A tree-based approach to identify indispensable foods in minimum-cost food baskets.

Introduction: Optimization techniques, such as linear programming, can be used to estimate the minimum cost of a nutrient-adequate food basket, to determine if individuals or households can afford nutritious diets. These cost estimates typically account for seasonal fluctuations but often overlook significant disruptions in the availability of affordable nutritious food that can severely impact food and nutrition security. Methods: This paper proposes a tree-based method, the binary search tree, to assess the resilience of the cost estimate of the minimum-cost food basket. In particular, this method aims to identify indispensable foods in these baskets - those whose unavailability would lead to a substantial cost increase. The binary search tree operates by iteratively excluding essential food items while ensuring the construction of minimum-cost nutritious baskets. It considers all relevant combinations of foods up to a specified size and avoids unnecessary optimizations, thereby saving computation time. We describe how the resulting tree can be evaluated and condensed to capture only the necessary information for decision makers. The construction and evaluation of the binary search tree are independent of the (dietary) restrictions or type of optimization model (i.e., linear, non-linear or integer) included. Results: In general, the binary search tree can identify all (combinations of) foods whose exclusion leads to a significant cost increase of a nutritious food basket. Furthermore, it can detect possible substitute effects between foods and identify key limiting nutrients. A case study is presented in which the binary search tree is applied to data from Ebonyi, Nigeria, modeled using linear programming. We report all combinations of up to five foods that, when unavailable, can impact food and nutrition security in Ebonyi. Conclusion: The BST can provide insights into local food and nutrition security when facing drastic disruptions in access to nutritious foods by identifying indispensable foods. Its results can be used to inform and design interventions in the context of humanitarian operations.

The importance of different forest management systems for people's dietary quality in Tanzania.

Context: A large body of literature has shown that forests provide nutritious foods in many low- and middle-income countries. Yet, there is limited evidence on the contributions from different types of forest and tree systems. Objectives: Here, we focus on individual trees and smaller forest patches outside established forest reserves as well as different forest management systems. Methods: We do so by combining novel high-resolution data on tree cover with 24-h dietary recall surveys from 465 women in Tanzania. Results: We show that people with more unclassified tree cover (i.e., individual trees and small forest patches) in their nearby surroundings have more adequate protein, iron, zinc, and vitamin A intakes. We also find that having a nearby forest under Participatory Forest Management (PFM) system is associated with higher adequacy levels of energy, iron, zinc and vitamin A. By contrast, tree cover within other types of forest (e.g., Government Forest Reserves and Government Forest Plantations) is not positively associated with people's dietary quality. Conclusions: Our key finding is that having individual trees, smaller forest patches and/or forest under PFM in close proximity is more beneficial for people's diets than other types of established forests. Our results highlight the nutritional importance of trees outside established forests and question the often-assumed benefits of forests if these are made inaccessible by social barriers (e.g., legislation). Finally, our results emphasize the need to distinguish between different forest management systems when studying forest-diet linkages. Supplementary Information: The online version contains supplementary material available at 10.1007/s10980-024-01961-6.

Managing nutrition-biodiversity trade-offs on coral reefs.

Coral reefs support an incredible abundance and diversity of fish species, with reef-associated fisheries providing important sources of income, food, and dietary micronutrients to millions of people across the tropics. However, the rapid degradation of the world's coral reefs and the decline in their biodiversity may limit their capacity to supply nutritious and affordable seafood while meeting conservation goals for sustainability. Here, we conduct a global-scale analysis of how the nutritional quality of reef fish assemblages (nutritional contribution to the recommended daily intake of calcium, iron, and zinc contained in an average 100 g fish on the reef) relates to key environmental, socioeconomic, and ecological conditions, including two key metrics of fish biodiversity. Our global analysis of more than 1,600 tropical reefs reveals that fish trophic composition is a more important driver of micronutrient concentrations than socioeconomic and environmental conditions. Specifically, micronutrient density increases as the relative biomass of herbivores and detritivores increases at lower overall biomass or under high human pressure. This suggests that the provision of essential micronutrients can be maintained or even increase where fish biomass decreases, reinforcing the need for policies that ensure sustainable fishing, and that these micronutrients are retained locally for nutrition. Furthermore, we found a negative association between micronutrient density and two metrics of fish biodiversity, revealing an important nutrition-biodiversity trade-off. Protecting reefs with high levels of biodiversity maintains key ecosystem functions, whereas sustainable fisheries management in locations with high micronutrient density could sustain the essential supply of micronutrients to coastal human communities.

Potential Nutrient Contribution of Community-Based Insects in Children's Food in Northern Ghana.

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.

Position of the Society for Nutrition Education and Behavior: The Importance of Emergency-Related Food and Nutrition Education Before, During, and After a Disaster.

It is the position of the Society for Nutrition Education and Behavior that for effective recovery from and resilience to disasters, it is essential that impacted individuals and communities have access to safe, nutritious, and culturally and contextually appropriate foods and beverages, and receive emergency-related food and nutrition education before, during, and after a disaster. Despite the increasing number, duration, and intensity of disasters worldwide, there is relatively limited guidance for research, policy, and practice about addressing the emergency-related food and nutrition needs of affected populations. Although nutrition emergencies tend to be understudied, emerging efforts are working to advance food and nutrition security during disaster response and recovery. To help elevate the importance of emergency-related food and nutrition education before, during, and after a disaster, Society for Nutrition Education and Behavior, which represents the unique professional interests of nutrition educators worldwide, summarizes the relevant literature and puts forth recommendations for all those who are engaged in this work in the following 4 key areas: (1) improving communication and outreach, (2) fostering community engagement and locally-driven preparedness, (3) building the evidence base and translating the evidence into action, and (4) training current professionals and the next generation of public health leaders. Altogether, before, during, and after a disaster, those who engage in this work, among other allies, can help elevate the importance of nutrition education and other strategies to promote healthy eating behaviors through research, policy, and practice.

Processing and preservation technologies to enhance indigenous food sovereignty, nutrition security and health equity in North America.

Indigenous foods are carriers of traditional native North American food culture and living philosophy. They are featured by the wide varieties in fresh and processed forms, richness in nutrition, flavor, health benefits and diversity in origins, but are usually misunderstood or underrepresented in the modern food systems. Conventional processing and cooking methods are sometimes labor-intensive, less efficient and lack science-based guidelines to prevent unseen safety risks and food loss. Global and regional climate change have caused additional challenges to conventional cooking/processing, and increased native communities' reliance on externally produced foods, which have resulted in increasing nutritional unbalance and prevalence of diet-related health issues. Current and emerging technologies, such as storage and packaging, drying, safety processing, canning, pickling, and fermentation, which treat foods under optimized conditions to improve the safety and extend the shelf-life, are increasingly used in current food systems. Therefore, exploring these technologies for indigenous foods offers opportunities to better preserve their nutrition, safety, and accessibility, and is critical for the sovereignty and independence of indigenous food systems, and sustainability of indigenous food culture. This mini-review focuses on identifying adoptable processing and preservation technologies for selected traditional indigenous foods in North America, summarizing education, extension, and outreach resources and discussing the current challenges and future needs critical to expanding knowledge about indigenous foods and improving food sovereignty, nutrition security, and health equity.

Benefits of using both the Hunger Vital Sign and brief nutrition security screener in health-related social needs screening.

Food security is a commonly screened for health-related social need at hospitals and community settings, and until recently, there were no tools to additionally screen for nutrition security. The purpose of this study was to assess the potential advantage of including a one-item brief nutrition security screener (BNSS) alongside the commonly used two-item Hunger Vital Sign (HVS) food security screener for identifying individuals with diet-related health risks. Cross-sectional survey data were collected from April to June 2021. Generalized linear mixed models were used to assess associations between screening status and dietary and health variables. Recruitment was done across five states (California, Florida, Maryland, North Carolina, and Washington) from community-based organizations. Participants (n = 435) were, on average, 44.7 years old (SD = 14.5), predominantly women (77%), and racially/ethnically diverse. In adjusted analyses, being in the food insecure and nutrition insecure group (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for self-reported "fair" or "poor" general health [OR = 2.914 (95% CI = 1.521-5.581)], reporting at least one chronic condition [2.028 (1.024-4.018)], and "low" fruit and vegetable intake [2.421 (1.258-4.660)], compared with the food secure and nutrition secure group. These findings support using both the HVS and BNSS simultaneously in health-related social needs screening to identify participants at the highest risk for poor dietary and health outcomes and warrant further investigation into applying these screeners to clinical and community settings.

Food security and nutrition security are related to a household's ability to get enough food and to get food that is good for their health, respectively. Patients at hospitals, or clients who go to food pantries for help, are often asked about their food security status. This is referred to as screening. On the basis of their answers, they may get help such as referral to a food pantry and/or consultation with a dietitian. While there is a standard tool to screen for food security status, until recently, there has not been one for nutrition security. We used both the commonly used Hunger Vital Sign (HVS) food security screener and the newly developed brief nutrition security screener to identify food and nutrition security screening status. Being in the food insecure and nutrition insecure groups (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for poor dietary and health outcomes. These findings support using both the HVS and brief nutrition security screener simultaneously in health-related social needs screening to identify participants at the highest risk.

Association between participation in the supplemental nutrition assistance program and perception of limited availability and choice of healthy foods.

BACKGROUND: Nutrition security encompasses stable and equitable access, availability, affordability, and utilization of healthy foods. AIM: To evaluate the relationship of two newly created dichotomous measures that represent aspects of nutrition security (i.e., perceived limited availability and healthfulness choice) with Supplemental Nutrition Assistance Program (SNAP) participation. METHODS: Logistic regression models were run for each outcome separately with adjustment for age, income-to-poverty ratio, gender, education, race, and food security. RESULTS: Adults using social services (e.g., food pantries) were enrolled (N = 402) in this cross-sectional analysis. SNAP participants (61.7%) were not different from non-SNAP participants in perceiving limited availability (aOR [95% CI]: 1.21 [0.75, 1.95]) or limited ability to choose (aOR [95% CI]: 0.69 [0.43, 1.12]) healthy foods. CONCLUSIONS: Both SNAP and non-SNAP participants with low socioeconomic status report limited availability of healthy foods in their environment and a limited ability to choose healthy foods.

Food (in)security in relation to nutrition (in)security in a national cross-sectional sample of Supplemental Nutrition Assistance Program participants: considerations of an emerging construct.

BACKGROUND: Food insecurity, lack of access to sufficient food for an active, healthy life, is a persistent problem in the United States. Recently, nutrition security has emerged as a new concept. However, limited research exists examining how nutrition security relates to the established concept of food security. OBJECTIVES: This study assessed a recent metric of nutrition security and explored how well it describes the underlying construct among a sample of Supplemental Nutrition Assistance Program (SNAP) participants. We examined the correlation between food and nutrition security and demographic predictors of joint food and nutrition security status. METHODS: We conducted a national, web-based survey (Qualtrics; 30 September-19 October, 2022) in English and Spanish of adults aged ≥18 y (n = 1454) who reported receiving SNAP benefits in the past 12 mo. We measured food security using the US Department of Agriculture 6-item Food Security Survey and assessed nutrition security using the Gretchen Swanson Center for Nutrition Household Nutrition Security measure. We used multinominal logistic regression to examine demographic predictors of food and nutrition security. RESULTS: The majority (80.4%) of SNAP participants experienced food insecurity, and 59.1% reported experiencing nutrition insecurity. Food and nutrition security were moderately correlated (0.41); 55.6% of SNAP participants were both food and nutrition insecure, 3.5% were food secure but nutrition insecure, 24.8% were food insecure but nutrition secure, and 16.1% were both food and nutrition secure. Of SNAP participants, 24.8% reported experiencing food insecurity but not nutrition insecurity. Hispanic ethnicity and Southern residence were associated with joint food and nutrition insecurity. CONCLUSIONS: These findings raise questions about how nutrition security is conceptualized and measured and its added value beyond existing food security measurement scales. Further research is needed to understand differences in food and nutrition security experiences and risk factors and determine a validated definition and measure of nutrition security for future policy solutions.

Assessing and Monitoring Nutrition Security in the United States: A Narrative Review of Current Measures and Instruments.

PURPOSE OF REVIEW: Because nutrition plays a crucial role in the development of chronic diseases, ensuring nutrition security is important for promoting population health. Nutrition security is defined as having consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being. Distinguished from food security, nutrition security consists of two constructs: healthy diets and nutritional status. The study aimed to identify population measures that reflect the important constructs of nutrition security (i.e., healthy diets and nutritional status) to inform U.S. nutrition security assessment and monitoring. RECENT FINDINGS: Through a narrative review conducted across multiple databases, associations between subconstructs of healthy diets and nutritional status were identified. Of the six subconstructs that constitute healthy diets, nutrient adequacy and moderation were most often used to assess and monitor healthfulness of U.S. population diets and were associated with health outcomes. There is little evidence of an association between health outcomes and macronutrient balance or diversity in the U.S. Thirteen instruments were identified as potentially suitable for measuring at least one subconstruct of healthy diet in the population. This review highlights the importance of nutrition security in addressing population health challenges. It emphasizes the potential use of multiple instruments and measures to comprehensively monitor population nutrition security and inform intervention strategies. Identifying feasible and practical measures for assessing and monitoring nutrition security is imperative for advancing population health and mitigating the burden of chronic diseases.

A theoretical explanation for how a nutrition counseling and medically tailored meal delivery program benefitted participants living with lung cancer.

PURPOSE: The purpose of this study was to assess participants' perceptions and experiences while participating in a Food is Medicine medically tailored meal plus intensive nutrition counseling intervention to create a theoretical explanation about how the intervention worked. METHODS: This interpretive qualitative study included the use of semi-structured interviews with active participants in a randomized controlled trial aimed at understanding how a medically tailored meal plus nutrition counseling intervention worked for vulnerable individuals with lung cancer treated at four cancer centers across the USA. During the 8-month long study, participants in the intervention arm were asked to be interviewed, which were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory. RESULTS: Twenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention's mechanism of action. The explanatory process includes three linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life. CONCLUSIONS: These findings provide evidence that a Food is Medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals' adjustment to their diagnosis and resulted in perceived positive behavior change.

Incorporating Halal Into Healthy and Equitable Dietary Patterns to Address Food and Nutrition Security Among K-12 and University Students: A Perspective.

Food and nutrition insecurity exist at an alarming rate in the US educational system, ranging from 17% among K-12 students up to 58.8% among university students. Many Muslim American students face food and nutrition insecurity due, in part, to a lack of acknowledgment of student adherence to halal dietary guidelines and the availability of certified halal options at school. This has implications for health, learning, and social outcomes. In this perspective paper, we provide short-term, mid-term, and long-term recommendations to address food and nutrition insecurity among halal-observant students to advance healthy dietary patterns.

Bidirectional Relationship Between Sickle Cell Disease and Food Insecurity: Scoping Review.

Introduction: In the United States, sickle cell disease (SCD)-the homozygous inheritance of a point mutation within the beta-globin chain of hemoglobin-affects between 80,000 and 100,000 people. Adequate nutrition can influence the pathophysiology of SCD, and individuals with SCD who are undernourished are more likely to have impaired immune function and disease exacerbation. Undernourishment is often caused by food insecurity (FI), which is defined as "a household-level economic and social condition of limited or uncertain access to adequate food" by the USDA. FI disproportionately affects African Americans, a population disproportionately affected by SCD in the United States. Objectives: We performed a scoping review to better understand the relationship between FI and SCD severity. Methods: A comprehensive search for peer-reviewed research articles and meeting abstracts was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selected studies were reviewed for descriptive analysis by three independent reviewers. Results: In total, 72 studies were identified, 62 were excluded for meeting inclusion criteria. The remaining 10 studies, 5 of which were meeting abstracts, were reviewed. Although limited evidence is available, the results of this scoping review suggest a bidirectional relationship between SCD and FI. Seven key themes were identified to help elucidate this relationship: 1) prevalence of FI among individuals with SCD, 2) child versus caregiver experiences of FI, 3) psychosocial factors, 4) food assistance benefits, 5) dietary intake, 6) external spending, 7) healthcare utilization. Conclusion: Findings from this scoping review suggest how SCD and FI work in tandem to exacerbate each other. Furthermore, the findings illustrate current gaps in the literature and opportunities for actions to address FI among individuals living with SCD.

The Fall Armyworm and Larger Grain Borer Pest Invasions in Africa: Drivers, Impacts and Implications for Food Systems.

Invasive alien species (IAS) are a major biosecurity threat affecting globalisation and the international trade of agricultural products and natural ecosystems. In recent decades, for example, field crop and postharvest grain insect pests have independently accounted for a significant decline in food quantity and quality. Nevertheless, how their interaction and cumulative effects along the ever-evolving field production to postharvest continuum contribute towards food insecurity remain scant in the literature. To address this within the context of Africa, we focus on the fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae), and the larger grain borer, Prostephanus truncatus (Horn) (Coleoptera: Bostrichidae), two of the most important field and postharvest IAS, respectively, that have invaded Africa. Both insect pests have shown high invasion success, managing to establish themselves in >50% of the African continent within a decade post-introduction. The successive and summative nature of field and postharvest damage by invasive insect pests on the same crop along its value chain results in exacerbated food losses. This systematic review assesses the drivers, impacts and management of the fall armyworm and larger grain borer and their effects on food systems in Africa. Interrogating these issues is important in early warning systems, holistic management of IAS, maintenance of integral food systems in Africa and the development of effective management strategies.

Differences in Socioeconomic, Dietary Choice, and Nutrition Environment Explanatory Variables for Food and Nutrition Security among Households with and without Children.

This study's purpose was to compare socioeconomic, dietary choice, and nutrition environment variables associated with food and nutrition security in USA households with and without children. Data were collected in 2021 and consisted of households at risk of or experiencing food insecurity. Multivariable logistic regression was used to identify significant explanatory variables for food and nutrition security by household type-with or without children (<18 years of age). Food insecurity rates were 74% and 64% in households with and without children, respectively. Nutrition insecurity rates were 38% and 30% in households with and without children, respectively. For both household types, greater dietary choice increased odds (4-15 times) of food and nutrition security. In households with children, more fast-food meals increased the odds (60%) of food security, while more processed meals and greater utilization barriers to healthful meals decreased the odds (40-50%). Greater utilization barriers also decreased the odds (20%) of food security in households without children. In households with children, higher income and greater healthfulness choice increased the odds (20% and 3 times) of nutrition security, while low (vs. high) perceived limited availability of foods doubled the odds in households without children. Dietary choice is an influential and crucial factor of food and nutrition security.

Food and nutrition security definitions, constructs, frameworks, measurements, and applications: global lessons.

Food security (FS) is a powerful social determinant of health (SDOH) and is crucial for human and planetary health. The objectives of this article are to (i) provide clarity on the definitions of FS and nutrition security; (ii) provide a framework that clearly explains the links between the two constructs; (iii) summarize measurement approaches, and (iv) illustrate applications to monitoring and surveillance, policy and program design and evaluation, and research, mainly based on the ongoing rich experience with food insecurity (FI) scales. A clear and concise definition of FI and corresponding frameworks are available. There are different methods for directly or indirectly assessing FI. The best method(s) of choice need to be selected based on the questions asked, resources, and time frames available. Experience-based FI measures disseminated from the United States to the rest of the world in the early 2000s became a game changer for advancing FI research, policy, program evaluation, and governance. The success with experience FI scales is informing the dissemination, adaptation, and validation of water insecurity scales globally. The many lessons learned across countries on how to advance policy and program design and evaluation through improved FS conceptualization and measurement should be systematically shared through networks of researchers and practitioners.

Acid-active proteases to optimize dietary protein digestibility: a step towards sustainable nutrition.

Introduction: Historically, prioritizing abundant food production often resulted in overlooking nutrient quality and bioavailability, however, environmental concerns have now propelled sustainable nutrition and health efficacy to the forefront of global attention. In fact, increasing demand for protein is the major challenge facing the food system in the 21st century with an estimation that 70% more food is needed by 2050. This shift has spurred interest in plant-based proteins for their sustainability and health benefits, but most alternative sources of protein are poorly digestible. There are two approaches to solve digestibility: improve the digestibility of food proteins or improve the digestive capacity of consumers. Enhancing nutrient digestibility and bioavailability across diverse protein sources is crucial, with proteases presenting a promising avenue. Research, inspired by the proteases of human breast milk, has demonstrated that exogenous microbial proteases can activate within the human digestive tract and substantially increase the digestion of targeted proteins that are otherwise difficult to fully digest. Methods: Here, we introduce the use of an acid-active family of bacterial proteases (S53) to improve the digestibility and nutritional quality of a variety of protein sources, evaluated using the INFOGEST 2.0 protocol. Results: Results from in vitro digestibility indicate that the most effective protease in the S53 family substantially improves the digestibility of an array of animal and plant-derived proteins-soy, pea, chickpea, rice, casein, and whey. On average, this protease elevated protein digestibility by 115% during the gastric phase and by 15% in the intestinal phase, based on the degree of hydrolysis. Discussion: The widespread adoption of these proteases has the potential to enhance nutritional value and contribute to food security and sustainability. This approach would complement ongoing efforts to improve proteins in the food supply, increase the quality of more sustainable protein sources and aid in the nourishment of patients with clinically compromised, fragile intestines and individuals like older adults and high-performance athletes who have elevated protein needs.