Nutrition Resilience Research Articles

Nutrient density: addressing the challenge of obesity.

Obesity rates are increasing worldwide. Potential reasons include excessive consumption of sugary beverages and energy-dense foods instead of more nutrient-rich options. On a per kJ basis, energy-dense grains, added sugars and fats cost less, whereas lean meats, seafood, leafy greens and whole fruit generally cost more. Given that consumer food choices are often driven by price, the observed social inequities in diet quality and health can be explained, in part, by nutrition economics. Achieving a nutrient-rich diet at an affordable cost has become progressively more difficult within the constraints of global food supply. However, given the necessary metrics and educational tools, it may be possible to eat better for less. New metrics of nutrient density help consumers identify foods, processed and unprocessed, that are nutrient-rich, affordable and appealing. Affordability metrics, created by adding food prices to food composition data, permit calculations of both kJ and nutrients per penny, allowing for new studies on the economic drivers of food choice. Merging dietary intake data with local or national food prices permits the estimation of individual-level diet costs. New metrics of nutrient balance can help identify those food patterns that provide optimal nutritional value. Behavioural factors, including cooking at home, have been associated with nutrition resilience, defined as healthier diets at lower cost. Studies of the energy and nutrient costs of the global food supply and diverse food patterns will permit a better understanding of the socioeconomic determinants of health. Dietary advice ought to be accompanied by economic feasibility studies.

Sustainable food systems for optimal planetary health.

Sustainable food systems are an important component of a planetary health strategy to reduce the threat of infectious disease, minimize environmental footprint and promote nutrition. Human population trends and dietary transition have led to growing demand for food and increasing production and consumption of meat, amid declining availability of arable land and water. The intensification of livestock production has serious environmental and infectious disease impacts. Land clearing for agriculture alters ecosystems, increases human-wildlife interactions and leads to disease proliferation. Context-specific interventions should be evaluated towards optimizing nutrition resilience, minimizing environmental footprint and reducing animal and human disease risk.

Impact evaluation of different cash-based intervention modalities on child and maternal nutritional status in Sindh Province, Pakistan, at 6 mo and at 1 y: A cluster randomised controlled trial.

BackgroundCash-based interventions (CBIs), offer an interesting opportunity to prevent increases in wasting in humanitarian aid settings. However, questions remain as to the impact of CBIs on nutritional status and, therefore, how to incorporate them into emergency programmes to maximise their success in terms of improved nutritional outcomes. This study evaluated the effects of three different CBI modalities on nutritional outcomes in children under 5 y of age at 6 mo and at 1 y.Methods and findingsWe conducted a four-arm parallel longitudinal cluster randomised controlled trial in 114 villages in Dadu District, Pakistan. The study included poor and very poor households (n = 2,496) with one or more children aged 6–48 mo (n = 3,584) at baseline. All four arms had equal access to an Action Against Hunger–supported programme. The three intervention arms were as follows: standard cash (SC), a cash transfer of 1,500 Pakistani rupees (PKR) (approximately US$14; 1 PKR = US$0.009543); double cash (DC), a cash transfer of 3,000 PKR; or a fresh food voucher (FFV) of 1,500 PKR; the cash or voucher amount was given every month over six consecutive months. The control group (CG) received no specific cash-related interventions. The median total household income for the study sample was 8,075 PKR (approximately US$77) at baseline. We hypothesized that, compared to the CG in each case, FFVs would be more effective than SC, and that DC would be more effective than SC—both at 6 mo and at 1 y—for reducing the risk of child wasting. Primary outcomes of interest were prevalence of being wasted (weight-for-height z-score [WHZ] < −2) and mean WHZ at 6 mo and at 1 y.The odds of a child being wasted were significantly lower in the DC arm after 6 mo (odds ratio [OR] = 0.52; 95% CI 0.29, 0.92; p = 0.02) compared to the CG. Mean WHZ significantly improved in both the FFV and DC arms at 6 mo (FFV: z-score = 0.16; 95% CI 0.05, 0.26; p = 0.004; DC: z-score = 0.11; 95% CI 0.00, 0.21; p = 0.05) compared to the CG. Significant differences on the primary outcome were seen only at 6 mo. All three intervention groups showed similar significantly lower odds of being stunted (height-for-age z-score [HAZ] < −2) at 6 mo (DC: OR = 0.39; 95% CI 0.24, 0.64; p < 0.001; FFV: OR = 0.41; 95% CI 0.25, 0.67; p < 0.001; SC: OR = 0.36; 95% CI 0.22, 0.59; p < 0.001) and at 1 y (DC: OR = 0.53; 95% CI 0.35, 0.82; p = 0.004; FFV: OR = 0.48; 95% CI 0.31, 0.73; p = 0.001; SC: OR = 0.54; 95% CI 0.36, 0.81; p = 0.003) compared to the CG. Significant improvements in height-for-age outcomes were also seen for severe stunting (HAZ < −3) and mean HAZ. An unintended outcome was observed in the FFV arm: a negative intervention effect on mean haemoglobin (Hb) status (−2.6 g/l; 95% CI −4.5, −0.8; p = 0.005). Limitations of this study included the inability to mask participants or data collectors to the different interventions, the potentially restrictive nature of the FFVs, not being able to measure a threshold effect for the two different cash amounts or compare the different quantities of food consumed, and data collection challenges given the difficult environment in which this study was set.ConclusionsIn this setting, the amount of cash given was important. The larger cash transfer had the greatest effect on wasting, but only at 6 mo. Impacts at both 6 mo and at 1 y were seen for height-based growth variables regardless of the intervention modality, indicating a trend toward nutrition resilience. Purchasing restrictions applied to food-based voucher transfers could have unintended effects, and their use needs to be carefully planned to avoid this.Trial registrationISRCTN registry ISRCTN10761532

Increasing food security and nutrition resilience in response to climate change in east Africa: findings from a multisectoral symposium

Abstract Background The symposium Kuwa Tayari (be prepared in English): finding pathways to nutrition and food security resilience in response to climate change in East Africa was held in Eldoret, Kenya, in May, 2016. The goals of this symposium were to increase awareness, stimulate research ideas and recommendations, catalyse the development of training opportunities, and provide an evidence base for policy and decision-making in these regions in preparation for, and response to, our changing world. Here, we describe the structure, aims, and outcome of the symposium. Methods The 2-day symposium was a partnership initiative between University of Toronto Dalla Lana School of Public Health in Toronto, Canada, and Moi University, College of Health Sciences, School of Public Health in Eldoret, Kenya. Target audiences were scientists, students, and educators in public health, environmental studies, agriculture, agroecology, civil society, non-government organisations, and government stakeholders. Symposium organisers did a literature review to develop a background paper that helped inform the selection of five planetary health subthemes of the symposium: (1) agriculture, nutrition, and agro-biodiversity; (2) water security; (3) renewable and sustainable cooking fuels; (4) nutrition and food security issues affecting vulnerable populations; and (5) human rights and sustainable development. The symposium format consisted of keynote and oral abstract presentations, plenary discussions, small group work, poster viewing sessions, and networking opportunities. A final report was produced to highlight key outcomes and recommendations. Findings There were 121 attendees at the symposium from 26 institutions in Kenya, Uganda, Canada, USA, and elsewhere; most were from academic and community organisations. Participants' reasons for attending were met: personal growth and development, networking, research, course and training ideas, and potential collaborations. There was consensus on the need to invest in innovative, context-specific, climate-smart agricultural practices that support sustainable livelihoods and development, and improve food security at the household level throughout east Africa. Interpretation Multisectoral, transdisciplinary, community-based, and population health research and interventions are needed to address the complex and interconnected issues of climate change, nutrition, and food security. Within east Africa, participatory initiatives that engage vulnerable populations (such as women, pastoral populations, and the urban poor), and those that integrate indigenous food system practices are crucial. Training priorities should be in the areas of integration of climate change topics into existing public health curriculums, and novel interdisciplinary courses on planetary health. Funding Canadian Institutes of Health Research.

Nutrition Resilience in the Seattle Obesity Study: How to Eat Better for Less

Socioeconomic factors may pose a barrier to adopting higher quality diets, lower body weights and better health. However, some population sub‐groups appear to consume higher quality diets despite multiple socioeconomic constraints. In prior research based on NHANES data, we identified this phenomenon as “nutrition resilience”. The Seattle Obesity Study (SOS) is an ongoing exploration of socioeconomic, psychosocial, and environmental determinants of diet quality, body weights and health. The SOS is based on a stratified sample of adult male and female residents of Seattle‐King County. In the present analyses, based on 1,700 participants, nutrition resilience (NR) was defined as the intersection of higher quality diets and lower diet costs. Data on socioeconomic, psychosocial, behavioral and environmental variables, and body weights were collected using telephone and in‐person surveys. Diet quality was measured using Healthy Eating Index (HEI‐2010) scores obtained using the Fred Hutchinson Cancer Research Center (FHCRC) Food Frequency Questionnaires (FFQ). Daily diet cost estimate for each participant was also obtained using the FHCRC FFQ. Median splits of diet quality (HEI‐2010) and estimated diet cost were used to categorize participants into four quadrants. The NR participants i.e. high quality low cost quadrant accounted for 20% of the sample. The NR diets were comparable in quality to “high quality high cost” quadrant (HEI score = 78 for both) but at significantly lower diet cost ($7.7/1800kcal/d vs. $10.8/1800kcal/d respectively). A series of regression analyses examined the potential contributions of age, gender, race/ethnicity, incomes and education, food‐related attitudes and behaviors to nutrition resilience. The NR group did not differ by demographics or income. However, the NR group was more likely to be college educated, prioritized the importance of eating healthy, had fewer meals away from home, and was more likely to cook dinner meals at home (p‐value &lt;0.05 for each). The NR diets were characterized by HEI scores reflecting more whole grains, more dairy, more total proteins foods, more seafood and plant proteins, but less saturated fats, less sodium and significantly less empty calories as compared to the other three groups. Adjusted analyses showed that the NR group had the lowest BMI of all the four quadrants. In particular, the NR group had significantly lower BMI than the “low cost low quality” group (β=−2.1, 95% CI: −3.2, −1.1). Exploring the mechanisms underlying the NR phenomenon may offer unique insights into targeted dietary interventions aimed at minorities and other vulnerable populations.Support or Funding InformationThe study was supported by NIH grant NIDDK R01DK076608.

Nutritional Resilience Following the 2015 Earthquake in Nepal

BACKGROUNDThe earthquake that hit Nepal in April, 2015, caused considerable structural damage and loss of life but little is known about the longer term impacts of the earthquake on nutritional status of preschool children and related risk factors. This analysis provides the first systematic national estimate of the nutritional situation in Nepal following the earthquake.OBJECTIVEIdentify individual, household and community level factors associated with stunting in Nepali children 6–59 months of age.METHODSThe Policy and Science for Health, Agriculture, and Nutrition (PoSHAN) study under the Nutrition Innovation Lab operating in Nepal has established a national agriculture‐to‐nutrition surveillance system comprising a representative sample of ~5500 households in 63 wards across 21 districts, 7 in each of the 3 agro‐ecological zones of the country. Within each ward, all households with a child under 5 years of age or a newly married woman were eligible for inclusion. We present data from three annual rounds of data collection conducted at the same sites in the same season each year (2013, 2014, and 2016), with &lt;50% of 2016 data yet available at submission. Household agricultural, SES, dietary, anthropometric, program and other risk factor and resource data were collected each year. Child anthropometry included height and weight, with status expressed as height‐for‐age (HAZ) and weight‐for‐height or length (WHZ or WLZ) z‐scores against the WHO growth reference.RESULTSData is available for 5401 children surveyed in 2013, 5474 in 2014 and, to date, 2188 in 2016. Over the 3‐year period the national prevalence of stunting (&lt;‐2HAZ) remained stable at 35.5%, 37.4%, and 34.6%, respectively. Wasting (&lt;‐2 WHZ or WLZ) decreased from 17.7% to 16.3% to 12.9% in 2013, 2014 and 2016, respectively. The final analysis will isolate trends in agricultural productivity, household food security, dietary diversity and nutritional status by quake affected areas within zones.CONCLUSIONAvailable data from one year after the earthquake suggests that the earthquake was not associated with an increase in national rates of malnutrition, and are consistent with a reduction in wasting malnutrition over the three period.Support or Funding InformationSupported by USAID Feed the Future Innovation Lab for Nutrition

Importance of taste, nutrition, cost and convenience in relation to diet quality: Evidence of nutrition resilience among US adults using National Health and Nutrition Examination Survey (NHANES) 2007–2010

Concerns with taste, nutrition, cost, and convenience are said to be key influences on food choices. This study examined the importance of food-related attitudes in relation to diet quality using US national level data. Interactions by socioeconomic status (SES), gender and race/ethnicity were tested. Analyses of 8957 adults from National Health and Nutrition Examination Survey (NHANES 2007–2010) were conducted in 2014–15. Perceived importance of taste, nutrition, cost, and convenience in dietary choices were assessed using 4-point Likert scales. Education and family income-to-poverty ratio (FIPR) were SES indicators. Healthy Eating Index (HEI-2010), a measure of adherence to 2010 dietary guidelines, was the diet quality measure. Survey-weighted regressions examined associations between attitudes and HEI, and tested for interactions. Taste was rated as “very important” by 77.0% of the US adults, followed by nutrition (59.9%), cost (39.9%), and convenience (29.8%). However, it was the perceived importance of nutrition that most strongly predicted HEI (β: +8.0 HEI scores among “very important” vs. “not at all important”). By contrast, greater importance for taste and convenience had a weak inverse relation with HEI (β: −5.1 and −1.5 respectively), adjusting for SES. Significant interactions were observed by race/ethnicity, but not SES and gender. Those who prioritized nutrition during food shopping had higher-quality diets regardless of gender, education and income in the US. Certain racial/ethnic groups managed to eat healthy despite attaching importance to cost and convenience. This is the first evidence of nutrition resilience among US adults using national data, which has huge implications for nutrition interventions.

Honey bee foragers balance colony nutritional deficiencies

Honey bee colonies, foraging predominantly on a single pollen source, may encounter nutritional deficits. In the present study, we examined the nutritional resilience of honey bee colonies, testing whether foragers shift their foraging effort towards resources that complement a nutritional deficit. Eight honey bee colonies were kept in screened enclosures and fed for 1 week a pollen substitute diet deficient in a particular essential amino acid. Foragers were subsequently tested for a preference between the same diet previously fed, a different diet that was similarly deficient, or a diet that complemented the deficiency. Foragers preferred the complementary diet over the same or similar diets. Appetitive conditioning tests showed that bees were able to discriminate also between the same and similar diets. Overall, our results support the hypothesis that honey bees prefer dietary diversity, and that they do not just include novel sources but specifically target nutritionally complementary ones. Whereas we specifically focused on deficiencies in essential amino acids, we cannot rule out that bees were also complementing correlated imbalances in other nutrients, most notably essential fatty acids. The ability of honey bees to counter deficient nutrition contributes to the mechanisms which social insects use to sustain homeostasis at the colony level.

Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization.

Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention. A retrospective cohort study was performed to investigate the temporal evolution of nutritional parameters (serum albumin, serum phosphate, serum creatinine, equilibrated normalized protein catabolic rate, and interdialytic weight gain) and a composite nutritional score derived from these parameters, in two populations: (1) incident hemodialysis (HD) patients who started HD between January 2006 and December 2011 and were followed for up to 54 months (median 16.3), and (2) prevalent patients with HD vintage ≥2.5 years who were hospitalized between January 2006 and December 2011 and followed from 6 months before to 6 months after hospitalization. In incident patients (n=126,964), each of the nutritional parameters improved after HD initiation, with a mean composite nutritional score at the 24th percentile at the start of HD and reaching a plateau at the 57th percentile toward the end of the second year on dialysis. Nutritional parameters increased more rapidly and reached higher values among patients who survived longer. In hospitalized patients (n=14,193), the nutritional parameters and the composite score began to decline 1-2 months before hospitalization, reached their lowest level in the month after hospitalization, and then partially recovered in the subsequent 5 months. The degree of recovery of the nutritional score was inversely related to the number of rehospitalizations. This study increases the understanding of nutritional resilience and its determinants in HD patients. Application of the nutritional score, pending further validation, may facilitate targeted and timely interventions to avert the negative consequences of inadequate nutrition in chronic HD patients.

Nutrition Economics: How to Eat Better for Less.

Food prices and diet costs contribute to socioeconomic disparities in diet quality and health. Lower-cost diets provide ample calories but lack essential nutrients. Nutrition economics can remedy health disparities by helping to identify food patterns that are nutrient-rich, affordable, and appealing. First, nutrient profiling models--such as the Nutrient Rich Food (NRF) family of indices--are able to separate foods that are energy-dense from those that are nutrient-rich. Whereas energy-dense foods contain more calories than nutrients, nutrient-rich foods contain more nutrients than calories. Second, new value metrics have identified affordable healthy foods, based on nutrients per unit cost. Third, these methods have now been applied to the analyses of individual foods and beverages, meals, menus, and the total diet. The Healthy Eating Index (HEI), based on compliance with dietary guidelines, was the principal measure of total diet quality. Although healthier diets did generally cost more, some population subgroups managed to obtain nutrient-dense diets at a lower cost. Being able to create affordable, healthy food patterns on limited budgets is an example of nutrition resilience.

Wild Foods from Farm and Forest in the East Usambara Mountains, Tanzania

This study explored the role of wild foods in the diets of children and mothers in the East Usambara Mountains (N = 274 dyads). We identified 92 wild food species. Although dietary diversity (most measures) was not different between seasons, wild foods accounted for a greater percentage of items consumed in the wet (food insecure) season. Many wild foods were obtained on farm; wild foods obtained from the forest accounted for less than 3% of food items consumed. Wild foods were used by virtually all informants but contributed only 2% of total energy in the diet. However, they contributed large percentages of vitamin A (RAE) (31%), vitamin C (20%), and iron (19.19%). Agricultural factors (e.g., hours spent in farm) were associated with greater wild food use. These findings suggest participation in agriculture may be important for the maintenance of wild food use, and that wild foods can play an important role in the nutritional resilience of local people.

Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study

BackgroundThe authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread.MethodsThis cross-sectional study was carried out in 2007 using random sampling of kindergartens in order to select 350 preschoolers. Binary logistic regression was used to compare resilient (adequate nutrition) and vulnerable (stunted) groups with those with moderate nutrition.ResultsApproximately 37% of the subjects demonstrated nutritional resilience and 15% were vulnerable. Factors associated with nutritional resilience were child younger age, normal birth weight, actively hand- or spoon-feeding when the child was below two years, and residential stability in the past two years. The only factor associated with nutritional vulnerability was lower total score on the mother's General Health Questionnaire, which we interpret as a marker of maternal mental health.ConclusionsChildren with low-birth weight and older children had worse nutritional resiliency outcomes. Further, poorer outcomes for children were associated with lower maternal mental health status, as well as increased family residential instability. Our results add to the large literature on the pervasive effects of violence and instability on children and underscore the need for resources for early intervention and for the urgent resolution of the Palestinian and other armed conflicts.

Nutritional Resilience in a Hostile Environment: Positive Deviance in Child Nutrition

The term "positive deviance" applies to the study of children who demonstrate above-average growth in impoverished environments. Favorable values on known malnutrition correlates and attentive child care characterize positive deviants. Best-growing children do not necessarily mirror the malnourished; for example, best- and worst-nourished infants may both get more breast-milk substitutes than middle growers. Positive deviants receive more high-quality foods, physical interaction, affection and praise, and verbal and environmental stimulation. Factors that influence child growth through care quality also predict cognitive development, health, and social adjustment. They include: the type of society; parental education, mental health, initiative, and work burden; family and community structure; and the value of children to parents. Feeding practices related to growth include: permitting the child to control the length of feeding, encouraging eating while avoiding a power struggle, actively spoon- or hand-feeding, not displacing appetite by giving frequent sweets, and timely introduction of appropriate foods.

Nutrient cycling and growth in forest ecosystems of south western Australia: Relevance to agricultural landscapes

Nutrient and hydrologic cycles in harvested native forests in southern Australia are largely balanced. For example, we have little or no evidence of any decline in nutrient capital or availability in harvested forests. Short-term and small-scale reductions in evapotranspiration due to loss of leaf area after harvesting are adequately balanced at the landscape scale by large areas of regenerating or older-age forest. In contrast, agricultural systems on similar soils are a) dependent on large inputs of fertilisers to maintain growth and b) frequently subject to increasing salinity and waterlogging or other forms of degradation. The large-scale replacement of long-lived communities of perennial and often deep- rooting native species with annual crops or other communities of shallow-rooting species might be better managed within the framework of knowledge developed from studies of native plant communities. However, application of such a mimic concept to systems of low natural productivity is limited when agricultural systems require continued high productivity. Nonetheless, the mimic concept may help in developing sustainable management of agriculture on marginal lands, and contribute to the nutritional resilience of agroecosystems. Relevant characteristics for mimic agroecosystems in south western Australia include: high species diversity, diversity of rooting attributes, utilisation of different forms of nutrients (especially of N and P) in space and time, and the promotion of practices which increase soil organic matter content.