The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review.

BACKGROUND: Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs. METHODS: We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before-after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131). FINDINGS: We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity. INTERPRETATION: There is considerable scope to repurpose existing nutrition interventions to reduce the growing burden of the DBM in LMICs. In settings undergoing rapid nutrition transition, specific policy attention is required to ensure that food-based or supplement-based MCH programmes do not unintentionally increase maternal or child overweight. Consistent reporting of undernutrition and overnutrition outcomes in all nutrition interventions is essential to expand the evidence base to identify and promote interventions maximising benefits and minimising harms on the DBM. FUNDING: President's Scholarship (Imperial College London) and National Institute for Health and Care Research. TRANSLATIONS: For the Portuguese, Spanish and French translations of the abstract see Supplementary Materials section.

Are advertising policies affirmative in restricting the marketing of foods high in fat, salt and sugar (HFSS) in India?: evidence from SWOT Analysis.

The regulatory Indian environment for advertising high fat, salt, and sugar (HFSS) foods and non-alcoholic beverages, on various media was reviewed. Identified national-level policies were categorised as mandatory or self-regulatory based on legal content. For each mandatory regulation, Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was undertaken to determine how existing policies could be strengthened to safeguard children from unhealthy food advertisements. Thirteen policies (nine mandatory; four self-regulatory) relevant to advertising in India were identified. Of the nine mandatory policies, Guidelines for Prevention of Misleading Advertisements and Endorsements for Misleading Advertisements, 2022, is the only policy that restricts HFSS food advertisements to children across all media. There are key shortfalls, including limited scope of 'child-targeted' advertisements and lack of criteria to define HFSS foods. A robust regulatory framework is needed to protect children from HFSS food marketing, not just what is 'directed' at them, with clear evidence-based food classification criteria.

Contribution of natural food environments to nutritional intake and biomarker status: insights from the women of indigenous santhal communities of Jharkhand, India.

BACKGROUND: Many indigenous communities reside in biodiverse environments replete with natural food sources but show ​poor access and utilization. METHODS: To understand the links between indigenous food access, dietary intakes, and biomarkers, we conducted a cross-sectional study among women of the Santhal Community (n = 211) from 17 villages in the Godda district of Jharkhand, India. Survey methods included household surveys, dietary intake assessment (24 HDR) and micronutrient and inflammatory biomarkers' estimation. RESULTS: The diversity in access to foods from different natural sources expressed as Food access diversity index was low. This led to poor consumption and thus a low Minimum Dietary Diversity. The mean nutrient intake was less than the estimated average requirement for all nutrients. Women with higher dietary diversity scores had higher nutrient intakes. Thiamine and calcium intakes were significantly higher in women consuming indigenous foods than non-consumers. One-fourth of the women had elevated levels of inflammatory biomarkers. The prevalence of iron deficiency was approximately 70%. Vitamin A insufficiency (measured as retinol-binding protein) was observed in around 33.6% women, while 28.4% were deficient. Household access to natural food sources was associated with specific biomarkers. The access to kitchen garden (baari) was positively associated with retinol-binding protein levels and negatively with inflammatory biomarkers, while access to ponds was positively associated with ferritin levels. CONCLUSION: The findings highlight the role of access to diverse natural foods resources, including indigenous foods, for improving nutrition security in indigenous communities. Nutrition and health programs promoting indigenous food sources should include the assessment of biomarkers for effective monitoring and surveillance.

Timing and factors associated with complementary feeding in India.

Introducing complementary feeding at 6 months can reduce premature death. We examined timing and factors associated with complementary feeding using the Indian Human Development Survey II (n = 11,218 women). Only 21% of mothers initiated complementary feeding at 6 months, 42% at 7-9 months, 33% at ≥10 months. In adjusted results, we found mothers with low income, with no formal education, and who had never formally worked were less likely to introduce complementary feeding at 6 months (p > 0.05). Our results indicate women in less advantaged groups are less likely to initiate complementary feeding at recommended age than women in more advantaged groups.

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.

Indigenous Foods of India: A Comprehensive Narrative Review of Nutritive Values, Antinutrient Content and Mineral Bioavailability of Traditional Foods Consumed by Indigenous Communities of India.

India is endowed with several indigenous foods (IFs), that hold special cultural significance among local and ethnic caommunities, yet no attempts have been made till date to systematically compile their nutritive values. As per FAO's recent mandate on creation of "Global-Hub on Indigenous Food Systems," IFs have received renewed global recognition for their potential to contribute to improved food security while enhancing biodiversity across the world. Hence, the useful properties of wild IFs require proper study and documentation in order to bridge the gap between scientific evidence generation and indigenous peoples' ancestral knowledge. For this purpose, we conducted a literature search in two scientific databases: PubMed and Google Scholar, between July 2020 and December 2021, to identify studies reporting nutritive values and/or antinutrient content of IFs (not included in Indian food composition database), consumed by Indian indigenous communities. A total of 52 Indian research articles were included, from which data was selected and extracted, to create a compendium on nutrient (n = 508) and antinutrient (n = 123) content of IFs, followed by computation of antinutrient-to-mineral molar ratios for 98 IFs to predict their mineral bioavailability. Maximum nutritive values were available for green leafy vegetables (n = 154), followed by other vegetables (n = 98), fruits (n = 66), cereals (n = 63), roots & tubers (n = 51) and nuts and legumes (n = 36). Several IFs seen to have better nutritional content than conventional foods and were found to be rich (i.e., >20% Indian recommended dietary allowances per reference food serve) in iron (54%), calcium (35%), protein (30%), vitamin C (27%), vitamin A (18%), zinc (14%) and folate (13%). Some IFs displayed high levels of antinutrients, however, anti-nutrient-to-mineral molar ratios were found to be low (for mainly leafy vegetables, other vegetables, and roots and tubers), thus indicating high mineral bioavailability. Hence, efforts are desirable to encourage the inclusion of these nutritionally superior IFs into the usual diets of indigenous communities. The IF database collated in our review can serve as a resource for researchers and policymakers to better understand the nutritional properties of region-specific IFs and promote them through contextual food-based interventions for improved dietary quality and nutrition outcomes in indigenous population of India.

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.

Standardisation and application of a novel multiplex assay for estimating micronutrient status and inflammatory markers in women of Sauria Paharia and Santhal tribes of Jharkhand.

This study aimed to document the method standardisation and assessment of micronutrient and inflammatory markers in women from indigenous tribal communities of Jharkhand using a low-volume, high-throughput assay. This cross-sectional study was done among women of the reproductive age group from Sauria Paharia and Santhal tribal households (HH) in selected villages. Capillary blood samples were collected from the women during a HH survey to estimate ferritin, soluble transferrin receptor, retinol binding protein 4 and inflammatory biomarkers, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) using a multiplex assay. Vitamin D and Hb were estimated using an LC-MS technique and cyanmethaemoglobin method, respectively. A multiplex Luminex-based method was developed and standardised. The assay was used to estimate biomarkers in samples from 413 women (178 and 235 from Sauria Paharia and Santhal tribes, respectively). Over 51 % of women had raised CRP or AGP levels. Fe status was significantly better in Sauria Paharia compared with the Santhal women. Anaemia prevalence was 72 % among Santhal women. The proportion of women with Fe deficiency increased after adjusting for inflammation. The overall prevalence of vitamin A deficiency and insufficiency was 25 and 34 %, respectively, with similar prevalence in both tribes. All Santhal women had sufficient vitamin D levels, while 25 and 20 % of Sauria Paharia women had insufficient and deficient vitamin D levels, respectively. Our low-volume, high-throughput multiplex assays may provide a feasible approach for assessing nutritional biomarkers in nutritionally vulnerable hard-to-reach communities.

Diet Quality, Nutritional Adequacy and Anthropometric Status among Indigenous Women of Reproductive Age Group (15-49 Years) in India: A Narrative Review.

In India, indigenous communities are nutritionally vulnerable, with indigenous women suffering the greater burden. Studies and surveys have reported poor nutritional outcomes among indigenous women in India, yet systematic documentation of community-specific nutrition data is lacking. We conducted a narrative review of 42 studies to summarise the nutritional profile of indigenous women of India, with details on their food and nutrient intakes, dietary diversity, traditional food consumption and anthropometric status. Percentage deficits were observed in intake of pulses, green leafy vegetables, fruits, vegetables, flesh foods and dairy products when compared with recommended dietary intakes for moderately active Indian women. Indices of diet quality in indigenous women were documented in limited studies, which revealed poor dietary diversity as well as low consumption of diverse traditional foods. A high risk of nutritional inadequacy was reported in all communities, especially for iron, calcium, and vitamin A. Prevalence of chronic energy deficiency was high in most communities, with dual burden of malnutrition in indigenous women of north-eastern region. Findings from this review can thus help guide future research and provide valuable insights for policymakers and program implementers on potential interventions for addressing specific nutritional issues among indigenous women of India.

Pathways of Climate Change Impact on Agroforestry, Food Consumption Pattern, and Dietary Diversity Among Indigenous Subsistence Farmers of Sauria Paharia Tribal Community of India: A Mixed Methods Study.

Climate change poses severe threats to the social, cultural, and economic integrity of indigenous smallholder subsistence farmers, who are intricately linked with their natural ecosystems. Sauria Paharia, a vulnerable indigenous community of Jharkhand, India, are smallholder farmers facing food and nutrition insecurity and have limited resources to cope with climate change. Eighteen villages of Godda district of Jharkhand inhabited by Sauria Paharia community were randomly selected to conduct a mixed methods study. In 11 out of 18 study villages, we conducted focus group discussions (FGDs) to examine the perception of this indigenous community regarding climate change and its impact on agroforestry and dietary diversity. In all 18 villages, household and agricultural surveys were conducted to derive quantitative estimates of household food consumption patterns and agroforestry diversity, which were triangulated with the qualitative data collected through the FGDs. The FGD data revealed that the community attributed local climatic variability in the form of low and erratic rainfall with long dry spells, to reduced crop productivity, diversity and food availability from forests and waterbodies. Declining agroforestry-produce and diversity were reported to cause reduced household income and shifts from subsistence agricultural economy to migratory unskilled wage laboring leading to household food insecurity. These perceptions were supported by quantitative estimates of habitual food consumption patterns which revealed a predominance of cereals over other food items and low agroforestry diversity (Food Accessed Diversity Index of 0.21 ± 0.15). The adaptation strategies to cope with climate variability included use of climate-resilient indigenous crop varieties for farming, seed conservation and access to indigenous forest foods and weeds for consumption during adverse situations and lean periods. There were mixed views on cultivation of hybrid crops as an adaptation strategy which could impact the sustained utilization of indigenous food systems. Promoting sustainable adaptation strategies, with adequate knowledge and technology, have the potential to improve farm resilience, income, household food security and dietary diversity in this population.

Agroforestry diversity, indigenous food consumption and nutritional outcomes in Sauria Paharia tribal women of Jharkhand, India.

Like several indigenous populations, Sauria Paharias, a vulnerable indigenous tribal group residing in a biodiverse environment of Jharkhand, India, have high levels of undernutrition. We assessed agroforestry and dietary diversity, food consumption especially indigenous food (IF) intake and nutritional status of Sauria Paharia women through a cross-sectional study conducted in 18 villages of Godda district, Jharkhand. Household level information was elicited through household surveys including a dietary survey and a food frequency questionnaire. Twenty-four-hour dietary recalls (24 HDR) and anthropometric assessments were taken on one randomly selected woman per household. An index, Food Accessed Diversity Index (FADI) created to measure agroforestry diversity, showed a low mean score of 0.21 ± 0.15 and range: 0, 0.85. Fifty-nine percent of women consumed any IF during 24 HDR. Median minimum dietary diversity score for women (MDD-W) was 3 (acceptable score ≥5). More than 96% of women had intakes below estimated average requirements for all nutrients studied (energy; vitamins A, C, thiamine, riboflavin, niacin, pyridoxine; folate; iron; calcium and zinc) except protein; 41% women were underweight. IF consumption was independently associated with calcium and vitamin A intake. Decision trees developed for micronutrient consumption at different levels of MDD-W score and IF consumption scenarios revealed 1.3 to 2.9 times higher consumption of micronutrients among women with MDD-W ≥ 3 or 4. Strategies like agricultural extension programmes promoting indigenous varieties and nutrition education for increasing dietary diversity with IFs have potential to address undernutrition in Sauria Paharia women.

Rapid tool based on a food environment typology framework for evaluating effects of the COVID-19 pandemic on food system resilience.

The coronavirus disease 2019 (COVID-19) and associated mitigation measures are highlighting resiliency and vulnerability of food systems with consequences for diets, food security, and health outcomes. Frameworks and tools are called for to evaluate impacts of the COVID-19 pandemic as well as identify entry points for implementing preparedness efforts. We support it is critical to adopt a food environment typology framework based on the different types of food environments that people have access to in order to examine how their relationship with food environments shift with disruptions such as COVID-19 and, ultimately impact diets and food security. Here, we provide an overview of applying a food environment typology framework for developing and implementing a rapid tool to evaluate the effects of COVID-19 on interactions people have with their food environments. This tool was developed on the basis of a preliminary case study with smallholder farmers in China that generated a set of key hypotheses. We modified the tool in order to be applicable to diverse contexts in low-, middle-, and high-income countries. Other researchers can implement the rapid tool presented here during times of COVID-19 as well as other disruptions towards identifying barriers and opportunities for enhancing food system resilience.

Leveraging Traditional Ecological Knowledge and Access to Nutrient-Rich Indigenous Foods to Help Achieve SDG 2: An Analysis of the Indigenous Foods of Sauria Paharias, a Vulnerable Tribal Community in Jharkhand, India.

Indigenous food systems of traditional communities are potentially sustainable, have nutrient rich food sources and can enhance dietary diversity. Sauria Paharias, are one of the particularly vulnerable tribal groups of Jharkhand India, who despite residing in rich biodiverse environment and possessing traditional ecological knowledge, lag behind various health, and nutritional indicators. Our study explored their traditional ecological knowledge around indigenous foods (IFs), their routine consumption, access, and nutritive values. A cross-sectional mixed methods study was carried out in 18 villages of Godda district, Jharkhand. Free list of all IFs known to the community was developed using focus group discussions. This was followed by enumerating commonly consumed as well as little or historically used IFs. Following the taxonomic classification of these foods, their nutritive values were searched in literature or food samples were analyzed in accredited laboratories. Reasons for consumption and non-consumption of specific IFs were explored. The community was aware of a large number of IFs (n = 193) but only 50% of these were routinely consumed. Rest were either little used or historically consumed. About 47.6% IFs (n = 92) were identified using taxonomic classification; of which 87 IFs were classified based on their common names in secondary literature and five food items were collected, herbariums were prepared and identified. Nutritive values were documented for 84 IFs (this included both routinely consumed as well as little used); out of which 55 foods were found to have nutritive values in existing literature and 29 foods were analyzed in laboratory. Many of these IFs were rich in micronutrients like calcium, iron, zinc, folic acid, vitamin A, and vitamin C. Common reasons for preferences or non-consumption of specific IFs included taste, availability, access seasonality, opportunity cost of access and processing time. Promoting adequate intake of commonly accessed nutrient rich IFs and revival of little used IFs while addressing the causes of non-consumption and mainstreaming them into the daily diets could be an effective strategy to increase the intake of micronutrients. Policies focusing on incorporation of nutrient rich IFs into dietary diversification strategies and ongoing supplementary feeding programs can help address malnutrition in the community.

Traditional Food Environment and Factors Affecting Indigenous Food Consumption in Munda Tribal Community of Jharkhand, India.

Indigenous food (IF) systems, derived from natural ecosystems are perceived to be sustainable and nutritionally adequate. Mundas, an indigenous tribal community in Jharkhand India, are surrounded by rich agroforestry resources, yet display high levels of malnutrition. Our study explored the food environment of Munda community, different IFs they accessed, levels of utilization of IFs in routine diets, their nutritional attributes and factors influencing IF consumption. A cross-sectional mixed-methods study was conducted in nine villages of Murhu and Torpa blocks in Khunti district, Jharkhand. Using focus group discussions and key informant interviews, we did free-listing of IFs known to the community. This was followed by enumerating preferred and little used/historically consumed IFs, along with reasons. Qualitative enquiries were recorded and transcribed verbatim; data were coded and analyzed using thematic framework approach. The listed IFs were identified through common names and photographs, and verified by ethnobotanist in the team. The nutritive values of identified IFs were searched in literature or nutritional analysis of specific plant based foods were undertaken in an accredited laboratory. The community demonstrated traditional ecological knowledge of several IFs (n = 194), which are accessed from wild, cultivated and built food environments. Taxonomic classification was available for 80% (n = 156) IFs, out of which 60 foods had nutritive values in secondary literature and 42 foods were analyzed in laboratory. Many IFs were rich in micronutrients like calcium, iron, folate, vitamin A and C. Among the listed IFs, only 45% were commonly consumed, while rest were little used/historically consumed. Factors like desirable taste, satiety, perceived nutrition benefits, adaptability to climate variability, traditional practice of food preservation and their cultural importance promoted IF consumption. However, local climatic impacts on agroforestry systems, easy access to foods bought from markets or distributed under government food security schemes, and promotion of hybrid seeds by local agricultural organizations, emerged as potential barriers. Thus, reinforcement of traditional ecological knowledge and informal food literacy, along with promotion of climate resilient attributes of IFs, can contribute to sustainable food systems in Munda community.

Assessing the sustainability of post-Green Revolution cereals in India.

Sustainable food systems aim to provide sufficient and nutritious food, while maximizing climate resilience and minimizing resource demands as well as negative environmental impacts. Historical practices, notably the Green Revolution, prioritized the single objective to maximize production over other nutritional and environmental dimensions. We quantitatively assess outcomes of alternative production decisions across multiple objectives using India's rice-dominated monsoon cereal production as an example. We perform a series of optimizations to maximize nutrient production (i.e., protein and iron), minimize greenhouse gas (GHG) emissions and resource use (i.e., water and energy), or maximize resilience to climate extremes. We find that increasing the area under coarse cereals (i.e., millets, sorghum) improves nutritional supply (on average, +1% to +5% protein and +5% to +49% iron), increases climate resilience (1% to 13% fewer calories lost during an extreme dry year), and reduces GHGs (-2% to -13%) and demand for irrigation water (-3% to -21%) and energy (-2% to -12%) while maintaining calorie production and cropped area. The extent of these benefits partly depends on the feasibility of switching cropped area from rice to coarse cereals. Based on current production practices in 2 states, supporting these cobenefits could require greater manure and draft power but similar or less labor, fertilizer, and machinery. National- and state-level strategies considering multiple objectives in decisions about cereal production can move beyond many shortcomings of the Green Revolution while reinforcing the benefits. This ability to realistically incorporate multiple dimensions into intervention planning and implementation is the crux of sustainable food production systems worldwide.

Analysing the policy space for the promotion of healthy, sustainable edible oil consumption in India.

OBJECTIVE: To identify opportunities and challenges for the promotion of healthy, sustainable oil consumption in India. DESIGN: We use a framework for policy space analysis which distinguishes between policy context, process and characteristics. SETTING: We focus on the Indian edible oils sector and on factors shaping the policy space at a national level. PARTICIPANTS: The study is based on the analysis of policy documents and semi-structured interviews with key experts and stakeholders in the edible oils sector. RESULTS: We find opportunities associated with the emergence of multisectoral policy frameworks for climate adaptation and non-communicable disease (NCD) prevention at a national level which explicitly include the oils sector, the existence of structures for sectoral policy coordination, some supportive factors for the translation of nutrition evidence into practice, and the possibility of integrating nutrition-sensitive approaches within current state-led agricultural interventions. However, the trade-offs perceived across sustainability, NCD prevention and food security objectives in the vegetable oils sector are considered a barrier for policy influence and implementation. Sustainability and nutrition advocates tend to focus on different segments of the value chain, missing potential synergies. Moreover, policy priorities are dominated by historical concerns for food security, understood as energy provision, as well as economic and strategic priorities. CONCLUSIONS: Systematic efforts towards identifying synergistic approaches, from agricultural production to distribution of edible oils, as well as increased involvement of nutrition advocates with upstream policies in the oils sector, could increase policy influence for advocates of both nutrition and sustainability.

Innovative matrix for applying a food systems approach for developing interventions to address nutrient deficiencies in indigenous communities in India: a study protocol.

BACKGROUND: Indigenous communities retain knowledge of the land and food resources rooted in historical continuity within their region of residence. Food systems research can be leveraged to identify strategies to encourage sustainable use of complex multi-species agroforestry systems by indigenous communities contributing to nutritional needs while simultaneously preserving the ecosystems and their benefits to society. Till date, the analyses of food systems have predominantly focused on high income countries often overlooking the alternatives (dietary and production) that would be most relevant to low and middle income countries (LMIC). Thus, innovative methodological approaches are needed to comprehensively characterize diverse food systems in LMICs with special reference to indigenous communities. DESIGN: This protocol paper describes a food systems approach that will be employed to understand diverse and dynamic food systems of vulnerable tribal communities of Jharkhand, India and leverage their agroforestry systems to improve dietary diversity, nutrition status and address food security. Four tribal groups namely Santhal, Ho, Munda and Sauria Paharia of Godda, West Singhbhum and Khunti districts of Jharkhand would be studied. This will be an exploratory cross-sectional study design, along with a longitudinal component to capture seasonality in dietary intake and agricultural diversity. A mixed methods approach will be used based on a conceptual framework on drivers of food systems, food supply chain, food environment (both wild & cultivated, and market food environments), as well as consumer behaviour and maternal and child health outcomes in tribal communities. The quantitative surveys will be conducted on socio-economic, demographic profile of households, their availability of, access to and utilization of food environment and nutritional status of reproductive age group women and children under 5 years. Qualitative enquiries will examine barriers and facilitators to increase sustainable production, procurement and consumption of indigenous foods. The final outcome would be development of interventions to promote indigenous food consumption. DISCUSSION: By utilizing a combination of value chain analysis and 'Optifoods linear programming software' that will use above information on indigenous community, dietary intake, nutritional status and food environment, evidence based interventions promoting indigenous food systems aimed at addressing food and nutritional security of tribal communities will be developed.

Inadequate Zinc Intake in India: Past, Present, and Future.

BACKGROUND: India has made important strides in reducing nutritional deficiencies over the past several decades. However, for micronutrients such as zinc, previous studies have suggested a worsening situation, contrary to most other dietary indicators. Adding to this burden, higher carbon dioxide (CO2) levels of 550 ppm, projected to potentially occur within decades, could reduce the zinc content of many staple crops. OBJECTIVE: To assess the historical prevalence of inadequate zinc intake, as well as to estimate the future prevalence attributable to rising CO2. METHODS: Seven household food consumption surveys between 1983 and 2012 were used to calculate total dietary zinc, phytate, and absorbable zinc intakes and to assess the prevalence of historic inadequacy in zinc intake. The added nutritional effect of elevated CO2 on zinc intake is then modeled. RESULTS: Prevalence of inadequate absorbable zinc intake has increased from 17.1% (15.3%-19.0%) in 1983 to 24.6% (22.3%-27.1%) in 2011-12, corresponding to an additional 82 million people consuming inadequate zinc than would have otherwise if 1983 rates had persisted. These increases in inadequacy have been driven by a relatively constant zinc intake being increasingly insufficient to meet a 5% growth in zinc requirements due to the aging of the population. Reaching 550 ppm CO2 by 2050 could potentially increase the prevalence of inadequate zinc intake by another 3.9 percentage points (2.1-5.8), corresponding to 65 million additional people having inadequate zinc intake. CONCLUSIONS: The persistently worsening trend for zinc-opposite most other measures of human nutrition-shows that it may pose an ongoing risk unless addressed.

Estimates of Indigenous Food Consumption and Their Contribution to Nutrient Intake in Oraon Tribal Women of Jharkhand, India.

INTRODUCTION: Oraon tribes of India have high levels of undernutrition. Dietary diversification is one of the food-based interventions to ameliorate malnutrition. OBJECTIVES: This study assessed the awareness and availability of indigenous foods and estimated dietary intakes and nutritional status with emphasis on indigenous food consumption among women in the Oraon tribal community in Jharkhand, India. DESIGN: A cross-sectional study with a longitudinal component on dietary intake assessment to capture seasonality. SETTING: Selected villages in Raidih block of Gumla district of Jharkhand. PARTICIPANTS: Reproductive-age Oraon tribal women (N =143). METHODS: Household and dietary surveys were conducted. A 24-hour dietary recall for 2 consecutive days (repeat surveys in 2 other seasons) and food frequency questionnaire were adminsitered on 1 woman per household. Anthropometric assessments were also carried out. OUTCOMES: Socioeconomic status, awareness about indigenous foods, dietary intake pattern, and contribution of indigenous food to nutrient intake of Oraon tribal women in the reproductive age-group. RESULTS: Comprehensive awareness about indigenous food resources was present. However, household food security and actual intake of indigenous foods were low. Higher intake of key micronutrients, calcium and iron, was observed among those who consumed indigenous foods. About 40% of the woman had various degrees of chronic energy deficiency. CONCLUSION: Despite rich knowledge, nutrient-rich indigenous food resources remain underutilized in the Oraon tribal community of Jharkhand, India. Identifying strategies to promote dietary diversity via optimum indigenous food intake could contribute to both food and nutrition security.