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The Role of Food Systems in Shaping Diets and Addressing Malnutrition: Delivering on the Sustainable Development Agenda.
Hemrich, G
World review of nutrition and dietetics. 2020;:116-126
Abstract
This paper provides an overview of the role of food systems in improving diets and addressing all forms of malnutrition, drawing on the experience of the Food and Agriculture Organization of the United Nations (FAO) and its partners. Firstly, it highlights the growing momentum for food systems' contribution to nutrition outcomes, against a recent resurgence in the number of people suffering from hunger, slow progress in stunting among children, and the emergence of an obesity crisis and related health implications. Secondly, it reviews the Global Panel and CFS-HLPE conceptual frameworks linking food systems to diet and nutrition, as these have significant implications for identifying nutrition-oriented food systems policies and actions. Thirdly, the paper illustrates recent initiatives that support global food systems governance and policy coherence. This includes the CFS multi-stakeholder process for the development of Voluntary Guidelines on Food Systems for Nutrition and five FAO regional symposia on "Sustainable Food Systems for Healthy Diets and Improved Nutrition." Fourthly, the paper provides examples of how the development of food systems policy options is being supported at country level, and in particular how various policy options are being framed (IFPRI, Nuffield Council, World Bank). Lastly, the need to build the evidence base at global and country levels to inform food systems policy options is put into sharp focus, using examples from IFPRI's development of a research agenda for healthier diets in Ethiopia, the annual State of Food Security and Nutrition in the World, and the FAO/WHO Global Individual Food Consumption Data Tool platform.
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2.
Zinc Deficiency-An Independent Risk Factor in the Pathogenesis of Haemorrhagic Stroke?
Grüngreiff, K, Gottstein, T, Reinhold, D
Nutrients. 2020;(11)
Abstract
Zinc is an essential trace element for human health and plays a fundamental role in metabolic, immunological and many other biological processes. The effects of zinc are based on the intra- and extracellular regulatory function of the zinc ion (Zn2+) and its interactions with proteins. The regulation of cellular zinc homeostasis takes place via a complex network of metal transporters and buffering systems that react to changes in the availability of zinc in nutrition, chronic diseases, infections and many other processes. Zinc deficiency is associated with impairment of numerous metabolic processes, reduced resistance to infections due to impaired immune functions, changes in skin and its appendages and disorders of wound healing and haemostasis. While ischemic heart attacks (myocardial infarction) occur more frequently with meat-based normal diets, haemorrhagic strokes are more frequently observed with vegetarian/vegan diets. The causes are discussed as deficiencies of various micronutrients, such as vitamin B12, vitamin D, various amino acids and also zinc. In the present review, after a description of the functions of zinc and its resorption, a discussion of daily food intake will follow, with a special focus on the importance of food composition and preparation for the zinc balance. The close interrelationships between proteins, especially albumin and zinc will be discussed. Finally, the possible causes and consequences of a zinc deficiency on the blood vessels and blood coagulation are considered.
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3.
Energy expenditure and caloric targets during continuous renal replacement therapy under regional citrate anticoagulation. A viewpoint.
Jonckheer, J, Spapen, H, Malbrain, MLNG, Oschima, T, De Waele, E
Clinical nutrition (Edinburgh, Scotland). 2020;(2):353-357
Abstract
BACKGROUND Indirect calorimetry (IC) is the gold standard for measuring energy expenditure in critically ill patients However, continuous renal replacement therapy (CRRT) is a formal contraindication for IC use. AIMS To discuss specific issues that hamper or preclude an IC-based assessment of energy expenditure and correct caloric prescription in CRRT-treated patients. METHODS Narrative review of current literature. RESULTS Several relevant pitfalls for validation of IC during CRRT were identified. First, IC measures CO2 production (VCO2) and O2 consumption to calculate resting energy expenditure (REE) with the Weir equation. VCO2 measurements are influenced by CRRT because CO2 is exchanged during the blood purification process. CO2 exchange also depends on type of pre- and/or postdilution fluid(s). CO2 dissolves in different forms with dynamic but unpredictable impact on VCO2. Second, the effect of immunologic activation and heat loss on REE caused by extracorporeal circulation during CRRT is poorly documented. Third, caloric prescription should be adapted to CRRT-induced in- and efflux of different nutrients. Finally, citrate, which is the preferred anticoagulant for CRRT, is a caloric source that may influence IC measurements and REE. CONCLUSION Better understanding of CRRT-related processes is needed to assess REE and provide individualized nutritional therapy in this condition.
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4.
Impact of Dietary Interventions during Pregnancy on Maternal, Neonatal, and Child Outcomes in Low- and Middle-Income Countries.
Lassi, ZS, Padhani, ZA, Rabbani, A, Rind, F, Salam, RA, Das, JK, Bhutta, ZA
Nutrients. 2020;(2)
Abstract
Optimal nutrition plays a crucial role in pregnancy. Maternal malnutrition is a risk factor for maternal, fetal, and neonatal complications and is more prevalent in low and middle-income countries (LMICs). This review aims to study the effectiveness of antenatal macronutrient nutritional interventions on maternal, neonatal, and child outcomes. We searched the CENTRAL, PubMed, Embase, and other databases for randomized controlled trials and quasi-experimental designs on healthy pregnant women in LMICs. We also searched grey literature and reports from Google Scholar, Web of Science, and websites of different organizations. Title/abstract screening, full-text screening, and data extraction filtered 15 studies for inclusion. Balanced energy protein (BEP) supplementation (n = 8) studies showed a reduced incidence of perinatal mortality, stillbirths, low birth weight (LBW) infants, small for gestational age (SGA) babies and increased birth weight. Food distribution programs (FDPs) (n =5) witnessed reduced rates of SGA, stunting, wasting, and increased birth weight and birth length. Studies on intervention for obesity prevention (n = 2) showed reductions in birth weight. Other findings were statistically insignificant. Subgroup analyses were conducted to study the effectiveness of supplementation between regions, location, the timing of supplementation and nutritional status; however, there were a limited number of studies in each subgroup. Data from our review supports the antenatal supplementation of BEP and FDP for the prevention of adverse maternal, neonatal, and child outcomes that can be utilized for future policymaking. However, more research is required before recommending obesity prevention programs.
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5.
Bone Health in Childhood Chronic Disease.
Weber, DR
Endocrinology and metabolism clinics of North America. 2020;(4):637-650
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Abstract
Many children with chronic disease are now surviving into adulthood. As a result, there is a growing interest in optimizing bone health early in the disease course with the dual goals of improving quality of life during childhood and reducing life-long fracture risk. Risk factors for impaired bone health in these children include immobility, nutritional deficiency, exposure to bone toxic therapies, hormonal deficiencies affecting growth and pubertal development, and chronic inflammation. This review focuses on the chronic diseases of childhood most commonly associated with impaired bone health. Recent research findings and clinical practice recommendations, when available, for specific disorders are summarized.
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6.
Nutrition during childhood cancer treatment: current understanding and a path for future research.
Joffe, L, Ladas, EJ
The Lancet. Child & adolescent health. 2020;(6):465-475
Abstract
Proper nutritional status during cancer therapy has been recognised as being integral to a variety of health outcome measures, including overall survival, treatment tolerance, and quality of life. The prevalence of malnutrition, defined by WHO as either undernutrition or overnutrition, among children and adolescents with cancer is reported to be as high as 75%. Yet, over the past two decades there have been limited advances in elucidating the underlying pathophysiological drivers of malnutrition in this population. This effect has resulted in a paucity of research aimed at improving nutritional assessment and intervention among this group. This Review presents an in-depth discussion of the role of nutritional status in paediatric cancer care, as well as evolving avenues of investigation that might propel personalised nutrition into a viable reality. Thus, nutritional science might facilitate individualised intervention strategies, and thereby help to optimise clinical outcomes for patients and survivors of childhood cancer.
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7.
The Double Burden of Malnutrition Calls for Better Diet Quality Worldwide.
Krawinkel, MB
World review of nutrition and dietetics. 2020;:89-94
Abstract
The double burden of malnutrition presents a great challenge to society and research. Whilst undernutrition in all its forms - wasting, stunting, micronutrient deficiency - still affects millions of children and adults worldwide, overweight and obesity have become increasingly prevalent even in countries where people are sometimes facing food insecurity. Adequate breastfeeding and improved dietary diversity are still goals to be fulfilled. The challenge for scientists as well as administrators and politicians is to address these problems within a framework that is market-oriented almost everywhere. This implies that producers and traders of food attempt to get people to consume as much as possible independent from dietary requirements. Studies have demonstrated gaps in achieving optimal breastfeeding in regions where this type of infant feeding is lifesaving. Most children in sub-Saharan Africa are still not fed a minimum acceptable diet as defined by WHO. Benefits from phytochemicals, like polyphenols and vitamins, are increasingly better understood, as are food effects on the human gut microbiota. Recent research underlines the importance of behavioral change based on information and capabilities. Besides the focus on child growth and public health, the environmental effects of food production and processing need to be considered carefully. The publication of the "Food in the Anthropocene" report has set the stage for developing sustainable food systems everywhere in the world. This requires much more focus on local and regional resources and their optimal utilization.
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8.
Toxicological risk factors in the burden of malnutrition: The case of nutrition (and risk) transition in sub-Saharan Africa.
Frazzoli, C, Mantovani, A
Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association. 2020;:111789
Abstract
Toxicant exposures may worsen the micronutrient status, especially during the womb-to-childhood development, impairing organism programming and increasing the risk for health disorders in adulthood. Growing evidence calls for an integrated risk analysis of the interplay of environment, behavior and lifestyle, where a) imbalanced diet and micronutrient deficiencies may increase the vulnerability to toxicants and alter body defence systems and b) intake of antinutrients and contaminants may increase nutritional requirements. Such scenarios are especially evident in communities undergoing a fast nutrition transition, such as in many countries of sub-Saharan Africa. Specific challenges of toxicological risk analysis in sub-Saharan Africa still need a thorough assessment, including: rapid changes of lifestyle and consumers' preferences; dumping of foods and consumer' products; risk management under weak or non-existent awareness, legislation enforcement and infrastructures. The significant and growing literature from Africa-led scientific research should be used to build quality-controlled data repositories supporting regulatory top-down actions. Meanwhile, bottom-up actions (eg consumer's empowerment) could exploit social and economic drivers toward a qualified African presence in the global and local markets. A science-based combination of top-down and bottom-up actions on preventable toxicological risk factors will contribute fighting the new forms of malnutrition and prevent multi-factorial diseases. Exposures to toxicants should be included in the integrated approach proposed by WHO to address the urgent health challenge of simultaneously reduce the risk or burden of both malnutrition (ie deficiency of one or more essential nutrients) and overweight, obesity, and diet-related NCDs.
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9.
Unravelling the Food-Health Nexus to Build Healthier Food Systems.
Yambi, O, Rocha, C, Jacobs, N, ,
World review of nutrition and dietetics. 2020;:1-8
Abstract
The urgent call to transform global food systems is well founded on the need to reduce the effects of food systems on human health, environment, peoples' rights, and creation of a just society. Unhealthy diets contribute significantly to the global disease burden and pose huge risks to morbidity and mortality. Efforts to transform diets are highly dependent on transformation of the food system. All countries are now affected by the various forms of malnutrition - undernutrition, overweight and obesity, micronutrient deficiencies - with progress often too slow and in some cases going into reverse. Concomitantly, the number of food insecure is increasing, and the prevalence of non-communicable disease is high. IPES-Food, in collaboration with the Global Alliance for the Future of Food, undertook a review of the scientific evidence covering a whole range of global health impacts associated with food systems. The review examined how food and farming systems affect human health, explored why the negative impacts are systematically reproduced and why we fail to prioritize them politically, and how we can build healthier food systems for all. Five categories of health impacts were examined: (i) occupational hazards; (ii) environmental contamination; (iii) contaminated, unsafe, and altered foods; (iv) unhealthy dietary patterns, and (v) food insecurity. The study confirmed that food systems affect health through multiple, interconnected pathways, generating severe human and economic costs. It also highlighted how prevailing power relations in the food system help to shape and sometimes obscure our understanding of the impacts. Five leverage points for building healthier food systems are recommended: (i) promotion of food systems thinking; (ii) reasserting scientific integrity and research as a public good; (iii) bringing the alternatives to light; (iv) adopting the precautionary principle, and (v) building integrated food policies under participatory governance.
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10.
Programming towards Improved Nutrition: Welthungerhilfe's Approach to the Prevention of Malnutrition - In All Its Forms.
Mogge, M, Welte, S
World review of nutrition and dietetics. 2020;:105-115
Abstract
Social injustice and poor policy frameworks contribute to hunger and all forms of malnutrition in a variety of ways. With its work in 38 partner countries, Welthungerhilfe (WHH) aims to make a significant contribution to achieving the Sustainable Development Goal target of eradicating hunger and all forms of malnutrition by 2030. In order to achieve this, WHH has strengthened its strategic approach: "Programming towards Improved Nutrition (PtIN)" is WHH's initiative to improve nutrition among children, women, and men of vulnerable households. PtIN is an integrated, intersectoral system approach which considers the multiple causes of malnutrition and identifies the enabling factors that contribute to reaching food and nutrition security. PtIN consists of four pillars: First, the rights-based approach, which puts the most vulnerable population groups as rights holders into the center of all efforts. Second, a multisectoral approach and thinking in systems supports the better alignment of relevant sectors to work in a more nutrition-sensitive way. A special emphasis is set on the link between humanitarian and development interventions to fight malnutrition and strengthen resilience in a comprehensive approach. Third, a multi-stakeholder approach refers to the fact that only joint measures by all relevant actors concerned can bring about a lasting end to all forms of malnutrition, including overweight and obesity. Fourth, by recognizing malnutrition as a complex problem that needs a complex answer and to understand the bigger picture, context-specific nutrition programming approaches help to capture holistically the magnitude, severity, and the causes of food and nutrition insecurity within a specific community or region of a country. PtIN calls on governments to ensure the appropriate legal framework and supports the empowerment of citizens and civil society organizations in partner countries to participate in the design, implementation, and monitoring of policies and programs. PtIN also especially addresses small and medium private sector actors as important stakeholders in shaping healthy food systems.