Adapting food environment frameworks to recognize a wild-cultivated continuum.

Food environments, or interfaces between consumers and their food systems, are a useful lens for assessing global dietary change. Growing inclusivity of nature-dependent societies in lower-and middle-income countries is driving recent developments in food environment frameworks. Downs et al. (2020) propose a food environment typology that includes: wild, cultivated, informal and formal market environments, where wild and cultivated are "natural food environments." Drawing from transdisciplinary perspectives, this paper argues that wild and cultivated food environments are not dichotomous, but rather exist across diverse landscapes under varying levels of human management and alteration. The adapted typology is applied to a case study of Indigenous Pgaz K'Nyau food environments in San Din Daeng village, Thailand, using the Gallup Poll's Thailand-adapted Diet Quality Questionnaire with additional food source questions. Wild-cultivated food environments, as classified by local participants, were the source of more food items than any other type of food environment (37% of reported food items). The case of Indigenous Pgaz K'Nyau food environments demonstrates the importance of understanding natural food environments along a continuum from wild to cultivated.

Centering context when characterizing food environments: the potential of participatory mapping to inform food environment research.

Food environments are a critical place within the food system to implement interventions aimed at enabling sustainable diets. In this perspective article, we argue for the need for food environment research to more comprehensively examine the different types of food environments that people access within their communities to ensure that interventions and programs are better aligned with people's lived experiences. We highlight the potential ways in which participatory mapping (PM) can be leveraged to better design food environment research by: (1) identifying the different food environment types that are accessed within a given community; (2) providing insight into the timing for data collection; (3) informing the prioritization of where to conduct food environment assessments; and (4) highlighting the dynamism of food environments over time (e.g., across a given day or across seasons). We provide a case study example of the application of PM and the lessons learned from it in Cambodia. By conceptualizing food environments in a more comprehensive way, from the perspective of the people living within a given community, we will be able to measure food environments in a way that more closely aligns with people's lived experiences.

Comparing The Mediterranean and The Japanese Dietary Pattern in Relation to Longevity - A Narrative Review.

BACKGROUND: The Mediterranean dietary pattern (MDP) and Japanese dietary pattern (JDP) have received increasing attention from the scientific community and media because of their contribution to longevity and health. Although similarities between the two dietary patterns are evident, a detailed comparison between the MDP and the JDP has yet to be explored. AIMS: This narrative review aimed to explore the similarities and differences between the MDP and JDP regarding longevity while reflecting on the adoption of these diets by other populations outside their regions of origin. CONCLUSIONS: Both dietary patterns are plant-based, minimally processed, and sustainable for their respective regions and have been shown to significantly prolong life expectancy in populations. However, the dietary patterns also differ regarding macronutrient ratios, the specific foods consumed, and the individual cultural characteristics of each population. Additionally, both dietary patterns are part of broader lifestyle patterns, including other behaviors, like abstaining from smoking, engaging in regular physical activity, having low-stress levels, and a sense of community, spirituality/ religiousness, and purpose. Their promotion to other populations should be implemented after considering different perspectives, such as cultural and socioeconomical.

Convenience as a dimension of food environments: A systematic scoping review of its definition and measurement.

Convenience is a major driver of food choice throughout the world, yet it is often inconsistently conceptualised, defined and measured. This limits the scope for food systems policy and interventions to leverage convenience to improve diet and nutrition outcomes. We conducted a systematic literature review to determine how convenience is both defined and measured in food environment and nutrition research. Six databases were systematically searched and studies were screened by two independent reviewers based on pre-defined eligibility criteria, yielding 243 studies for inclusion in the final review. 77% of studies did not explicitly define convenience. Among those that did, the dimensions and components within definitions varied. 83% of studies used perceived measures of convenience rather than objective measures. Convenience was most commonly measured in high income countries (64%) and in relation to the home food environment (53%), followed by formal retail (40%). Very few studies measured convenience in relation to the informal retail or cultivated food environments, and no studies considered convenience in relation to wild food environments. The vast majority of studies did not consider the validity or reliability of the measures of convenience. Based on our findings we propose a definition of convenience as a characteristic that results in reduced requirement for resources including time, physical effort, mental effort and skills by the consumer in relation to the planning, acquisition, preparation, storage, transport, consumption or clean-up of food. This definition can be used to help guide the development of measurement tools that can be used to assess convenience across different dimensions and contexts in a more comprehensive way. We also propose a framework for considering convenience as an entry point in food systems to improve diets and nutrition outcomes.

The British Columbia Farmers' Market Nutrition Coupon Program Reduces Short-Term Household Food Insecurity Among Adults With Low Incomes: A Pragmatic Randomized Controlled Trial.

BACKGROUND: The British Columbia Farmers' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers' markets. OBJECTIVE: To examine the impact of the BC FMNCP on the short-term household food insecurity, malnutrition risk, mental well-being, sense of community (secondary outcomes), and subjective social status (exploratory outcome) of adults with low incomes post-intervention and 16 weeks post-intervention. DESIGN: Secondary analyses from a pragmatic randomized controlled trial conducted in 2019 that collected data at baseline, post-intervention, and 16 weeks post-intervention. PARTICIPANTS/SETTING: Adults ≥18 years with low incomes were randomized to an FMNCP group (n = 143) or a no-intervention control group (n = 142). INTERVENTION: Participants in the FMNCP group received 16 coupon sheets valued at $21 Canadian dollars (CAD)/sheet over 10 to 15 weeks to purchase healthy foods from farmers' markets and were eligible to participate in nutrition skill-building activities. MAIN OUTCOME MEASURES: Outcomes included short-term household food insecurity (modified version of Health Canada's 18-item Household Food Security Survey Module), malnutrition risk (Malnutrition Universal Screening Tool), mental well-being (Warwick-Edinburgh Mental Well-Being Scale), sense of community (Brief Sense of Community Scale), and subjective social status (MacArthur Scale of Subjective Social Status community scale). STATISTICAL ANALYSIS: Mixed-effects linear regression and multinomial logistic regression examined between-group differences in outcomes post-intervention and 16 weeks post-intervention. RESULTS: The risk of marginal and severe short-term household food insecurity was lower among those in the FMNCP group compared with those in the control group (relative risk ratio [RRR] 0.15, P = 0.01 and RRR 0.16, P = 0.02) post-intervention, with sustained reductions in severe household food insecurity 16 weeks post-intervention (RRR 0.11, P = 0.01). No statistically significant differences were observed in malnutrition risk, mental well-being, sense of community, or subjective social status post-intervention or 16 weeks post-intervention. CONCLUSIONS: The BC FMNCP reduced short-term household food insecurity but was not found to improve malnutrition risk or psychosocial well-being among adults with low incomes compared with a no-intervention control group.

The impact and implementation of an mHealth intervention to improve infant and young child feeding in Senegal: IIMAANJE protocol for a cluster randomized control trial.

Behavior change communication (BCC) strategies have the potential to improve infant feeding and nutrition outcomes among infants and young children in low- and middle-income countries. More recently, there has been a shift toward the adoption of mHealth interventions-the use of mobile phones to transmit health-related information or direct care-to promote recommended BCC strategies among the caregivers of infants and young children. In Senegal, most infants and young children are not fed according to recommended practices leading to a high prevalence of undernutrition and micronutrient deficiencies. The aims of this cluster randomized control trial, using an effectiveness-implementation (type 1) hybrid design, were to: (1) determine the impact of an mHealth IYCF intervention on IYCF practices and nutrition outcomes; and (2) examine the implementation, costs, and opportunities for scaling up the mHealth messaging intervention. The trial was conducted in three regions in Senegal (Thies, Fatick, Diourbel) with 488 mother, father and children (6-23 months) triads. The intervention included 8 scripted messages, that underwent cognitive testing prior to the intervention implementation, and 8 unscripted messages from positive deviants. One voice message and one text message were sent each week to members of our experimental group for a 16-week period. The impact of the intervention was assessed through a household survey, 24-h dietary recall, and hemoglobin measurements before and after the intervention implementation. The primary outcomes were minimal acceptable diet (MAD) and anemia. We also included a total of 54 participants in nine focus groups held with mothers and fathers and semi-structured interviews with Badienou Gox (i.e., community health workers) (n = 6) and national partners and program implementers (n = 6) to examine the intervention implementation process. The study was registered prior to data collection on Clinicaltrials.gov (Identifier: NCT05374837).

Impact of a farmers' market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial.

BACKGROUND: Adults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers' markets. OBJECTIVE: The objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes. METHOD: In a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10-15 wk to purchase healthy foods from farmers' markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately post-intervention (10-15 wk), and 16-wk post-intervention (26-31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at post-intervention and 16-wk post-intervention. Subgroup analyses examined program impacts by sex and age group (18-59 y, ≥60 y). RESULTS: There were no significant differences in HEI-2015 total scores between the FMNCP and control groups at post-intervention (-0.07; 95% CI: -4.07, 3.93) or 16-wk post-intervention (1.22; 95% CI: -3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at post-intervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk post-intervention. CONCLUSION: The FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes. This trial was registered at [clinicaltrials.gov] as [NCT03952338].

Riverine food environments and food security: a case study of the Mekong River, Cambodia.

Rivers are critical, but often overlooked, parts of food systems. They have multiple functions that support the food security, nutrition, health and livelihoods of the communities surrounding them. However, given current unsustainable food system practices, damming and climate change, the majority of the world's largest rivers are increasingly susceptible to environmental degradation, with negative implications for the communities that rely on them. Here we describe the dynamism and multifaceted nature of rivers as food environments (i.e. the place within food systems where people obtain their food) and their role in securing food security including improved diets and overall health. We also provide a conceptual framework that explain rivers as food environments within the broader food system and describe approaches to characterizing these food environments to better inform our understanding of how they influence food security and nutrition outcomes. Applying this framework to the Mekong River in Cambodia, we describe rivers as multifaceted wild food environments embedded within ecosystems, sociocultural and political environments and sectors of influence. We also explain the ways in which individual factors might influence how communities interact with this food environment. Developing and articulating food-related, ecosystem-specific frameworks and their constructs can guide implementation of policies aimed to improve specific public health or environmental sustainability outcomes. Our conceptual framework incorporates the multiple dimensions of rivers, which will aid future work and public health policy framing to better describe, understand and intervene to ensure protection of rivers' biodiversity and ecosystems as well as food security, health and livelihoods.

Souvent négligés, les cours d'eau jouent pourtant un rôle vital dans les systèmes alimentaires. Ils remplissent de nombreuses fonctions qui contribuent à la sécurité alimentaire, à la nutrition, à la santé et aux moyens de subsistance des communautés avoisinantes. Toutefois, en raison d'un système alimentaire actuel aux pratiques non durables, de la construction de barrages et du changement climatique, la plupart des grands fleuves et rivières du monde sont de plus en plus exposés aux dégradations environnementales, avec des conséquences néfastes pour les communautés qui en dépendent. Dans le présent document, nous évoquons le dynamisme et les multiples facettes des cours d'eau en tant qu'environnements alimentaires (c'est-à-dire l'endroit où les gens se procurent de la nourriture au sein d'un système alimentaire), ainsi que la manière dont ils favorisent la sécurité alimentaire, notamment par le biais d'un régime plus équilibré et d'une meilleure santé en général. Nous fournissons également un cadre conceptuel qui définit les cours d'eau comme environnements alimentaires au sein d'un système plus vaste et décrit les approches caractérisant ces environnements, afin que nous puissions mieux comprendre l'influence qu'ils exercent sur la sécurité alimentaire et la nutrition. En appliquant ce cadre au fleuve Mékong, au Cambodge, nous dévoilons les multiples facettes de ces environnements alimentaires naturels variés qui font partie intégrante des écosystèmes, des milieux politiques et socioculturels, mais aussi des sphères d'influence. Nous expliquons en outre la façon dont certains facteurs individuels sont susceptibles d'interférer dans les interactions que les communautés entretiennent avec cet environnement alimentaire. Développer et formuler des cadres et structures liés à l'alimentation, propres à chaque écosystème, peut orienter la mise en œuvre de mesures visant à améliorer des résultats spécifiques dans le domaine de la santé publique ou de la préservation de l'environnement. Notre cadre conceptuel inclut les différents aspects des cours d'eau, ce qui aidera à mener de futurs travaux et à élaborer des politiques de santé publique pour mieux les qualifier, les appréhender et intervenir en vue d'assurer la protection de la biodiversité et des écosystèmes fluviaux ainsi que la sécurité alimentaire, la santé et les moyens de subsistance.

Los ríos son partes fundamentales de los sistemas alimentarios, pero con frecuencia se ignoran. Tienen múltiples funciones que favorecen la seguridad alimentaria, la nutrición, la salud y los medios de vida de las comunidades que los rodean. Sin embargo, dadas las actuales prácticas insostenibles del sistema alimentario, la construcción de embalses y el cambio climático, la mayoría de los ríos más grandes del mundo son cada vez más susceptibles a la degradación medioambiental, con implicaciones negativas para las comunidades que dependen de ellos. En este documento, se describe el dinamismo y la naturaleza polifacética de los ríos como entornos alimentarios (es decir, el lugar dentro de los sistemas alimentarios donde las personas obtienen sus alimentos) y su función para garantizar la seguridad alimentaria, incluida la mejora de los hábitos alimentarios y la salud en general. Asimismo, se proporciona un marco conceptual que explica los ríos como entornos alimentarios dentro del sistema alimentario en su conjunto y se describen enfoques para caracterizar estos entornos alimentarios con el fin de comprender mejor cómo influyen en los resultados de la seguridad alimentaria y la nutrición. Mediante la aplicación de este marco al río Mekong en Camboya, se describen los ríos como entornos alimentarios silvestres multifacéticos integrados en ecosistemas, entornos socioculturales y políticos y sectores de influencia. Además, se explican cómo los factores individuales pueden influir en la interacción de las comunidades con este entorno alimentario. El desarrollo y la articulación de marcos específicos de los ecosistemas relacionados con la alimentación y sus constructos pueden orientar la aplicación de políticas destinadas a mejorar determinados resultados en materia de salud pública o sostenibilidad medioambiental. El marco conceptual que se presenta incorpora las múltiples dimensiones de los ríos, lo que ayudará en futuros trabajos y en la formulación de políticas de salud pública a describir, comprender e intervenir mejor para asegurar la protección de la biodiversidad y los ecosistemas fluviales, así como la seguridad alimentaria, la salud y los medios de subsistencia.

Leveraging Nutrient-Rich Traditional Foods to Improve Diets among Indigenous Populations in India: Value Chain Analysis of Finger Millet and Kionaar Leaves.

Many indigenous foods are nutrient-rich but are often underutilized even among populations at high risk of malnutrition. The aims of this study were to conduct value chain analysis of one cultivated crop (finger millet among the Munda tribe) and one wild green leafy vegetable (Koinaar leaves among the Sauria Paharia tribe) of two Indigenous communities in Jharkhand state, India and to identify entry points for interventions aimed at supporting production and consumption. Semi-structured interviews were conducted with stakeholders among each tribal group and transcripts were open coded and organized based on key themes across the steps of the value chain for each food independently. Improved storage techniques and infrastructure, machinery for processing and improved cooking fuel would help reduce barriers across the finger millet supply chain related to postharvest losses, processing labor and safety concerns related to cooking. For Koinaar leaves, improving drying techniques to increase consumption across seasons and providing training and support to increase opportunities for selling leaves in local markets, where participants mentioned potential language barriers, could strengthen the supply chain. Improving extension services and focusing beyond production has potential to improve the production and consumption of both nutrient-rich crops among Indigenous communities in India.

Indigenous Foods to Address Malnutrition: An Inquiry into the Diets and Nutritional Status of Women in the Indigenous Community of Munda Tribes of Jharkhand, India.

Background: Indigenous people globally experience poor nutrition outcomes, with women facing the greater burden. Munda, a predominant tribe in Jharkhand, India, live in a biodiverse food environment but yet have high levels of malnutrition. Objectives: To assess diets and the nutritional status of Munda tribal women and explore associations with their Indigenous food consumption, dietary diversity, and socioeconomic and demographic profiles. Methods: A cross-sectional study with a longitudinal component to capture seasonal dietary intake was conducted in 11 villages of the Khunti district, Jharkhand. Household surveys and FFQs, supplemented with 2-d 24-h dietary recall and anthropometric assessments on 1 randomly selected woman per household were conducted. Results: Limited access to diverse foods from a natural food environment (Food Accessed Diversity Index score of 0.3 ± 0.3) was observed. More than 90% women in both seasons had usual nutrient intakes below the estimated average requirements for all nutrients except protein and vitamin C; 35.5% of women were underweight. The mean Minimum Dietary Diversity Score among women (MDDS) was low [2.6 ± 0.6 in wet monsoon; 3 ± 0.7 in winters (acceptable ≥5)]. Higher MDDS contributed to higher usual nutrient intakes (P <0.001). Indigenous food intakes in both seasons (wet monsoon and winter) were low, e.g. Indigenous green leafy vegetables [10.5 and 27.8% of the recommended dietary intake (RDI), respectively], other vegetables (5.2% and 7.8% of RDI, respectively), and fruits (5.8 and 22.8% of RDI, respectively). Despite low intakes, the Indigenous food consumption score was positively associated with usual intake of vitamin A, riboflavin, vitamin C, pyridoxine, and calcium (P < 0.05) in the wet monsoon and thiamine, riboflavin, and zinc (P < 0.001) in winters. After adjusting for covariates, Indigenous food consumption was associated with a higher usual intake of vitamin A (P  < 0.001) in the wet monsoon season. Conclusion: Contextual food-based interventions promoting Indigenous foods and increasing dietary diversity have the potential to address malnutrition in Munda women.

Food Environments and Their Influence on Food Choices: A Case Study in Informal Settlements in Nairobi, Kenya.

The food environments that people have access to shape their food choices. The purpose of this study was to use mixed methods to characterize the external food environment in informal settlements in Nairobi, Kenya and to examine the individual factors that influence the way in which women interact with those environments to make food choices. We used a combination of food environment assessments (vendor mapping, collection of food prices, food quality assessments) and five focus group discussions with women (n = 26) in four villages within two informal settlements in Nairobi (Mukuru and Kibera) to better understand the drivers of food choice. We found a large number (n = 1163) of vendors selling a variety of food within the settlements. The highest number of vendors were selling fruits and/or vegetables; however, there was limited diversity of fruits available. Animal-source foods were considered relatively expensive as compared to plant-based foods, including prepared fried snacks. We found that the way women interacted with their food environments was influenced by individual factors such as income, time, convenience, and preferences. Our findings suggest that interventions targeting both the external food environment as well as individual factors such as income will be necessary to support healthy diets among low-income populations living in informal settlements in Kenya.

The Influence of Food Environments on Food Security Resilience during the COVID-19 Pandemic: An Examination of Urban and Rural Difference in Kenya.

Hunger and food insecurity has worsened due to the COVID-19 pandemic. The types of food environments (e.g., natural/built) that people can access may improve household resilience to food-system shocks. This paper examines (1) urban and rural differences in the perceived influence of the COVID-19 pandemic on agricultural, livelihoods, food environment attributes, diets; and (2) whether access to different food environments was associated with food security. A two-part telephonic survey (COVID-19 Surveillance Community Action Network Food Systems Tool and Household Food Insecurity Access Scale) was conducted in Western Kenya (n = 173) and an informal settlement in Nairobi (n = 144) in January/February 2021. Limitations on the acquisition of farm inputs and movement restrictions had an adverse impact on agriculture and food sales. Urban residents reported a more significant impact on livelihoods (97% vs. 87%, p < 0.001), with day laborers being the most impacted. Rural respondents reported access to significantly more food environments and lower food insecurity. Multiple linear regression analysis revealed that younger respondents, ≤1 income source, had more difficulty acquiring food, decreased access to cultivated environments, and increased access to informal markets were predictors for higher food insecurity. These data indicate that access to specific types of food environments may improve household resilience.

Strengthening Vegetable Production and Consumption in a Kenyan Informal Settlement: A Feasibility and Preliminary Impact Assessment of a Sack Garden Intervention.

Background: Over 85% of Kibera's population, an informal settlement in Nairobi, Kenya, is food insecure. Nutrition-sensitive agriculture interventions, such as sack gardens, have the potential to diversify diets-in turn, improving household food security and diet quality. Furthermore, the sale of extra vegetables may provide an income for program participants. Objectives: The aim of this paper was to conduct a feasibility assessment and preliminary impact assessment of a nutrition-sensitive urban agriculture intervention that used sack gardens for women in Kibera. Methods: Women, from a women's empowerment program, in Kibera (n = 36; n = 21 full program participants, n = 11 withdrawn, n = 4 new members) were engaged in a sack garden intervention in June 2018. A mixed-method approach was used to assess the feasibility and preliminary impact of the program. Qualitative semi-structured interviews (n = 25; n = 18 full program participants, n = 5 withdrawn, n = 2 new members), administered at the end of the pilot phase (March 2019), identified barriers and facilitators (e.g., preferences, inputs, group dynamics) to the production, consumption, and sale of self-produced vegetables. Quantitative surveys (n = 21 full program participants), administered in June 2018 and March 2019, were conducted to evaluate preliminary intervention impact on food security and diet quality through analysis of the Household Hunger Scale (HHS) and Minimum Dietary Diversity for Women (MDD-W). Results: Key barriers included insufficient inputs and group work difficulties, particularly around communication. Facilitators included positive intervention feedback, social bonds and teamwork, participants' self-sufficiency, and preference for sack garden vegetables over market vegetables. Post-intervention, participants reported reduced household food insecurity. Recommendations for program scale-up include investment in additional inputs, a water-collection/irrigation system, additional training, and placing sack gardens closer to women's homes to reduce time constraints. Conclusions: This study suggests that sack gardens may provide partial solutions to improve diet quality; however, further research is needed to assess any impact on household income.

Effect of COVID-19 Pandemic on Food Systems and Determinants of Resilience in Indigenous Communities of Jharkhand State, India: A Serial Cross-Sectional Study.

The COVID-19 pandemic has globally jeopardized food security, with heightened threats for the most vulnerable including smallholder farmers as well as rural, indigenous populations. A serial cross-sectional study was conducted to document effect of COVID-19 pandemic on food environment, agricultural practices, diets and food security, along with potential determinants of food systems resilience, among vulnerable smallholder farmer households in indigenous communities of Santhal, Munda, and Sauria Paharia of Jharkhand state, India. Telephonic household surveys were conducted in two phases i.e., lockdown and unlock phase to assess the impact of the pandemic on their food systems and agricultural practices. Market surveys were conducted during the unlock phase, to understand the impact on local informal markets. Secondary data on state and district level food production and Government food security programs were also reviewed. For data analysis purpose, a conceptual framework was developed which delineated possible pathways of impact of COVID-19 pandemic on food environment, food security and food consumption patterns along with factors that may offer resilience. Our findings revealed adverse effects on food production and access among all three communities, due to restrictions in movement of farm labor and supplies, along with disruptions in food supply chains and other food-related logistics and services associated with the pandemic and mitigation measures. The pandemic significantly impacted the livelihoods and incomes among all three indigenous communities during both lockdown and unlock phases, which were attributed to a reduction in sale of agricultural produce, distress selling at lower prices and reduced opportunity for daily wage laboring. A significant proportion of respondents also experienced changes in dietary intake patterns. Key determinants of resilience were identified; these included accessibility to agricultural inputs like indigenous seeds, labor available at household level due to back migration and access to diverse food environments, specifically the wild food environment. There is a need for programs and interventions to conserve and revitalize the bio-cultural resources available within these vulnerable indigenous communities and build resilient food systems that depend on shorter food supply chains and utilize indigenous knowledge systems and associated resources, thereby supporting healthy, equitable and sustainable food systems for all.

Building climate-sensitive nutrition programmes.

The food system and climate are closely interconnected. Although most research has focused on the need to adopt a plant-based diet to help mitigate climate change, there is also an urgent need to examine the effects of climate change on food systems to adapt to climate change. A systems approach can help identify the pathways through which climate influences food systems, thereby ensuring that programmes combating malnutrition take climate into account. Although little is known about how climate considerations are currently incorporated into nutrition programming, climate information services have the potential to help target the delivery of interventions for at-risk populations and reduce climate-related disruption during their implementation. To ensure climate services provide timely information relevant to nutrition programmes, it is important to fill gaps in our knowledge about the influence of climate variability on food supply chains. A proposed roadmap for developing climate-sensitive nutrition programmes recommends: (i) research aimed at achieving a better understanding of the pathways through which climate influences diet and nutrition, including any time lags; (ii) the identification of entry points for climate information into the decision-making process for nutrition programme delivery; and (iii) capacity-building and training programmes to better equip public health practitioners with the knowledge, confidence and motivation to incorporate climate resilience into nutrition programmes. With sustained investment in capacity-building, data collection and analysis, climate information services can be developed to provide the data, analyses and forecasts needed to ensure nutrition programmes target their interventions where and when they are most needed.

Les systèmes alimentaire et climatique sont étroitement liés. Bien que la plupart des recherches se concentrent sur le besoin d'adopter un régime végétarien pour contribuer à atténuer le changement climatique, il est également urgent d'examiner les effets de ce changement climatique sur les systèmes alimentaires afin de les adapter en conséquence. Une approche systémique peut aider à déterminer dans quelle mesure le climat influence les systèmes alimentaires, et dès lors à faire en sorte que les programmes de lutte contre la malnutrition en tiennent compte. On ignore encore sous quelle forme les considérations climatiques sont actuellement intégrées dans les programmes de nutrition. Cependant, les services climatologiques peuvent contribuer à cibler le déploiement d'interventions pour les populations à risque, ainsi qu'à réduire les perturbations causées par le climat au cours de leur mise en œuvre. Pour veiller à ce que ces services fournissent à point nommé des informations utiles aux programmes de nutrition, il faut impérativement combler le manque de connaissances en matière d'impact des variations climatiques sur les chaînes d'approvisionnement alimentaire. La feuille de route proposée pour l'élaboration de programmes de nutrition adaptés au changement climatique recommande: (i) de mener des recherches visant à mieux comprendre dans quelle mesure le climat influence l'alimentation et la nutrition, en tenant compte des éventuels décalages temporelshoraires; (ii) d'identifier les points d'entrée des informations relatives au climat dans le processus décisionnel de déploiement des programmes alimentaires; et enfin, (iii) de développer des plans de formation et de renforcement des capacités afin que les professionnels de la santé publique disposent des connaissances, de la confiance et de la motivation nécessaires pour intégrer l'adaptation au changement climatique dans les programmes de nutrition. En investissant durablement dans le renforcement des capacités ainsi que dans la collecte et l'analyse de données, il est possible d'instaurer des services climatologiques qui communiqueront les informations, analyses et prévisions requises pour que les programmes de nutrition organisent leurs actions à l'endroit et au moment où elles deviennent indispensables.

El sistema alimentario y el clima están muy interconectados. Aunque la mayoría de las investigaciones se han centrado en la necesidad de adoptar una dieta basada en el consumo de plantas para ayudar a mitigar el cambio climático, también es urgente analizar los efectos del cambio climático en los sistemas alimentarios para adaptarse al mismo. Un enfoque sistémico puede ayudar a identificar las vías a través de las que el clima influye en los sistemas alimentarios, garantizando así que los programas de lucha contra la malnutrición tengan en cuenta el clima. Si bien se sabe poco sobre cómo se incorporan en la actualidad los aspectos climáticos a los programas de nutrición, los servicios de información climática tienen el potencial de ayudar a orientar las intervenciones hacia las poblaciones de riesgo y a reducir los trastornos relacionados con el clima durante su aplicación. Para garantizar que los servicios climáticos proporcionen información oportuna y relevante a los programas de nutrición, es importante solucionar las carencias de nuestros conocimientos sobre la influencia de la variabilidad climática en las cadenas de suministro de alimentos. Una hoja de ruta propuesta para desarrollar programas de nutrición sensibles al clima recomienda i) la investigación destinada a lograr una mejor comprensión de las vías a través de las que el clima influye en la dieta y en la nutrición, incluidos los retrasos; ii) la identificación de los puntos de entrada de la información sobre el clima en el proceso de toma de decisiones para la ejecución de los programas de nutrición; y iii) los programas de creación de capacidad y formación para preparar mejor a los profesionales de la salud pública con los conocimientos, la confianza y la motivación que permitan incorporar la adaptación al clima en los programas de nutrición. Si se invierte de manera sostenida en la creación de capacidades, la recopilación y el análisis de datos, se pueden desarrollar servicios de información climática que proporcionen los datos, los análisis y las previsiones necesarios para garantizar que los programas de nutrición orienten sus intervenciones donde y cuando más se necesiten.

Drivers of food choice among women living in informal settlements in Nairobi, Kenya.

Suboptimal diets drive the multiple burdens of malnutrition among women living in informal settlements. Women's food choices have important implications for their health, as well as that of their families. The purpose of this study was to examine how food choice decisions might differ across different age groups of women living in informal settlements in Nairobi, Kenya. Using in-depth interviews which incorporated a free-listing task, we determined the factors influencing food choice decisions in women in two informal settlements, Kibera and Mukuru. Among women in all age groups, we found income and food price to be the most salient factors influencing food choice decisions. Differences across age groups regarding food choice considerations included individual preference and quality being more salient factors amongst younger women while household preferences were more salient among older women. Women also reported making trade-offs between food affordability and other factors including time and nutrition, which led to sub-optimal diets. Our findings suggest that interventions in these settings may need to be tailored to specific age groups. Additionally, interventions may need to target both individual factors and the external food environment to help women overcome the trade-offs they often find themselves making in food choice decisions.

Examining the trade-offs of palm oil production and consumption from a sustainable diets perspective: lessons learned from Myanmar.

OBJECTIVE: The aim of this study was to examine the trade-offs related to the production and consumption of palm oil in Myanmar from a sustainable diets perspective. DESIGN: We used an enhanced value chain analysis approach that included semi-structured interviews with key stakeholders; market analyses to assess edible oils in markets and focus groups as well as surveys with consumers to ascertain their perceptions and practices related to edible oils. SETTING: Four settings in Myanmar (upper income urban; lower income urban; middle-income urban; lower income rural). PARTICIPANTS: Key stakeholders (n 12) from government, trade bodies and civil society organisations were included in the interviews. Women from each of the regions participated in four focus groups (n 32), and a convenience sample of male and female consumers participated in the surveys (n 362). RESULTS: We found mistrust of the oil sector overall. Poor production practices, leading to low yields, limit the economic viability of oil palm production in Myanmar and contribute to negative environmental (e.g. deforestation) and social outcomes (e.g. land conflicts). Consumers demonstrated low preferences for palm oil as compared with traditional oils from a taste, health and transparency perspective; however, they indicated that its relative low cost led to its purchase over other oils. CONCLUSIONS: The Burmese example suggests that there may be limited benefits, and significant costs, of investing in palm oil production in regions where there are coordinating disincentives from a sustainable diets perspective. However, if oil palm cultivation is to continue, there are opportunities to improve its economic viability and environmental sustainability.