Nutrition

Nutrition combined Environmental Assessment of Global Diets

Authors: Abhishek Chaudhary1, Alexander Mathys1
Author Affiliations: 1Institute of Food, Nutrition and Health, ETH Zurich

Food systems are at the heart of majority of global Sustainable Development Goals (SDGs). Past studies have shown that dietary transformation such as replacing animal-sourced food with plant-based alternatives on a national level can lead to reduced environmental impact as well as reduced human health risk. However, most studies have focused either on a particular country, limited number of nutrients (e.g. total calories, fat or protein) and selected environmental damage indicators (e.g. GHG emissions). Thus, these previous studies have not considered micronutrient intake, whose deficiency (so called ‘hidden hunger’) affects more than 2 billion people globally. Here we investigate whether nutrient and environmental sustainability point to convergent or divergent goals by considering nation-specific dietary patterns, comprehensive nutrient composition of food items and multiple environmental indicators (climate change, water use, land use, biodiversity loss). We first assess the nutritional quality of average national diets of 156 countries taking into account the total daily intake of >25 essential macro and micro nutrients and several nutrients of health concern (e.g. cholesterol, sugar, saturated fat) and comparing them to their daily dietary reference intakes (DRI) and maximum reference values (MRV) respectively. Next, we compile the environmental footprint of national diets through literature review and databases of emission factors for individual food items. The results show that different countries have widely varying scores depending upon the indicator considered. Currently, high-income nations score well on essential nutrient intake, but poorly on environmental footprint, and health sensitive nutrient intake indicators. We found that transitioning towards standard dietary guidelines and more plant-based diets would improve both nutrition indicators and environmental footprints of all nations in general, but might need to be accompanied by supplementation of micronutrients such as Selenium, Vitamin-D and Vitamin-B12 whose intake is currently met primarily through animal-based foods. Our integrated nutrition-environmental quantitative assessment of global diets can provide new insights to policy-makers of individual countries for setting improvement targets on areas of concern and adopt measures to achieve nutrition, human health and environmental sustainability goals.

The role of global dietary transitions in biodiversity loss

Authors: Peter Alexander1, Roslyn Henry1, Sam Rabin2, Peter Anthoni2, Thomas Pugh, Mark Rounsevell2, Almut Arneth2
Author Affiliations: 1University of Edinburgh; 2Karlsruhe Institute of Technology; 3University of Birmingham

Background: Anticipated dietary transitions—including shifts toward greater animal production consumption—coupled with an increasing population, will place greater pressure on the global land system for food production. These changes have the potential to create harm to both the environmental and human heath, and thus impact planetary health. For example, achieving food security through agricultural expansion and intensification threatens global biodiversity and the functioning of natural ecosystems. Global transitions to diets lower in meat could reduce agricultural land and the associated inputs required, but to date, the potential impact of dietary changes on biodiversity have not been quantified.

Methods: To investigate potential land use change, a model system has been developed that couples a biologically-representative global vegetation model (LPJ-GUESS) with a land use model (PLUMv2). LPJ-GUESS simulates yield potentials globally at 0.5° resolution for crops and pasture under a range of management intensities, and for a time-dependent atmospheric CO2 level and climatic forcing. PLUMv2 uses these yields, in conjunction with other socio-economic parameters, to simulate future land use and management inputs (fertilizer and irrigation water) for given dietary assumptions.

The simulation results are used to explore the potential impact of land use resulting from alternative dietary scenarios on regional and global biodiversity for different taxa. Furthermore, the extent to which global protected areas—as recorded by the World Database of Protected Areas (WDPA)—help to reduce land use change impacts is modelled and considered.

Findings: Results show the importance of dietary choice and protected areas for biodiversity conservation in terrestrial ecosystems. We find that current projected dietary demand, with increasing meat consumption, causes both the expansion of agricultural areas as well as increased intensity of production in global biodiversity hotspots. However, global transitions to diets lower in meat (in addition to maintaining existing WDPA protection) substantially reduces the loss of natural land in areas of high biodiversity.

Interpretation: The links between global meat consumption and agricultural expansion and intensification in biodiversity hotspots are demonstrated and quantified by the results. They suggest the potential and need to help safeguard natural ecosystems and associated biodiversity through alterations in food demand.

Zinc deficiency in India from future CO2

Authors: Matt Smith1, Ruth DeFries2, Ashwini Chhatre3, Samuel Myers1
Author Affiliations: 1Harvard T.H. Chan School of Public Health; 2Columbia University; 3Indian School of Business, Hyderabad, India;

Background India has made great strides toward improving nutrition over the past several decades despite rapid population growth, though all movement has not been consistently positive, particularly for zinc. A previous examination of food balance sheet data by Wessells and Brown (2012) estimated that the prevalence of zinc deficiency in India has increased from 28% to 31% between 1990 and 2005, despite a global decrease from 20.7% to 19.6% over that same period. This worrisome trend has the potential to be exacerbated by rising anthropogenic carbon dioxide emissions. 550 ppm CO2, a concentration predicted to occur by 2050 on our current trajectory, has been shown to deplete most major grains of 5-11% of their zinc (Myers et al., 2014). This is particularly critical for India, which relies upon grain crops for nearly three-quarters of their dietary zinc.

Methods To explore the cause of these past trends as well as the magnitude of the impact of rising CO2 on future zinc deficiency, we used data from seven nationally representative Indian National Sample Survey rounds of household food consumption between 1983 and 2012, paired with nutritional densities from the Indian Food Composition Tables, to calculate past and current zinc from the diet. We then estimate the future risk of zinc deficiency due to depletion of zinc from crops grown under elevated anthropogenic CO2 (550 ppm) by 2050.

Findings We find that nationwide deficiency has increased from 17.1% (15.3–19.0%; 95% UI) in 1983 to 24.6% (22.3–27.1%) in 2011-12, corresponding to an additional 83 million more people becoming zinc deficient than would have otherwise if 1983 rates had persisted. These increases have been driven by a steady drop in coarse cereal consumption (mainly millet and sorghum) and an insufficient increase in per capita zinc intake to keep pace with the growing requirements of an aging population. Deficiency is concentrated in specific subgroups: urban populations, rice-eating states, and, peculiarly, those in the top income quartile. Future CO2 is likely to continue and enhance this trend by depleting dietary zinc further, potentially increasing zinc deficiency by another 5.5% (3.3–7.8%). This corresponds to an additional 93 million people (56-131M) becoming deficient due to elevated CO2 by 2050.

Interpretation Zinc deficiency is a significant cause of morbidity and mortality globally and is trending in the wrong direction in India. Changes in diet, an aging population, and anthropogenic CO2 emissions are likely to exacerbate this concerning trend into the future.

Relationships between forests, deforestation and nutritional outcomes: an observational study in nine African countries

Authors: Thomas Pienkowski1, B. Dickens2, H. Sun3, A.S Waldron, W. Symes3, L.R. Carrasco3
Author Affiliations: 1Department of Zoology, University of Oxford; 2Saw Swee Hock School of Public Health, University of Singapore; 3Department of Biological Sciences, University of Singapore

Background: Ecosystems have complex relationships with public health, and environmental degradation can disrupt important health related ecosystem services. Agricultural expansion is a leading driver of deforestation, yet malnutrition remains a significant cause of morbidity. It is therefore important to understand the links between forest cover, deforestation and indicators of malnutrition when managing landscapes for sustainable development. Recent research has illustrated the importance of forests in supporting dietary diversity. However, there remains little evidence of the effects of forest on broad nutritional outcomes such as underweightness.

Methods: We explored relationships between nutritional outcomes in children under five years of age and forest cover and loss gradients (in 10km buffers around communities) in 61,032 African households between 2003 and 2014. USAID Demographic Health Survey data was combined with spatially explicit land cover, climatic, infrastructural, and demographic data in a series of generalized linear mixed-effects models. These models explored the role of forests and deforestation on children’s nutritional outcomes, the mediating effect of socio-economic and infrastructural context, and how these relationships changed over time.

Findings: In urban areas, children in communities surrounded by one standard deviation (SD) higher forest cover than the mean experienced 10.8% (95% CI 3.0%–18.0%, p = 0.0073) lower incidence of underweightness and 11.7% (95% CI 1.9–20.6%, p = 0.0212) less wasting. However, in rural areas the relationship was reversed, with children suffering 6.0% (95% CI 1.6%–10.6%, p = 0.0074) higher incidence of underweightness in areas of higher forest cover. Additionally, underweightness was 6.7% (95% CI 1.4%–12.3%, p= 0.0124) higher in urban areas and 2.6% (95% CI 0.04%–5.2%, p = 0.0460) higher in rural areas with one SD greater deforestation, although this relationship appeared to diminish over time.

Interpretation: Forest loss appears to be associated with worse nutrition in the short term, although unmeasured frontier migration may play a role. Our results also suggest that forest cover is associated with worse nutritional outcomes in rural areas but better outcomes in urban areas of Africa. Our study does not explicitly measure the role of forests in improving dietary diversity. Therefore, the extent to which the benefits of forests in reducing the ‘hidden hunger’ of micro-nutrient deficiency are offset by potential costs is not clear. Nevertheless, these health costs should be recognised and accounted for in efforts to meet sustainable development objectives.

Improving efficiency in the food system and environmental conservation through agricultural biodiversity in Busia County

Authors:Aurillia Manjella1Victor Wasike2, Teresa Borelli3, Danny Hunter3,4
 Author Affiliations: 1Biodiversity for Food and Nutrition Project, Bioversity International, Kenya; 2Genetic Resources Research Centre, Nairobi, Kenya; 3Healthy Diets from Sustainable Food Systems Initiative, Bioversity International, Italy; 4Charles Perkins Centre, University of Sydney, Australia

Background: Despite the abundance of edible biodiversity, both wild and cultivated, malnutrition and food insecurity persist in Busia, Kenya, where poverty indices range from 63% to 74% and 1 in 4 children under five are stunted, 11% are underweight and 4% are thin for age. Much of this diversity, used in traditional food preparations, has potential to provide access to key micronutrients for healthy and balanced diets as well as act as an important source of community resilience to climate change and economic turbulence. Yet, lack of consumer awareness of the value of local biodiversity, poorly developed value chains and negative perceptions associated with traditional foods have led to the disappearance of many nutrient-rich species and the shift to unhealthy diets. The study shows that heightened knowledge of the value of biodiversity and improved value chain efficiencies can help to conserve biodiversity and improve local food systems.

Methods: A farmer business school model was developed and training provided to 25 farmer groups across 7 sub-counties on the sustainable production of traditional vegetables, post-harvest handling, contract farming, nutrition and value addition. At the same time, select species were analyzed for nutritional content, a food procurement model was tested supporting market linkages between farmers and local institutions and nutrition education activities carried out to improve the capacity of schools and clinics to incorporate traditional foods in institutional meals.

Findings: Traditional vegetables are rich in iron, with cowpea leaves, for example, found to contain 17 times more iron than kales. Since the data was made available to all value chain actors and the food procurement model was implemented, a 12% increase was recorded in the number of households cultivating local biodiversity both for household consumption and off-farm sales, along with an increase in the plot size devoted to traditional vegetable cultivation. Furthermore, household incomes rose by 47% as a result of direct links with institutional markets.

Interpretation: The project has positively impacted the abundance, composition and distribution of species and revived interest in local food biodiversity, in addition to producing benefits around diverse diets. Experience in implementing the Busia model was used to inform global policy mechanisms that aim to mainstream biodiversity into sustainable food systems using public procurement, particularly schools, as a platform for improving nutrition. Nationally, a Biodiversity Policy is being developed for Busia that recognizes the importance of local biodiversity, including for improved livelihoods, community resilience and health and nutrition.

 

Harnessing agricultural biodiversity and managing landscapes for improved nutrition and well-being in Sri Lanka

Authors:Azra Sartaj1, W.L.G Samarasinghe1, D. Hunter2,3
Author Affiliations: 1Plant Genetic Resources Center and Biodiversity for Food and Nutrition Project; 2Bioversity International, Italy & Health Food Systems node; 3Charles Perkins Centre, University of Sydney

Background: Profound change including poor land use practices, habitat mismanagement, land degradation, misuse of agro-chemicals, deforestation and urbanization has meant once healthy ecosystems are struggling to sustain production systems and other essential services in Sri Lanka. It is estimated around 750,000 people struggle to adapt to adverse changing climate especially severe drought and flash floods. This lack of adaptability in turn drastically affects ecosystem services essential to sustain human health and well-being including the provision of food and healthy diets, biodiversity and habitats, soil and water quality.

Methods: Baseline assessments involving field visits, group discussions and questionnaire surveys were undertaken in three unique agro-ecosystems: the village tank cascade system; ‘Kandyan’ home gardens; and, ‘Owita’ peri-urban system to determine agrobiodiversity status, food security status, dietary diversity, socio-economic status and associated traditional knowledge. Subsequently food composition analysis, ethno-botany studies and value chain analysis of local agro-biodiversity were conducted.

Findings: Baseline assessments revealed local food production systems are under threat including reduction in the diversity and consumption of available food, loss of traditional knowledge, culture and skills. Food insecurity percentages of 59.9%, 60.2% and 21% respectively were recorded while the incidence of diet related nutrition and health problems, including stunting, wasting, under-weight and NCDs, continue to rise. Surveys depicted marketing value chains needs to be strengthened for new biodiversity products to enhance agribusinesses around local biodiversity with identified nutrition indicators.

Interpretations: Underutilized and locally-adapted agrobiodiversity has been identified and prioritized, based on criteria including food composition data, to address common nutritional deficiencies especially iron, vitamin A and zinc, while at the same time promoting biodiversity conservation. Foxtail millet (Setaria italic), wood apple (Limonia acidissima) and leafy vegetables including Centella asiatica, Alternanthera sessilis & Sesbania grandiflora have been identified as excellent sources of micro-nutrients. These target crops, and others, are being introduced and promoted into home gardens and surrounding farming landscapes to enhance not only household food security but also the management and diversity of agroecosystems via land restoration and the revitalization of indigenous crops with high nutritional value. Furthermore, the target crops also contribute to livelihood improvement: promotion of organic cultivation methods with certification systems such as participatory guarantee schemes is promoted amongst smallholder growers to increase supply with an emphasis on premium pricing. They also grow well without overuse or reliance on agrochemicals, an added benefit for human health and agroecosystems. Findings are being used for formulation of improved policies and marketing guidelines related to ecosystems, agrobiodiversity, nutrition and health using a holistic approach to promote cross-sectorial policy and value chain platforms.

A methodological exploration for assessing the impact of drought on stunting in Kenyan children

Authors: Kate Lillepold1Ashley Aimone1Susan Keino2, Paula Braitstein1
Author Affiliations: 1Dalla Lana School of Public Health, University of Toronto; 2Department of Human Nutrition, College of Health Sciences, Moi University

Background
Globally, droughts are occurring more regularly and are having negative impacts on population health; particularly in countries like Kenya, where agriculture is a primary driver of the economy and source of subsistence for many communities. Children are particularly vulnerable to weather-related shocks. Previous research has demonstrated an association between drought and cross-sectional indicators of malnutrition, such as stunting. In this study, we have explored various longitudinal and spatial analysis approaches to evaluate the impact of drought on the risk of stunting over time and space among young children in Kenya.

Methods
Using anthropometric data from three geo-referenced Kenyan Demographic and Health Surveys (KDHS), and the self-calibrated Palmer Drought Severity Index (scPDSI), we started by developing multivariate linear regression and spatial lag and error models (with Moran’s I calculations) to explore the relationship between drought and height-for-age z-scores (HAZ) in children 0-5 years of age. Initial covariates included the age of the child, sex, maternal age, height and education, wealth index, urban or rural location, birth weight and length, and source of drinking water. Subsequent analyses included multilevel and geographically weighted regression modelling, using frequentist or Bayesian methods, with the addition of household-level covariates such as livelihood zones. In order to assess the impact of changes in drought severity on child HAZ scores over time, multiple years of the KDHS were analyzed using spatio-temporal modelling.

Findings
Preliminary results from the multivariate linear model demonstrated a negative non-significant association between drought severity and HAZ among Kenyan children in 2014 (beta=0.033, p=0.101); however, there was a significant interaction between drought and age (beta=-0.002, p<0.001). The spatial lag model gave similar results. Other significant variables included wealth index, age, sex, maternal education, and maternal height. Global Moran’s I calculations indicated that there was a slight positive spatial autocorrelation across child HAZ scores (I=0.047, p<0.001).

Interpretation
Increased drought was associated with a non-significant decrease in HAZ among Kenyan children. However, a significant interaction between age and drought indicates that the effect of drought varied by age. Findings from this study will help to inform the development of methodological approaches for improving our understanding of the role of climate change in child health. Expanding these analyses to other East African countries will also contribute to the development of national adaptation strategies and planning in anticipation of increased climate variability.

Application of the Dietary Environmental Index in USDA food patterns: a comparison of observed and recommended dietary patterns

Authors: Naglaa El-Abbadi1,2Miriam E. Nelson3, Timothy S. Griffin4Christian J. Peters4, Nicole E. Tichenor3, Paul F. Jacques1,2
Author Affiliations: 1Nutritional Epidemiology Program Jean Mayer USDA Human Nutrition Research Center on Aging; 2Friedman School of Nutrition Science and Policy Tufts University; 3Sustainability Institute, University of New Hampshire; 4Agriculture, Food, and the Environment Program Friedman School of Nutrition Science and Policy

Background: Identifying and promoting dietary patterns that enhance overall diet quality and health outcomes within ecologically viable parameters is crucial for dietary sustainability and food security. Future dietary recommendations must place nutritional health in the context of environmental effects, but we lack methods for aligning health and sustainability concerns in our dietary choices. In answer to this, we previously developed the Dietary Environmental Index (DEX) to quantify the association between the environmental impacts and nutritional value of a wide range of foods consumed in the U.S., and in this study have applied the DEX to examine overall dietary patterns.

Methods: We scored approximately 1200 commonly consumed foods reported in the 2007-08 National Health and Nutrition Examination Survey (NHANES) using the Nutrient Rich Foods index (NRF) 9.3. The resultant nutrient density value was divided by an aggregate environmental impact score (EIS) composed of 4 life cycle assessment (LCA) indicators representing land and water resource use, eutrophication, and greenhouse gas emissions, to compute the DEX value of each food product. For the current investigation, DEX was calculated for the three USDA food patterns promoted by the 2015 Dietary Guidelines for Americans (DGA), the Healthy U.S., Mediterranean, and Vegetarian food patterns, based on daily meal plans, and for a typical American diet based on NHANES dietary intake data.

Findings: DEX scores of isocaloric daily sample menus for the 3 USDA food patterns varied depending on foods selected. Preliminary results when foods representative of typical consumption in the United States were assessed showed more favorable DEX scores for a Vegetarian diet, and less favorable for a more traditional U.S. omnivorous diet, with a Mediterranean diet positioned between. However, menus that instead prioritized recommended and healthier food choices shifted DEX scores, and resulted in the 3 dietary patterns scoring similarly.

Interpretation: This study will provide insight on how observed and recommended dietary patterns fare in aligning diet quality and sustainability, and highlights the importance of considering the relative nutrition-to-environmental impact of food choices for overall diet sustainability.

Exploring extended human-chicken interaction and associated public health risks and risk mitigation strategies in rural Tanzania

Authors: Elpidius Rukambile1Vitali Sintchenko2, Gary Muscatello1, Wende Maulaga3, Robyn Alders4
Author Affiliations: 1School of Life and Environmental Sciences, University of Sydney; 2Centre for Infectious Diseases and Microbiology – Public Health, Sydney Medical School, University of Sydney; 3Tanzania Veterinary Laboratory Agency; 4Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney

Poultry keeping, particularly scavenging village chickens, is one of the main agricultural activities in rural Tanzania. There are 4.7 million agricultural households in Tanzania of which 78 percent (3.7 million) raise chickens. Scavenging village chickens are frequently the only source of poultry meat and eggs in rural areas and contribute 20 percent of these products consumed in urban areas. Promoting village chicken production is a key option for achieving an adequate supply of animal- source protein and micronutrients as they are readily accessible to a majority of households. Village chickens are highly adaptable and are expected to be one of the agricultural commodities less affected by climate change. Therefore, several initiatives have been made to enable increased production in support of sustainable nutritional diversity and income generation in the village context. Keeping chickens under scavenging systems increases human-chicken interaction whereby chickens freely gain access to every part of the human house including the kitchen and children’s play areas which increases the risk of humans acquiring chicken-associated infections. Chickens colonised by enteric pathogens of public health importance shed pathogens in the environment through faeces which increases the risk of human chicken-origin environmental enteropathy, which may contribute to undernutrition and stunting in children. The study site is in a semi-arid area of Central Tanzania where households are already suffering increased water shortages and crop failures due to weather variability and lower and erratic rainfall. Hygiene practices associated with risks which may lead to chicken-associated pathogens entering the human food chain were investigated using mixed methodology: a questionnaire (84 households within 718 enrolled in a larger study), key informant interviews (10), focus group discussions (8) and two-weekly reports of the incidence of diarrhoea in enrolled households (84 of 718 households) across three wards in Central Tanzania. Of all risk factors analysed, only two were positively associated with diarrhoeal incidence in enrolled children: i) access of chickens to unwashed utensils (p<0.001); and ii) access of chickens to washed utensils (p<0.001). Options for addressing potential enteric bacterial infection risks associated with raising chickens under extensive systems are discussed. Implementation of feasible and culturally acceptable risk mitigation strategies are important if sustainable village scavenging chicken production and improved public health in rural areas are to be achieved in the face of a changing climate.

The role of drought tolerant crops in Food and Nutrition Security in Kenya

Authors: Esther Omosa1, Moses Siambi2Patrick Audi2Christine Wangari2Maureen Cheserek2Rhoda Nungo2
Author Affiliations: 1International Livestock Research Institute; 2International Crops Research Institute for the Semi Arid Tropics (ICRISAT)

The role of drought tolerant cereals and legumes in food and nutrition security in Kenya
Given their nutrient density and adaptability to hash climatic conditions, drought tolerant cereals (millets and sorghum) and legumes (green grams, pigeon peas and ground nuts) provide opportunities for nourishing rural households across the lifespan all year round. They are particularly important in preparation of complementary foods for children and are routinely consumed by some households besides being culturally significant in special ceremonies like weddings, child birth and thanks giving. This is an ongoing intervention project whose objective is to increase production and utilization of the selected Drought Tolerant Crops (DTCs) namely; sorghum, finger millet, green grams pigeon peas and green grams-among households within the project site to improve nutrition.

The households were purposively chosen from agro-ecological zones that favor growth of the DTCs and then given early maturing-high yielding DTC seed to plant. Nutrition education trainings and social behavior change communication was targeted to the farmers. Information education materials were distributed among households, radio shows or spots and cooking demonstrations on new recipes and products done to influence greater utilization and other desired nutrition practices. Data was collected at household level using qualitative and quantitative methods. Data on quantities of DTCs harvested and kept aside for home consumption was collected and comparisons done with the commonly grown cereals and legumes. Key informant interviews and focused group discussions were used to collect data on dietary practices and dietary diversity scores calculated.

Preliminary results indicate that the beneficiary households did not suffer food insecurity in the current failed seasonal rains, there was an increase in the quantities of DTCs kept aside for household consumption, and some were sold to purchase other nutritious foods besides meeting non-food purchases. Thus filling the gap of lack of any cereal or legume that would have existed since all of the commonly grown cereals and legumes failed up to 90% alongside the depressed rains. The final phase of the project is upscaling the DTC seed distribution, linking farmers to markets and raising nutrition awareness to have the desired behavior and impact on food and nutrition security. The DTC therefore have potential to impact on food and nutrition security through availability in the farms and access-from sale of surplus of the DTCs.

Ecosystem Services Provided by the Village Tank Cascade System (VTCS) in Sri Lanka: A Case Study of Bellankadawala VTCS

Author: Gamini Pushpakumara1PB Dharmasena2Harsha Kadupitiya3, Jeevika Weerahewa1, Sujith Rathnayake4, Danny Hunter5,6
Author Affiliations: 1University of Perdeniya; 2FAO, Sri Lanka; 3Natural Resources Management Centre, Department of Agriculture, Sri Lanka; 4Ministry of Mahaweli Development and Environment, Sri Lanka; 5Bioversity International, Italy and Healthy Food Systems node; 6Charles Perkins Centre, University of Sydney

The Village Tank Cascade System (VTCS) is an ancient and unique agricultural system mainly found in the dry and intermediate zones of Sri Lanka, and covers around 20% of land area of the country. The basic structure of a VTCS is a cluster of hydrologically, ecologically and socially inter-connected tanks built to collect, store, purify and utilize rainwater for humans and animal consumption and agricultural purposes. An upstream forest catchment, tree strip and a meadow, a soil ridge, seepage interceptor, a paddy field with a common drainage and a hamlet buffer have been added to the tank to facilitate the provision of good quality water for irrigation, humans and animals. The ecosystem services provided by these segments in traditional VTCSs were found to be diverse and large. However, over time, some of the above land use segments have been converted to agricultural lands and certain tanks, which were meant for other purposes have also been converted to irrigation tanks. Further, overuse of agrochemicals, silting, pollution of tank water, wildlife-human conflicts, and poorer nutrition of human have also impacted on ecosystem services and human health in VTCSs. This study recorded the nature and degree of provision of ecosystem services in Bellankadawala VTCS complex over time. Field visits and a questionnaire survey conducted among the villagers were used to identify the ecosystem services provided by each segment of the VTCS in the past and the present.

Over time, the upstream forest catchment, meadow, the soil ridge, and the seepage interceptor have been converted to agricultural lands and the common drainage is not functioning in its full capacity or encroached. The hamlet buffer has been used for the construction shelters or agricultural purposes whereas the tree strip has been degraded. With the transformation of the social structure from ancient feudal system to present economic based system, emphasis has been given largely to provisioning services particularly food and with lesser emphasis on regulating and supporting services, and a significant drop in the diversity of provisioning services could be observed (tank as a drinking water, collection of medicinal plants, rattan and reed). The unique cultural services provided by the ancient VTCS are no longer in existence. The results of this study highlight the need for system approach in decision making, scientific restoration of tanks and connected land use segments to widen and deepen the ecosystem services provided by VTCS, including for human health and wellbeing.

Aflatoxin Contamination of Village Grains in Central Tanzania: Food and Agricultural Practices in Relation to Contamination and Exposure Risk

Authors: Godfrey Magoke1,2Robyn Alders2, Mark Krockenberger3, Wayne L. Bryden4, Furaha Mramba1, Wende Maulaga1
Author Affiliations: 1Tanzania Veterinary Laboratory Agency, Temeke Veterinari, Dar es Salaam2School of Life and Environmental Science, University of Sydney; 3Sydney School of Veterinary Science, University of Sydney; 4School of Agriculture and Food Sciences, University of Queensland

Background
A study was conducted in the semi-arid Manyoni District of Central Tanzania, involving eight village communities to: 1) determine the degree of aflatoxin contamination of village grains immediately postharvest and following storage; and 2) gain knowledge of grain food production practices and food habits so as to identify areas where interventions to mitigate potential aflatoxin contamination are best employed.

Methods
Grain samples were randomly selected immediately post-harvest (n=134) and following 6 months or more after storage (n=157). Sample screening (AflaCheckTM, Vicam) was followed by quantitative determination of samples containing ≥10 µg/kg total aflatoxins by the HPLC. To understand community knowledge, responses were sought from 76 randomly selected adults (55 women, 21 men) by a questionnaire covering pre-harvest, harvest and post-harvest practices, food preparation and knowledge on food toxins.

Findings
The grain categories and proportion of positive samples (≥10 µg/kg) for immediate post-harvest and storage grains respectively, were; maize (8/35, 22/47), groundnut (8/39, 4/17), sorghum (2/24, 5/41), rice (0/6, 1/8), bulrush millet (0/6, 0/7), sesame (2/11, 2/23), sunflower seeds (0/9, 2/10), and green gram (2/4, 3/4). Contamination was more significant in maize and groundnut and ranged up to 192 µg/kg and 198 µg/kg respectively in immediate post-harvest samples and 213 µg/kg and 351 µg/kg respectively in storage samples. Respondent questionnaires revealed farmers: had no knowledge of food toxins; received limited extension services; did not generally use irrigation, fertilizers or pesticides; relied on inefficient harvesting, drying and storage technologies; and frequently consumed unpolished grains.

Interpretation
Village grains in Central Tanzania may contain high concentrations of aflatoxins. Existing practices and lack of food toxin knowledge may contribute to contamination and exposure. Therefore, farmers would benefit from better extension services, using livestock manure as fertilizer, being assisted with drought tolerant seeds, better harvesting, drying and storage technologies to achieve safe food production, resulting in improved maternal and child nutrition.

Development of the Food Composition Tables for Pacific Islands Household Income and Expenditure Surveys

Author: Joanna Russell1, Yasmine Probst2, Karen Charlton2
Author Affiliations: 1School of Health & Society, Faculty of Social Sciences, University of Wollongong; 2School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong

Background: In recent times, the Pacific Island Countries and Territories (PICTs) have been going through the nutrition transition with dietary patterns rapidly changing from traditional diets towards diets that include imported processed foods, often high in fat, sugar and salt. The current Pacific Islands Food Composition Tables, 2nd Edition (PIFCT) were published in 2004 and do not include imported foods that are increasingly being consumed.
The aim of this project was to develop a revised database with updated nutrient composition data and expand the number of commonly consumed foods in order to be aligned more closely to current diets within the Pacific Region. A second criterion is for the database to be applied to the analysis of food data collected as part of the Household Income & Expenditure Surveys (HIES) routinely conducted in PICTs.

Methods: Food items included in the database, the Food Composition Tables for Pacific Island Household Income and Expenditure Surveys, were selected based on the frequency of acquisition reported in PICT’s existing HIES surveys. To provide connection between the HIES datasets and the revised database, food items were categorised according to the Classification of Individual consumption according to Purpose (COICOP) codes.
The database provides 23 nutrients for each food item in addition to edible portion conversion factors. Nutrient profiles of food items are underpinned by the PIFCT but, to provide current nutrient data and edible portions, data were imputed from international tables of different countries and regions to allow complete nutrient datasets. International tables were selected based on their regional relevance, validity of data and whether the data are up to date. Once all nutrient profiles had been sourced, the quality was confirmed by summing the proximate values. Food items were included if they fell within ±10% of energy.

Results: The database is currently being pilot tested using data from the two week food diary collected as part of the Federated States of Micronesia’s 2013 Household Income and Expenditure Survey with results expected to be reported early in 2018.

Interpretation: The food composition data in this database can be used in a variety of ways including dietary comparisons between various PICTs, as well as monitor trends over time within these countries.

Non-domesticated animal-source food consumption in Timor-Leste

Author: Johanna Wong1Brigitte Bagnol2,3, Karen Charlton2, Heather Grieve4, Joanita Jong5Mu Li6, Robyn Alders1,3
Author Affiliations: 1School of Veterinary Science, School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney; 2Department of Anthropology, University of the Witwatersrand, Johannesburg; 3International Rural Poultry Centre, Kyeema Foundation, Brisbane Australia and Maputo, Mozambique;4Independent nutrition consultant, Dili, Timor-Leste; 5Ministry of Agriculture and Fisheries, Dili, Timor-Leste; 6School of Public Health, University of Sydney

Prior to modern agriculture, humans obtained food by hunting, gathering and fishing, leading nomadic lifestyles to ensure sustainable land and water use. Today, to feed our current population, modern food systems have expanded to encroach on much of the world’s wild reserves, leaving ever smaller regions where much of the world’s biodiversity is concentrated. Utilisation of non-domesticated animal-source foods (ASF) is controversial, as while it can make valuable contributions to human nutritional intake, it also threatens biodiversity if hunting levels exceed reproductive capacity.

In some rural areas in Timor-Leste, villagers supplement their diets with non-domesticated plant- and animal-source foods, however little information exists regarding the frequency, seasonality and animal species utilised. A longitudinal, mixed-methods study collected data from three rural villages in Timor-Leste participating in a pilot Newcastle disease vaccination program for village chickens. Households were selected for participation in the study if they had one child under two years at enrolment, and mothers and children followed longitudinally. Quantitative data was collected across the three agricultural seasons (dry, heavy rain and light rain), and include maternal and child dietary diversity data based on a 24-hour recall period, anthropometric measurements, and hemoglobin measurements.

Qualitative data collection was performed annually through key informant interviews and focus group discussions. Key informants include village and sub-village chiefs, cultural leaders, local and municipal health and agricultural staff. Gender-disaggregated focus group discussions, involving both young and old members of the community and direct observation of household practices were also included in the suite of research tools.

Qualitative methods were used to create lists of non-domesticated plant and animal foods available, discuss seasonality, and triangulate with quantitative data on seasonal food consumption. Together, they show that local laws and accessibility of forested areas heavily influences the practice of hunting, with the majority of participants in one village stating that they do not hunt in that village due to local laws and lack of forested areas, and with no recorded consumption of non-domesticated ASF. This compares to a distant village close to forested areas with no local laws forbidding hunting, in which low numbers of households consumed non-domesticated ASF in every season. Participants most commonly reported the consumption of “wild birds”, which include jungle fowl, pigeon, and turtledove, and was the most commonly consumed non-domesticated ASF for children. Ongoing analysis will provide new information is important in understanding the roles of wild areas on human diets and nutrition.

Nutritional impacts of flooding due to unseasonably early monsoon rainfall in Bangladesh

Authors: Sabine Gabrysch1Jillian Waid2Amanda Wendt1Anna Müller1Abdul Kader1Upasona Gosh3
Author Affiliations: 1Institute of Public Health and Heidelberg Center for the Environment, Heidelberg University; 2Helen Keller International, Bangladesh3Institute of Health Management Research, India

Background
Subsistence farmers are particularly vulnerable to shocks from natural disasters and already suffer from food insecurity and malnutrition. In 2017, unseasonably heavy rains in mid-April filled the Northeastern flood plain early and destroyed the annual rice crop before it was ready to be harvested. We aim to quantify the impact of this flood on food security and dietary diversity of women and children in the area, describe families’ coping strategies and evaluate whether a dietary diversification program could attenuate negative impacts.

Methods
The study is nested within the “Food and Agricultural Approaches to Reducing Malnutrition” (FAARM) cluster-randomized trial in rural Sylhet Division, evaluating the impact of a Homestead Food Production program on undernutrition. In 96 villages, nearly 2700 young women are visited every two months to collect data on diets, morbidities, pregnancies and births. We also collected data on flood affectedness, coping strategies and household food security half a year after the event and will continue to collect data on diets and health. We used multilevel regression adjusting for intervention allocation to quantify the effect of the degree of flood affectedness on food security and nutrition outcomes.

Findings
We have interviewed 2403 women and 56% reported that their families were affected by the flood to a great extent, while 21% were not affected at all. Of the 1571 families who usually grow rice and grew this year, 34% harvested at least as much as usual, while 28% expect a shortfall of 5 or more months of rice consumption this year compared to a usual year. Income losses were also reported by many households. Six months after the flood, only 30% of families were food secure and 40% of women consumed an adequately diverse diet.

Families with a large rice shortfall (5 or more months) had more than double the odds of food insecurity (OR 2.5, 95% CI 1.8-3.6) than those with no shortfall, adjusting for baseline food insecurity and usual rice harvest. Dietary diversity among women in these families was 0.4 food groups lower (95% CI 0.1-0.7) than in families with no shortfall, adjusting for dietary diversity one year ago. The most commonly reported coping strategy of the 1335 greatly affected families was borrowing money (58%), mostly from outside lenders.

Interpretation
Natural disasters exacerbate food insecurity and worsen dietary diversity among subsistence farmers. In a changing climate, these are becoming more frequent in Bangladesh and elsewhere.

Relationships between forests, deforestation and nutritional outcomes: an observational study in nine African countries

Author: Thomas Pienkowski1B. Dickens2H. Sun3A.S. Waldron3W. Symes3L.R. Carrasco3
Author Affiliations: 1Department of Zoology, University of Oxford; 2Saw Swee Hock School of Public Health, University of Singapore; 3Department of Biological Sciences, University of Singapore

Background: Ecosystems have complex relationships with public health, and environmental degradation can disrupt important health related ecosystem services. Agricultural expansion is a leading driver of deforestation, yet malnutrition remains a significant cause of morbidity. It is therefore important to understand the links between forest cover, deforestation and indicators of malnutrition when managing landscapes for sustainable development. Recent research has illustrated the importance of forests in supporting dietary diversity. However, there remains little evidence of the effects of forest on broad nutritional outcomes such as underweightness.

Methods: We explored relationships between nutritional outcomes in children under five years of age and forest cover and loss gradients (in 10km buffers around communities) in 61,032 African households between 2003 and 2014. USAID Demographic Health Survey data was combined with spatially explicit land cover, climatic, infrastructural, and demographic data in a series of generalized linear mixed-effects models. These models explored the role of forests and deforestation on children’s nutritional outcomes, the mediating effect of socio-economic and infrastructural context, and how these relationships changed over time.

Findings: In urban areas, children in communities surrounded by one standard deviation (SD) higher forest cover than the mean experienced 10.8% (95% CI 3.0%–18.0%, p = 0.0073) lower incidence of underweightness and 11.7% (95% CI 1.9–20.6%, p = 0.0212) less wasting. However, in rural areas the relationship was reversed, with children suffering 6.0% (95% CI 1.6%–10.6%, p = 0.0074) higher incidence of underweightness in areas of higher forest cover. Additionally, underweightness was 6.7% (95% CI 1.4%–12.3%, p= 0.0124) higher in urban areas and 2.6% (95% CI 0.04%–5.2%, p = 0.0460) higher in rural areas with one SD greater deforestation, although this relationship appeared to diminish over time.

Interpretation: Forest loss appears to be associated with worse nutrition in the short term, although unmeasured frontier migration may play a role. Our results also suggest that forest cover is associated with worse nutritional outcomes in rural areas but better outcomes in urban areas of Africa. Our study does not explicitly measure the role of forests in improving dietary diversity. Therefore, the extent to which the benefits of forests in reducing the ‘hidden hunger’ of micro-nutrient deficiency are offset by potential costs is not clear. Nevertheless, these health costs should be recognised and accounted for in efforts to meet sustainable development objectives.

Improving efficiency in the food system and environmental conservation through agricultural biodiversity in Busia County

Authors: Aurillia Manjella1, Victor Wasike2,Teresa Borelli3, Danny Hunter4
Author Affiliations: 1Bioversity International, Biodiversity for Food and Nutrition Project, Kenya2Genetic Resources Research Centre, Nairobi, Kenya3Bioversity International, Healthy Diets from Sustainable Food Systems Initiative; 4Bioversity International, Italy & Healthy Food Systems node, Charles Perkins Centre, University of Sydney, Australia

Background: Despite the abundance of edible biodiversity, both wild and cultivated, malnutrition and food insecurity persist in Busia, Kenya, where poverty indices range from 63% to 74% and 1 in 4 children under five are stunted, 11% are underweight and 4% are thin for age. Much of this diversity, used in traditional food preparations, has potential to provide access to key micronutrients for healthy and balanced diets as well as act as an important source of community resilience to climate change and economic turbulence. Yet, lack of consumer awareness of the value of local biodiversity, poorly developed value chains and negative perceptions associated with traditional foods have led to the disappearance of many nutrient-rich species and the shift to unhealthy diets. The study shows that heightened knowledge of the value of biodiversity and improved value chain efficiencies can help to conserve biodiversity and improve local food systems.

Methods: A farmer business school model was developed and training provided to 25 farmer groups across 7 sub-counties on the sustainable production of traditional vegetables, post-harvest handling, contract farming, nutrition and value addition. At the same time, select species were analyzed for nutritional content, a food procurement model was tested supporting market linkages between farmers and local institutions and nutrition education activities carried out to improve the capacity of schools and clinics to incorporate traditional foods in institutional meals.

Findings: Traditional vegetables are rich in iron, with cowpea leaves, for example, found to contain 17 times more iron than kales. Since the data was made available to all value chain actors and the food procurement model was implemented, a 12% increase was recorded in the number of households cultivating local biodiversity both for household consumption and off-farm sales, along with an increase in the plot size devoted to traditional vegetable cultivation. Furthermore, household incomes rose by 47% as a result of direct links with institutional markets.

Interpretation: The project has positively impacted the abundance, composition and distribution of species and revived interest in local food biodiversity, in addition to producing benefits around diverse diets. Experience in implementing the Busia model was used to inform global policy mechanisms that aim to mainstream biodiversity into sustainable food systems using public procurement, particularly schools, as a platform for improving nutrition. Nationally, a Biodiversity Policy is being developed for Busia that recognizes the importance of local biodiversity, including for improved livelihoods, community resilience and health and nutrition.

A methodological exploration for assessing the impact of drought on stunting in Kenyan children

Authors: Kate Lillepold1, Ashley Aimone1, Susan Keino2, Paula Braitstein1
Author Affiliations: 1Dalla Lana School of Public Health, University of Toronto; 2College of Health Sciences, Moi University

Background
Globally, droughts are occurring more regularly and are having negative impacts on population health; particularly in countries like Kenya, where agriculture is a primary driver of the economy and source of subsistence for many communities. Children are particularly vulnerable to weather-related shocks. Previous research has demonstrated an association between drought and cross-sectional indicators of malnutrition, such as stunting. In this study, we have explored various longitudinal and spatial analysis approaches to evaluate the impact of drought on the risk of stunting over time and space among young children in Kenya.

Methods
Using anthropometric data from three geo-referenced Kenyan Demographic and Health Surveys (KDHS), and the self-calibrated Palmer Drought Severity Index (scPDSI), we started by developing multivariate linear regression and spatial lag and error models (with Moran’s I calculations) to explore the relationship between drought and height-for-age z-scores (HAZ) in children 0-5 years of age. Initial covariates included the age of the child, sex, maternal age, height and education, wealth index, urban or rural location, birth weight and length, and source of drinking water. Subsequent analyses included multilevel and geographically weighted regression modelling, using frequentist or Bayesian methods, with the addition of household-level covariates such as livelihood zones. In order to assess the impact of changes in drought severity on child HAZ scores over time, multiple years of the KDHS were analyzed using spatio-temporal modelling.

Findings
Preliminary results from the multivariate linear model demonstrated a negative non-significant association between drought severity and HAZ among Kenyan children in 2014 (beta=0.033, p=0.101); however, there was a significant interaction between drought and age (beta=-0.002, p<0.001). The spatial lag model gave similar results. Other significant variables included wealth index, age, sex, maternal education, and maternal height. Global Moran’s I calculations indicated that there was a slight positive spatial autocorrelation across child HAZ scores (I=0.047, p<0.001).

Interpretation
Increased drought was associated with a non-significant decrease in HAZ among Kenyan children. However, a significant interaction between age and drought indicates that the effect of drought varied by age. Findings from this study will help to inform the development of methodological approaches for improving our understanding of the role of climate change in child health. Expanding these analyses to other East African countries will also contribute to the development of national adaptation strategies and planning in anticipation of increased climate variability.

Forests improve vulnerable children’s diet in rural developing countries

Author: Ranaivo Rasolofoson1Merlin Hanauer2Ari Pappinen3Brendan Fisher1Taylor Rickets1
Author Affiliations: 1Gund Institute for Environment, University of Vermont2Sonoma State Universit; 3University of Eastern Finland 

Background:
Micronutrient malnutrition affects about a third of the world’s population. Children in developing countries are particularly vulnerable. Consequences include impaired cognitive and physical development, and increased childhood morbidity and mortality. Recent studies suggest that forests help alleviate micronutrient malnutrition by increasing diet diversity. However, evidence about the impacts of forests on diet diversity is thin and mostly based on case studies of limited relevance to global policies. Existing evidence is also weak because of poor study design. Furthermore, how impacts of forests on diet diversity vary between and within communities has not received due attention; though such information could point to actions needed to enhance desired impacts.

Methods:
We estimate the impacts of forests on diet diversity of children under five of over 43,000 rural households across 27 developing countries. We strengthen the evidence by using empirical designs that are attentive to assumptions necessary for causal interpretations and adequately account for confounding factors that could mask or mimic the impact. We also investigate how impacts vary with level of development and access to capital, such as markets, roads and education.

Findings:
We find that high exposure to forests causes children to have at least 25% greater dietary diversity compared to lack of exposure. A closer look at a subset of sub-Saharan African countries indicates that impacts are generally higher for less developed communities, but highest with certain level of access to markets and roads, and education.

Interpretation:
Our results are comparable to the impacts of some nutrition-sensitive agricultural programs. Therefore, our study establishes the causal relationship between forests and diet and thus strengthens the evidence for integrating forest conservation and management into portfolios of nutrition interventions. Our results also suggest that complementary measures endowing households some access to capital increase the nutrition-sensitivity of forest related interventions.

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