Nutrition Concern Research Articles

The implementation of a self-care tool for patients that may reduce clinician burden.

11017 Background: Addressing the side effects and concerns of patients is paramount during cancer treatment. At this time, this significant workload often involves active management by oncology clinicians which may exacerbate clinician burnout. However, minor side effects and routine concerns may be managed by patients themselves. While there are valuable resources available online including Cancer.net by the American Society of Clinical Oncology (ASCO), patients may benefit from a targeted and personalized approach. Herein, we developed a novel online patient self-assessment and self-care tool within Kaiser Permanente Northern California (KPNC), an integrated healthcare system caring for about 4.5 million patients, that aims to help patients with cancer address routine concerns, enabling them to participate in targeted self-management. Methods: Under the novel 4R Oncology model (Right Info / Right Care / Right Patient / Right Time), the self-care tool was implemented to promote patient self-management and improve team-based care and was further developed into a web-based intervention by KPNC. Patients with specific minor concerns were directed to Cancer.net webpages that described how these concerns could be self-addressed. We assessed pageview (a page loaded within a browser) data from May 2021 to December 2022. Main topics were Managing Side Effects and Concerns Related to Your Cancer Treatment, Nutrition Concerns, Emotional or Practical Concerns, Additional Resources and COVID-19 information. If patients were unable to address their concerns with the self-care tool, they were instructed to contact their care team for follow-up. Results: Within the 20-month study period, there were 4,991 total pageviews of the self-care tool. The most pageviews in one month were 501 in November 2022 and the least were 93 in December 2021. Pageviews increased over time with most months in 2022 reaching over 200 pageviews compared to only half of months in 2021 surpassing 200 pageviews. The most frequent pageviews were diarrhea (124), nutrition (124), sleep (101), use of herbs or supplements (100) and nausea or vomiting (98). While there were many topics available on the website, the most viewed pages involved gastrointestinal concerns. The least viewed included Life Care Planning/Advance Health Care Directive (6) and Chemobrain (8). Conclusions: Examination of pageview data from a self-assessment and self-care tool targeting patients with cancer within an integrated healthcare system reveals substantial interest in self-management. While it is unclear whether patients find the self-care tool’s information useful currently, further research is underway using patient surveys to evaluate its utility. Implementation of helpful information can empower visitors to be aware of their options and engage in self-management of routine conditions, which in turn can optimize their health while decreasing oncology clinician burnout.

Diet Quality and Changes in Food Intake during the University Studies in Polish Female Young Adults: Linkages with Food Experiences from Childhood and Perceived Nutrition Concerns.

The transition from adolescence to young adulthood may be associated with unfavorable changes in food intake due to some substantial transformations in social life and environment. Factors that affect food choices and diet quality during early adulthood are still not well-recognized. This paper aims to explore the relationship between females’ childhood food experiences related to parents’ monitoring practices and healthy eating guidance, perceived nutrition concerns, changes in food intake during university studies, and diet quality. A cross-sectional study with the use of CAWI (Computer-Assisted Web Interview) was carried out on 657 female students aged 19–30 years. Beliefs and Eating Habits Questionnaire (KomPAN) was used to assess the frequency of eating various kinds of food and then to calculate the diet-quality index (DQI). Adults’ Memories of Feeding in Childhood (AMoFiC) questionnaire was used to assess food experiences from childhood, and Health Concern Scale (HCS) was used to assess nutrition concerns. Associations between changes in food intake, diet quality, and selected factors describing the study sample were verified using logistic regression analysis. The DQI of the majority of students indicated a low intensity of nonhealthy and pro-healthy dietary characteristics. The intensity was higher among nutrition and health students, those with low nutrition concerns, and those with childhood experiences of monitoring. The chances of a negative change in food intake were increased by a higher score for childhood food experiences associated with parents’ monitoring practices. The chances of a negative DQI were increased by bigger concerns about nutrition and by technical and agricultural majors; however, they were reduced by positive changes in food intake. Both childhood food experiences and perceived nutrition concerns should be factored into strategies aimed at improving youth diet and educating parents about effective parental feeding practices.

Diet Quality and Nutrition Concerns of People with Parkinson’s Disease and Their Informal Caregivers: A Mixed Methods Study

Limited research exists regarding the diet quality and nutritional concerns of people with Parkinson’s disease (PwPD) and their informal caregivers. The study’s purpose was to assess diet quality via the Healthy Eating Index-2015 (HEI-2015) and self-reported nutrition concerns via semi-structured, dyadic interviews of 20 PwPD (69.7 ± 9.2 yrs) and their caregivers (66.7 ± 13.0 yrs). HEI-2015 scores were 58.3 ± 12.4 and 58.1 ± 10.6 for PwPD and caregivers, respectively. Reported dietary concerns related to PD included: change in appetite or amount eaten, gastrointestinal issues, food-medication management, chewing/swallowing issues, and change in taste/smell. The poor diet quality and nutrition concerns identified suggest nutrition professionals and caregivers are critical on the healthcare team to promote optimal health among PwPD. Future research should address overall and specific aspects of diet quality, and nutritional concerns identified by dyads in this study, such as gastrointestinal issues and food-medication management.

Does visibility matter? – A simple nudge reduces the purchase of sugar sweetened beverages in canteen drink coolers

Obesity is a growing public health problem and the increased prevalence calls for preventive measures. Choice architecture and dual brain process thinking has been suggested as a promising strategy. One of the behaviors that are of significant public health nutrition concern is the intake of sugar sweetened beverages (SSB’s) of young people. An intervention was developed for 4 canteens for students (age 16–23) of vocational schools. We slightly re-arranged the location of SSB’s in drink coolers by reducing visibility. The canteen managers collected data on sales volumes of beverages in combination over a period of 3 weeks and the data collection was supplemented with interviews and observations. The results showed that the intervention was able to reduce the purchasing of SSB in three of the four canteens. In one of the canteens where the cooler was behind the cafeteria desk there were little difference. It is assumed to be due to the fact that the students could not see the cooler while standing in line. The results suggests that rethinking of the canteen interior and physical food environment has the potential to affect purchasing of SSB.

Critical appraisal of Ayurveda nutraceuticals in the management of undernourished in children

Background: Malnutrition is the most widespread health and nutrition concern globally while undernutrition is the problem specifically seen in developing countries. It is a significant global health challenge, with dire implications for the growth, development and immune response of children in all ages. Aim: This article attempts to explore the various dietary and drug interventions mentioned in Ayurveda for the nourishing therapy (Brimhana) to treat undernutrition. Material and methods: Information have been collected from screening thoroughly different classical texts of Ayurveda, e-databases, journal publications and other related publications till date. Observations: The important aetiology in the disease Karshya (undernutrition) is the depletion of Rasa Dhatu (plasma), which should be addressed through the appropriate use of dietary preparations in form of nutraceuticals and medicinal products. The wide variety of the food items and herbal drug preparations with property to enrich the nutrient pool, improve the digestive capacity and promote the growth and development are promising interventions to tackle mild to moderate under nutrition in children. Conclusion: The detail study of the topic in the ancient and modern literature decipher that the Karshya (undernutrition) condition referred to in Ayurveda that has similar aetiology and characteristics as undernutrition. The Ayurveda approaches to treat the condition of undernutrition by Brimhana Chikitsa in form of the food and drug preparations can be made used to attain proper growth and development in children by improving the quality and quantity of Dhatu mainly Rasa Dhatu and functions of Agni in the body

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

Validation Of A Sports Nutrition Knowledge Questionnaire For Athletes In The Uniter Kingdom And Ireland

PURPOSE: This study aimed to establish validity of an Australian/New Zealand developed sports nutrition knowledge questionnaire, Platform to Evaluate Athlete Knowledge in Sports-Nutrition Questionnaire (PEAKS-NQ) for use in United Kingdom and Irish (UK-I) athletes. METHODS: To confirm content validity, a convenience sample (n=16) of sports nutritionists (SN) from elite, UK-I sports institutes provided feedback on the PEAKS-NQ via a modified Delphi method. After minor changes, the UK-I version of the PEAKS-NQ (section A: demographics; sections B-F knowledge domains; max score 113 points) was administered via weblink to a convenience sample of UK-I SN recruited from the British Dietetic Association Senior Exercise and Nutrition Register, and elite athletes (EA) training at elite sports institutes in the UK-I. SN scores were the benchmark informing instrument construct validity. Cronbach’s alpha (good≥0.7) established internal consistency. Independent t-tests or non-parametric tests were conducted as appropriate. Results are reported as mean±SD, proportions and effect size (ES). RESULTS: SN achieved greater overall (SN (n=23): 92.3±9.3% vs EA (n=154): 71.4±10.0%; ES: 2.1; p <0.0005) and individual section scores (p<0.0005) except section B (p=0.072). Sub-section scores were as follows; Section B-Food Groups (SN: 95.7±5.6%, EA: 91.5±7.8%), Section C-Nutrients (SN: 92.5±4.1%, EA: 76.3±9.5%), Section D-Applied Sports Nutrition (SN: 88.5±8.9%, EA: 56.7±14.5%), Section E-Competition Nutrition (SN: 88.6±5%, EA:62.3±15.8%), Section F-Supplements and Sports Nutrition Concerns (SN: 92.3±9.3%, EA: 73.5±20.5%). Largest knowledge differences between SN and EA were in section D. Sex, education level and sport type (endurance, high intensity/intermittent) did not independently influence EA total score. Instrument overall Cronbach’s alpha (0.82) was good. CONCLUSIONS: This study confirms content and construct validity of the PEAKS-NQ for assessing sports nutrition knowledge in UK-I athletes.

Perceived Health and Nutrition Concerns as Predictors of Dietary Patterns among Polish Females Aged 13-21 Years (GEBaHealth Project).

Health-related concerns can often be factors influencing health-related behaviours. It remains unclear whether a high level of concerns is associated with pro-healthy or unhealthy dietary behaviours and whether any associations between nutrition-related concerns and dietary behaviours exist in a population of girls and young women. The aim of the study was to investigate the associations between perceived health and nutrition concerns and dietary patterns in a representative sample of Polish young females. Data was collected in 2012 through a cross-sectional quantitative survey within the GEBaHealth (Girls Eating Behaviours and Health) project in a group of 1107 Polish girls aged 13–21 years old. Dietary patterns were identified by Principal Component Analysis (PCA) based on dietary data collected with Food Frequency Questionnaires (FFQs). Nutrition and health concerns were assessed separately by two indices: Health Concern Index (HCI) and Nutrition Concern Index (NCI); both based on the Health Concern Scale (HCS). The associations between perceived health and nutrition concerns and each dietary pattern were investigated using logistic regression analysis. Displaying a higher level of health concerns increased the chances of adherence to the upper tertile of ‘Fruit & vegetables’ pattern (adjusted odds ratio [adj. ORs]: 1.46, 95% Confidence Interval [95% CI]: 1.02–2.10). Displaying a lower level of health concerns increased the chances of the adherence to the upper tertiles of ‘Traditional Polish’, ‘Dairy & fats’, ‘Fruit and vegetables’ and ‘Fast food & sweets’ patterns (adj. ORs: 1.87, 95% CI: 1.31–2.67; 1.66, 95% CI: 1.18–2.34; 1.57, 95% CI: 1.11–2.22; 1.52, 95% CI: 1.08–2.13; respectively). No significant associations were found between levels of nutrition concerns and dietary patterns in the adjusted model. We found associations between self-perceived health concerns and dietary patterns in our study sample, suggesting health concerns can be an important predictor of dietary behaviours in girls and young women. To increase the effectiveness of healthy eating, an emphasis should be laid on health, reinforced with awareness of nutrition, when advising on food-related decisions.

Nutrition Needs for Patients With Head &amp; Neck Cancer

Nutrition Needs for Patients With Head &amp; Neck Cancer

Possible role of zinc in diminishing lead-related occupational stress-a zinc nutrition concern.

Lead and zinc are mostly present at the same occupational source and usually found as co-contaminants. Lead is known to associate with detrimental effects to humans. Zinc however is an essential nutrient and its deficiency causes debilitating effects on growth and development. Besides, it acts as core ion of important enzymes and proteins. The purpose of this study was to examine if zinc concentrations are associated with blood lead levels and if zinc may prevent lead-induced DNA damage. Blood samples were collected from 92 workers as participants occupationally exposed to lead or lead and zinc and 38 comparison participants having no history of such exposure. Lead and zinc levels were determined from blood by atomic absorption spectrophotometry and genetic damage was assessed by comet assay. Correlation was calculated by Spearman's rho. Lead concentrations were observed to increase among workers with increase in years of exposure. There was a significant difference (p<0.001) in blood lead levels between workers and controls. In addition, significant difference (p<0.001) in the genetic damage was observed among workers and controls. A clear effect of increased occupational exposure was visible among workers. Multiple regression analysis further reveals the positive effect of lead, while as the inverse effect of zinc on DNA damage. The results suggest that zinc may influence body lead absorption and may have a role in preventing the genetic damage caused by lead.

Dietary restraint, life satisfaction and self-discrepancy by gender in university students

This study aimed to characterize dieting and non-dieting university students by gender, based on their satisfaction with life and their food-related life, self-discrepancy, food behavior and health-related aspects. A non-probabilistic sample of 305 students from five Chilean state universities responded a questionnaire that included the Revised Restraint Scale, the Satisfaction with Life Scale, the Satisfaction with Food-related Life Scale, the Health-related Quality of Life Index, the Nutrition Interest Scale and the Self-Discrepancy Index. Socio-demographic characteristics, food behavior, and approximate weight and height were also enquired. Chronic dieters and non-dieters were distinguished according to the median score of the Revised Restraint Scale. 51.1% of women and 55.5% of men classified as chronic dieters, sharing characteristics such as nutrition concern, mental health problems, higher body mass index, and physical and economic self-discrepancy. Women dieters reported lower life satisfaction and satisfaction with food-related life, more health problems and health-related restriction of food, while men dieters showed higher social and emotional self-discrepancy.

Nutrition Concerns of Insufficient and Excessive Intake of Dietary Minerals in Lactating Women: A Cross-Sectional Survey in Three Cities of China.

ObjectiveObjectives of this study were 1) to investigate the mineral intake by Chinese lactating women, 2) to explore the dietary source of minerals, and 3) the ratios between different dietary minerals.MethodsA total of 468 lactating women in 5–240 days post-partum participated in this study. Food intakes by participants were measured using one time of 24-hour dietary recall, and minerals from food were calculated based on the Chinese Food Composition Table, second edition.ResultsIn post-partum, women had inadequate food intake. 81.0% of women’s daily intake of dairy products was lower than 300g, and 97.1% of women’s daily intake of salt over 6g. For mineral intake, there were 81.8%, 59.0%, 47.6%, 45.7% and 66.8% of women’s calcium, magnesium, iron, zinc and selenium intake lower than the estimated average requirement, respectively, and 91.7% of women’s excessive intake of sodium. The calcium/phosphorus and sodium/potassium ratios were 0.41±0.26/1 and 3.13±2.89/1, respectively. Considering the dietary sources of minerals, 27.3%, 25.3% and 30.1% of iron, zinc and calcium were from animal-based food, respectively, and 60.3%, 66.1% and 58.0% of iron, zinc and calcium were from plant-based food, respectively. The phosphorus-protein ratio was 0.014±0.003/1. Lactation stage was associated with nutrient intake. Women within 30 days post-partum and the ones who live in Guangzhou had a significantly lower intake of certain minerals, while women with a high education experience had a high intake of calcium, potassium, iron and zinc. Productive age, whether obese or not, and delivery ways were not associated with mineral intakes (P all >0.05).ConclusionChinese women in three studied cities had an inappropriate food intake and resulted in both insufficient and excessive intakes of certain minerals.

Do Fructose-Containing Sugars Lead to Adverse Health Consequences? Results of Recent Systematic Reviews and Meta-analyses

Sugars have replaced fat as the dominant public health nutrition concern. A fructose-centric view of cardiometabolic disease has emerged whereby fructose-containing sugars are thought to have deleterious effects on body weight, fasting and postprandial blood lipids, glycemia, blood pressure, uric acid, and markers of nonalcoholic fatty liver disease. Long-term prospective cohort studies have not supported these associations when assessing the relation between total fructose-containing sugars at any amount of intake and incident cardiometabolic disease. Conversely, a consistent signal for harm has been reported for sugary beverages when comparing the highest with the lowest intakes. These associations, however, do not hold at moderate intakes, which are more reflective of real-world intakes, are subject to important collinearity effects, and have small risk estimates with modest population-attributable risk fractions. Higher-level evidence from controlled feeding trials shows that fructose-containing sugars in either liquid or solid form have adverse cardiometabolic effects only when they supplement diets with excess calories compared with the same diets without the excess calories. In the absence of harm when fructose-containing sugars are exchanged for other sources of carbohydrate under energy-matched conditions, excess calories appear to be the dominant consideration. Like with the earlier fat story, it is difficult to separate the contribution of fructose-containing sugars from that of other sources of excess calories in the epidemic of obesity and cardiometabolic disease. Attention needs to remain focused on reducing the overconsumption of all caloric foods associated with obesity and cardiometabolic disease, including sugary beverages and foods, and promoting greater physical activity.

Demographic and psychographic associations of consumer intentions to purchase healthier food products

ObjectiveThis study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. MethodsA national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. ResultsNutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. ConclusionCommunication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.

Dietary Adequacy of Vitamin D and Calcium among Inuit and Inuvialuit Women of Child-Bearing Age in Arctic Canada: A Growing Concern

BackgroundArctic populations are at an increased risk of vitamin D inadequacy due to geographic latitude and a nutrition transition. This study aimed to assess the adequacy of dietary vitamin D and calcium among women of child-bearing age in Arctic Canada.MethodsThis study collected data from 203 randomly selected women of child-bearing age (19-44 years) in Nunavut and the Northwest Territories of Arctic Canada. Cross-sectional surveys using a validated quantitative food frequency questionnaire were analysed to determine the dietary adequacy of vitamin D and calcium and summarize the top foods contributing to vitamin D and calcium intake among traditional food eaters (TFE) and non-traditional food eaters (NTFE).ResultsThe response rate was between 69-93% depending on the community sampled. Mean BMIs for both TFE and NTFE were above the normal range. Traditional food eaters had a significantly higher median vitamin D intake compared with non-traditional eaters (TFE = 5.13±5.34 µg/day; NTFE = 3.5±3.22 µg/day, p = 0·004). The majority of women (87%) were below the Estimated Average Requirements (EAR) for vitamin D. Despite adequate median daily calcium intake in both TFE (1299±798 mg/day) and NTFE (992±704 mg/day; p = 0.0005), 27% of the study population fell below the EAR for calcium. Dairy products contributed the most to intake of vitamin D (TFE = 30.7%; NTFE = 39.1%) and calcium (TFE = 25.5%; NTFE = 34.5%).ConclusionsInadequate dietary vitamin D intake is evident among Inuit and Inuvialuit women of child-bearing age in Arctic Canada. Promotion of nutrient-rich sources of traditional foods, supplementation protocols and/or expanded food fortification should be considered to address this nutrition concern.

Cultures with Unique Nutrition Concerns: Lesbian, Gay, Bisexual, Transgender

Learning Outcome: There is a lack of data on nutrition issues of concern to the Lesbian, Gay, Bisexual and Transgender community.Lesbian, Gay, Bisexual and Transgender (LGBT) individuals include all races, ethnicities, religions, and social classes. 7–10% of Canadians and 4% of Americans identify as LGBT. LGBT experience unique health disparities, as noted in Healthy People 2020. With increasing awareness and acceptance of LGBT, more individuals are acknowledging their identity. This study assessed the literature on nutrition issues of relevance to LGBT, and the availability of appropriate nutrition education materials. PUBMED was searched using the terms female and male homosexuality, gay, bisexual, transsexualism, transgender, and nutrition and health from 1998–2012. None of the articles addressed nutrition issues. Lesbians and bisexual females are more likely to be overweight or obese, contributing to an increased risk of heart disease, diabetes, and certain cancers. Gay and bisexual males have a higher rate of eating disorders and body dissatisfaction. Transgendered undergoing hormone therapy are at higher risk for cardiovascular disease, decreased bone density, and impaired glucose metabolism, thus requiring specialized nutrition counseling. LGBT have the highest rates of abuse of tobacco, alcohol, and other drugs, which may affect their nutrition status. Healthcare providers need to be aware of the special nutrition needs of LGBT. Despite increased risks, there is little research done or nutrition education materials available to address these concerns.Funding Disclosure: None

Gender Identity: A Culture with Unique Nutrition Concerns

Lesbian, Gay, Bisexual and Transgender (LGBT) individuals encompass all races and ethnicities, religions, and social classes. It is estimated that between 7 and 10 percent of Canadians and 3.8 percent of Americans gender identify themselves as LGBT. Members of the LGBT culture experience a number of unique health disparities. Healthy People 2020 has considered this problem pressing enough to include LGBT as an area of concern in its latest edition. For example, lesbians and bisexual females are more likely to be overweight or obese which may contribute to an increased risk of heart disease, diabetes, certain cancers, and other health problems. Gay and bisexual males have a higher rate of eating disorders and body dissatisfaction. Transgender individuals undergoing hormone therapy are at higher risk of developing cardiovascular disease and decreased bone density. Theymay also experience impaired glucosemetabolism and often gain abdominalweight due to this therapy thus requiring specialized nutrition counseling. LGBT populations have the highest rates of substance abuse for tobacco, alcohol, andother drugs, all ofwhichmay affect their nutrition status. If a person discloses their gender identity during nutrition counseling the dietitian needs to ask additional screening questions to assesswhether the client has unique nutritional needs. Dietitiansmay need to address weight management issues for transgender patients undergoing hormonal therapy. In general, healthcare provider’s need tomake themselves more aware of the special nutrition needs of members of the LGBT community.

Implementing the Nutrition Screening Tool For Every Preschooler (NutriSTEP®): In Community Health Centres

Identifying nutrition-related problems during the early years may provide an opportunity to enhance parents' abilities to support healthy growth and development. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a validated, parent-administered questionnaire designed to identify preschool children at nutritional risk. Parents can complete NutriSTEP® in under five minutes. Parents' and staff's views of NutriSTEP® implementation feasibility were assessed in two community health centres. Parents attending preschool immunization clinics were recruited. Parents, staff, and physicians were asked for their opinions on screening. The 412 (34%) parent questionnaires completed indicated that parents found NutriSTEP® easy to complete and helpful for identifying areas of nutrition concern. Staff estimated screening distribution took one to three minutes. Clerks and nurses expressed concern about additional workload and demands on parents. Managers believed NutriSTEP® was easy to implement. Physicians considered nutrition screening of preschoolers important, and felt that health centres were the best location for screening. NutriSTEP® was relatively easy to implement in two community health clinics. While staff expressed concern about increased workload, parents found it easy to complete and helpful.

Nutrition Concerns and Health Effects of Vegetarian Diets

Vegetarians exhibit a wide diversity of dietary practices, often described by what is omitted from their diet. When a vegetarian diet is appropriately planned and includes fortified foods, it can be nutritionally adequate for adults and children and can promote health and lower the risk of major chronic diseases. The nutrients of concern in the diet of vegetarians include vitamin B(12), vitamin D, ω-3 fatty acids, calcium, iron, and zinc. Although a vegetarian diet can meet current recommendations for all of these nutrients, the use of supplements and fortified foods provides a useful shield against deficiency. A vegetarian diet usually provides a low intake of saturated fat and cholesterol and a high intake of dietary fiber and many health-promoting phytochemicals. This is achieved by an increased consumption of fruits, vegetables, whole-grains, legumes, nuts, and various soy products. As a result of these factors, vegetarians typically have lower body mass index, serum total and low-density lipoprotein cholesterol levels, and blood pressure; reduced rates of death from ischemic heart disease; and decreased incidence of hypertension, stroke, type 2 diabetes, and certain cancers than do nonvegetarians.

Malnutrition in Emergencies: The Framing of Nutrition Concerns in the Humanitarian Appeals Process, 1992 to 2009

This paper examines how nutrition has been used to raise humanitarian relief resources through the United Nations appeals process, from 1992 to early 2009. Recent calls for "nutrition safety nets" as a response to the world food price crisis reflect a growing recognition of nutrition as a key element in crisis management, not simply as a metric of how bad things have become. The evolution in thinking about the role of nutrition in emergency programming is reflected in changes in how nutrition has been conceptualized and presented in the consolidated appeals process. Based on a desk review, supported by key informant interviews, the paper highlights important changes that include an increasing distinction that separates nutrition from food, water, and health; the importance of synergies across sectors; increased emphasis on "essential packages" of inputs and services versus stand-alone activities; the importance of technical rigor in food and nutrition assessment and surveys; the need for technical competency and capacity in the design and management of nutrition interventions; and the importance of planning for long-term change even in delivering a short-term response. There has also been growing emphasis on specificity in objectives--a trend linked to demand for more accountability across the humanitarian system. Enhanced emergency preparedness will require further capacity building and improved systems for surveillance and data management. Without more systematic, targeted attention to pre-crisis malnutrition, the resources needed to tackle nutrition problems during emergencies will continue to grow.