐effects RR = 0.86 0.60, 1.24) although high heterogeneity was observed in the maternal mortality estimate (I2 = 74%, P = 0.02). VA supplementation during pregnancy was found to improve haemoglobin levels and reduce anaemia risk (<11.0 g/dL) during pregnancy (random‐effects RR = 0.81 0.69, 0.94), also with high heterogeneity (I2 = 52%, P = 0.04). We found no effect of VA/βC supplementation on mother‐to‐child HIV transmission in pooled analysis, although some evidence suggests that it may increase transmission. There is little consistent evidence of benefit of maternal supplementation with VA or βC during pregnancy on maternal or infant mortality. While there may be beneficial effects for certain outcomes, there may also be potential for harm through increased HIV transmission in some populations.
The aim of this study was to explore United States (U.S.) seafood consumption patterns, food sourcing, expenditures, and geography of consumption. We analyzed seafood intake and food sourcing using ...the National Health and Nutrition Examination Survey (NHANES) cycles 2007-2008 to 2015-2016 for US adults ≥19 years old (
= 26,743 total respondents;
= 4957 respondents consumed seafood in the past 24 h). Seafood expenditures were extrapolated by combining NHANES with three other public datasets. U.S. adults consumed 63% of seafood (by weight) at home. The top sources of seafood (by weight) were food retail (56%), restaurants (31%), and caught by the respondent or someone they know (5%). Sixty-five percent of consumer expenditures for seafood were at restaurants and other "away from home" sources while 35% were at retail and other "at home" sources. Slightly less than half of overall U.S. food expenditures are "away from home," which is much lower than for seafood, suggesting that consumers have very different spending habits for seafood than for an aggregate of all foods.
This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6–23 months in Eastern and Southern Africa using data from nine Demographic ...and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6–11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin‐A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.
Diets of children in Eastern and Southern Africa lack diversity with large equity gaps in most food groups. Risk factors for low dietary diversity include wealth, education and media access. Interventions addressing affordability and access to diverse diets are required.
Key messages
Diets of children in Eastern and Southern Africa (ESA) lack diversity.
A number of common risk factors predict dietary diversity across countries.
Risk factors for low dietary diversity include wealth, education and media access.
Wide equity gaps were apparent for most food groups in ESA.
Interventions addressing affordability and access to diverse diets are needed.
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