The Holy Grail of Nutrition, at least this month

One of the holy grails in nutrition is to better understand how agriculture and our food system can improve nutrition and health. Well, it is the current flavor of the month. Often called “nutrition sensitive programming or approaches,” most are trying to figure out where the linkages are between food and nutrition. Go figure! Determining what works best and where, and how to exploit those benefits remains elusive to say the least. A whole bunch of scientists and experts are on the case though, so have no fear my friends…Many of those experts have been publishing on the subject as of late, and here is a quick summary:

Haddad and colleagues at IDS did a systematic review that examined if agricultural interventions made an impact on nutritional outcomes. The bottom line of the review showed that agricultural interventions increased the production and consumption of nutritious foods but there was no evidence of an impact on the prevalence of malnutrition in children. Ouch.

Haddad also wrote an “evidence matters” brief on agriculture and nutrition. He calls for more impact evaluations of these multi-sectoral programs and better designed studies to begin with that have robust funding to do adequate sampling.

Another systematic review done by a research group at Emory was released and confirmed the IDS study. The review showed that first, the studies were not of great quality or homogeniety making them more difficult to be reviewed, critiqued and compared. Their review did show however that agricultural strategies improved diet patterns and diversity, and vitamin A intakes for both women and children. There were no improvements in stunting, underweight and wasting – ie child growth. The authors stated the following: “overall the evidence base for the potential of agricultural strategies to improve the nutrition and health of women and young children is largely grounded in a limited number of highly heterogeneous, quasi-experimental studies, most of which have significant methodological limitations. While household food production strategies hold promise for improving the nutrition of women and children, the evidence base would be strengthened by additional research that is methodologically robust and adequately powered for biological and dietary indicators of nutrition.” Ouch again.

Dangour and colleagues at the London School published a very interesting paper on food chain and health series. They discuss thoughtfully on the negative effects of agriculture on health including climate change, dietary quality and diseases along the food chain. They also pay kudos to the importance of biodiversity and its role in ecosystems, and constituents of diets, two areas with tremendous neglect in science and development.

IFPRI is always rock steady. They have put out two books/reports. The first book came out a few months back entitled “Reshaping agriculture for nutrition and health.” The book is filled with enriched chapters from researchers, practitioners, and policymakers in which they explore the links among agriculture, nutrition, and health and identify ways to strengthen related policies and programs. Chapter 5 by Derek Heady is a standout. The work summarizes the discussions from a global meeting that took place on the same subject in New Dehli in early 2011. I wrote a review of the meeting here.

The second release is a book of policy briefs entitled “Scaling up in agriculture, rural development and nutrition.” This collection of briefs examines how to scale up these three areas. There were really only three chapters that closely examined nutrition with a summary of the Scaling Up Nutrition movement, the Alive and Thrive project in Bangladesh (the most interesting) and the ol’ reliable orange fleshed sweet potato story that IFPRI and HarvestPlus have written about to its very darkest death. We get it already…but can we do more than just eat vitamin-A rich potatoes? We need more stories. I look forward to seeing the impact data on the next generation of  biofortified to see if they do indeed make a dent in nutritional status.

FAO and Bioversity International just released a book entitled “Sustainable diets and biodiversity.” This book presents “the current state of thought on the common path of sustainable diets and biodiversity.” Some of the case studies in chapter 3 are really interesting, especially the one on insect consumption. I also hear in chapter 1 there is a killer sub-chapter on the ensuring agriculture biodiversity and nutrition remain central to addressing the MDG1 hunger target (wink wink). Sustainable diets is really catching on these days with the idea that sustainable diets are foreseen as an important element for a shift towards sustainable development and a green economy.

A recent paper in the AJCN emphasizes the importance of sustainable diets through greenhouse gas emission reductions. By taking one element of environmental sustainability, greenhouse gases, the researchers test the compatibility of diets that meet dietary requirements for health with dietary changes needed to reduce greenhouse gases. Based on UK requirements, the authors recommend that a sustainable diet that meets dietary needs while lowering greenhouse gases would be one with lower meat consumption with 52 different food items. Although the study and the modeling have major limitations, it was a very interesting and creative research design and overall hypothesis, and most importantly, messaging.

PNAS just came out with a special issue on Agriculture Development and Nutrition Security, led by Patrick Webb of Tufts and colleagues. The introduction piece is a thoughtful one and I believe builds a roadmap of how we can not only think about food systems globally, but themes to build a new generation of development practitioners and scientists. The authors call for a “roadmap for a transdisciplinary science to support change of sufficient scale and scope.”

And if none of those releases wet your beak, PLoS just put out a collection on “Big Food.” PLos describes the series as the following: “ims to examine and stimulate debate about the activities and influence of the food industry in global health. We define “Big Food” as the multinational food and beverage industry with huge and concentrated market power. The series adopts a multi-disciplinary approach and includes critical perspectives from around the world.” So far, the three essays, and one perpective isn’t fairly cutting the Sarah Lee cake if you know what I mean. One piece by the media-popular Marion Nestle, shows an interesting choice from the editors. They need many more opinions including those who actually engage or dare I say, work in the private sector. Or at least, those who understand economics and its importance in development and nutrition. Let’s hope they solicit more perspectives. So far the series ain’t all that and a bag of chips, preferably Frito Lays…

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6 Responses to The Holy Grail of Nutrition, at least this month

  1. Judy McLean says:

    Hi Jess – In response to the need for evidence regarding the impact of agricultural interventions on nutritional status as well as livelihoods and measures of household food security, we are conducting a 3-arm randomized control trial among 900 households in Prey Veng Province, Cambodia, with Helen Keller International. Interventions arms include HKI’s traditional Homestead Food Production (HFP)/nutrition education model and an HFP plus Fish Ponds arm. We believe this is the first such study and has been designed to evaluate impact in as rigorous a manner as possible given field conditions. We are very thankful that CIDA IDRC’s Food Security Fund agreed that this research was important to the international community and are supporting us in this 30-month trial. There is a website and blog for people interested in following the project with more on the design on-line at Canadian Clinical Trials Best, Judy

  2. Yassir Islam says:

    “the ol’ reliable orange fleshed sweet potato story that IFPRI and HarvestPlus have written about to its very darkest death.”

    Not sure whether to take that as a compliment or challenge, but we’re not quite done. Stay tuned for yet another sweet potato news release this week, this time with more of the evidence that nutritionists want.

    • urwhatueat says:

      Hi Yassir. I would take it as both! Thanks for the information. What would be great to see is some of the latest developments on the next generation of biofortified crops. It will be interesting to see the fruits of HarvestPlus’s labor ie the iron beans, zinc rice, iron pearl millet. I think the sweet potato is important, but I want to hear about some of the others. Can you share any information on the other crops and how they are fairing?

  3. Yassir Islam says:

    Yes, vitamin A cassava (Nigeria), iron bean (Rwanda), and iron pearl millet (India) have also been released. Vitamin A maize should also be out in Zambia next month. These varieties do not have the full nutrient targets as yet, but can help pave the way for the next generation of nutrient-rich crops. Nutritional studies on these crops are also ongoing. Our study published in the Journal of Nutrition yesterday provides further strong evidence on the positive nutritional impact of orange sweet potato in Uganda. Coupled with similar evidence from Mozambique, and other studies, the case has been made for orange sweet potato (OSP). This study showed that an agriculture intervention promoting OSP and evaluated using a state-of-the-art randomized evaluation design actually works. This is no easy feat, as this type of research is time consuming and complex. It is now time too look at the nutritional impact of other crops. Stay tuned!

    • urwhatueat says:

      Thanks for the update Yassir. Indeed, this research and the rollout of these crops is not an easy task. We all need to be patient to ensure H+ gets the evidence right. The Gates Foundation just released a white paper on agriculture investment/nutrition outcomes. Biofortification was highlighted as a major focus.

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