Peak timing of slowest growth velocity among young children coincides with highest ambient temperatures in Burkina Faso: a longitudinal study.

BACKGROUND: Seasonal cycles in climatic factors affect drivers of child growth and contribute to seasonal fluctuations in undernutrition. Current growth seasonality models are limited by categorical definitions of seasons that rely on assumptions about their timing and fail to consider their magnitude. OBJECTIVE: We disentangle the relationship between climatic factors and growth indicators, using harmonic regression to determine how child growth is related to peaks in temperature, precipitation, and vegetation. METHODS: Longitudinal anthropometric data collected between August 2014 and December 2016 from 5039 Burkinabè children measured monthly from age 6 to 28 mo (108,580 observations) were linked with remotely sensed daily precipitation, vegetation, and maximum air temperature. Our models parsimoniously extract a cyclic signal with multiple potential peaks, to compare the magnitude and timing of seasonal peaks in climatic factors and morbidity with that of nadirs in growth velocity (cm/mo, kg/mo). RESULTS: Length and weight velocity were slowest twice a year, coinciding both times with the highest temperatures, and peak fever incidence. Length velocity is slowest 13 d after the first temperature peak in April, and 5 d after the second. Similarly, weight velocity is slowest 13 d before the first temperature peak, and 11 d before the second. The statistical relationship between temperature and anthropometry shows that when the current temperature is higher, weight velocity is lower (ß = -0.0048; 95% CI: -0.0059, -0.0038), and length velocity is higher (ß = 0.0088; 95% CI: 0.0070, 0.0105). CONCLUSIONS: Results suggest that child health and development are more affected by high temperatures than by other aspects of climatic seasonality such as rainfall. Emerging shifts in climatic conditions will pose challenges to optimal growth, highlighting the importance of changes that optimize the timing of nutrition interventions and address environmental growth-limiting conditions. CLINICAL TRIAL REGISTRY: Clinicaltrials.gov: NCT02071563.

COVID-19 mobility restrictions and stay-at-home behaviour in 2020 were associated with higher retail food prices worldwide.

COVID-19 policy responses have included mobility restrictions, and many people have chosen to stay at home to avoid exposure. These actions have ambiguous impacts on food prices, lowering demand for food away from home and perishables, while increasing supply costs for items where workers are most affected by the pandemic. We use evidence from 160 countries to identify the net direction and magnitude of association between countries' real cost of all food and mobility restriction stringency. We investigate the deviation of each month's price level in 2020 from that month's average price level during the previous three years and find that an increase in mobility restriction stringency from no restrictions to most restrictive is associated with an increase in the real cost of all food of more than one percentage point across all models. We then examine the relationship between retail food price levels by food group and stay-at-home behaviour around markets in 36 countries and find positive associations for non-perishables, dairy and eggs.

Beyond the Food Systems Summit: Linking Recommendations to Action-The True Cost of Food.

A transformation of food systems is needed to achieve the 17 Sustainable Development Goals specified in the 2030 Agenda for Sustainable Development. Recognizing the true costs and benefits of food production and consumption can help guide public policy decisions to effectively transform food systems in support of sustainable healthy diets. A new, expanded framework is presented that allows the quantification of costs and benefits in three domains: health, environmental, and social. The implications for policy makers are discussed. Curr Dev Nutr 2023;x:xx.

Sibling rivalry between twins in utero and childhood: Evidence from birthweight and survival of 95 919 twin pairs in 72 low- and middle-income countries.

BACKGROUND: This study explores the magnitude and timing of sex and gender disparities in child development by describing differences in health outcomes for male and female siblings, comparing twins to control for all aspects of life circumstances other than sex and gender. METHODS: We construct a repeat cross-sectional dataset of 191 838 twins among 1.7 million births recorded in 214 nationally representative household surveys for 72 countries between 1990 and 2016. To test for biological or social mechanisms that might favor the health of male or female infants, we describe differences in birthweights, attained heights, weights, and survival to distinguish gestational health from care practices after each child is born. RESULTS: We find that male fetuses grow at the expense of their co-twin, significantly reducing their sibling's birthweight and survival probabilities, but only if the other fetus is male. Female fetuses are born significantly heavier when they share the uterus with a male co-twin and have no significant difference in survival probability whether they happen to draw a male or a female co-twin. These findings demonstrate that sex-specific sibling rivalry and male frailty begin in utero, prior to gender bias after birth that typically favors male children. CONCLUSIONS: Sex differences in child health may have competing effects with gender bias that occurs during childhood. Worse health outcomes for males with a male co-twin could be linked to hormone levels or male frailty, and could lead to underestimates of the effect sizes of later gender bias against girls. Gender bias favoring surviving male children may explain the lack of differences in height and weight observed for twins with either male or female co-twins.

Tracing global flows of bioactive compounds from farm to fork in Nutrient Balance Sheets can help guide intervention towards healthier food supplies.

Adequate supplies of healthy foods available in each country are a necessary but not sufficient condition for adequate intake by each individual. This study provides complete Nutrient Balance Sheets that account for all plant-based and animal-sourced food flows from farm production through trade to non-food uses and waste in 173 countries from 1961 to 2018. We track 36 bioactive compounds in all farm commodities recorded by the Food and Agriculture Organization of the United Nations, accounting for nutrient-specific losses in processing and cooking as well as bioavailability. We compare supply to requirements given each country's age-sex distribution and find that the adequacy of food supplies has increased but often remains below total needs, with even faster rise in energy levels and lower density of some nutrients per calorie. We use this nutrient accounting to show how gaps could be filled, either from food production and trade or from selected biofortification, fortification and supplementation scenarios for nutrients of concern such as vitamin A, iron and zinc.

Linear Growth Spurts are Preceded by Higher Weight Gain Velocity and Followed by Weight Slowdowns Among Rural Children in Burkina Faso: A Longitudinal Study.

BACKGROUND: The temporal relationship between length (linear) and weight (ponderal) growth in early life is important to support optimal nutrition program design. Studies based on measures of attained size have established that wasting often precedes stunting, but such studies do not capture responsiveness of growth to previous compared with current conditions. As a result, the temporality of linear and ponderal growth relationships remain unclear. OBJECTIVES: We used growth velocity indicators to assess the temporal bidirectional relationships between linear and ponderal growth in children. METHODS: Using monthly anthropometric measurements from 5039 Burkinabè children enrolled at 6 months of age and followed until 28 months from August 2014 to December 2016, we employed multilevel mixed-effects models to investigate concurrent and lagged associations between linear and ponderal growth velocity, controlling for time trends, seasonality, and morbidity. RESULTS: Faster ponderal growth is associated with faster concurrent and subsequent linear growth (0.21-0.72 increase in length velocity z-score per unit increase in weight velocity z-score), while faster linear growth is associated with slower future weight gain (0.009-0.02 decrease in weight velocity z-score per unit increase in length velocity z-score), especially among children 9-14 months. Ponderal growth slows around the same time as peaks in morbidity, followed roughly a month later by slower linear growth. CONCLUSIONS: Use of velocity measures to assess temporal dependencies between linear and ponderal growth demonstrate that the same growth-limiting conditions likely affect both length and weight velocity, that slow ponderal growth likely limits subsequent linear growth, and that linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid slowdowns in weight gain.

Global variation in the cost of a nutrient-adequate diet by population group: an observational study.

BACKGROUND: Nutrient deficiencies limit human development and could be caused by the high cost of locally available foods needed to meet nutrient requirements. We aimed to identify the populations whose nutrient needs are most difficult to meet with existing global food systems. METHODS: In this observational study, we used the International Comparison Program 2017 collection of global food prices to measure cost per day and cost per calorie of meeting nutrient needs, based on least-cost diets within upper and lower bounds for energy and 20 nutrients for healthy populations across 20 demographic groups in 172 countries. We then analysed the composition of these least-cost diets by food groups to estimate how the affordability of foods for meeting nutrient needs varied by age, sex, and reproductive status. FINDINGS: In 2017, the global median of diet costs per day was US$2·32 (IQR 1·95-2·76), with cost highest for adolescent boys aged 14-18 years at $2·72 (2·31-3·15). For females, median cost was highest for adolescents aged 14-18 years during pregnancy and lactation at $2·64 (2·29-3·15), exceeding the cost for adult men aged 19-30 years. The global median of diet cost per 1000 kcal was $0·94 (IQR 0·80-1·12), and was higher for females throughout the life course than for males, peaking for adolescent girls aged 9-13 years ($1·17 [95% CI 1·15-1·19]) and women older than 70 years ($1·18 [1·17-1·19]). Diet costs were most sensitive to requirements for calcium, iron, zinc, and vitamins C and E, as well as the upper bounds on carbohydrates and sodium. Total diet costs per day did not vary significantly with national income; however, in high-income countries, the composition of least-cost diets included more animal-source foods, whereas in low-income countries, diets with more pulses, nuts and seeds, and fruits and vegetables provided the most affordable way to meet nutrient requirements. INTERPRETATION: Diets with adequate nutrients were unaffordable for many demographic groups, especially women and girls. These results could help to guide agriculture and food policy or transfer programmes to support populations at risk of inadequate intake. FUNDING: The Bill & Melinda Gates Foundation and UKAid.

Retail prices of nutritious food rose more in countries with higher COVID-19 case counts.

The COVID-19 pandemic has curtailed lives and livelihoods, leading to price spikes for some foods and declines for others. We compare monthly retail food prices in up to 181 countries from January 2019 to June 2021, test for differences over time and find that average prices rose significantly, especially for more nutritious food groups in countries with higher COVID-19 case counts. Analysis of retail prices by food group complements data on farm commodity prices and overall consumer price indexes, helping to guide policy for resilience and response to shocks.

Monthly measurement of child lengths between 6 and 27 months of age in Burkina Faso reveals both chronic and episodic growth faltering.

BACKGROUND: Linear growth faltering is determined primarily by attained heights in infancy, but available data consist mainly of cross-sectional heights at each age. OBJECTIVES: This study used longitudinal data to test whether faltering occurs episodically in a few months of very low growth, which could potentially be prevented by timely intervention, or is a chronic condition with slower growth in every month of infancy and early childhood. METHODS: Using anthropometric data collected monthly between August 2014 and December 2016, we investigated individual growth curves of 5039 children ages 6-27 mo in Burkina Faso (108,580 observations). We evaluated growth-curve smoothness by level of attained length at ∼27 mo by analyzing variation in changes in monthly growth rates and using 2-stage regressions: 1) regressing each child's length on their age and extracting R2 to represent curve smoothness, initial length, and average velocity by age; and 2) regressing extracted parameters on individual-level attained length. RESULTS: Short children started smaller and remained on their initial trajectories, continuously growing slower than taller children. Growth between 9 and 11 mo was the most influential on attained length; for each 1-cm/mo increase in growth velocity during this period, attained length increased by 6.71 cm (95% CI: 6.59, 6.83 cm). Furthermore, a 0.01 increase in R2 from individual regression of length on age was associated with a 3.10-cm higher attained length (95% CI: 2.80, 3.41 cm), and having 2 consecutive months of slow growth (<15th centile relative to the sample) was associated with 1.7-cm lower attained length (95% CI: -1.80, -1.59 cm), with larger effects in younger children, suggesting that smoother growth patterns were also associated with higher attained length. CONCLUSIONS: Children who experience extreme growth faltering are likely less resilient to systematic growth-limiting conditions as well as episodic insults to their growth.This trial was registered at clinicaltrials.gov as NCT02071563.

Sustainable food systems and nutrition in the 21st century: a report from the 22nd annual Harvard Nutrition Obesity Symposium.

Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition, and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world can come together at the UN Food Systems Summit in late 2021 and make strong and binding commitments toward food system transformation. The NIH-funded Nutrition Obesity Research Center at Harvard and the Harvard Medical School Division of Nutrition held their 22nd annual Harvard Nutrition Obesity Symposium entitled "Global Food Systems and Sustainable Nutrition in the 21st Century" in June 2021. This article presents a synthesis of this symposium and highlights the importance of food systems to addressing the burden of malnutrition and noncommunicable diseases, climate change, and the related economic and social inequities. Transformation of food systems is possible, and the nutrition and health communities have a significant role to play in this transformative process.

Assessing Diet Quality Where Families Share Their Meals: Evidence from Malawi.

BACKGROUND: Where families eat together from a common dish, the shared meal must be nutrient dense enough in each nutrient to meet the needs of the highest-need member. OBJECTIVES: This study aimed to develop an aggregate household nutrient requirement benchmark that satisfies all members' needs in a context in which meals are shared and to illustrate how that metric could inform food and nutrition policy making. METHODS: We merged nationally representative survey data for Malawi in 2010, 2013, and 2016-2017 with individual nutrient requirements and local food composition data to compute the adequacy of each household's aggregate consumption given its demographic composition and primary occupation. To meet each person's nutrient needs at any level of energy balance, the nutrient density of their shared diet needs to be within boundaries of the most restrictive member. We classified the adequacy of each household's diet using these energy-adjusted densities and examined differences by sociodemographic characteristics. RESULTS: Accounting for meal sharing and nutrient density needs of the highest-need member, virtually all households' food consumption is insufficiently nutrient dense in riboflavin, selenium, lipids, and vitamin B-12, and most consumption is insufficiently nutrient dense in zinc and phosphorus as well. Meeting needs of women, adolescent girls, and young children using shared diets would on average require 145% more iron, 98% more zinc, and approximately 70% more phosphorus and vitamin C than if their needs were met with individualized diets. CONCLUSIONS: Establishing shared nutrient requirements is feasible using existing survey data and can help set sufficiency criteria in settings in which families share meals. In Malawi, current diets and food composition are inadequate for many nutrients, especially in households with more women and adolescent girls. The results call for concerted investment to increase access to and use of more nutrient-dense foods.

Food Systems as Drivers of Optimal Nutrition and Health: Complexities and Opportunities for Research and Implementation.

The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems-on pathways, value chains, and development and validation of metrics of diet quality-is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.

Beyond price and income: Preferences and food values in peri-urban Viet Nam.

Sub-optimal diets are one of the most important risk factors contributing to the global burden of disease. Developing a better understanding of the drivers of food choice, including the role of individual preferences, is important to address this issue. The objective of this mixed methods research was to identify the relative importance of preferences for different food quality attributes (e.g. nutrition, food safety, price and convenience) that might influence shopping habits and food choice in the context of a rapidly changing peri-urban food environment in Hanoi Province, Viet Nam. A total of 264 women were randomly selected and interviewed using Best-Worst Scaling to elicit preferences among food quality attributes for different food groups (leafy green vegetables, fruits, instant foods, snack foods). A subset of these respondents (n = 40) participated in focus group discussions in order to explore their preferences and food values in more detail. The food quality attributes considered to be most important varied by food group with nutrition and food safety (both immediate and future health) ranking highest for leafy green vegetables and fruits, convenience for instant foods, and taste for snack foods. Price was considered least important across all food groups. Focus group discussions reinforced these results with additional insights particularly regarding trade-offs between nutrition, food safety, convenience, and price. This research demonstrates the feasibility of identifying important drivers of consumption in a South East Asian context using Best-Worst Scaling. These results could help inform the design of behavior change interventions and guide food system policies that seek to shift consumer choices towards healthier diets.

Modelling the potential cost-effectiveness of food-based programs to reduce malnutrition.

Poor quality diets contribute to malnutrition globally, but evidence is weak on the cost-effectiveness of food-based interventions that shift diets. This study assessed 11 candidate interventions developed through Delphi techniques to improve diets in India, Nigeria, and Ethiopia. A Markov simulation model incorporated time, individual-level, nutrition, and policy parameters to estimate health impacts and cost-effectiveness for reducing stunting, anaemia, diarrhea, and mortality in preschool children. At an assumed 80% coverage, interventions considered would potentially save between 0·16 and 3·20 years of life per child. The average cost-effectiveness ratio ranged from US$9 to US$2000 per life year saved. This approach, linking expert knowledge, known costs, and modelling, offers potential for estimating cost-effective investments for better informed policy choice where empirical evidence is limited.

Global dietary convergence from 1970 to 2010, despite inequality in agriculture, leaves undernutrition concentrated in a few countries.

Humans globally have similar nutritional needs but face large differences in natural resource endowments and local food production. This study quantifies food system inequality across countries based on natural resource inputs, food/nutrient outputs, and nutrition/health outcomes, from 1970 to 2010. Animal source foods and overweight/obesity show rapid convergence while availability of selected micronutrients demonstrate slower convergence. However, all variables are more equally distributed than national income per capita, whose Gini coefficient declined from 0·71 to 0·65. Inequalities in total and animal-source dietary energy declined from 0·16 to 0·10 and 0·55 to 0·36, respectively. There was convergence in overweight/obesity prevalence from 0·39 to 0·27, while undernutrition and stunting became increasingly concentrated in a few high-burden countries. Characterizing cross-country inequalities in agricultural resources, foods, nutrients, and health can help identify critical opportunities for agriculture and food policies, as well as prioritize research objectives and funding allocation for the coming decade.

Cost and affordability of nutritious diets at retail prices: Evidence from 177 countries.

Many policies and programs aim to bring nutritious diets within reach of the poor. This paper uses retail prices and nutrient composition for 671 foods and beverages to compute the daily cost of essential nutrients required for an active and healthy life in 177 countries around the world. We compare this minimum cost of nutrient adequacy with the subsistence cost of dietary energy and per-capita spending on all goods and services, to identify stylized facts about how diet cost and affordability relate to economic development and nutrition outcomes. On average, the most affordable nutrient adequate diet exceeds the cost of adequate energy by a factor of 2.66, costing US$1.35 per day to meet median requirements of healthy adult women in 2011. Affordability is lowest in Sub-Saharan Africa. The sensitivity of diet costs to each requirement reveals the high cost of staying within acceptable macronutrient ranges, particularly the upper limit for carbohydrates. Among micronutrients, total diet costs are most sensitive to requirements for calcium as well as vitamins A, C, E, B12, folate and riboflavin. On average, about 5% of dietary energy in the least-cost nutrient adequate diets is derived from animal source foods, with small quantities of meat and fish. Over 70% of all animal products in least-cost diets is eggs and dairy, but only in upper-middle and high-income countries. In lower income countries where egg and dairy prices are significantly higher, they are replaced by larger volumes of vegetal foods. When controlling for national income, diet costs are most significantly correlated with rural travel times and rural electrification. These data suggest opportunities for targeted policies and programs that reduce market prices and the cost of nutritious diets, while improving affordability through nutrition assistance, safety nets and higher earnings among low-income households.

Association Between Restaurant Menu Item Descriptions and Their Nutrient Content.

INTRODUCTION: Item descriptions on restaurant menus often include claims about health and other attributes, and these are much less regulated than the language on packaged food labels. This study tests whether menu items with claims have different nutritional content from items without claims. METHODS: Investigators compiled a data set of menu items, their claims, and their nutrition content using MenuStat. Data included 84,788 item-year observations at up to 96 of the top-selling restaurant chains from 2012 to 2018. Items were identified with general health, health-related ingredients, nutrient content, product sourcing, and vegan or vegetarian claims through a matching algorithm. Mixed-effects models were used to examine the effect of claims on calories, nutrients to limit (e.g., saturated fat and sodium), and other nutrients by dish types (sides, main dishes, desserts). RESULTS: Most dishes with claims were lower in calories; however, items with claims were not consistently lower in other nutrients to limit (sodium, saturated fat, sugar, or trans fat). Vegan or vegetarian desserts had 128 mg (95% CI=20.9, 235.1) more sodium than desserts without this claim. Main and side dishes with claims had equivalent or higher sugar content than items without claims. Many items with claims were lower in saturated fat, especially main dishes with a nutrient content claim (-2.8 percentage points, 95% CI= -3.4, -2.2). CONCLUSIONS: Items with claims were high in nutrients to limit. Additional efforts to increase transparency around excessive ingredients, such as the sodium warning labels, could be implemented by the restaurant industry.

Food Compass is a nutrient profiling system using expanded characteristics for assessing healthfulness of foods.

Nutrient profiling systems (NPS) aim to discriminate the healthfulness of foods for front-of-package labelling, warning labels, taxation, company ratings and more. Existing NPS often assess relatively few nutrients and ingredients, use inconsistent criteria across food categories and have not incorporated the newest science. Here, we developed and validated an NPS, the Food Compass, to incorporate a broader range of food characteristics, attributes and uniform scoring principles. We scored 54 attributes across 9 health-relevant domains: nutrient ratios, vitamins, minerals, food ingredients, additives, processing, specific lipids, fibre and protein, and phytochemicals. The domain scores were summed into a final Food Compass Score (FCS) ranging from 1 (least healthy) to 100 (most healthy) for all foods and beverages. Content validity was confirmed by assessing nutrients, food ingredients and other characteristics of public health concern; face validity was confirmed by assessing the FCS for 8,032 foods and beverages reported in NHANES/FNDDS 2015-16; and convergent and discriminant validity was confirmed from comparisons with the NOVA food processing classification, the Health Star Rating and the Nutri-Score. The FCS differentiated food categories and food items well, with mean ± s.d. ranging from 17.1 ± 17.2 for savoury snacks and sweet desserts to 81.6 ± 16.0 for legumes, nuts and seeds. In many food categories, the FCS provided important discrimination of specific foods and beverages as compared with NOVA, the Health Star Rating or the Nutri-Score. On the basis of demonstrated content, convergent and discriminant validity, the Food Compass provides an NPS scoring a broader range of attributes and domains than previous systems with uniform and transparent principles. This publicly available tool will help guide consumer choice, research, food policy, industry reformulations and mission-focused investment decisions.