Four ways blue foods can help achieve food system ambitions across nations.

Blue foods, sourced in aquatic environments, are important for the economies, livelihoods, nutritional security and cultures of people in many nations. They are often nutrient rich1, generate lower emissions and impacts on land and water than many terrestrial meats2, and contribute to the health3, wellbeing and livelihoods of many rural communities4. The Blue Food Assessment recently evaluated nutritional, environmental, economic and justice dimensions of blue foods globally. Here we integrate these findings and translate them into four policy objectives to help realize the contributions that blue foods can make to national food systems around the world: ensuring supplies of critical nutrients, providing healthy alternatives to terrestrial meat, reducing dietary environmental footprints and safeguarding blue food contributions to nutrition, just economies and livelihoods under a changing climate. To account for how context-specific environmental, socio-economic and cultural aspects affect this contribution, we assess the relevance of each policy objective for individual countries, and examine associated co-benefits and trade-offs at national and international scales. We find that in many African and South American nations, facilitating consumption of culturally relevant blue food, especially among nutritionally vulnerable population segments, could address vitamin B12 and omega-3 deficiencies. Meanwhile, in many global North nations, cardiovascular disease rates and large greenhouse gas footprints from ruminant meat intake could be lowered through moderate consumption of seafood with low environmental impact. The analytical framework we provide also identifies countries with high future risk, for whom climate adaptation of blue food systems will be particularly important. Overall the framework helps decision makers to assess the blue food policy objectives most relevant to their geographies, and to compare and contrast the benefits and trade-offs associated with pursuing these objectives.

Aquatic foods to nourish nations.

Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type ('seafood' or 'fish')1-4. Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases5,6 while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms.

Toward healthy and sustainable diets for the 21st century: Importance of sociocultural and economic considerations.

Four years after the EAT-Lancet landmark report, worldwide movements call for action to reorient food systems to healthy diets that respect planetary boundaries. Since dietary habits are inherently local and personal, any shift toward healthy and sustainable diets going against this identity will have an uphill road. Therefore, research should address the tension between the local and global nature of the biophysical (health, environment) and social dimensions (culture, economy). Advancing the food system transformation to healthy, sustainable diets transcends the personal control of engaging consumers. The challenge for science is to scale-up, to become more interdisciplinary, and to engage with policymakers and food system actors. This will provide the evidential basis to shift from the current narrative of price, convenience, and taste to one of health, sustainability, and equity. The breaches of planetary boundaries and the environmental and health costs of the food system can no longer be considered externalities. However, conflicting interests and traditions frustrate effective changes in the human-made food system. Public and private stakeholders must embrace social inclusiveness and include the role and accountability of all food system actors from the microlevel to the macrolevel. To achieve this food transformation, a new "social contract," led by governments, is needed to redefine the economic and regulatory power balance between consumers and (inter)national food system actors.

Estimating the environmental impacts of 57,000 food products.

Understanding and communicating the environmental impacts of food products is key to enabling transitions to environmentally sustainable food systems [El Bilali and Allahyari, Inf. Process. Agric. 5, 456-464 (2018)]. While previous analyses compared the impacts of food commodities such as fruits, wheat, and beef [Poore and Nemecek, Science 360, 987-992 (2018)], most food products contain numerous ingredients. However, because the amount of each ingredient in a product is often known only by the manufacturer, it has been difficult to assess their environmental impacts. Here, we develop an approach to overcome this limitation. It uses prior knowledge from ingredient lists to infer the composition of each ingredient, and then pairs this with environmental databases [Poore and Nemecek Science 360, 987-992 (2018); Gephart et al., Nature 597, 360-365 (2021)] to derive estimates of a food product's environmental impact across four indicators: greenhouse gas emissions, land use, water stress, and eutrophication potential. Using the approach on 57,000 products in the United Kingdom and Ireland shows food types have low (e.g., sugary beverages, fruits, breads), to intermediate (e.g., many desserts, pastries), to high environmental impacts (e.g., meat, fish, cheese). Incorporating NutriScore reveals more nutritious products are often more environmentally sustainable but there are exceptions to this trend, and foods consumers may view as substitutable can have markedly different impacts. Sensitivity analyses indicate the approach is robust to uncertainty in ingredient composition and in most cases sourcing. This approach provides a step toward enabling consumers, retailers, and policy makers to make informed decisions on the environmental impacts of food products.

Sustainability considerations are not influencing meat consumption in the US.

The consumption of animal-source foods, and particularly red meat from ruminants, is a major contributor to greenhouse gas emissions, freshwater use, and loss of biodiversity. Reducing red meat consumption has been identified as a key strategy to mitigate climate change; however, little is known about how to effectively intervene to promote its reduction in the United States (US). This study aimed to examine meat (red, unprocessed, and poultry) and seafood consumption patterns, the factors influencing their consumption (including a reduction in their consumption over time), and how these differed based on socioeconomic variables. The study was conducted through an online survey with a representative sample of the US population (n = 1224) in 2021 using KnowledgePanel®. Overall, we found that most participants reported consuming red meat (78%), processed meat (74%), or poultry (79%) 1-4 times per week, with several differences in consumption patterns based on socio-demographic characteristics. A substantial proportion of the population reported reducing their red (70%) and processed meat (64%) consumption over the previous year, which was much higher than those that reported reducing poultry (34%) or seafood (26%). Key factors influencing red meat reduction were health and price, while environmental sustainability and animal welfare were less important, particularly among certain socio-demographic groups. These findings can help provide insight into how best to frame messaging campaigns aimed at shifting red meat consumption in the US to support climate change mitigation. Focusing on the factors that resonate more with consumers is more likely to lead to shifts in consumption patterns.

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.

A collective call to strengthen monitoring and evaluation efforts to support healthy and sustainable food systems: 'The Accountability Pact'.

There is widespread agreement among experts that a fundamental reorientation of global, regional, national and local food systems is needed to achieve the UN Sustainable Development Goals Agenda and address the linked challenges of undernutrition, obesity and climate change described as the Global Syndemic. Recognising the urgency of this imperative, a wide range of global stakeholders - governments, civil society, academia, agri-food industry, business leaders and donors - convened at the September 2021 UN Food Systems Summit to coordinate numerous statements, commitments and declarations for action to transform food systems. As the dust settles, how will they be pieced together, how will governments and food corporations be held to account and by whom? New data, analytical methods and global coalitions have created an opportunity and a need for those working in food systems monitoring to scale up and connect their efforts in order to inform and strengthen accountability actions for food systems. To this end, we present - and encourage stakeholders to join or support - an Accountability Pact to catalyse an evidence-informed transformation of current food systems to promote human and ecological health and wellbeing, social equity and economic prosperity.

The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries.

BACKGROUND: Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. OBJECTIVES: We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. METHODS: We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. RESULTS: Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. CONCLUSIONS: The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.

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.

A focused ethnographic study on the role of health and sustainability in food choice decisions.

In the United States, typical dietary patterns are not necessarily healthy and sustainable. In order to shift diets, we need to provide support to individuals in a way that reflects what matters most to them. In this study, we aimed to identify the considerations that are most important to individuals regarding food-related decisions, and to determine how those considerations relate to specific foods, with a focus on health and environmental sustainability. In a sequential mixed-methods design, we first conducted 27 semi-structured interviews with participants in California and Nebraska. These interviews included a free-listing activity, where we used a technical construct of salience, Smith's S Index, to identify the considerations that were most important to our participants. We followed up with 20 of those participants to complete a pile-sorting survey, where participants sorted and rated 42 food items for price, taste, health, convenience, familiarity, and environmental impact. Our findings showed that the most salient considerations cited by our participants were price, health, taste, and time. There was consensus for how participants rated the foods for price, taste, convenience, and familiarity. However, there was only weak consensus for how participants rated the foods for health impact, and no consensus for how participants rated the foods for environmental impact. There was also disagreement on how to sort new plant-based products intended to replace or substitute meat and other animal-based foods. These findings have implications for how to communicate about healthy and sustainable diets. They highlight conflicting considerations, disagreement in classification of new products, and limited consensus for perceived health and environmental impact of foods, which present challenges to the achievement of diets that are healthy and environmentally sustainable in the United States.

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.

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.

The interface between consumers and their food environment in Myanmar: an exploratory mixed-methods study.

OBJECTIVE: To examine consumers' perceptions of their food environments, their food consumption patterns and preferences, and to better understand the attributes of foods that are available within food environments in Myanmar. DESIGN: An exploratory mixed-methods study using a combination of focus group discussions, market and consumer surveys. SETTING: Four study settings in Myanmar were included: an upper-income township of Yangon; a lower-income township of Yangon; a middle-income township in the southern Myanmar town of Dawei; and a lower-income village in the country's dry zone of Magway. PARTICIPANTS: Thirty-two women participated in the focus groups discussions, twenty market surveys were conducted and 362 consumers (both men and women) completed food consumption surveys. RESULTS: Focus group participants indicated that the availability of a diverse range of foods had increased over time, while the quality of foods had decreased. Health was seen primarily through the lens of food safety and there was an overall lack of knowledge about which foods were more or less healthy. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities. The market surveys suggested that fresh, minimally processed and highly processed foods were available at all markets across the study settings. CONCLUSIONS: Consumers are exposed to a variety of foods, of varying quality, within their food environments in Myanmar. Interventions aimed at increasing consumer knowledge regarding healthy diets and improving food safety are needed.

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.

An mHealth voice messaging intervention to improve infant and young child feeding practices in Senegal.

Mobile health (mHealth) interventions have the potential to improve infant and young child feeding (IYCF) practices; however, gaps in the literature remain regarding their design, implementation, and effectiveness. The aims of this study were to design an mHealth voice messaging intervention delivered to mothers and fathers targeting IYCF practices and examine its implementation and impact in households with children 6-23 months in three rural villages in Senegal. We conducted focus groups (n = 6) to inform the intervention development. We then conducted a pilot study (n = 47 households) to examine the impact of the intervention on IYCF practices of children 6-23 months. Voice messages were sent to the children's mothers and fathers over a period of 4 weeks (two messages per week; eight messages in total), and 24-hr dietary recalls and food frequency questionnaires (FFQs) were conducted before and immediately after the implementation of the mHealth intervention to examine its impact on IYCF practices. Overall, three of the eight behaviours increased and one decreased. There was a significant increase in the number of children that consumed fish (60% vs. 94%; p = .008) as measured by the 24-hr recall after the completion of the intervention. We also found significantly higher frequency of egg (p = .026), fish (p = .004), and thick porridge (p = .002) consumption in the previous 7 days measured by the FFQ. Our findings suggest that voice messaging IYCF interventions in Senegal have the potential to improve IYCF behaviours among young children in the short term. Future research should entail scaling-up the intervention and examining its sustainability over the long-term.

Systematic review of the design, implementation and effectiveness of mass media and nutrition education interventions for infant and young child feeding.

OBJECTIVE: To systematically review the design, implementation and effectiveness of mass media and nutrition education interventions for improving infant and young child feeding (IYCF) practices and related psychosocial factors. DESIGN: A search of PubMed, Embase and PsycINFO databases, a Google search, and a consultation with experts in the field of IYCF performed in July 2016. SETTING: Low- and middle-income countries, as defined by the World Bank Group. SUBJECTS: Eligible studies: included a mass media component (with or without nutrition education); conducted a pre-post evaluation (with or without a control group); assessed IYCF knowledge, attitudes, beliefs and/or practices; and were published in English between 2000 and present. RESULTS: Eighteen unique studies were identified that examined the effect of mass media (types included: television; print; voice and/or SMS (text) messages; radio; megaphones/loudspeakers; videos; social media; songs/dramas) and nutrition education interventions on IYCF practices within thirteen countries. Of these, fifteen studies reported improvements in breast- and/or complementary feeding practices, using indicators recommended by the WHO, and six studies reported improvements in related psychosocial factors. However, little detail was provided on the use of formative research, a formal behaviour change theory and behaviour change techniques. Few studies reported both dose delivered and participants' exposure to the intervention. CONCLUSIONS: Despite evidence of effectiveness, few common elements in the design of interventions were identified. Future research should consistently report these details to open the 'black box' of IYCF interventions, identify effective design components and ensure replicability.

The association between active tobacco use during pregnancy and growth outcomes of children under five years of age: a systematic review and meta-analysis.

BACKGROUND: Despite considerable global efforts to reduce growth faltering in early childhood, rates of stunting remain high in many regions of the world. Current interventions primarily target nutrition-specific risk factors, but these have proven insufficient. The objective of this study was to synthesize the evidence on the relationship between active tobacco use during pregnancy and growth outcomes in children under five years of age. METHODS: In this systematic review and meta-analysis, six online databases were searched to identify studies published from January 1, 1980, through October 31, 2016, examining the association between active tobacco use during pregnancy and small-for-gestational age (SGA), length/height, and/or head circumference. Ecological studies were not included. A meta-analysis was conducted, and subgroup analyses were carried out to explore the effect of tobacco dosage. RESULTS: Among 13,189 studies identified, 210 were eligible for inclusion in the systematic review, and 124 in the meta-analysis. Active tobacco use during pregnancy was associated with significantly higher rates of SGA (pooled adjusted odds ratio [AORs] = 1.95; 95% confidence interval [CI]: 1.76, 2.16), shorter length (pooled weighted mean difference [WMD] = 0.43; 95% CI: 0.41, 0.44), and smaller head circumference (pooled WMD = 0.27; 95% CI: 0.25, 0.29) at birth. In addition, a dose-response effect was evident for all growth outcomes. CONCLUSION: Tobacco use during pregnancy may represent a major preventable cause of impaired child growth and development.