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by IFPRI | June 14, 2019

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Observability of food safety losses in maize: Evidence from Kenya
Hoffmann, Vivian; Mutiga, Samuel K.; Harvey, Jagger W.; Nelson, Rebecca J.; Milgroom, Michael G.. Article in press

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Effects of dose and duration of zinc interventions on risk factors for Type 2 Diabetes and Cardiovascular Disease: A systematic review and meta-analysis
Pompano, Laura M.; Boy, Erick. Article in press

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No meta-analysis has examined the effect of dose and duration of zinc interventions on their impact on risk factors for type 2 diabetes (T2D) or cardiovascular disease (CVD). This study aimed first to compare the effects of zinc interventions dichotomized as low versus high dose (<25 mg/d and ≥25 mg/d, respectively) and short versus long duration (<12 wk and ≥12 wk, respectively) on risk factors for T2D and CVD. Second, it discusses the results from the low-dose and long-duration meta-analyses as a foundation for understanding what impact a zinc-biofortification intervention could have on these risk factors. The PubMed and Cochrane Review databases were searched through January 2020 for full-text, human studies providing zinc supplements (alone) at doses ≤75 mg/d and a placebo. Data on study and sample characteristics and several T2D and CVD risk factors were extracted. There were 1042 and 974 participants receiving zinc and placebo, respectively, from 27 studies. Low-dose zinc supplementation (<25 mg/d) significantly benefited fasting blood glucose, insulin resistance, triglycerides, total cholesterol, and LDL cholesterol. High-dose zinc supplementation (≥25 mg/d) benefited glycated hemoglobin and insulin resistance. Short-duration interventions (<12 wk) benefited fasting blood glucose, insulin resistance, and triglycerides, while long-duration studies (≥12 wk) benefited fasting blood glucose, triglycerides, and total and LDL cholesterol. Effect sizes for low-dose and long-duration interventions were of equal or greater magnitude to those from high-dose or short-duration interventions. Low-dose and long-duration zinc supplementation each improved more risk factors for T2D and CVD than high-dose and short-duration interventions, respectively. It is currently unknown whether low doses of zinc delivered over long durations via a biofortified crop would similarly impact these risk factors. However, this review suggests that low-dose, long-duration zinc intake from supplements, and potentially biofortification, can benefit risk factors for T2D and CVD.

Income variability, evolving diets, and elasticity estimation of demand for processed foods in Nigeria
de Brauw, Alan; Herskowitz, Sylvan. Article in press

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We present evidence on evolving dietary patterns in Nigeria using six rounds of household consumption data from the Nigerian General Household Survey panel between 2011 and 2016. First, following conventional definitions in the literature, we show that Nigeria has not shown any aggregate increase in consumption of highly processed foods over this period, contrary to patterns observed elsewhere in the region. In fact, consumption of highly processed foods at home has declined, while food consumed away from home, often assumed to be highly processed, has risen substantially. We then show that estimates of food expenditure elasticities of different food types are highly sensitive to different estimation approaches and raise concerns about some frequently used methods in the literature. In the absence of credible exogenous variation, we argue for the importance of panel methods and household fixed effects to control for time invariant factors likely to confound cross‐sectional estimates. Finally, we examine semiparametric Engel curves for different food groups and find that apparent curvature in the relationships between food budget shares and overall food expenditure levels in the raw data become nearly linear when removing variation explained by time‐invariant household factors.

Conflict of interest in nutrition: Where’s the power? Comment on “Towards preventing and managing conflict of interest in nutrition policy? An analysis of submissions to a consultation on a draft WHO tool”
Harris, Jody; Nisbett, Nicholas; Gillespie, Stuart. Article in press

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Actual or perceived conflict of interests (COIs) among public and private actors in the field of nutrition must be managed. Ralston et al expose sharply contrasting views on the new World Health Organization (WHO) COI management tool, highlighting the contested nature of global debates. Both the WHO COI tool and the Ralston et al paper are largely quiet on aspects of power among different actors, however, which we argue is integral to these conflicts. We suggest that power needs to be acknowledged as a factor in COI; that it needs to be systematically assessed in COI tools using approaches we outline here; and that it needs to be explicitly addressed through COI mechanisms. We would recommend that all actors in the nutrition space (not only private companies) are held to the same COI standards, and we would welcome further studies such as Ralston et al to further build accountability.

Assessing statistical similarity in dietary intakes of women of reproductive age in Bangladesh
Wable, Gargi; Dickin, Katherine; Kanbur, Ravi; Menon, Purnima; Rasmussen, Kathleen M.; Hoddinott, John F.. Article in press

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Women of reproductive age (WRA) need adequate nutrient intakes to sustain a healthy pregnancy, support fetal growth, and breastfeed after childbirth. However, data on women's dietary intake in low‐ and middle‐income countries (LMICs) are limited, and assessment of differences between dietary intakes of pregnant or lactating women compared with that of nonpregnant, nonlactating (NPNL) women is untested. Using single, multiple‐pass 24‐h dietary recall data from a sample of WRA residing in rural Bangladesh, we examined women's dietary intakes for energy, protein, calcium, iron, vitamin A, and dietary diversity for three groups: NPNL (n = 2,903), pregnant (n = 197), and lactating women (n = 944). We used equivalence testing to examine similarity in adjusted intakes for pregnant versus NPNL women and lactating versus NPNL women with a predetermined equivalence threshold based on recommendations specific for each reproductive stage. On average, both pregnant and lactating women had insufficient intakes for all dietary measures. Although statistically significant differences were observed between pregnant and NPNL women for energy intake and dietary diversity and between lactating and NPNL women for energy and protein intake, the magnitudes of these differences were too small to reject equivalence. Statistical similarity was also evident in all micronutrients and dietary diversity for both two‐group comparisons. Understanding statistical differences and similarities between dietary measures of women in distinct reproductive stages has important implications for the relevance, appropriateness, and evaluation of maternal diet‐enhancing interventions in LMICs, especially during pregnancy and lactation, when demand for macronutrients and micronutrients is elevated.

Affordability of nutritious diets in rural India
Raghunathan, Kalyani; Headey, Derek D.; Herforth, Anna. Article in press

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In 2015–16 some 38% of preschool children in India were stunted, 21% wasted, and more than half of Indian mothers and young children were anemic. Though widely studied, surprisingly little research on malnutrition in India explores the role of diets, particularly the affordability of nutritious diets given low wages and the significant structural problems facing India’s agricultural sector. To explore this we used nationally representative rural price and wage data to estimate the least cost means of satisfying India’s national dietary guidelines, referred to as the Cost of a Recommended Diet (CoRD), and assessed the affordability of this diet relative to male and female wages for unskilled laborers. Although we find that dietary costs have increased substantially for both men and women, rural wage rates increased more rapidly, implying that nutritious diets became substantially more affordable over time. However, in absolute terms nutritious diets in 2011 were still expensive relative to unskilled wages, constituting approximately 80–90% of female and 50–60% of male daily wages. Overall, we estimate that 63–76% of the rural poor could not afford a recommended diet in 2011. Achieving nutritional security in India requires a much more holistic focus on improving the affordability of the full range of nutritious food groups (not just cereals), a reappraisal of social protection schemes in light of the cost of more complete nutrition, ensuring that economic growth results in sustained income growth for the poor, and more timely and transparent monitoring of food prices, incomes and dietary costs.

Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: A randomized controlled trial in rural Ethiopia
Argaw, Alemayehu; Bouckaert, Kimberley P.; Wondafrash, Mekitie; Kolsteren, Patrick W.; Lachat, Carl; De Meulenaer, Bruno; Hanley-Cook, Giles; Huybregts, Lieven. Article in press

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Covid‐19 and global food security
Swinnen, Johan; McDermott, John. Article in press

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Covid‐19 has major implications for global food security. The virus itself and the policy reactions have triggered a massive recession and major disruptions in food value chains. The combination of both has been dramatic for the food and nutrition security of billions of poor people around the world. The impacts are heterogeneous, depending on the nature of the commodity, the resource‐intensity of the food systems, and the level of economic development. Covid‐19 affects the food security and nutrition of poor people more strongly than that of richer people. Women, children and migrants are particularly affected. It is important to balance movement control and other social distancing measures with policy initiatives to improve the food and nutrition security and livelihoods of vulnerable groups. A crucial issue moving forward is to make food supply chains, and food systems generally, more resilient for the future. While many food systems have been significantly disrupted, others have been more resilient, with food supplies relatively unaffected. Innovations are helping to overcome obstacles and make food supply chains more resilient for the future. Overall, the insights and lessons from Covid‐19 should help to design better policies and build more resilient and inclusive food systems for the future.

Cost and affordability of nutritious diets at retail prices: Evidence from 177 countries
Bai, Yan; Alemu, Robel; Block, Steven A.; Headey, Derek D.; Masters, William A.. Article in press

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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.

Early marriage and early childbearing in South Asia: Trends, inequalities, and drivers from 2005 to 2018
Scott, Samuel; Nguyen, Phuong Hong; Neupane, Sumanta; Pramanik, Priyanjana; Nanda, Priya; Bhutta, Zulfiqar A.; Afsana, Kaosar; Menon, Purnima. Article in press

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Early marriage (EM) and early childbearing (ECB) have far‐reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever‐married women aged 20–24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We find that EM/ECB are still common in Bangladesh (69%/69%), Nepal (52%/51%), India (41%/39%), and Pakistan (37%/38%), with large subnational variation in most countries. EM has declined fastest in India (AARR of –3.8%/year), Pakistan (–2.8%/year), and Bangladesh (–1.5%/year), but EM elimination by 2030 will not occur at these rates. Equity analyses show that poor, uneducated women in rural areas are disproportionately burdened. Regression decomposition analysis shows that improvements in wealth and education explained 44% (India) to 96% (Nepal) of the actual EM reduction. Investments across multiple sectors are required to understand and address EM and ECB, which are pervasive social determinants of maternal and child wellbeing.

Factors influencing obesogenic behaviours of adolescent girls and women in low‐ and middle‐income countries: A qualitative evidence synthesis
Trübswasser, Ursula; Verstraeten, Roosmarijn; Salm, Leah; Holdsworth, Michelle; Baye, Kaleab; Booth, Andrew; Feskens, Edith J. M.; Gillespie, Stuart; Talsma, Elise F.. Article in press

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This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low‐ and middle‐income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10–19 years of age) or women of reproductive age (15–49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty‐two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.

The role of health in education and human capital: Why an integrated approach to school health could make a difference in the futures of schoolchildren in low-income countries
Cohee, Lauren M.; Halliday, Katherine E.; Gelli, Aulo; Mwenyango, Irene; Lavadenz, Fernando. Article in press

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Do tradeoffs among dimensions of women’s empowerment and nutrition outcomes exist? Evidence from six countries in Africa and Asia
Quisumbing, Agnes R.; Sproule, Kathryn; Martinez, Elena M.; Malapit, Hazel Jean L.. Article in press

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Although women’s empowerment and gender equality are often linked with better maternal and child nutrition outcomes, recent systematic reviews find inconclusive evidence. This paper applies a comparable methodology to data on the Women’s Empowerment in Agriculture Index (WEAI), an internationally-validated measure based on interviews of women and men within the same household, from six countries in Africa and Asia to identify which dimensions of women’s empowerment are related to household-, woman-, and child-level dietary and nutrition outcomes. We examine relationships between women’s empowerment and household-level dietary diversity; women’s dietary diversity and BMI; and child-related outcomes, controlling for woman, child, and household characteristics. We also test for differential associations of women’s empowerment with nutrition outcomes for boys and girls. We find few significant associations between the aggregate empowerment scores and nutritional outcomes. The women’s empowerment score is positively associated only with child HAZ, while lower intrahousehold inequality is associated with a higher likelihood of exclusive breastfeeding and higher HAZ but with lower BMI. However, analysis of the subdomain indicators finds more significant associations, suggesting that tradeoffs exist among different dimensions of empowerment. Women’s empowerment accounts for a small share of the variance in nutritional outcomes, with household wealth and country-level factors accounting for the largest share of the variation in household and women’s dietary diversity. In contrast, most of the variation in child outcomes comes from child age. Improving nutritional outcomes requires addressing the underlying determinants of poor nutrition in addition to empowering women and improving gender equality.

How climate change interacts with inequity to affect nutrition
Salm, Leah; Nisbett, Nicholas; Cramer, Laura; Gillespie, Stuart; Thornton, Philip. Article in press

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Climate change poses a growing threat to the achievement of optimal nutritional status, both directly through affecting food production and indirectly through altering social and economic influences in people's lives. These adverse nutrition outcomes are not evenly distributed across the world, and vulnerable populations are the most impacted. Understanding how different forms of inequity interact with climate change and adverse nutritional outcomes is a novel area of research in today's challenging environment of increased climate change pressures. This article presents the results of a systematic literature search undertaken to identify the connections, trends and pathways between climate change, inequity and nutrition outcomes. Forty‐six peer‐reviewed studies are identified that explore these complex interactions with a specific focus on the extent to which equity is a fundamental component of climate change and nutrition research. The pathways captured in this body of evidence are mapped to current framework thinking to identify trends and gaps. While there is a trend for studies to acknowledge an unfair distribution of vulnerability to adverse nutrition outcomes, there is less attention given to the (lack of) recognition of the social situations which increase these groups' vulnerability and the absence of representation or inclusion of these groups as vital decision‐makers. Studies that do incorporate these core dimensions of equity take mixed‐method and qualitative approaches. This highlights an inherent value in stepping outside the usual scope of empirical climate change research, one that incorporates the voices of those most affected.

Standard minimum dietary diversity indicators for women or infants and young children are good predictors of adequate micronutrient intakes in 24–59-month-old children and their nonpregnant nonbreastfeeding mothers in rural Burkina Faso
Diop, Loty; Becquey, Elodie; Turowska, Zuzanna; Huybregts, Lieven; Ruel, Marie T.; Gelli, Aulo. Article in press

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Background: Simple proxy indicators are needed to assess and monitor micronutrient intake adequacy of vulnerable populations. Standard dichotomous indicators exist for nonpregnant women of reproductive age and 6–23-mo-old children in low-income countries, but not for 24–59-mo-old children or pregnant or breastfeeding women.
Objectives: This study aimed to evaluate the performance of 2 standard food group scores (FGSs) and related dichotomous indicators to predict micronutrient adequacy of the diet of rural Burkinabe 24–59-mo-old children and women of reproductive age by physiological status.
Methods: A 24-h recall survey was conducted at dry season among 1066 pairs of children and caregivers. Micronutrient adequacy was evaluated by the mean probability of adequacy (MPA) of intake over 11 micronutrients. Proxy indicators were FGS-10 [10 food groups based on the FAO/FHI360 minimum dietary diversity for women (MDD-W) guidelines] and related MDD-W (FGS-10 ≥5); and FGS-7 [7 groups based on the WHO infant and young child (IYC) feeding MDD guidelines] and related MDD-IYC (FGS-7 ≥4).
Results: FGS-10 and FGS-7 were similar across children and women (∼3 groups). FGS-10 performed better than FGS-7 to predict MPA in children (Spearman rank correlation = 0.59 compared with 0.50) and women of all 3 physiological statuses (Spearman rank correlation = 0.53–0.55 compared with 0.42–0.52). MDD-W and MDD-IYC performed well in predicting MPA >0.75 in children and MPA >0.6 in nonpregnant nonbreastfeeding (NPNB) women, but a 4-group cutoff for FGS-10 allowed a better balance between sensitivity, specificity, and proportion of correct classification. MPA levels for pregnant and breastfeeding women were too low to assess best cutoff points.
Conclusions: MDD-IYC or an adapted MDD-W (FGS-10 ≥4 instead of FGS-10 ≥5) can be extended to 24–59-mo-old children and NPNB women in similar-diet settings. The inadequacy of micronutrient intakes in pregnant and breastfeeding women warrants urgent action. Micronutrient adequacy predictors should be validated in populations where a higher proportion of these women do meet dietary requirements.

Nutrition‐sensitive agriculture programme impacts on time use and associations with nutrition outcomes
van den Bold, Mara; Bliznashka, Lilia; Ramani, Gayathri V.; Olney, Deanna K.; Quisumbing, Agnes R.; Pedehombga, Abdoulaye; Ouédraogo, Marcellin. Article in press

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Success of nutrition‐sensitive agriculture programmes targeted to women may be influenced by increased demands on women's and other household members' time and by time‐related trade‐offs to accommodate programme participation. However, evidence of how such programmes impact time use and whether changes in time‐related demands negatively influence maternal or child health and nutrition outcomes is limited. This paper examines the impact of Helen Keller International's Enhanced Homestead Food Production programme in Burkina Faso (2010–2012) on women's and men's time use and associations between changes in women's time use and maternal and child health and nutrition outcomes. We used quantitative data from a cluster‐randomized controlled trial (baseline 2010, endline 2012) and qualitative data from two rounds of process evaluation (2011, 2012). Two‐stage analyses were used to first assess programme impacts on women's and men's time use using difference‐in‐difference impact estimates and second to evaluate whether programme impacts on women's time use were associated with changes in women's and children's health and nutrition outcomes. Programme impacts were considered significant if corrected P < 0.01, and associations were considered significant if p < 0.05 and p < 0.01. Qualitative data were analysed through manual coding and by calculating the means and standard deviations for the time spent by women and men on activities in intervention and control groups. Findings show that the programme significantly increased the amount of time women spent on agriculture in the intervention compared to the control group, but this was not associated with changes in maternal or child health or nutrition outcomes. Process evaluation data supported these findings.

Food for thought? Experimental evidence on the learning impacts of a large-scale school feeding program
Aurino, Elisabetta; Gelli, Aulo; Adamba, Clement; Osei-Akoto, Isaac; Alderman, Harold. Madison, WI Article in press

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There is limited experimental evidence on the effects of large-scale, government-led interventions on human capital in resource-constrained settings. We report results from a randomized trial of the government of Ghana’s school feeding. After two years, the program led to moderate average increases in math and literacy standardized scores among pupils in treatment communities, and to larger achievement gains for girls and disadvantaged children and regions. Improvements in child schooling, cognition, and nutrition constituted suggestive impact mechanisms, especially for educationally-disadvantaged groups. The program combined equitable human capital accumulation with social protection, contributing to the “learning for all” sustainable development agenda.

Assessing the performance of the Caregiver Reported Early Development Instruments (CREDI) in rural India
Alderman, Harold; Friedman, Jed; Ganga, Paula; Kak, Mohini; Rubio‐Codina, Marta. Article in press

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Although many education and health programs aim to improve early childhood development, it is challenging to assess developmental levels of infants and small children through large household surveys. The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost instrument for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development (Bayley‐III), a reliable and widely used instrument, albeit one not always suited to large‐scale data collection efforts given its length, cost, and complexity of administration. The CREDI validation exercise showed that caregivers can provide assessments in keeping with the more interactive (hence more time‐consuming and training‐intensive) Bayley‐III instrument. Noteworthy, there was no indication that concordance of the instruments differed by education of the caregiver. This is important as it points to alternate feasible tools to measure child development outcomes through large‐scale surveys.

Evaluating parliamentary advocacy for nutrition in Tanzania
te Lintelo, D. J. H.; Pittore, K.. Article in press

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The global nutrition community is currently putting significant efforts into supporting parliamentary advocacy, aiming to bring nutrition higher up on political agendas in low-income countries with high burdens of malnutrition. Evaluating the effects of parliamentary advocacy is fraught with methodological challenges and case studies are scarce. This article adopts a contribution analysis and process tracing procedure to evaluate whether parliamentary advocacy influenced political party manifestos in Tanzania in the run up to the 2015 general election. We present a rare and empirically rich application of this systematic qualitative evaluative method. We find that configurations of activities, actors and outputs can be plausibly understood to have had a contributory role in achieving increased attention to nutrition in the party manifesto of the election winner. We further identify key risks and assumptions that mediated parliamentary advocacy and development evaluators’ ability to evaluate its outcomes, including: targeting; timing; circulation; intelligibility; power; elites; resources; and political space.

Assessing factors influencing adolescents’ dietary behaviours in urban Ethiopia using participatory photography
Trübswasser, Ursula; Baye, Kaleab; Holdsworth, Michelle; Loeffen, Megan; Feskens, Edith J. M.; Talsma, Elise F.. Article in press

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Objective: To assess factors influencing dietary behaviours of adolescents in Addis Ababa, Ethiopia. Design: Using the qualitative participatory method Photovoice, participants received training on the basics of Photovoice and took photographs related to (un)healthy eating in their environment. Transcripts of individual interviews, focus group discussions and photographs were coded for thematic analysis. Setting: One private and one public school located in the same, central neighbourhood in Addis Ababa, Ethiopia to explore how school populations of different socio-economic status experience the same neighbourhood environment. Participants: Twenty-six adolescents aged 14–19 years old, of which there were seventeen girls and nine boys. Results: Findings from the current study indicate that food safety concerns appear to be the major influencing factors for adolescents’ dietary choices. Unhealthy and unsafe foods appear to be widely available and/or affordable in adolescents’ neighbourhoods and almost half of the photographs taken by adolescents depicted poor hygiene conditions related to food vendors. Participants considered foods available in their environments as generally unsafe, calling for more packaged food. Conclusions: Concerns for food safety, hygiene and affordability are the dominating factors for adolescents’ food choices. These concerns, together with limited nutrition knowledge and preference for packaged foods, could make cheap, ultra-processed packaged foods more desirable.