Patrick Webb

• Ph.D.
• Chief Nutritionist at United States Agency for International Development (USAID)

Objective To analyse the health and environmental implications of adopting national food based dietary guidelines (FBDGs) at a national level and compared with global health and environmental targets. Design Modelling study. Setting 85 countries. Participants Population of 85 countries. Main outcome measures A graded coding method was developed...

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, educatio...

The potential for seaweed to contribute to food security, through production, processing and trade, in low- and middle-income countries worldwide. This is a review of current knowledge, a look to the future, and assessment of data gaps.

A new food system indicator framework and monitoring architecture is presented to track food system transformation towards global development, health and sustainability goals. Five themes are considered: (1) diets, nutrition and health; (2) environment, natural resources and production; (3) livelihoods, poverty and equity; (4) governance; and (5) r...

Background Women's empowerment is one critical pathway through which agriculture can impact women's nutrition; however, empirical evidence is still limited. We evaluated the associations of women's participation, input, and decision-making in key agricultural and household activities with women's diet quality. Methods We analyzed data from a cross...

Nationally representative household surveys collect geocoded data that are vital to tackling health and other development challenges in sub-Saharan Africa. Scholars and practitioners generally assume uniform data quality but subnational variation of errors in household data has never been investigated at high spatial resolution. Here, we explore wi...

O objectivo principal deste estudo foi avaliar os níveis de aflatoxina B1 (AFB1) sérica em crianças de 6 a 59 meses de idade e estimar a sua associação com o crescimento linear nessas crianças. Para atingir esse objectivo, a equipa conduziu um estudo transversal que se focou em compreender a extensão e o nível de exposição à aflatoxina, determinand...

Due to complex interactions, changes in any one area of food systems are likely to impact—and possibly depend on—changes in other areas. Here we present the first annual monitoring update of the indicator framework proposed by the Food Systems Countdown Initiative, with new qualitative analysis elucidating interactions across indicators. Since 2000...

The social dimension of sustainable diets, which addresses the impacts of food value chains on people, animals and communities, is under-represented in the food systems field. We present a definition of the social dimension of sustainable diets, clarify its boundaries and propose corresponding outcomes. Three case studies highlight the connectivity...

The idea of nutrition transition was critical to conceptualizing patterns of the global burden of malnutrition in line with demographic and epidemiological transitions of the 20 th century. However, earlier typologies are less reflective of the nuances which characterize today’s nutrition reality. This analysis presents a new paradigm for conceptua...

Background Milk is an important source of protein for many Indian households. However, milk intake is very low. Hence, it is necessary to examine production–consumption linkages of milk within the paradigm of accessibility, availability, and affordability. Objectives This study examined linkages between milk consumption and production, accounting...

Quality complementary feeding (CF) of infants and young children is key to their growth and development. But in Jordan, providing appropriate CF remains a challenge. This study assesses trends in infant and young child feeding (IYCF) practices, and consumption by infants and young children aged 6–23 months of breast milk substitutes (BMSs), sugar‐s...

Background: There is a need for empirical evidence on changes in employment and food consumption during pandemic situations in households belonging to the informal economy. Objective: To examine changes food insecurity, household diet diversity and employment in agriculture during the COVID-19 pandemic (September 2021) and pre-COVID-19 (2019 - e...

In the 4 years since the EAT–Lancet Commission's report on food in the Anthropocene, so much has changed. Global volatile supplies and costs of food, fuel, and fertilisers contribute to inflation and social instability. The effects of the COVID-19 pandemic disrupted economies and societies across the globe, and the risk of new emerging infectious d...

Background: Production-to-consumption linkages are important to improve consumption of nutrient-rich foods to tackle malnutrition. However, understanding specific contextual factors influencing production, distribution, and consumption in rural communities is necessary. Objective: To explore household-, farm-, and market-level factors affecting...

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child populat...

Introduction Research on the impacts of dietary patterns on human and planetary health is a rapidly growing field. A wide range of metrics, datasets, and analytical techniques has been used to explore the role of dietary choices/constraints in driving greenhouse gas (GHG) emissions, environmental degradation, health and disease outcomes, and the af...

Transforming food systems is essential to bring about a healthier, equitable, sustainable, and resilient future, including achieving global development and sustainability goals. To date, no comprehensive framework exists to track food systems transformation and their contributions to global goals. In 2021, the Food Systems Countdown to 2030 Initiat...

Background: The COVID-19 pandemic disrupted livelihoods and diets across the world. This study aimed to assess changes in household diet diversity and food consumption between the pre-COVID-19 period (December 2019-January 2020) and during the lockdown (March-May 2020), and to identify the socio-economic characteristics that determine these change...

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, educatio...

Citation: Pokharel, A.; Webb, P.; Miller, L.C.; Zaharia, S.; Shrestha, R.; Davis, D.; Trevino, J.A.; Baral, K.P.; Paudel, K.; Ghosh, S. Relationship between Animal Sourced Food Consumption and Early Childhood Development Outcomes. Nutrients 2023, 15, 315. https://doi. Abstract: Early-childhood development (ECD) is an important determinant of a chil...

Contemporary food systems are unable to keep up with the food and nutritional demands of the world’s population and are unsustainable. The situation is set to worsen in the future due population growth and climate change, increasing competition for land, water, and other natural resources, and emerging diseases, conflict, and economic volatility. G...

Hunger and malnutrition can be said to be one of the important global problems that have recently been exacerbated by climate change and environmental degradation. Meanwhile, an estimated two billion people suffer from micronutrient malnutrition, mostly due to low intake of vitamins and minerals such as iron and zinc. Biofortification, an agricultu...

Children with weight‐for‐age z‐score (WAZ) <−3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6–59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <−3 versus children with WAZ ≥−3 receiv...

The complexity and interconnectivity of food systems and climate requires new thinking and research designs that better address the real‐world challenges of securing the resilience and sustainability of human and environmental systems. Central to such an approach is coherent action across sectors and scales. Although inter‐and transdisciplinary app...

Exposure to dietary aflatoxins has been recognized as a potential threat to child nutrition and growth, in addition to being a known carcinogen. The ability to accurately assess concentration of aflatoxin in the blood of at-risk individuals is therefore very important to inform public health policies and on-the-ground programs around the world. Ven...

The cost and affordability of least-cost healthy diets by time and place are increasingly used as a proxy for access to nutrient-adequate diets. Recent work has focused on the nutrient requirements of individuals, although most food and anti-poverty programs target whole households. This raises the question of how the cost of a nutrient-adequate di...

Introduction Women and infants are among the most vulnerable groups for micronutrient deficiencies. Pregnancy micronutrient status can affect birth outcomes and subsequent infants’ growth. Methods We determined the relationship between maternal iron and vitamin A status at delivery using several biomarkers (ferritin, soluble transferrin receptor [...

The cost and affordability of least‐cost healthy diets by time and place are increasingly used as a proxy for access to nutrient‐adequate diets. Recent work has focused on the nutrient requirements of individuals, although most food and antipoverty programs target whole households. This raises the question of how the cost of a nutrient‐adequate die...

The European Commission (EC) established a High-Level Expert Group (HLEG) to assess the needs and options for strengthening the science-policy interface (SPI) for improved food systems governance. The HLEG concludes that food system transformation must be better supported through more ambitious interlinked science-policy-society interfaces and reco...

Objectives To assess factors associated with failure to respond to treatment for moderate acute malnutrition (MAM) while enrolled in a supplementary feeding program (SFP) in Pujehun District, Sierra Leone. Methods This was a secondary analysis of a cluster-randomized trial. The main study examined the cost-effectiveness of four specialized nutriti...

Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and...

Objective There are scant empirical data on the impacts of the COVID-19 pandemic on food security across the globe. India is no exception, with insights into the impacts of lockdown on food insecurity now emerging. We contribute to the empirical evidence on the prevalence of food insecurity in Bihar state before and after lockdown, and whether the...

Childhood stunting remains a public health burden worldwide. Although many studies have examined early life and in-utero risk factors; most have been observational and have used analytic techniques that make inferences limited to population means, thereby obscuring important within-group variations. This study addressed that important gap. Using da...

Background Aflatoxins are mycotoxins produced by naturally occurring fungi on food, and aflatoxin B1 (AFB1) is carcinogenic, immunotoxic and hepatotoxic. This study assesses the relationship between AFB1 in Nepali infants at 12 months of age and their diet at 9 and 12 months of age. Methods The study used data collected from 1329 infants enrolled...

Objective To implement and measure the effects of a multi-level multi-sectoral social behavior change (SBC) intervention in Agago District of Northern Uganda and to determine the potential for scale-up. Intervention Compare the Nutrition Impact and Positive Practice (NIPP) approach to a NIPP+ approach. The NIPP approach involves nutrition educatio...

Objectives Approximately one-third of the world’s stunted (low height-for-age) preschool-aged children live in India. The success of interventions designed to tackle stunting appears to vary by location and depth of poverty. We developed small-area estimation models to assess the potential impact of increments in household income on stunting across...

Background: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countries...

Background: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countri...

Background Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities.

Importance: Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health g...

Objectives To investigate the feasibility of eye-tracking-based testing of the speed of visual orienting in malnourished young children at rural clinics in Sierra Leone. Design Prospective dual cohort study nested in a cluster-randomised trial. Setting 8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute...

Evidence of the impact of exposure to multiple mycotoxins and environment enteric dysfunction (EED) on child growth is limited. Using data from a birth cohort study, the objectives of this study were to (a) quantify exposure to multiple mycotoxins (serum aflatoxin [AFB1 ] and ochratoxin A [OTA], urinary fumonisin [UFB1 ] and deoxynivalenol [DON]),...

In rural Bangladesh, intake of nutrient-rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity,...

The affordability of nutritious diets is increasingly used as a metric of how well a food system provides access to nutritious diets for all. Recent work on least-cost diets has focused on individuals, while most food and anti-poverty programs and policies target the household level. Members within households have differing nutritional needs, prese...

The anticipated failure of many countries to achieve the Sustainable Development Goals by 2030 necessitates the assessment of science–policy engagement mechanisms for food systems transformation. We explore options for enhancing existing partnerships, mandates and resources — or reimagining a new mission — for science–policy interfaces.

Abstract Background The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth. Methods Data were collected from...

Background Adoption of healthy and sustainable diets could be essential for safe-guarding the Earth's natural resources and reducing diet-related mortality, but their adoption could be hampered if such diets proved to be more expensive and unaffordable for some populations. Therefore, we aimed to estimate the costs of healthy and sustainable diets...

People in fragile environments face shocks that negatively affect their nutrition. Many governments put policy mechanisms in place to promote recovery of households after adverse shocks; however, resilience is difficult to measure because some apparent recovery could be the result of statistical randomness and reversion to trends. This paper demons...

Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world ca...

Background Where families eat together from a common dish, the shared meal must be nutrient dense enough in each nutrient to meet the needs of the highest-need member. Objectives This study aimed to develop an aggregate household nutrient requirement benchmark that satisfies all members’ needs in a context in which meals are shared and to illustra...

In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We ident...

Examining the role of environmental enteric dysfunction (EED) in child growth requires noninvasive, field-appropriate biomarkers. Alternatives to the traditionally used lactulose:mannitol (L:M) test have been explored, but few studies have compared the L:M test to host fecal mRNA transcripts. The objectives of this study were to examine whether 1)...

Independent Expert Report: The urgency of food systems transformation is widely agreed. The UN Food Systems Summit (UNFSS), in September 2021, presents the opportunity to develop political momentum behind food system transformation at national and international levels. Given the scale and ambition of this vision, and that many countries are at...

This study investigates the impact of the Uganda Community Connector Project (UCCP) integrated nutrition, water-sanitation-hygiene (WaSH), rural credit and agriculture program on the dietary quality of smallholder farm households in Uganda. We use a longitudinal panel data set, generated using a cross-sectional Randomized Control Trial (RCT) study...

Objectives To examine differences in outcomes when using MUAC and/or WHZ to identify wasted children by sex in Burkina Faso and Sierra Leone. Methods Spearman's correlation was calculated to examine the relationship between MUAC and WHZ. Kappa Statistics were calculated to examine the agreement between MUAC and WHZ in identifying wasted children....

Objectives Two field studies assessed the effectiveness and cost-effectiveness of specialized nutritious foods (SNF) to prevent and treat malnutrition among children 6–24 months old in Burkina Faso and 6–59 months old in Sierra Leone. In-home observations (IHO) were conducted to understand household use of SNFs. The IHO data are unique, as local en...

Objectives To examine factors associated with stunting in Agago District, Uganda Methods We used cross-sectional data from a quantitative baseline survey of 870 households of the ONCE (One Nutrition in Complex Environments) project currently being conducted in Agago district of Uganda. Survey data used include infant anthropometry, infant feeding...

Pulses (also known as legumes) are important in achieving nutrient adequacy in India due to their quality protein content. This study compared district-level pulse production and consumption across India, and household and district-level determinants of pulse intake, including availability, accessibility and affordability, using multi-level models...

Poor quality diets contribute to malnutrition globally, but evidence is weak on the cost-effectiveness of food-based interventions that shift diets. This study assessed 11 candidate interventions developed through Delphi techniques to improve diets in India, Nigeria, and Ethiopia. A Markov simulation model incorporated time, individual-level, nutri...

Background: Moderate acute malnutrition (MAM) affects 33 million children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effectively improved MAM recovery rates. Information costs and cost-effectiveness differences are still needed. Objectives: We assessed recovery and sustained recover...

This study aimed to enumerate the serum aflatoxin B1 (AFB1) in children 6-59 months of age and estimate its association with linear growth in these children. To accomplish this aim, the team conducted a cross-sectional study that focused on understanding the extent and level of aflatoxin exposure as measured through presence in a serum sample from...

Background Measures that better describe “healthy” and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed. Objectives We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes....

The value of animal-sourced foods (ASFs) in providing key nutrients, particularly for child growth and where diets are of low quality, is understood mainly from cross-sectional assessment of current consumption. Longitudinal panel data from Nepal, Bangladesh and Uganda were used here to assess associations among previous (lagged) and contemporaneou...

Background Naturally occurring aflatoxins may contribute to poor growth and nutritional statuses in children. Objectives We analyzed the relationship between contemporary and lagged aflatoxin exposure and 1) length-for-age z-score (LAZ); and 2) length, knee-heel length, stunting, weight-for-age z-score (WAZ), and weight-for-length z-score (WLZ)....

Aflatoxin M1 (AFM1) is the hydroxylated metabolite of aflatoxin B1 (AFB1) formed in the liver of mammals and subsequently excreted in breastmilk (BM) of mammals. Humans are exposed to AFM1 mainly through the consumption of aflatoxin contaminated milk and foods. Determining levels of AFM1 is of significant public health importance due to the risk of...

Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growt...

Background We aimed to systematically identify, standardise and disseminate individual-level dietary intake surveys from up to 207 countries for 54 foods, beverages and nutrients, including subnational intakes by age, sex, education and urban/rural residence, from 1980 to 2015. Methods Between 2008–2011 and 2014–2020, the Global Dietary Database (...

Food systems lie squarely at the intersection of several over-arching goals of the United Nations and member states, as embodied in the Sustainable Development Goals, including, eliminating poverty, hunger and malnutrition in all its forms, achieving good health and well-being, while promoting environmental sustainability. The need for radical tran...

Why did the UN World Food Programme (WFP) receive the 2020 Nobel Peace Prize? And what does that have to do with nutrition? The answer to both questions is embedded in renewed concerns globally about food insecurity. the prize went to an ideal; one that is made concrete by the actions of thousands of WFP staff who risk their lives every year for th...

Background Women's dietary diversity and quality are limited in low- and middle-income countries (LMICs). Nutrition-sensitive interventions that promote food crop diversity and women's access to income could improve diets and address the double burden of malnutrition in LMICs. Objectives We examined the associations among food crop diversity and w...

There is an urgent need for tools to better understand and measure the nutrition challenges identified in the Sustainable Development Goals. Proposed updates to the existing Net State of Nutrition Index (NeSNI) do better at highlighting the multi-dimensional nature of malnutrition (undernutrition, overweight, and micronutrient deficiencies) that ca...