Abstract
Low and middle-income countries increasingly face a triple burden of malnutrition encompassing undernutrition, micronutrient deficiency, and excessive energy consumption contributing to overweight and obesity. Food systems are also becoming more complex, supported by investments in food processing and retailing. Traditional approaches addressing hunger, typically based on agricultural development, are deemed insufficient alone to address the problem and attention is now being directed to food value chains, although experience is currently limited. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of value chains and diet quality was undertaken, with particular focus on interventions and their related impact pathways. Interventions were classified according to their primary orientation: to increase the availability, accessibility, or desirability of nutritious food. We identified 24 separate interventions associated with 10 different impact pathways, demonstrating the numerous entry points and large potential for value chain interventions to influence diet quality. However, case study evidence regarding effectiveness remains scant. Most studies addressed individual nutrient-rich commodities that could address a nutritional deficiency in the community of interest. Rarely was overall diet quality assessed, and future studies could benefit from taking a wider perspective of dietary patterns and food substitutions. The value chain analytical approach was deemed valuable due to its consumer orientation that seeks to understand how food products are used and what motivates their choice. The systems perspective is also important as it considers the roles of actors involved in food production, distribution, marketing, and regulation. However, few studies directly engaged with the subject of the local food environment as the bridge connecting food production and food choice. The challenge is to combat the increasing prevalence of processed foods of low nutritional value through interventions that lead to nutritious food becoming more conveniently available, affordable, and desirable.
Highlights
Malnutrition exists in various forms—undernutrition, micronutrient deficiency, excessive energy intake contributing to overweight and obesity—and is widely prevalent
The most common indicators of success in the value chains and diet quality literature were observed to be much the same as those used in traditional value chain analysis, such as efficiency in production, success in delivering products with attributes identified as important to consumers, and overall market penetration
Did households consume more milk? Did they consume more vegetables? To some extent, nutrition-oriented or nutrition-sensitive value chain research is not clearly distinguishable from traditional value chain research applied to an individual nutrient-dense food
Summary
Malnutrition exists in various forms—undernutrition, micronutrient deficiency, excessive energy intake contributing to overweight and obesity—and is widely prevalent. Notwithstanding the important gains in food production quantity that have been achieved through agricultural productivity improvements, such as for rice and wheat in South Asia and maize in Sub-Saharan Africa, it is recognised that there should be a wider focus on diet quality in LMICs [11,18,19,20] This will be critical to address the United Nations sustainable development goals (SDGs), Goal 2, which aims to end all forms of hunger and malnutrition by 2030, making sure all people—especially children—have access to sufficient and nutritious food all year round [21]. The aim was to present the state of scientific evidence and to identify important knowledge gaps
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