Food Is Medicine: A Presidential Advisory From the American Heart Association.

Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the recommended clinical guidelines. An abundance of barriers, including food and nutrition insecurity, how food is marketed and advertised, access to and affordability of healthy foods, and behavioral challenges such as a focus on immediate versus delayed gratification, stand in the way of healthier dietary patterns for many Americans. Food Is Medicine may be defined as the provision of healthy food resources to prevent, manage, or treat specific clinical conditions in coordination with the health care sector. Although the field has promise, relatively few studies have been conducted with designs that provide strong evidence of associations between Food Is Medicine interventions and health outcomes or health costs. Much work needs to be done to create a stronger body of evidence that convincingly demonstrates the effectiveness and cost-effectiveness of different types of Food Is Medicine interventions. An estimated 90% of the $4.3 trillion annual cost of health care in the United States is spent on medical care for chronic disease. For many of these diseases, diet is a major risk factor, so even modest improvements in diet could have a significant impact. This presidential advisory offers an overview of the state of the field of Food Is Medicine and a road map for a new research initiative that strategically approaches the outstanding questions in the field while prioritizing a human-centered design approach to achieve high rates of patient engagement and sustained behavior change. This will ideally happen in the context of broader efforts to use a health equity-centered approach to enhance the ways in which our food system and related policies support improvements in health.

Carbon footprint of synthetic nitrogen under staple crops: A first cradle-to-grave analysis.

More than half of the world's population is nourished by crops fertilized with synthetic nitrogen (N) fertilizers. However, N fertilization is a major source of anthropogenic emissions, augmenting the carbon footprint (CF). To date, no global quantification of the CF induced by N fertilization of the main grain crops has been performed, and quantifications at the national scale have neglected the CO2 assimilated by plants. A first cradle-to-grave life cycle assessment was performed to quantify the CF of the N fertilizers' production, transportation, and application to the field and the uses of the produced biomass in livestock feed and human food, as well as biofuel production. We quantified the direct and indirect inventories emitted or sequestered by N fertilization of main grain crops: wheat, maize, and rice. Grain food produced with N fertilization had a net CF of 7.4 Gt CO2eq. in 2019 after excluding the assimilated C in plant biomass, which accounted for a quarter of the total CF. The cradle (fertilizer production and transportation), gate (fertilizer application, and soil and plant systems), and grave (feed, food, biofuel, and losses) stages contributed to the CF by 2%, 11%, and 87%, respectively. Although Asia was the top grain producer, North America contributed 38% of the CF due to the greatest CF of the grave stage (2.5 Gt CO2eq.). The CF of grain crops will increase to 21.2 Gt CO2eq. in 2100, driven by the rise in N fertilization to meet the growing food demand without actions to stop the decline in N use efficiency. To meet the targets of climate change, we introduced an ambitious mitigation strategy, including the improvement of N agronomic efficiency (6% average target for the three crops) and manufacturing technology, reducing food losses, and global conversion to healthy diets, whereby the CF can be reduced to 5.6 Gt CO2eq. in 2100.

Wasted Food, Wasted Resources? A Critical Review of Environmental Impact Analysis of Food Loss and Waste Generation and Treatment.

Food loss and waste (FLW) comes with significant environmental impacts and thus prevents a sustainable food system transition. Here we conducted a systematic review of 174 screened studies that assessed the environmental impacts of FLW generation and treatment. We found that the embodied impacts of FLW along the supply chain and impacts from FLW treatment received equal attention, but few studies have included both. The reviewed studies show narrow geographical (mostly conducted in industrialized countries) and food supply chain (mostly focused on the consumption stage) coverage. Life cycle analysis (LCA), material flow analysis (MFA), or their combination are the most commonly used to quantify FLW related environmental impacts. More method standardization, integration, and innovation and better FLW data with regional and stage resolution from a first-hand source are badly needed. Among the various proposed mitigation strategies covering technology, economy, behavior, and policy aspects, process optimization and waste management options are the most discussed. Our review calls for a more holistic environmental impact assessment of FLW generation and treatment and analysis of the trade-offs among different environmental impact categories and between supply chain stages, which would better inform relevant policy on effective environmental impact mitigation strategies toward sustainable food systems.

Knowledge, attitude and behaviours towards food sustainability in a group of Italian consumers. A cross-sectional study.

Sustainability is crucial for transforming the food system, addressing environmental and nutrition issues and depends on consumer perceptions and values. This cross-sectional study investigates the relationship between sustainability attitudes, knowledge, and eating behaviours. Nearly half reported high level of knowledge regarding food sustainability while 24% expressed high attitude towards food sustainability. Women reported higher levels of knowledge and attitude towards food sustainability. Logistic regression analyses, adjusted for age, sex, and education, revealed that using public transport, biking, or walking was significantly associated with higher odds of having a more positive overall attitude towards food sustainability (OR = 1.77). The overall knowledge score was a strong predictor of a positive overall attitude score (OR = 2.11). Examining individual knowledge-related items, almost all were associated with higher levels of knowledge, except those regarding food and environment interaction. These findings underline a complex scenario where consumers' awareness and knowledge highly influence the applicability of sustainable food choices.

Beyond profit margins: Orchestrating social, economic, and environmental sustainability within the Norwegian Salmon Food Supply Chain.

Food Supply Chains (FSCs) have become increasingly complex with the average distance between producers and consumers rising considerably in the past two decades. Consequently, FSCs are a major source of carbon emissions and reducing transportation costs a major challenge for businesses. To address this, we present a mathematical model to promote the three core dimensions of sustainability (economic, environmental, and social), based on the Mixed-Integer Linear Programming (MILP) method. The model addresses the environmental dimension by intending to decrease the carbon emissions of different transport modes involved in the logistics network. Several supply chain network characteristics are incorporated and evaluated, with a consideration of social sustainability (job generation from operating various facilities). The mathematical model's robustness is demonstrated by testing and deploying it to a variety of problem instances. A real-life case study (Norwegian salmon supply chain) helps to comprehend the model's applicability. To understand the importance of optimizing food supply networks holistically, the paper investigates the impact of multiple supply chain permutations on total cost, demand fluctuations and carbon emissions. To address fluctuations in retail demand, we undertook sensitivity analysis for variations in demand, enabling the proposed model to revamp Norway's salmon supply chain network. Subsequently, the results are thoroughly examined to identify managerial implications.

Potential Energy and Environmental Footprint Savings from Reducing Food Loss and Waste in Europe: A Scenario-Based Multiregional Input-Output Analysis.

Food loss and waste (FLW) contribute significantly to the global food system's economic and environmental burdens, including substantial greenhouse gas (GHG) emissions, resource depletion, and waste management challenges. In alignment with the European Commission's sustainability objectives and U.N. Sustainable Development Goal 12.3, this study explores the potential energy and environmental footprint savings achievable by halving FLW in Europe by 2030. Using a multiregional input-output model, we estimated the total global energy and environmental footprint savings across all stages of the food supply chain, considering industry-specific FLW rates and proportion weights. The findings reveal substantial environmental savings across Europe, with aggregate savings potentially reaching 51 Mt CO2e (0.09 t CO2e/p), 4,620 Mm3 (8 m3/p) of blue water, 106,446 km2 (179 m2/p) of cropland, 55,523 km2 (93 m2/p) of grassland, and 0.47 EJ (0.54 TJ/p) of energy. The greatest potential for savings was found in Western Europe, specifically in France, Germany, Belgium, and The Netherlands. However, countries with a lower per capita GDP, such as Greece, Croatia, Bulgaria, and Romania, also demonstrate significant per capita savings potential, indicating that wealth does not necessarily correlate with higher environmental savings. Agricultural production emerged as the stage with the highest footprint reduction potential for GHG and resource footprints across Europe, while the foodservice and institutional stages offer the greatest energy-saving potential. Geographical disparities underscore the need for region-specific policies. These results challenge the wealth-sustainability correlation and advocate for adaptable policies that transcend national wealth and accommodate regional disparities, underlining the pivotal roles of the agricultural production and consumption stages in footprint savings.

The revised Healthy Purchase Index (r-HPI): a validated tool for exploring the nutritional quality of household food purchases.

BACKGROUND: The Healthy Purchase Index (HPI) assesses the nutritional quality of food purchases (FP) from food group expenditure shares only. However, it was developed from the FP of a disadvantaged population. OBJECTIVE: To adapt and validate the HPI for a general population. METHODS: FP were obtained from a representative sample of French households (Kantar WorldPanel) subdivided into two subsamples. The first sample (n = 4375) was used to adapt and validate the score; the second sample (n = 2188) was used to test external validity. The revised-HPI (r-HPI) includes 2 subscores: the diversity subscore and the quality subscore. Diversity subscore points were awarded when expenditure shares were above the 25th percentile for 5 food groups ("Fruits", "Vegetables", "Starches", "Dairy", "Meat, Fish and Eggs"). Regression models between the expenditure shares of each food group and the Mean Adequacy Ratio (MAR) and the Mean Excess Ratio (MER) of FP were used to select quality subscore components and define cut-offs for point allocation. Construct validity was assessed on the first sample using Spearman's correlations between the r-HPI and the four nutritional quality indicators (NRF9.3, MAR, MER, energy density), and also by comparing the r-HPI of monthly FP of sub-populations defined by criteria known to influence diet quality (age, gender, income, education) and between households having a monthly food basket of higher (MAR > median and MER and energy density < median) vs. lower nutritional quality within the population, using Wilcoxon tests or pairwise comparisons of contrasts. External validity was tested by performing the same analyses on the 2nd sample of 2188 households. RESULTS: The adaptation led to include new components (e.g. red meat) and define new cut-offs (e.g. - 1 point when budget share for red meat > 21%). The r-HPI (mean = 6.50 ± 3.58) was strongly correlated with NRF9.3, MAR, MER and energy density (0.59, 0.52, - 0.41 and - 0.65, respectively, p < 0.01) and poorly correlated with total energy content (- 0.096, p < 0.001). The r-HPI was significantly higher in women (ß = 1.41 [0.20], p < 0.01), households having a food basket of higher nutritional quality (ß = 4.15 [0.11], p < 0.001), and increased significantly with age, income and education levels. Similar results were obtained in the 2nd sample. CONCLUSION: We showed the validity of the r-HPI in a large sample of French households. As it does not require food quantity or nutrient content, it can be used as a valuable tool to explore FP behaviours. Cut-offs can be used in health promotion to provide nutri-economic counselling.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system.

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Profiling ultra-processed foods in Thailand: sales trend, consumer expenditure and nutritional quality.

BACKGROUND: Ultra-processed foods (UPF) are associated with adverse health outcomes. This study aimed to analyse the national trends in retail sales, consumer expenditure and nutritional quality of UPFs in Thailand. METHODS: The study used data from the Euromonitor Passport database for analysis of retail sales and consumer expenditure, and from the Mintel Global New Products Database for nutritional analysis using the WHO Southeast Asian Region nutrient profile model. RESULTS: The study found the highest per capita sales volume and value of UPFs in 2021 were sauces, dressings & condiments (8.4 kg/capita) and carbonated soft drinks (27.1 L/capita), respectively. However, functional & flavoured water, ready-made meals and baked goods had the highest observed (2012-2021) and expected (2021-2026) sales growth. Supermarkets were responsible for most of the UPF sales since 2012, but convenience stores had larger growth in retail values. Growth in consumer expenditure per capita on UPFs from 2012 to 2020, ranged between 12.7% and 34%, and till 2026 is forecast to grow between 26% and 30%. More than half of UPFs exceeded at least one nutrient cutoff, 59.3% for total fats, 24.8% for saturated fats, 68.2% for total sugars and 94.3% for sodium. CONCLUSIONS: The findings suggest a need for regulatory and non-regulatory measures such as UPF taxation and marketing restrictions, and market incentives for producing non-UPFs. A system for regularly monitoring and evaluating healthiness (both nutritional and processing aspects) of food products, especially UPFs, is required.

Association between health care access and food insecurity among lower-income older adults with multiple chronic conditions in Washington State, USA.

OBJECTIVE: Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity. DESIGN: Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey. SETTING: Washington State, USA. PARTICIPANTS: Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more. RESULTS: The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not. CONCLUSIONS: Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity.

Store-specific grocery shopping patterns and their association with objective and perceived retail food environments.

OBJECTIVE: To explore store-specific grocery shopping patterns and assess associations with the objective and perceived retail food environment (RFE). DESIGN: This cross-sectional study used principal component analysis and hierarchical cluster analysis to identify grocery shopping patterns and logistic regression models to assess their associations with the RFE, while adjusting for household characteristics. SETTING: The Montpellier Metropolitan Area, France. PARTICIPANTS: To be eligible for inclusion, participants had to be 18 years of age or older and reside in the Montpellier Metropolitan Area. Analyses were carried out on 415 households. RESULTS: Households of cluster 'Supermarket' (49 % of households) primarily shopped at supermarkets and were less likely to live near a convenience store. Households of cluster 'Diversified' (18 %) shopped mostly at organic stores, at markets, at specialised stores, and from producers and were more likely to have a market in their activity space. Households of cluster 'Discount' (12 %) primarily shopped at discounters and were less likely to perceive a producer in their activity space. Households of cluster 'Convenience' (12 %) mostly shopped online or in convenience stores. Finally, households of cluster 'Specialized' (9 %) had high expenditures in greengrocers and in other specialised food stores and were more likely to live near a specialised food store. CONCLUSIONS: This study highlighted the importance of considering both perceived and objective RFE indicators, as well as assessments around the home and in activity space. Understanding how people buy food and interact with their RFE is crucial for policymakers seeking to improve urban food policies.

Distribution of fresh foods in food pantries: challenges and opportunities in Illinois during the COVID-19 pandemic.

BACKGROUND: The charitable food system distributes free food to clients across the U.S., but many nutrition and health-focused efforts encounter barriers to success, which were exacerbated during the COVID-19 pandemic. The objective of the current study was to understand barriers and facilitators to distributing nutritious, fresh foods in food pantries across Illinois during the COVID-19 pandemic. METHODS: Forty-nine pantry representatives participated in focus groups in October 2021. A codebook was created based on relevant literature, stakeholder interests, and an initial review of the recordings. Transcripts of each group were coded and analyzed using a basic interpretive approach. RESULTS: Pantries distribution of fresh foods was impacted by community partners, food bank policies and practices, and the quality of the donated fresh foods. Physical constraints of pantries limit fresh food storage capacity. The COVID-19 pandemic magnified stressors in the charitable food system which highlighted how community partners might improve fresh food distribution. CONCLUSION: Focus groups with food pantry representatives across Illinois provided key insights that can inform future efforts to facilitate fresh food distribution in the charitable food system. Future studies should evaluate the effects of the suggested initiatives and changes at the food pantry, food bank, and policy levels.

Unpredictable fasting transiently alters corticosterone and feeding behavior but not body mass or later HPA axis function in zebra finches (Taeniopygia guttata).

The hypothalamic-pituitary-adrenal (HPA) axis is commonly activated in response to unpredictable conditions, including unstable or inadequate food supply. Extended exposure to unpredictable food resources can alter HPA axis function, with the potential for negative fitness consequences. We addressed the interrelationships of unpredictable food resources, HPA axis activity, and food intake in adult and juvenile zebra finches (Taeniopygia guttata). Finches exposed to prolonged periods of unpredictable food elevate corticosterone (the primary avian glucocorticoid) when food is unavailable; however, whether they experience chronic elevation in baseline corticosterone during periods of unpredictability, even when food is available, is unclear. We subjected adults and juveniles to an extended period of temporally unpredictable food (consisting of a random daily fast) or predictable food supply. We investigated baseline corticosterone under fed conditions and in response to an acute fast (mimicking the daily fasting periods in the unpredictable treatment), and assessed differences in body mass, food intake, and corticosterone responses to restraint. Regardless of sex and age, individuals in both treatment groups elevated corticosterone when fasted, and baseline corticosterone under fed conditions was indistinguishable between groups. Thus, corticosterone levels were not persistently elevated in the unpredictably fed group. Treatment groups did not differ in body mass or corticosterone responses to restraint, but unpredictably fed birds consumed food more rapidly when food was available. Our findings suggest that the unpredictably fed birds experienced repeated, moderate elevations in corticosterone. Such elevations may aid birds in coping with unpredictable food sources, in part by activating compensatory changes in foraging behavior.

TinyML-Sensor for Shelf Life Estimation of Fresh Date Fruits.

Fresh dates have a limited shelf life and are susceptible to spoilage, which can lead to economic losses for producers and suppliers. The problem of accurate shelf life estimation for fresh dates is essential for various stakeholders involved in the production, supply, and consumption of dates. Modified atmosphere packaging (MAP) is one of the essential methods that improves the quality and increases the shelf life of fresh dates by reducing the rate of ripening. Therefore, this study aims to apply fast and cost-effective non-destructive techniques based on machine learning (ML) to predict and estimate the shelf life of stored fresh date fruits under different conditions. Predicting and estimating the shelf life of stored date fruits is essential for scheduling them for consumption at the right time in the supply chain to benefit from the nutritional advantages of fresh dates. The study observed the physicochemical attributes of fresh date fruits, including moisture content, total soluble solids, sugar content, tannin content, pH, and firmness, during storage in a vacuum and MAP at 5 and 24 ∘C every 7 days to determine the shelf life using a non-destructive approach. TinyML-compatible regression models were employed to predict the stages of fruit development during the storage period. The decrease in the shelf life of the fruits begins when they transition from the Khalal stage to the Rutab stage, and the shelf life ends when they start to spoil or ripen to the Tamr stage. Low-cost Visible-Near-Infrared (VisNIR) spectral sensors (AS7265x-multi-spectral) were used to capture the internal physicochemical attributes of the fresh fruit. Regression models were employed for shelf life estimation. The findings indicated that vacuum and modified atmosphere packaging with 20% CO2 and N balance efficiently increased the shelf life of the stored fresh fruit to 53 days and 44 days, respectively, when maintained at 5 ∘C. However, the shelf life decreased to 44 and 23 days when the vacuum and modified atmosphere packaging with 20% CO2 and N balance were maintained at room temperature (24 ∘C). Edge Impulse supports the training and deployment of models on low-cost microcontrollers, which can be used to predict real-time estimations of the shelf life of fresh dates using TinyML sensors.

Eligibility and Prevalence of the American Heart Association Heart Check Certification Program in the US Packaged Food and Beverage Supply: A Cross-Sectional Study.

Objective: Consumers in the US make choices within a food supply dominated by processed packaged foods and beverage products. Front-of-package nutrition labels (FOPL) equip consumers to make healthier choices, but further evaluation and regulation regarding FOPL format, scope, and display have been recommended by the World Health Organization. As a leader in consumer FOPL guidance, the American Heart Association's (AHA) Heart Check programme certifies food companies seeking to add an AHA Heart Check logo as a FOPL for qualifying heart healthy products. A cross-sectional assessment of the AHA Heart Check Standard Certification was conducted within the US packaged food and beverage supply to assess the eligibility and prevalence of the programme as a FOPL. Methods: Data were derived from Label Insight's Open Data initiative, which is the largest publicly-available US branded food composition database. The proportions of products that were certified and eligible to be certified for the Standard Certification were reported by nutrient attributes, grocery aisles and food brands. Results: Among 153,453 products examined, fewer than 1% exhibited the Heart Check certification on their label. Among products that were not Heart Check certified,13.8% were eligible for Standard Certification. The most common reason for ineligibility was the saturated fat content (52%), followed by total fat content (47%) and sodium content (47%). Heart Check certification and eligibility differed substantially across grocery aisle categories. Conclusions: The abundance of unhealthy products in the US packaged food and beverage supply and absence of harmonized FOPL policies suggest the need for FOPL like the Heart Check label to promote adherence to healthy diets. There are opportunities for food manufacturers and the AHA to certify more heart healthy foods and beverages. However, more consistent criteria and transparent labelling could enhance Heart Check certification to facilitate consumers' ability to make more informed and healthful purchases.

Critical success factor analysis of blockchain technology in agri-food supply chain management: A circular economy perspective.

In the sustainability system, which gives importance to the availability of resources, recycling, renewal, and reproduction strategies can be handled under the name of the circular economy. While there are many stages to be followed from food production to consumption and even recycling, one of the technologies that will contribute to the circular economy that can take an active role in these stages is blockchain technology. In this study, which is about the circular economy in sustainable supply chain management, the contribution of blockchain technology to agri-food supply chain management is discussed. The aim of the study is to research, analyze and prioritize the critical success factors of the use of blockchain technology for the agri-food sector on the way to the circular economy. As a first step, with the help of PESTEL analysis approach, 12 critical success factors for agri-food supply chain management under the political, economic, social, technological, environmental, and legal dimensions of blockchain technology within the scope of circular economy are determined. Analytic Network Process (ANP) and MultiAtributive Ideal-Real Comparative Analysis (MAIRCA) methods are used in an integrated way to consider the degree of influence between the factors and to determine the ideal optimal factor. In the results, it is determined that the political and technological sub-criteria of blockchain technology is determined, and it is observed that the criteria handled in line with the sustainability system are compatible with the perspective of reducing the waste of resources of the circular economy. If blockchain technology is used in the agri-food sector, it has been determined that it will contribute to the circular economy with the success factors in this study. "Ability to prevent food waste"; "Increased food security"; "Product lifecycle tracking" factors take priority in their ranking.

Food insecurity and dental caries prevalence in children and adolescents: A systematic review and meta-analysis.

BACKGROUND: Food insecurity (FI) is associated with dietary practices, which can act as a risk factor for dental caries. AIM: This study aimed to investigate the relationship between FI and dental caries prevalence in children and adolescents. DESIGN: MEDLINE (via PubMed), EMBASE, SCOPUS, ISI web of knowledge, Cochrane, and ProQuest Dissertations & Theses Global database (up to April 19, 2022) as well as reference lists were searched. Eligible studies compared dental caries prevalence in food-secure and food-insecure individuals younger than 19 years. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using a modified Newcastle-Ottawa Scale. Meta-analysis was performed, and the pooled odds ratio (OR) was calculated at 95% confidence interval (95% CI). RESULTS: Among the 1350 retrieved records, 10 cross-sectional reports were selected for systematic review. Six studies involving 8631 participants were included in the meta-analysis. More than half of the reports were published within the period 2019-2021. All studies except one were judged as low risk of bias. Overall, the prevalence of dental caries was greater among the food-insecure children and adolescents (OR: 2.01, 95% CI: 1.52-2.65, p < .001, I2 : 73.5%). Similarly, all three categories of FI were significantly associated with caries experience (marginal FI: OR: 1.88, 95% CI: 1.56-2.27, p < .001, I2 : 0.0%; low FI: OR: 2.42, 95% CI: 1.42-4.14, p = .001, I2 : 74.4%; very low FI: OR: 2.37, 95% CI: 1.88-3.00, p < .001, I2 : 0.0%). CONCLUSION: The results showed a significant association between FI status and dental caries in both childhood and adolescence; however, there was a lack of longitudinal studies for a better understanding of this association. Health policies leading to reduction in FI may also aim to reduce dental caries.

Transition to a sustainable food supply chain during disruptions: A study on the Brazilian food companies in the Covid-19 era.

The COVID-19 pandemic has brought negative impacts to global supply chains, in particular to the agricultural sector. Although these companies have been developing programs to mitigate the impacts caused by COVID-19, researchers have been worried about a possible weakening of the adoption of sustainable initiatives due to a focus on dealing with the consequences of the pandemic. Grounded on the Resource Orchestration Theory, the goal of this study was to assess the effects of the COVID-19 outbreak on sustainable (environmental, social, and economic) performance in the context of agri-food supply chains. To do so, a questionnaire survey was used to collect data from 349 different medium and large agri-food companies in Brazil. Data were analyzed using Structural Equation Modeling-Partial Least Squares technique. This study has found out that, under the impacts arising from COVID-19 pandemic (1) supply management and transportation and logistics management had a positive impact on food supply chains' sustainable performance; (2) the effects of relationship management and supply chain wide impact management were found to be negative on sustainable performance; and (3) the effects of demand and production management on sustainable performance were not considered significant. We propose a framework that clearly represents the relationship between the disrupted supply chain areas and sustainable performance through the development of orchestration capabilities. By knowing which kinds of impacts produce the most significant effects on sustainable performance, policy makers and managers will be able to make decisions and take actions to avoid negative effects and to improve firms' sustainable performance.

Synergies and trade-offs in drought resilience within a multi-level UK food supply chain.

Weather extremes are the biggest challenge for supply chains worldwide, with food supply chains particularly exposed due to agriculture's sensitivity to weather conditions. Whilst attention has been paid to farm-level impacts from, and adaptation to, weather extremes, there remains a need to better understand how different actors along the supply chain suffer, react and adapt to these natural hazards and how their resilience-building strategies affect other actors' and the whole system's resilience. Taking the UK potato supply chain as a case study, this paper analyses the synergies and trade-offs in drought resilience in a multi-level food supply chain. Data from an online survey (87) and interviews with key informants (27) representing potato supply-chain actors (growers, packers, processors, retailers) were used to analyse drought risk perceptions, impacts and coping strategies, long-term resilience measures and further actions to build system resilience. Results suggest that the potato supply chain has increased its resilience to weather extremes due to retailers and packers having a wider geographical spread of supply, an increasing reliance on forward contracts and favouring growers with water security. However, a conceptual framework of resilience-building strategies adopted by supply chain actors shows that these measures are largely designed to reduce their own risk without considering implications for other parts of the chain and the system as a whole. A more integrated approach to promote drought resilience in complex food supply chains that enables improved vertical collaboration and trust between actors is therefore needed.

Robust optimization and strategic analysis for agri-food supply chain under pandemic crisis: Case study from an emerging economy.

Pandemic crises like the coronavirus disease 2019 (COVID-19) have severely influenced companies working in the Agri-food industry in different countries. Some companies could overcome this crisis by their elite managers, while many experienced massive financial losses due to a lack of the appropriate strategic planning. On the other hand, governments sought to provide food security to the people during the pandemic crisis, putting extreme pressure on companies operating in this field. Therefore, the aim of this study is to develop a model of the canned food supply chain under uncertain conditions in order to analyze it strategically during the COVID-19 pandemic. The problem uncertainty is addressed using robust optimization, and also the necessity of using a robust optimization approach compared to the nominal approach to the problem is indicated. Finally, to face the COVID-19 pandemic, after determining the strategies for the canned food supply chain, by solving a multi-criteria decision-making (MCDM) problem, the best strategy is specified considering the criteria of the company under study and its equivalent values are presented ​​as optimal values of a mathematical model of canned food supply chain network. The results demonstrated that "expanding the export of canned food to neighboring countries with economic justification" was the best strategy for the company under study during the COVID-19 pandemic. According to the quantitative results, implementing this strategy reduced by 8.03% supply chain costs and increased by 3.65% the human resources employed. Finally, the utilization of available vehicle capacity was 96%, and the utilization of available production throughput was 75.8% when using this strategy.