Irmgard Jordan

Production and processing of foods as core aspects of nutrition-sensitive agriculture and sustainable diets

Some forms of malnutrition are partly due to agriculture not having nutrient outputs as an explicit goal. A better understanding of what is required from agricultural production and food processing for healthy and sustainable diets is needed. Besides nutritional quality or nutrient output, important factors are: water, soil, health hazards, agrobiodiversity and seasonality. Therefore, possible interactions among constituents of the food chain – human health, the environment, knowledge and education – should be considered from a systemic perspective. Nutrition-sensitive agriculture needs to consider and understand the role of biodiversity in improving dietary quality and dietary diversity as well as seasonality in food supply. Apart from improving agricultural systems in order to close the nutrition gap, efficient storage and food processing technologies to prolong shelf-life are required. If processing is poor, high food losses can cause food insecurity or increase the risk of producing unsafe and unhealthy food. Food storage and processing technologies, particularly at household level, are challenging and often not applicable to traditional crops. In order to achieve the aims of nutrition-sensitive agriculture, it is necessary to comprehend its complexity and the factors that influence it. This will require a trans-disciplinary approach, which will include the three sectors agriculture, nutrition and health at research, extension and political levels. Ensuring that farmers are knowledgeable about production systems, which sustainably provide adequate amounts of nutritious food while conserving the environment is an essential part of nutrition-sensitive agriculture. At the same time, for the benefits of nutrition-sensitive agriculture to be realized, educated consumers are required who understand what constitutes a healthy and sustainable diet.

Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study

Abstract Background: For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food. Aims and Objectives: A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0–<6 months with regard to food intake. Methods: Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and <6 months were selected for analysis (n  =  196). An ANCOVA test was performed on age of the infant with mothers’ height and weight as covariates. Results: Prevalence of stunting (infants’ length-for-age Z-score (LAZ) <−2SD) was 39%, wasting (WLZ <−2SD) 2%, and underweight (WAZ <−2SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (−1·13, 0·12) and WAZ (−0·41, 0·13) than infants not being exclusively breastfed (−1·59, 0·11, and −0·97, 0·11, respectively). There was no overall significant association between breastfeeding practice and WLZ. Conclusion: Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation.

Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia.

Poor infant and young child feeding (IYCF) practices are major determinants of chronic malnutrition. The main objective of this study was to assess the impact of a nutrition education (NE) programme aimed at promoting improved IYCF behaviours in combination with an agriculture intervention on children’s dietary diversity and nutritional status. From 2012 to 2014, a cluster randomised trial was rolled out in Cambodia in the context of an agriculture and nutrition project of the FAO of the UN. The cross-sectional baseline study was carried out in sixteen pre-selected communes in 2012. Restricted randomisation allotted the communes to either intervention (NE and agriculture intervention) or comparison arms (agriculture intervention only). The impact survey was conducted as a census in all FAO project villages in 2014. Caregivers of children aged 0–23 months were interviewed using standardised questions on socio-economic status and dietary diversity (24-h recall). Anthropometric measurements were taken. A difference-in-differences model was applied. The sample comprised 743 households with children ≥6 months of age at baseline and 921 at impact. After 1 year of NE, 69 % of the intervention households reported to have participated in the NE. Estimated mean child dietary diversity was significantly different at impact between comparison and intervention (3·6 and 3·9, respectively). In particular, the consumption of pro-vitamin A-rich foods and other fruits and vegetables increased. No treatment effects on height-for-age Z-scores could be shown. NE led to improvements in children’s diets. For effects on growth, it is assumed that longer NE activities are required to achieve sustainable behaviour change of age-appropriate infant feeding.

Nutrition education improves dietary diversity of children 6-23 months at community-level: Results from a cluster randomized controlled trial in Malawi

Background: Low dietary quality and quantity and inappropriate feeding practices can cause undernutrition. Poor nutritional status in early childhood is associated with growth faltering. The objective of the study was to assess the potential of community-based nutrition education to improve height-for-age z-scores in children 6–23 months of age. Methods and Findings: We carried out a cluster-randomized-controlled trial to assess the effectiveness of nutrition education. A total of 24 Extension Planning Area Sections served as clusters. The selection criteria were: the position of the extension officer was staffed and the sections had been selected by the project for activities in its first project year. The sections were randomized into intervention and control restricted on mean height for age Z-score using baseline information. In the intervention area, food security activities and community-based nutrition education was implemented. The control area received food security activities only. At baseline (2011) and endline (2014), caregivers with a child below two years of age were enrolled. Data assessment included anthropometric measurements, interviews on socio-economic status, dietary intake and feeding practices. A difference-in-differences estimator was used to calculate intervention effects. A positive impact on child dietary diversity was observed (B (SE) = 0.39 (0.15), p = 0.01; 95%CI 0.09–0.68). There was a non-significant positive intervention effect on mean height-for-age z-scores (B (SE) = 0.17 (0.12), p = 0.15; 95%CI -0.06–0.41). Limitations: The 24h dietary recalls used to measure dietary diversity did not consider quantities of consumed foods. Unrecorded poor quality of consumed foods might have masked a potential benefit of increased child dietary diversity on growth. Conclusions: Participatory community-based nutrition education for caregivers improved child dietary diversity even in a food insecure area. Nutrition education should be part of programs in food insecure settings aiming at ameliorating food insecurity among communities.

Role of Breastfeeding and Complementary Food on Hemoglobin and Ferritin Levels in a Cambodian Cross-Sectional Sample of Children Aged 3 to 24 Months

Background Iron deficiency derives from a low intake of dietary iron, poor absorption of iron, and high requirements due to growth as well as blood loss. An estimated number of about 50% of all anemia may be attributed to iron deficiency among young children in Cambodia. Methods A cross-sectional survey was conducted in rural Cambodia in September 2012. Villages in pre-selected communes were randomly chosen using stunting as a primary indicator of nutritional status. In total, 928 randomly selected households with children aged 3–23 months were included. Hemoglobin, ferritin, soluble transferrin receptor (sTfR), and retinol binding protein (RBP) were assessed from capillary blood samples. In addition, length/height and weight of mothers and children were taken and data on dietary diversity was collected. A child feeding index (CFI) was created. Associations between biomarkers of iron and vitamin A status and nutritional status or food intake were explored. Results Anemia prevalence was highest among 6- to 12-months-olds (71%). Ferritin and sTfR inversely correlated and were significantly associated with hemoglobin concentrations. The consumption of animal source foods (ASF) significantly impacts on the interaction between ferritin, sTfR and hemoglobin. Concentrations of RBP were significantly higher in children who had received a vitamin A supplement. The CFI was associated with sTfR and hemoglobin. Lower length and weight were associated with lower ferritin levels and showed an indirect effect on hemoglobin through ferritin. Conclusion Nutrition programs targeting children under 2 years of age need to focus on the preparation of complementary foods with high nutrient density to sustainably prevent micronutrient deficiency and generally improve nutritional status. Future assessments of the micronutrient status should include identification of hemoglobinopathies and parasitic infections to better understand all causes of anemia in Cambodian infants and young children. Trial Registration German Clinical Trials Register DRKS00004379

Nutrition-sensitive agriculture: new term or new concept?

BackgroundWithin the post-2015 agenda discussions of the United Nations, sustainable development goals (SDGs) are being drafted. In this context, nutrition-sensitive agriculture has been introduced. Nutrition-sensitive approaches in general are not new. They refer to improving or at least avoiding harm to the underlying and basic causes of malnutrition presented in the UNICEF conceptual framework. In order to answer the question of whether nutrition-sensitive agriculture is only a new term or also a new actionable concept with a comprehensive definition, framework, and political will, a questionnaire-based survey with representatives from 18 agricultural ministries of various countries was conducted on the basis of a literature review. Furthermore, the Final Communiqué of the Berlin Agriculture Ministers’ Summit 2014 was analyzed as an indication of political commitment following the steps of the qualitative content analysis of Mayring.ResultsCare was considered less than food security and health in the responses to the questionnaire and was not mentioned at all in the final communiqué. In the survey and the communiqué, mainly health aspects related to food safety and water issues were mentioned. However, the most mentioned aspect regarding food security was diversification/diversity. Because of the small sample size of the survey, the findings cannot be generalized. Nevertheless, together with the analysis of the communiqué, the results give some valuable insight into the interests of agricultural politicians for nutrition-sensitive agriculture and indicate that nutrition-sensitive agriculture has rarely been discussed from a systemic perspective. This is confirmed in the criticism expressed that an opportunity to address nutrition in a multisectoral approach that considers all underlying causes of malnutrition—food insecurity, poor health, and lack of care—was missed during the Second International Conference on Nutrition (ICN2).ConclusionsIn conclusion, nutrition-sensitive agriculture seems to be more of a term than a concept at the time of this study. To make ICN2 count in coming years and comprehensively address nutrition through a SDG, a systemic approach and true cross-sector collaboration are needed.

Reduced Morbidity Motivated Adoption of Infant and Young Child Feeding Practices after Nutrition Education Intervention in Rural Malawi

ABSTRACT This study assessed caregivers’ knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixed-methods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers’ reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child’s health benefits motivated mothers to adopt improved IYCF practices.

Determinants of Child Malnutrition and Infant and Young Child Feeding Approaches in Cambodia.

Womens diets often decrease with regard to amounts per meal and day as well as diversity if a households access to food is limited. The result is a monotonous diet that, in particular, negatively affects womens nutritional status during pregnancy and lactation and, thus, the infant. The infants diet is of utmost importance, as it needs to meet the nutrient requirements especially during the first 2 years of life, a critical window for the childs healthy development. In Cambodia, infant and young child feeding (IYCF) practices are poor. Preparation of a special complementary meal in addition to breast milk feeds for children aged 6-23 months is often not a common habit. Instead, children eat watery, plain rice porridges that do not meet the nutrient requirements at this young age. A lack of adequate caring practices such as responsive feeding exacerbates the risk of malnutrition. Caregivers are often unaware of the importance of nutrition during the first 2 years of life regarding its effects on childrens growth. In 2012, a randomized controlled trial (RCT) was started in two provinces of northern Cambodia: Oddar Meanchey and Preah Vihear. To contribute to reducing child mortality by addressing malnutrition among children 6-23 months of age, the Food and Agriculture Organization of the United Nations (FAO) implemented a nutrition-sensitive agriculture project with nutrition-specific actions, i.e. a nutrition education intervention was embedded in a food security project. Wealth, a childs age, and maternal education were identified as determinants of a childs dietary diversity. The older the child and/or the wealthier the household, the more diverse the childs diet. Maternal education was positively associated with the childs dietary diversity. Household dietary diversity was significantly associated with child dietary diversity in a model including group, childs age, maternal education, and wealth as confounders. The RCT also showed that a 2- to 3-month nutrition education programme carried out by government and community health volunteers as well as local NGOs addressing caregivers with a child between 5 and 18 months of age has great potential to improve IYCF practices. Since no impact on average height-for-age Z-scores could be demonstrated in this RCT, we suggest for Cambodia that (1) more emphasis be put on animal-source food and other protein sources in nutrition education, (2) nutrition education be implemented in the community through trained government and community members including peers as trainers, (3) sessions on family nutrition be included in the curriculum and the continuation of breastfeeding be emphasized, and (4) nutrition education be institutionalized, including continuous in-service training for sustainability.

Relationship between financial speculation and food prices or price volatility: applying the principles of evidence-based medicine to current debates in Germany

There is an unresolved debate about the potential effects of financial speculation on food prices and price volatility. Germany’s largest financial institution and leading global investment bank recently decided to continue investing in agricultural commodities, stating that there is little empirical evidence to support the notion that the growth of agricultural-based financial products has caused price increases or volatility. The statement is supported by a recently published literature review, which concludes that financial speculation does not have an adverse effect on the functioning of the agricultural commodities market. As public health professionals concerned with global food insecurity, we have appraised the methodological quality of the review using a validated and reliable appraisal tool. The appraisal revealed major shortcomings in the methodological quality of the review. These were particularly related to intransparencies in the search strategy and in the selection/presentation of studies and findings; the neglect of the possibility of publication bias; a lack of objective or rigorous criteria for assessing the scientific quality of included studies and for the formulation of conclusions. Based on the results of our appraisal, we conclude that it is not justified to reject the hypothesis that financial speculation might have adverse effects on food prices/price volatility. We hope to initiate reflections about scientific standards beyond the boundaries of disciplines and call for high quality, rigorous systematic reviews on the effects of financial speculation on food prices or price volatility.