Aya Hirata Kimura: Hidden hunger: gender and the politics of smarter foods

Human milk provides fatty acids (FA) for energy and essential n‐6 and n‐3 FA to support infant growth and development. The n‐3 FA docosahexaenoic acid (DHA) particularly important because of its crucial role in neural development and function. Low milk DHA is associated with poor infant visual and neural development. Using a longitudinal blinded intervention with 400mg/d DHA or placebo in gestation, we addressed the relationship between maternal n‐6 and n‐3 fatty acid status in gestation and DHA secretion in milk, and dietary determinants fatty acid intake and milk fatty acids. Blood was collected at 16 and 36 wks gestation, then breast milk collected at 1 mth postpartum for 156 mothers who exclusively breast fed term infants. FA was determined using 100m capillary column GLC. Fatty acid methodology, recovering trans and medium chain FA, impacts the number and accuracy of FA quantization, and data interpretation. Milk DHA was positively correlated to maternal DHA in gestation, varied from 0.06 to 1.25% milk FA, and was inversely related to milk trans FA. Medium chain FA from mammary gland synthesis, varied 3 fold, and were inversely related to milk 18:2n‐6 and 18:3n‐3, but not DHA, 20:5n‐3 or 20:4n‐6. Milk FA vary widely; diets high in hydrogenated fats are associated with low milk DHA, while diets rich in unsaturated vegetable oils may lower MCFA secretion in human milk. Supported by CIHR.

In this discussion of the nature of the world food and population problem attention is directed to the following: progress and prospects since the World Food Conference adopted a Universal Declaration on the Eradication of Hunger and Malnutrition in 1974; major elements of the food and population problem; the population side of the equation; how developing countries can increase food production; problems of malnutrition and the effective distribution of food; the need for increased investment in food; priority for increased food production; critical importance of international grain market stability; more effective means for meeting local food emergencies; the growing importance of food aid; and food security policies and country action programs. The 1974 World Food Conference adopted the following resolutions for safeguarding populations affected by drought and disaster from the fearful consequences of inadequate food supplies: increase food production in countries where it is most needed; broaden the effective distribution of food through measures for improving trade consumption and nutrition; and build a better system of world food security which can avoid the disruptively wide swings in food prices such as occurred so dramatically in 1972-74. The World Food Conference called on developing countries to place a higher priority on rural development and the role of the small farmers in meeting the food needs of poorer people. It called on developed countries to increase their assistance to low income countries. The progress of the last 4 years has been mixed. Good harvest for 3 successive years have contributed to the rebuilding of food stocks and a presently improved world food situation. In developing countries there has been increased investment in food production and governments have begun to focus more attention on the longterm food needs of their people. Yet the efforts thus far are still less than adequate to meet the needs. Mechanisms within the UN for emergency food relief have been strengthened. It is most unfortunate that much of the progress in the world food situation to date is the result of good weather. The world food problem has international dimensions which affect almost all countries but in the 1st instance it is a problem which primarily concerns most directly some 36-40 countries. Countries which have substantially lowered birthrates appear to be those effectively meeting the basic human needs of the broad mass of their populations for food health care (including family planning services) employment and improved roles for women. The most promising option open to low income developing countries faced with increasing food deficits is to produce much more of ther own food. It is in the basic interest of the U.S. and of other advanced industrial countries to support increased investment and a marked increase in food production in developing countries.

The future of environmental sustainability labelling on food products

SUMMARY Following an application from Mead Johnson & Company submitted pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of France, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver an opinion on the scientific substantiation of a health claim related to docosahexaenoic acid and arachidonic acid and brain development. The scope of the application was proposed to fall under a health claim referring to children’s development and health. The food constituents that are the subject of the health claim are docosahexaenoic acid (DHA) and arachidonic acid (ARA), which are well characterised fatty acids that can be quantified in foods by established methods. The absorption of DHA and ARA is well documented. The Panel considers that the food constituents DHA and ARA are sufficiently characterised. The claimed effect is the contribution to the optimal brain development of infants and young children. The target population proposed by the applicant is infants and young children (from birth to three years of age). The Panel considers that contribution to the normal development of the brain is beneficial for infants’ and children’s development and health. The applicant identified a total 33 publications as being pertinent to the health claim for humans. A total of 13 full publications which report original data from RCTs on the effects of 1 For citation purposes: Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from Mead

The term "hidden hunger" refers to an important vitamin and mineral shortage in humans that generally goes unnoticed by the telltale signs and symptoms of micronutrient deficiency illnesses. Hidden hunger is caused by micronutrient deficiency including vitamins and minerals such as vitamin D, vitamin B12, iron, iodine, and zinc. Deficits in vitamins and minerals affect 2 billion individuals worldwide (1). Low-income households frequently lack foods that contain sufficient amounts of vitamin A, iodine, iron, and occasionally other crucial nutrients. This restricts their ability to grow, develop, maintain good health, and work. Making sure people receive the necessary vitamins, minerals, and nutrients can help avoid undernutrition.
 
 Essential vitamins and minerals have a long history of discovery, and significant progress has been achieved in the prevention and treatment of linked classic deficiency illnesses (e.g., rickets, scurvy, and anemia). The possibility that an insufficient intake of micronutrients might have negative health effects even in the absence of overt illness symptoms has just lately come to light. From conception through the end of the second year of life, there is a 1,000-day window that is extremely important for growth and development and necessitates an appropriate intake of micronutrients. The concealed hunger brought on by a vitamin shortage does not result in actual hunger. Although you might not feel it in your stomach, it directly affects your health and vigor.
 The Lancet study (2), observed three key micronutrients i.e., vitamin A, zinc, and iron in 22 countries between the time period of 2003-2019. At least one of these nutrients was deficient globally in 372 million children aged 3 and 1.2 billion women of reproductive age. Three-quarters of these under-nutritioned children were present geographically in Africa, South Asia, and the Pacific and 57% of these women were from east and south Asia and The Pacific. Surprisingly, high income countries also had high prevalence of Hidden Hunger. This may be due to processed foods poor in micronutrients. The 2018 National Nutritional Survey (NNS) report (3) shows that Pakistan faces a triple burden of malnutrition with micronutrient deficiencies, under-nutrition, and obesity coexisting in its’s population. Pakistan has had long-running programs to fortify cooking oil, ghee, and wheat with vitamins. Despite these programs, levels of vitamin A and vitamin D deficits and severe iodine deficiency have risen since the last survey.
 The fundamental factors causing food insecurity and a poor diet, poverty and a lack of understanding of the value of nutritional diversification. Micronutrients need also increase in certain stages of life such as lactation, pregnancy and in various health conditions such as parasites, infections or diseases. Low absorption of micronutrients although they are consumed in right quantity also remains a major cause.
 Hidden hunger during pregnancy causes intrauterine growth restriction, which has an impact on the child's development. Deficiency of Iron causes low energy, low birthweight, anemia, impaired brain development and increased maternal mortality. Vitamin A deficiency causes blindness or visual impairment, infections such as diarrhea and increased danger of ailment and death. Zinc deficiency causes repeating infections and impaired immune system. Iodine deficiency causes goiter, retarded mental capacity and damages in brain of newborn. Hidden hunger is a prevalent problem, affecting people everywhere in the world and more severely in low-income countries like Pakistan.

Brain development requires a massive increase in brain lipogenesis and accretion of the essential omega-3 fatty acid docosahexaenoic acid (DHA). Brain acquisition of DHA is primarily mediated by the transporter Major Facilitator Superfamily Domain containing 2a (Mfsd2a) expressed in the endothelium of the blood-brain barrier (BBB) and other abundant cell types within the brain. Mfsd2a transports DHA and other polyunsaturated fatty acids (PUFAs) esterified to lysophosphatidylcholine (LPC-DHA). However, the function of Mfsd2a and DHA in brain development is incompletely understood. Here, we demonstrate, using vascular endothelial-specific and inducible vascular endothelial-specific deletion of Mfsd2a in mice, that Mfsd2a is uniquely required postnatally at the BBB for normal brain growth and DHA accretion, with DHA deficiency preceding the onset of microcephaly. In Mfsd2a-deficient mouse models, a lipidomic signature was identified that is indicative of increased de novo lipogenesis of PUFAs. Gene expression profiling analysis of these DHA-deficient brains indicated that sterol regulatory-element binding protein (Srebp)-1 and Srebp-2 pathways were highly elevated. Mechanistically, LPC-DHA treatment of primary neural stem cells down-regulated Srebp processing and activation in a Mfsd2a-dependent fashion, resulting in profound effects on phospholipid membrane saturation. In addition, Srebp regulated the expression of Mfsd2a. These data identify LPC-DHA transported by Mfsd2a as a physiological regulator of membrane phospholipid saturation acting in a feedback loop on Srebp activity during brain development.

Previous studies have suggested that docosahexaenoic acid (DHA) supplementation into n-3 fatty acid deficient diet improved spatial learning performance, but there was no significant difference in brain related function when DHA was added into a n-3 fatty acid adequate diet. Here, we investigated the effect of adding DHA into an n-3 fatty acid deficient or adequate diet on brain and liver fatty acid composition. On the second day after conception, Sprague Dawley strain dams were divided into four groups as follows; n-3 fatty acid deficient (Def), n-3 fatty acid deficient plus DHA (Def+DHA, 10.2% DHA), n-3 fatty acid adequate (Adq, 3.4% linolenic acid), and n-3 fatty acid adequate plus DHA (Adq+DHA, 3.31% linolenic acid plus 9.65% DHA). After weaning, male pups were fed on the same diets of their respective dams until adulthood. In brain fatty acid composition, the Def group showed a lower brain DHA (64% decrease), which was largely compensated for by an increase in docosapentaenoic acid (22:5n-6). Brain DHA in the Def+DHA group was increased to almost the same extent as in the Adq and Adq+DHA groups and there were no significant differences among them. Liver fatty acid composition showed a similar pattern to that of the brain, but liver DHA in the Def+DHA showed the highest percentage among the diet groups. In conclusion, n-3 fatty acid deficiency from gestation to adulthood leads to decreased brain DHA, which has been shown to be highly associated with poor spatial leaning performance. Thus, adequate brain DHA levels are required for optimal nervous function.

Approaches to reduce zinc and iron deficits in food systems

Global awareness of the 2030 Sustainable Development Goals (SDGs) has heightened the importance and role of food systems’ transformation in accelerating countries’ progress to achieve such goals in a timely manner. The agricultural and food systems’ transformation goal is to build resilience to vulnerabilities, shocks, and diseases such as undernourishment and obesity. The objective of this study is to specify the agricultural and food systems’ factors that contribute to reducing the impacts of undernourishment and obesity in selected populous and high-income countries. This study used panel data from 2000 to 2020, applying fixed and random-effect econometrics models to conduct the analyses. Results indicated that the per capita Gross Domestic Product (GDP), level of urbanization, and flood losses at food retail from a food systems perspective were the most influential factors in the prevalence of undernourishment. Meanwhile, the supply of fatty food was the significant nutrition variable affecting undernourishment. The cereal import dependency, per capita GDP, percentage of food imports from the value of food export, and value of domestic food production factors were the influential food system variables affecting the prevalence of obesity. Cereal import dependency and dietary energy supply are the significant factors affecting the prevalence of obesity. This study recommended a set of policy actions to address malnutrition, including sustainable and balanced food and nutrition systems’ transformation, food trade openness, and efforts to reduce adversary impacts of urbanization.

Docosahexaenoic acid and retinal function in children with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency.

Research conducted on food systems by higher institutions can contribute to sustainable food security and nutrition at a local level and reduce the impact of societal challenges such as malnutrition. Unfortunately, malnutrition itself manifests as hidden hunger causing unintended consequences such as illness negatively affecting economic progress. Traditionally, research in agriculture has not taken a food systems approach which is looking at challenges of food systems from farm to fork (all stages from production to consumption). Therefore, as we embrace the compelling call to transition from agriculture to food systems research approaches, mapping studies at a local level are needed. However, studies on food systems have been carried out at a macro (global or regional level), a micro-perspective investigation is needed to inform future research. A systematic review on existing literature (journals and thesis) was conducted to identify gaps and opportunities in research on food systems undertaken by researchers at the University of Nairobi. Information collected included; 1. institutions (faculties and department at the university, national policy, and international institutions collaborating with university of Nairobi), 2. crop types (cereals, legumes, vegetables, roots and tubers, and nuts), 3. food systems activities (production, postharvest, processing, and preservation, value addition and branding, consuming foods, input and output markets, obtaining nutrients as well as logistics and distribution) driving research on food systems. The contribution of each of the components (institutions, food systems activity and crop type) was also investigated through citation scores. The findings show that low research outputs on food systems were generated by the university of Nairobi compared to selected universities in Africa and across the globe. Research was focused on carbohydrate rich crops (maize, sorghum, cassava, irish potato, sweet potato, and rice) as compared to protective bioactive vitamin crops (vegetables, mango, and beans). This demonstrated low crop diversity and dietary quality. Research priority was given mainly to maize compared to traditional crops such as sorghum, African Leafy Vegetables, cassava and millets. Faculties such as health, science and technology, engineering, and humanities were involved in research in food systems in addition to agriculture, a potential indication of transdisciplinary research. Additionally, there was more collaborative research between university of Nairobi with institutions at a global level than with local institutions. The involvement of policy institutions in research was low, mainly restricted to the discipline of agriculture, production food system activity and in a few crops such as maize, cassava, and medicinal plants. Disparities in research existed along the food systems activities as more attention was focused on production activities. Other food system activities such as harvesting, processing and preservation, consumption, value addition and branding, input and output markets, as well as logistics and distribution activities, received low research priority. Each component (food system activity, crop type and institution) demonstrated contribution to sustainable food security as shown by citation scores. The findings demonstrate skewed focus in food systems research at the university of Nairobi. Agricultural research investment within institutions of higher learning will need to consider all food systems activities, under-researched crops and collaborations that advance transdisciplinary studies to promote inclusive contribution of food systems to food security at a local level. Further studies can focus on developing frameworks to advance transdisciplinary research.

10 - Regulatory Issues

Docosahexaenoic acid (DHA) is a fatty acid essential for the proper development and functioning of the nervous and visual system. DHA is found in significant concentrations in the phospholipids of neuronal membranes. DHA is provided by the mother during the fetal and early infancy life, during pregnancy and through breastfeeding. Given the importance of an adequate supply of the fatty acid to the newborn, it has been suggested DHA supplementation to the mother before and during the pregnancy and also during the breastfeeding period. In the recent years, research from different scientist have established that DHA has an important role in the development of the nervous system, as well as having an important key role in the preservation of this tissue, especially during aging and in some neurodegenerative diseases, such as Alzheimer's disease, Multiple Sclerosis and Parkinson's disease. DHA may preserve the integrity and the neuronal viability against different metabolic insults and/or cytotoxic events, among which inflammation and oxidative stress are the most relevant. The neuroprotective effects of DHA in neural tissue are mediated by a metabolic derivative, known as neuroprotectin D-1. This molecule may respond to aggression having anti-inflammatory, antiapoptotic and even neuroregenerative effects, which may contribute to preserve the proper neuronal viability as well as the health and function of the nervous system. This review discusses different evidences about the neuroprotective effect of DHA, during aging and against some neurodegenerative diseases, highlighting the important role of the proper nutrition in this protection

SUMMARY Following an application from Mead Johnson & Company submitted pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of France, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver an opinion on the scientific substantiation of a health claim related to docosahexaenoic acid and arachidonic acid and brain development. The scope of the application was proposed to fall under a health claim referring to children’s development and health. The food constituents that are the subject of the health claim are docosahexaenoic acid (DHA) and arachidonic acid (ARA), which are well characterised fatty acids that can be quantified in foods by established methods. The absorption of DHA and ARA is well documented. The Panel considers that the food constituents DHA and ARA are sufficiently characterised. The claimed effect is the contribution to the optimal brain development of infants and young children. The target population proposed by the applicant is infants and young children (from birth to three years of age). The Panel considers that contribution to the normal development of the brain is beneficial for infants’ and children’s development and health. The applicant identified a total 33 publications as being pertinent to the health claim for humans. A total of 13 full publications which report original data from RCTs on the effects of 1 For citation purposes: Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from Mead

Current UK baby food regulation is outdated, with no guidelines on added or total sugar levels.(1) Political inaction poses a threat to the nutrition and health of our children. Many products are high in sugar and are misleadingly marketed, appearing healthier than they are which confuses parents. Increased financial pressures on families has highlighted inequalities, with more healthy foods being over twice as expensive per calorie as less healthy foods.(2) We have no contemporary data on baby food quality in relation to cost. The study aimed to characterise UK commercial baby food quality and price and secondly to drive evidence-based change in UK food policy through broad and targeted dissemination and impact.All commercially available baby and toddler foods (for children under age 3) listed on websites of the 5 largest UK grocery retailers (Tesco, Sainsbury’s, Morrisons, Aldi and ASDA) were included in the sample. Websites were viewed between June-August 2024 to identify unique products. Nutritional, ingredient, and packet marketing details were collected along with price. Nutritional quality and marketing practices were evaluated using the WHO Nutrient & Promotion Profile Model (NPPM).(1) A dissemination and impact plan was drafted and delivered, drawing on sector-wide support to target policy-makers, retailers and manufacturers.632 products were analysed. All products are marketed inappropriately and many fall short of nutritional standards, in particular being very high in sugar. 28% of products were pouches with spouts, half of which had no warning not to drink via the spout. 25% of all products would require a front-of-pack ‘high-sugar’ indicator according to WHO standards and 55% of snacks contained added sugars. Of fruit-based purees sold as being suitable for early weaning (‘4+’ or ‘6+’ months) n47 (36%) were too low in energy (watery) whilst deriving an average of 71% (SD17) of their total energy from sugar. Cost analysis revealed that cheaper pouches tended to have lower energy density (higher water content) and cheaper fruit pouches derived a greater proportion of energy from sugar. Cheaper snacks were also higher in sugar.Dissemination and impact activities included targeted media and social media coverage, engaging with members of parliament, and a cross-sector webinar for stakeholders.This evidence highlights unacceptable issues with commercial baby foods. Legislative gaps have allowed poor quality products, with misleading and inappropriate marketing, to become mainstream. Understanding the role of price in product quality demonstrates how families shopping on a budget are more likely to take poorer quality products home, potentially widening social and health inequalities. Targeting all stakeholders including civil society (non-government organisations and families), baby food manufacturers/retailers and government policy makers should increase pressure for meaningful change throughout the food system and drive legislative reform to enable improved early years nutrition.