The role of diet in the management of psoriasis: a scoping review.

Psoriasis is a chronic, systemic, immune-mediated, inflammatory skin disease associated with significant comorbidities. Globally, there are an estimated 60 million people living with psoriasis (PLwP). There is a growing body of evidence on the role of diet in psoriasis management, and demand for dietary advice is high. However, there are no specific, evidence-based dietary guidelines. This scoping review summarises the literature on use and effectiveness of diet in the management of psoriasis to improve understanding of the evidence and assist PLwP and healthcare professionals (HCPs) to discuss diet. The findings were categorised into three themes: (1) dietary intakes of PLwP, (2) the perceived role of diet in psoriasis management and (3) dietary approaches to manage psoriasis symptoms. In cross-sectional studies PLwP were reported to have higher fat and lower fibre intakes compared with controls, and lower psoriasis severity was associated with higher fibre intake. However, research is limited. PLwP perceive diet to have an impact on symptoms and make dietary modifications which are often restrictive. Systematic reviews and RCTs found certain dietary approaches improved symptoms, but only in specific populations (e.g. PLwP with obesity and PLwP with coeliac disease), and evidence for supplement use is inconclusive. The grey literature provides limited guidance to PLwP; focusing on weight loss and associated comorbidities. Larger, controlled trials are required to determine dietary approaches for psoriasis management, especially in PLwP without obesity and non-coeliac PLwP. Further understanding of diet modification, information acquisition and experiences among PLwP will enhance holistic care for psoriasis management.

Dietary and agricultural adaptations to drought among smallholder farmers in South Africa: A qualitative study.

Building resilience to environmental change is an integral part of long-term climate adaptation planning and local policy. There is an increased understanding of the impact of climate change on global crop production however, little focus has been given to local adaptation pathways and rural smallholder community responses, especially regarding food security. It is becoming increasingly evident that local level decision-making plays a vital role in reducing vulnerability to environmental change. This research aimed to qualitatively investigate coping and adaptive strategies adopted by smallholder farming households to respond to the impacts of drought in rural KwaZulu-Natal, South Africa. Focus group discussions (n = 7) consisting of 5-9 participants and individual interviews (n = 9) using pre-tested topic guides, involving a total of 57 adults were conducted in rural areas of drought-affected districts: Msinga, Richmond and Umbumbulu of KwaZulu-Natal, in July 2018. The data were analysed using thematic analysis in NVivo 12. Thematic analysis identified three principal themes: 1. Perceived effects of droughts on the local food system and diets; 2. Current coping strategies; and 3. Enablers for successful adaptation. All sites reported a change in food consumption habits, with the majority perceiving drought to be the main driver behind a shift from vegetable-based to starch-based diets and decreased animal source food consumption. Only short-term coping strategies were implemented across the study sites. However, knowledge of long-term adaptation strategies existed but was unattainable to most respondents. Recommendations of perceived context-specific long-term adaptation strategies that could be used at a local scale were communicated by the respondents. However, they would need external help to actualize them. A need exists to support smallholder communities' short-term response methods to drought to achieve more holistic resilience and successful adaptation. Short-term adaptation strategies, if implemented alone, often have significant trade-offs with longer-term adaptation and building resilience. This study highlights the need for targeted, contextualised policy solutions to improve smallholder productivity during drought through a strategic combination of both short- and longer-term adaptation measures, i.e. short-term adaptation should be guided by a long-term adaptation strategy. Proper planning, including the use of climate scenarios combined with information on nutritional status, is needed to develop context-specific and transformative adaptation strategies. These strategies should aim to strengthen resilience at a local level and should be included as policy recommendations.

The impact of environmental changes on the yield and nutritional quality of fruits, nuts and seeds: a systematic review.

BACKGROUND: Environmental changes are predicted to threaten human health, agricultural production and food security. Whilst their impact has been evaluated for major cereals, legumes and vegetables, no systematic evidence synthesis has been performed to date evaluating impact of environmental change on fruits, nuts and seeds (FN&S) - valuable sources of nutrients and pivotal in reducing risks of non-communicable disease. METHODS: We systematically searched seven databases, identifying available published literature (1970-2018) evaluating impacts of water availability and salinity, temperature, carbon dioxide (CO2) and ozone (O3) on yields and nutritional quality of FN&S. Dose-response relationships were assessed and, where possible, mean yield changes relative to baseline conditions were calculated. RESULTS: 81 papers on fruits and 24 papers on nuts and seeds were identified, detailing 582 and 167 experiments respectively. A 50% reduction in water availability and a 3-4dS/m increase in water salinity resulted in significant fruit yield reductions (mean yield changes: -20.7% [95%CI -43.1% to -1.7%]; and -28.2% [95%CI -53.0% to -3.4%] respectively). A 75-100% increase in CO2 concentrations resulted in positive yield impacts (+37.8%; [95%CI 4.1% to 71.5%]; and 10.1%; [95%CI -30.0% to 50.3%] for fruits and nuts respectively). Evidence on yield impacts of increased O3 concentrations and elevated temperatures (>25°C) was scarce, but consistently negative. The positive effect of elevated CO2 levels appeared to attenuate with simultaneous exposure to elevated temperatures. Data on impacts of environmental change on nutritional quality of FN&S were sparse, with mixed results. DISCUSSION: In the absence of adaptation strategies, predicted environmental changes will reduce yields of FN&S. With global intake already well-below WHO recommendations, declining FN&S yields may adversely affect population health. Adaptation strategies and careful agricultural and food system planning will be essential to optimise crop productivity in the context of future environmental changes, thereby supporting and safeguarding sustainable and resilient food systems.