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Food biodiversity presents one of the most significant opportunities to enhance food and nutrition security today. The lack of data on many plants, however, limits our understanding of their potential and the possibility of building a research agenda focused on them. Our objective with this systematic review was to identify biodiverse food plants occurring in the Caatinga biome, Brazil, strategic for the promotion of food and nutrition security. We selected studies from the following databases: Web of Science, Medline/PubMed (via the National Library of Medicine), Scopus and Embrapa Agricultural Research Databases (BDPA). Eligible were original articles, published since 2008, studying food plants occurring in the Caatinga. We assessed the methodological quality of the studies we selected. We reviewed a total of fifteen studies in which 65 plants that met our inclusion criteria were mentioned. Of this amount, 17 species, including varieties, subspecies, and different parts of plants, had data on chemical composition, in addition to being mentioned as food consumed by rural communities in observational ethnobotanical studies. From the energy and protein data associated with these plants, we produced a ranking of strategic species. The plants with values higher than the average of the set were: Dioclea grandiflora Mart. ex Benth (mucunã), Hymenaea courbaril L. (jatobá), Syagrus cearensis Noblick (coco-catolé), Libidibia ferrea (Mart. ex Tul.) L.P.Queiroz (jucá), Sideroxylon obtusifolium (Roem. & Schult.) T.D.Penn. (quixabeira). We suggest that the scientific community concentrates research efforts on tree legumes, due to their resilience and physiological, nutritional, and culinary qualities.
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RESEARCH ARTICLE
Biodiverse food plants in the semiarid region
of Brazil have unknown potential: A
systematic review
Michelle Cristine Medeiros JacobID
1
*, Maria Fernanda Arau
´jo de Medeiros
1
, Ulysses
Paulino Albuquerque
2
1Laborato
´rio Horta Comunita
´ria Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte,
Natal, Rio Grande do Norte, Brazil, 2Botany Department, Laborato
´rio de Ecologia e Evoluc¸ão de Sistemas
Socioecolo
´gicos, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
*michellejacob@ufrn.edu.br
Abstract
Food biodiversity presents one of the most significant opportunities to enhance food and
nutrition security today. The lack of data on many plants, however, limits our understanding
of their potential and the possibility of building a research agenda focused on them. Our
objective with this systematic review was to identify biodiverse food plants occurring in the
Caatinga biome, Brazil, strategic for the promotion of food and nutrition security. We
selected studies from the following databases: Web of Science, Medline/PubMed (via the
National Library of Medicine), Scopus and Embrapa Agricultural Research Databases
(BDPA). Eligible were original articles, published since 2008, studying food plants occurring
in the Caatinga. We assessed the methodological quality of the studies we selected. We
reviewed a total of fifteen studies in which 65 plants that met our inclusion criteria were men-
tioned. Of this amount, 17 species, including varieties, subspecies, and different parts of
plants, had data on chemical composition, in addition to being mentioned as food consumed
by rural communities in observational ethnobotanical studies. From the energy and protein
data associated with these plants, we produced a ranking of strategic species. The plants
with values higher than the average of the set were: Dioclea grandiflora Mart. ex Benth
(mucunã), Hymenaea courbaril L. (jatoba
´), Syagrus cearensis Noblick (coco-catole
´), Libidi-
bia ferrea (Mart. ex Tul.) L.P.Queiroz (juca
´), Sideroxylon obtusifolium (Roem. & Schult.) T.
D.Penn. (quixabeira). We suggest that the scientific community concentrates research
efforts on tree legumes, due to their resilience and physiological, nutritional, and culinary
qualities.
Introduction
The scientific community pinpoints the reform of food systems as one of the main actions to
face the Global Syndemic of obesity, undernutrition, and climate change [14]. This reform
involves promoting sustainable diets, which connect the challenges of food and nutrition
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OPEN ACCESS
Citation: Jacob MCM, Arau
´jo de Medeiros MF,
Albuquerque UP (2020) Biodiverse food plants in
the semiarid region of Brazil have unknown
potential: A systematic review. PLoS ONE 15(5):
e0230936. https://doi.org/10.1371/journal.
pone.0230936
Editor: Rainer W. Bussmann, Ilia State University,
GEORGIA
Received: March 5, 2020
Accepted: April 14, 2020
Published: May 7, 2020
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0230936
Copyright: ©2020 Jacob et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the manuscript and its supporting
information files.
security (FNS) and biodiversity conservation, expressed in objectives 2 and 15 in the United
Nations 2030 agenda [5].
There is no doubt that the approach to sustainable diets is associated with the need to map
the available food biodiversity [6]. There are a variety of publications that already present data
of this nature. They are observational ethnobotanical studies, experimental research on the
chemical composition of food, ethnographic analyses, which are dispersed, separated in differ-
ent areas of knowledge: health, environmental, and agrarian sciences, as well as humanities,
among others. With this systematic review (SR), we seek to connect these data to provide the
state of available and known food biodiversity in one of the Brazilian ecosystems most threat-
ened by degradation processes associated with climate change, the Caatinga (dry seasonal for-
est). Considering that disciplinary barriers limit our perception of the problem of FNS, we
intend to lay the groundwork for a research agenda that includes the multiple disciplinary per-
spectives involved in the analysis of FNS.
Brazil has an estimated flora of 46,833 species, including algae, angiosperms, bryophytes,
fungi, gymnosperms, ferns and lycophytes [7]. A total of 6,053 of these species occur in the
Caatinga, one of the six Brazilian biomes, distributed over an area of 844,453 km
2
, which cor-
responds to almost 10% of the national territory. The Caatinga, where about 27 million people
live, is a region with successive periods of drought, hot weather, and xerophytic vegetation [8].
We justify the choice of this biome as part of this review in two ways. First, the accelerated pro-
cess of degradation via anthropic action highlights the urgency of finding strategies to protect
its species diversity. Second, the fact that the Caatinga covers the region of Brazil, the North-
east, with the second highest prevalence of severe food insecurity (hunger proxy) in the coun-
try [9], also is a rationale of our choice.
Evidence indicates that food biodiversity is one of the factors positively correlated with the
quality of diets. In a study to evaluate the nutritional adequacy and dietary biodiversity of the
diets of women and children in rural areas of Benin, Cameroon, Democratic Republic of
Congo, Ecuador, Kenya, Sri Lanka, and Vietnam, Lachat et al. [10] observed a positive associa-
tion between the species richness of food consumed and the quality of the diet, both in dry and
rainy seasons. They presented relevant data for policymakers in developing countries since the
global biodiversity hotspots coincide with areas of low income, poverty, and undernutrition
[11]. Other references emphasize the crucial role that native plants play in supplementing
essential micronutrients, providing a safety net during periods of scarcity [12]. Besides, there is
well-established evidence that links food diversity to the adequacy of energy, micronutrients,
and child growth [13].
On the other hand, we must consider that an environment rich in biodiversity does not
necessarily contribute to better quality diets. This is shown by the food consumption assess-
ment study carried out in the Democratic Republic of Congo by Termote et al. [14]. The
authors found that in this region of high biodiversity and with the population experiencing
severe food insecurity, the consumption of local plants was insufficient, limiting the adequacy
of diets. The authors listed the lack of information about these plants as one of the probable
reasons for their low consumption. Undoubtedly, one of the challenges involved in promoting
sustainable diets is the scarcity of data on availability, consumption, and nutritional composi-
tion of these kinds of plants, which we will call biodiverse food plants here [6,15]. We consider
biodiverse food plants (BFP) as plants of extensive use (e.g., beans, rice, corn) and unconven-
tional food plants (UFP), usually native, often neglected, and of culturally-limited use. For
UFP, we can also consider native and heirloom varieties of conventional foods grown locally.
In conventional dietary surveys, the consumption of BFP is often not analyzed, which is a
cause and a consequence of the absence of these species in food composition tables. It is a
cause because it is unproductive to collect data that will not be adequately analyzed. It is a
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Funding: This study was funded by the
Universidade Federal do Rio Grande do Norte
through a Scientific Initiation research scholarship
to MFAM (UFRN call 01/2018), and by the National
Council for Scientific and Technological
Development through a postdoctoral scholarship
to MCMJ (150654/2019-7) and research
productivity scholarship granted to UPA (302380/
2011-6). The Brazilian Coordenac¸a
˜o de
Aperfeic¸oamento de Pessoal de
´vel financed the
fee to publish this article (Finance Code 001).
Funders had no role in the study design, data
collection and analysis, decision to publish or
prepare the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
consequence because it is not productive to conduct food composition studies on plants that,
theoretically, are not consumed. The lack of data of this nature is more significant in the case
of the UFP [16].
Therefore, with this SR, our objective is to answer the following question: Which food plants
occurring in the Caatinga biome are strategic for promoting food and nutrition security? For
this, we listed and characterized food plants occurring in the Caatinga mentioned in the
reviewed studies, and then we selected strategic plants to promote FNS. To date, there is no SR
study on food plants in the Caatinga.
Method
This SR was conducted based on the PRISMA Statement, see File 1 for Checklist [17]. In com-
pliance with the requirements of Brazilian law, we registered our research with the Genetic
Heritage Management Council (SisGen, in Portuguese) under number A0AD60B. Our proto-
col for this review was not previously registered because our research does not analyze directly
any health-related outcomes.
Selection criteria
The following research question guided this review: Which food plants occurring in the Caa-
tinga biome are strategic for promoting food and nutritional security?
We selected articles following these eligibility criteria: (i) original articles, published in
English, Spanish, or Portuguese, from 2008 to 2020, the year in which we finalized our review;
(ii) papers focused on the study of food plants occurring in the Brazilian Caatinga biome.
We set our time frame beginning in 2008 because, in Brazil, the discussion on food biodi-
versity started to gain visibility from 2009, especially, under the name Plantas Alimentícias
Não Convencionais (UFP, in English). A quick query in Google Trends with this term demon-
strates the tendency that justifies our clipping. This criterion offered a proxy so that the time
frame was not arbitrary.
We also excluded repeated articles and review products.
Search sources
Between October 2018 and February 2020, we used four databases to perform the search: Web
of Science, Medline/PubMed (via the National Library of Medicine), Scopus, and Embrapa
Agricultural Research Databases. We used the first three because of their excellent perfor-
mance in collecting evidence for SR [18]. We added Embrapa’s database to gather more Brazil-
ian studies on the topic. Then, we manually checked the reference lists of the articles filtered
by the descriptors.
Search
The research consisted of applying the descriptors in each database. Following the PRISMA
guidelines, the search strategy applied to each of the databases is available in the S1 File,
attached.
Study selection
With the assistance of the reference manager Mendeley, we organized all records and deleted
duplicates. Applying the eligibility criteria previously outlined, one author (MFAM) and one
collaborator (LMS) selected the articles individually. Initially, titles and abstracts underwent a
first screening, at which point we excluded those that did not meet the selection criteria. In
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cases of discrepancies or uncertainties about inclusion, we consulted a second author
(MCMJ). Then, we proceeded to a full reading of potentially eligible texts.
Data extraction
We extracted data from the selected articles into a spreadsheet designed to answer the research
question. One author (MFAM) and one collaborator (LMS) were involved in the extraction.
We gathered the following information: (i) article data (authors, year of publication, journal);
(ii) location of the study and collection of plant material; (iii) objectives; (iv) design; (v) partici-
pants (when applicable); (vi) investigated results; (vii) methods; (viii) related results; (ix) qual-
ity; and (x) nutritional composition indicators available in the studies. One second author
(MCMJ) was responsible to verify the accuracy and scope.
We evaluated the methodological quality of the studies with the support of the following
recommendations: Analytical Quality Control (AQC) [19], Strengthening the Reporting of
Observational Studies in Epidemiology Statement (STROBE) [20] and the Consolidated Crite-
ria for Reporting Qualitative Research (COREQ) [21].
For the analysis of experimental food studies, we used the AQC, which consists of a check-
list of 21 criteria to evaluate reports of chemical analysis. As the identification of plant material
is relevant to our analysis and is not in this protocol, we added the item to it. Following the
method of Medeiros et al. [22] we gave a positive evaluation for this item when the authors
identified more than 80% of the taxa at the species level, which the author and her collabora-
tors considered as low risk. Therefore, we analyzed a total of 22 items in the case of experimen-
tal studies. In the case of ethnobotanical studies, as there are no consolidated protocols for
assessing their overall quality, we chose to adopt and adapt a consolidated protocol, the
STROBE, having as reference the objectives of our study. STROBE consists of a checklist of 22
essential items applied to observational epidemiological studies. Again, considering the rele-
vance of the identification of plant material, we added the Medeiros et al. reference to the pro-
tocol, for a total of 23 items. Finally, we used COREQ to analyze the only qualitative study in
our sample. This protocol is intended for the evaluation qualitative research reports that make
use of interviews. However, in the absence of a specific instrument for qualitative documentary
analysis, we adopted it and evaluated the applicable criteria (18 of 32 items) for the analysis of
documents.
After analyzing all the items, the studies received a point for each criterion fulfilled. Based
on the grades received, we established three categories for quality assessment: strong—when
the study met more than 80% of the criteria; moderate—from 50 to 80%; weak—less than 50%.
In cases of studies with mixed methods, we proceeded as follows: we evaluated both phases,
with different protocols, and calculated the arithmetic mean. In order to reduce bias in the
accumulated evidence, we discarded any study assessed as weak.
Summary of results
Considering the heterogeneous nature of the included studies, we produced narrative summa-
ries of each of the articles eligible for a full reading.
To survey the plants, we proceeded as follows: initially, we scanned the BFP presented in
the studies. We selected plants classified as food in the original studies and described in them
at the species level. With a previous list, we checked the scientific nomenclatures using the
Taxonomic Name Resolution Service v 4.0software. We updated all of them to the accepted
nomenclature. We selected plants with occurrence in the Caatinga biome by consulting the
Flora do Brazil 2020 database [23]. We considered the species as native or exotic, taking as ref-
erence the “origin” field in Flora do Brazil. We considered the occurrence to be in the Caatinga
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if in the field “phytogeographic domain” there was a reference to this biome. From the articles,
we collected the information to associate with the plants in our final list, such as popular
names, edible parts, culinary uses, and nutritional composition indicators, when available.
Other analyses
For this review, we divided the category of BFP into two: food plants and potentially edible
plants. In the first category, we include those plants reported as food in ethnobotanical or
mixed methods studies. The second, on the other hand, includes plants mentioned as edible
only in experimental studies, with no mention of their consumption by human groups in the
analyzed studies. For our analysis of strategic plants, we considered only the first category, that
is, the set of food plants. Of these, we analyzed those that had composition data associated with
them.
We emphasize that these two categories of plants may have antinutritional factors and toxic
compounds. Our decision to consider only plants with confirmed consumption by human
groups was a way of giving an objective reference that indicated a more significant potential
for the edibility of the plant.
Using the nutritional indicators provided by the studies—energy (Kcal or KJ) and protein
(g, grams)—we analyzed the species that had both higher energy and protein contributions.
We obtained this analysis by adding the energy data (converted into Kcal) to the calculation of
the energy coming specifically from the protein portion.
The diet of populations experiencing food insecurity in the area of this biome is deficient
mainly in protein and also in energy [24]. For this reason, we considered energy and protein
together as food markers with the potential to strengthen FNS in the region. We produced a
ranking of these plants and analyzed dispersion measures. We highlighted those with values
above the average of the set.
Results
Study selection
The search in the databases led to the recovery of 318 studies (122 in the Web of Science, 47 in
Medline/PubMed, 131 in Scopus and 18 in Embrapa). After excluding 88 duplicates, we con-
sidered 230 articles as eligible for the next stage of selection. Based on titles and abstracts, we
selected 23 articles for full reading. The articles excluded at this stage were mostly about plants
not associated with human consumption, such as plants consumed by animals or with other
categories of use, studies on unconventional animals present in human diets, studies on polli-
nation or research on agricultural efficiency of large-scale plantations, such as of soybeans. Of
the articles selected for full reading, we excluded eight publications because they did not fit the
inclusion criteria. One of the articles, for example, was excluded because it was an analysis of
the nutritional composition of a single plant that has no occurrence in the Caatinga biome
(Bombacopsis amazonica A. Robyns, castanha da chapada). Thus, a total of 15 articles make up
this SR. This selection work was carried out by two authors (MFAM and MCMJ) and one col-
laborator (LMS). Fig 1 shows the study selection process and the related flowchart.
Study characteristics
Nine of the studies we selected were ethnobotanical, eight of them were observational and
cross-sectional [2532], one was historical [33]. The size of their samples ranged from 15 to
117 people, with an average of 55 participants. The studies were set in communities in the Caa-
tinga area in the Brazilian states of Pernambuco (PE), Paraı
´ba (PB) and Rio Grande do Norte
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(RN). The historical research was based on the work Historia Naturalis Braziliae by Guilherme
Piso and Jorge Marcgrave. Considering the scarce and dispersed historical sources of the
South American continent, this book is a landmark in scientific studies that aim to make Bra-
zilian flora known.
Fig 1. Flowchart of the study selection process.
https://doi.org/10.1371/journal.pone.0230936.g001
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The randomized experimental studies of analysis of food composition totaled five [24,34
37]. These studies presented indicators of nutritional composition (macronutrients, micronu-
trients, and bioactive compounds), ranging from 1 to 14 species per study, with an average of
approximately five species. All plants analyzed were collected in the field by the authors of the
original studies.
One of the studies had a mixed method: an observational phase of ethnobotanical reference
(68 participants), and an experimental phase resulting in an analysis of the chemical composi-
tion of seven species.
Table 1 provides an overview of the main characteristics of the 15 studies included in this
review.
We grouped the results in two parts. The first includes food plants and potentially edible
plants, which consist of the plants mentioned in the studies that met our inclusion criteria. Sec-
ond, under the title of strategic food plants, we present the BFP with a nutritional profile that
addresses the main dietary deficiencies in the region.
Quality analysis
We evaluated the studies of moderate and strong quality. Characteristics of the experimental
studies that contributed most to our determination of moderate quality were the omission of
the reporting of limits, absence of interlaboratory proficiency tests, and lack of taxonomic
identification of flora. Two of the five studies did not report having performed the botanical
identification of the analyzed material [34,35]. We did not add nutritional data of these species
in our analysis of strategic plants. In ethnobotanical studies, we related moderate quality with
omission of study limitations, lack of generalization of the results, and absence of indication of
study design. All ethnobotanical studies included botanical identification of species. None of
the studies analyzed less than 85% of taxa at the species level. The qualitative study had a strong
evaluation. We did not rate any study as weak.
Food plants and potentially edible plants occurring in the Caatinga
From the studies, we extracted 65 species (Table 2). Some of these plants, occurring in Caa-
tinga, are native to other biomes, such as Talisia esculenta (Cambess.) Radlk. (pitomba), Ilex
paraguariensis L. (erva-mate), Genipa americana L. (genipapo), Inga edulis Mart. (inga
´), and
Piper marginatum Jacq (capeba). These plants may have been introduced to the region through
trade, exchange, or importation and now have their consumption incorporated by local com-
munities. Dimorphandra gardeneriana Tul., likewise, although it occurs in the Caatinga, is not
native to it. We justify its presence in our data by the fact that its collection happened in the
Araripe National Forest, located in a transition zone that presents traces of the Atlantic Forest,
Cerrado, and Caatinga.
Native plants corresponded to approximately 89% of the total (n58). The species belong to
22 families, the most frequent being Fabaceae, Euphorbiaceae, Cactaceae, and Arecaceae. The
plants most present in the studies were the following: S.tuberosa (umbu), C.jamacaru (man-
dacaru), C.tapia (trapia
´), H.courbaril (jatoba
´), and S.cearensis (coco-catole
´), being mentioned
by seven, six, five, five, and four of the articles, respectively.
Strategic food plants to promote food and nutrition security in the
Caatinga
Of the studies analyzed, six presented data on food composition. In total, they provided analy-
sis of 35 edible items, including varieties, subspecies, and different parts of plants. Only 17 of
these items had their consumption also reported in observational ethnobotanical studies.
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Table 1. Characterization of studies regarding biodiverse food plants in Caatinga biome.
Study
number
Data on
publication
(authors, year
and journal)
Setting Objective Design Participants Outcomes
investigated
Outcomes
measurement
method
Outcomes Quality
1 Almeida et al.,
2016 (34) Food
chemistry
Mossoro
´,
RN, Brazil
To evaluate the
bioactive
compounds and
the antioxidant
potential of the
fruit of Ximenia
americana L.
Randomized
experimental
study
N/A Bioactive
compounds and
antioxidant
activity—
flavonoids,
anthocyanins,
carotenoids,
vitamin C
Chemical
composition
analysis of
fruits harvested
directly from
wild plants
Fruits are a
potential source
of antioxidants,
with possible
applications in
pharmacology,
medicine and
nutrition
Moderate
2 Carvalho et.al.,
2011 (24)
Journal of Food
Composition
and Analysis
Floresta
Nacional do
Araripe, CE,
Brazil
To investigate the
food potential of
14 wild legumes
from the
Caatinga
Randomized
experimental
study
N/A Energy,
macronutrients,
micronutrients
and presence of
antinutrients—
lecithin, trypsin
inhibitor, urease–
and toxic
substances
Analysis of
chemical
composition of
ripe wild seeds
collected in dry
season
Seeds have
nutritional relief
equal to or
greater than
those found in
conventional
legumes such as
beans and
soybeans
Strong
3 Cavalcanti;
Bora; Carvajal,
2009 (35)
Cienc.e Tec.de
Alimentos
Santa Luzia,
PB, Brazil
To characterize
functional
properties of the
protein isolate of
Cnidoscolus
quercifolius Pohl
almonds
Randomized
experimental
study
N/A Macronutrients
and functional
properties
(absorption
capacity,
emulsification and
solubility) of the
two varieties of
the plant
Analysis of
chemical
composition of
ground
almonds
High lipid and
protein content.
Potential for
nutritional
applications. The
thornless variety
showed better
water and oil
absorption
capacity
Moderate
4 Cruz et al.,
2014 (25)
Journal of
Ethnobiology
and
Ethnomedicine
Altinho, PE,
Brazil
To analyze
participants’
perceptions of
native edible
plants and relate
to socioeconomic
factors
Ethnobotanical,
observational,
cross-sectional
study
39 people,>
18 years old,
living in one
Caatinga
rural
community
Relationship
between the
perception of food
plants with their
use (number of
items used) and
socioeconomic
factors (age,
gender, income
and occupation)
Semi-
structured
interviews
Flavor was the
positive
perception most
associated with
use; cultural
acceptance,
negative.
Perceptions
directly related to
age and income
Strong
5 Cruz; Peroni;
Albuquerque,
2013 (26)
Journal of
Ethnobiology
and
Ethnomedicine
Altinho, PE,
Brazil
To relate
knowledge, use
and management
of wild edible
plants and
socioeconomic
factors
Ethnobotanical,
observational,
cross-sectional
study
39 people,>
18 years old,
living in one
Caatinga
rural
community
Relationship
between
knowledge, use,
and management
(number of items
known,
consumed,
preparations) with
socioeconomic
factors (age,
gender, income,
and occupation)
Semi-
structured
interviews
Knowledge is
related to age, but
not to occupation
and uses.
Association
between age and
use may indicate
abandonment of
the resource
Strong
(Continued)
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Table 1. (Continued )
Study
number
Data on
publication
(authors, year
and journal)
Setting Objective Design Participants Outcomes
investigated
Outcomes
measurement
method
Outcomes Quality
6 Nascimento
et al., 2011 (36)
Food Research
International
Altinho, PE,
Brazil
To determine
nutritional
composition of
native Caatinga
species
Randomized
experimental
study
N/A Energy,
macronutrients
and bioactive
compounds—
anthocyanins,
flavonoids and
carotenoids
Analysis of
chemical
composition of
plants, ripe
fruits
Plants with high
nutritional
potential. The
study points out
plants of interest
for future
research on
bioactive
compounds (e.g.,
Sideroxylon
obtusifolium
(Roem. &
Schult.) T.D.
Penn.
Strong
7 Nascimento et.
al., 2012 (38)
Economic
Botany
Altinho, PE,
Brazil
Collect
ethnobotanical
and nutritional
data on famine
foods
Mixed methods.
Phase 1:
Ethnobotanical,
observational,
cross-sectional
study. Phase 2:
Randomized
experimental
study
68 people,>
18 years old,
living in two
Caatinga
rural
communities
Phase 1:
Relationship
between
knowledge and
socioeconomic
factors. Phase 2:
Energy,
macronutrients
and bioactive
compounds from
the seven main
species
Free list and
semi-
structured
interview
There is a
difference in
knowledge
between
communities.
The data
demonstrate the
nutritional
potential of
Caatinga plants.
Mandevilla
tenuiflora (J.C.
Mikan) Woodson
is indicated for
future studies
Strong
8 Nascimento
et al., 2013 (27)
Ecology of Food
and Nutrition
Altinho, PE,
Brazil
To compare
traditional
knowledge
regarding food
plants in two
rural
communities in
the Caatinga
Ethnobotanical,
observational,
cross-sectional
study
68 people,>
18 years old,
living in two
Caatinga
rural
communities
Relationship
between
knowledge and
use of plants with
socioeconomic
factors, comparing
data from two
communities
Free list, semi-
structured
interview and
adapted
version of 24h
Recall
There is a
difference in
knowledge
between
communities.
Despite extensive
knowledge,
native species
have low
frequency of
consumption in
communities
Strong
9 Santos et al.,
2009 (28)
Economic
Botany
Altinho, PE,
Brazil
To analyze the
contribution of
anthropogenic
landscapes to
providing useful
botanical
resources
Ethnobotanical,
observational,
cross-sectional
study
15 people,>
18 years old,
living in one
Caatinga
rural
community
Species
distribution by
categories of use—
forage, medicinal,
food and timber
Semi-
structured
interviews and
“field
herbarium”
The study
presents 119
species. Forage
was the main
category. 10% of
the plants have
food use, among
them Senegalia
bahiensis
(Benth.) Seigler &
Ebinger
Strong
(Continued)
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Table 1. (Continued )
Study
number
Data on
publication
(authors, year
and journal)
Setting Objective Design Participants Outcomes
investigated
Outcomes
measurement
method
Outcomes Quality
10 Santos et al.,
2014 (29)
Economic
Botany
Crato, CE,
Brazil;
Caruaru,
PE, Brazil
To investigate the
usefulness of
invasive native
and exotic plants
for residents of
two different
communities
Ethnobotanical,
observational,
cross-sectional
study
106 people,>
18 years old,
living in two
Caatinga
rural
communities
Relate species
considered
invasive (native
and exotic) with
their local
perception of
usefulness
Semi-
structured
interviews and
plot method
for vegetation
sampling
55 of the 56 local
species
considered
invasive are
considered
useful.
Participants
mentioned 12%
of plants as food,
among them
Passiflora
cincinnata Mast
Strong
11 Ferraz et al.,
2012 (30)
Bosque
Floresta, PE,
Brazil
To know the
types of use of
woody vegetation
made by
indigenous
family farmers
Ethnobotanical,
observational,
cross-sectional
study
30 people,>
18 years old,
living in one
Caatinga
rural
community
Categories of use
of woody species
—food, fodder,
fuel, construction
Participant
observation
and semi-
structured
interviews
27 species
identified. Forage
was the main use
category. 11% of
the plants are
mentioned as
food, among
them Croton
blanchetianus
Baill
Moderate
12 Juvik et al.,
2017 (37)
Molecules
Petrolina,
PE, Brazil
To identify non-
polar
constituents of
Bromelia
laciniosa Mart. ex
Schult. & Schult.
f., Neoglaziovia
variegata
(Arruda) Mez
and Encholirium
spectabile Mart.
ex Schult. &
Schult.f.
Randomized
experimental
study
N/A Fatty acids and
their derivatives,
very long chain
alkanes, vitamins
(αand β-
tocopherol),
triterpenoids and
derivatives
Analysis of
chemical
composition of
plants
Plants with high
nutritional
potential.
Highlight for the
presence of
vitamin E and
phytosterols with
potential
beneficial health
effects
Strong
13 Medeiros;
Albuquerque,
2014 (33)
Journal of
Ethnobiology
and
Ethnomedicine
N/A To list the food
plants described
in Histo
´ria
Naturalis
Braziliae (Piso
and Marcgrave,
17th century)
with a focus on
the Caatinga
Ethnobotanical,
historical,
descriptive study
N/A Taxonomic
classification,
identification of
plant parts, forms
of consumption
and verification of
use over time
Historical
document
analysis and
databases
search
The use of 80
food species is
recommended,
such as Spondias
tuberosa Arruda
and Cereus
jamacaru DC.
Some lack
nutritional
studies
Strong
14 Nunes et al.,
2018 (31)
Journal of
Ethnobiology
and
Ethnomedicine
São
Mamede,
PB, Brazil;
Lagoa, PB,
Brazil;
Itaporanga,
PB, Brazil
To investigate the
knowledge of
food plants in
three
communities,
comparing
communities and
gender
Ethnobotanical,
observational,
cross-sectional
study
117
indigenous
farmers,>18
years old,
living in three
Caatinga
rural
communities
Comparison of
knowledge of
native plants in
the three
communities and
their relationship
with
socioeconomic
factors
Semi-
structured
interviews
26 food species
are mentioned,
especially
Spondias
tuberosa Arruda.
Knowledge of
residents of the
three
communities is
low
Strong
(Continued)
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These data correspond to 15 species of food plants since P.gounellei (xique-xique) and P.
pachycladus sub. Pernambucoensis (facheiro) had both cladodes and fruits analyzed and
consumed.
The indicators consisted mostly of energy data, macronutrients (protein, fat, carbohydrate),
dietary fiber, micronutrients (vitamin C, vitamin E, potassium, sodium, calcium, magnesium,
iron, zinc, manganese, copper, chromium, molybdenum), and bioactive compounds (caroten-
oids, flavonoids, anthocyanins). We compiled data for the items that had energy and protein
indicators available in the studies we reviewed. The complete list of these plants is available in
Table 3.
All species are native. Of this group of plants, D.grandiflora,H.courbaril,S.cearensis,L.fer-
rea, and S.obtusifolium have higher energy and protein values than the group average (Fig 2).
Three of these five species that lead the ranking are Fabaceae. Based on their nutritional
content, we highlight the value of legumes, within the set of strategic plants, as species that can
significantly contribute to improving the pattern of diets in the region. The plants that lead the
ranking are in Fig 3.
Legend reads clockwise from upper left: Flower, leaves, and seeds of D.grandiflora, by
Michelle Jacob. Pods of L.ferrea by Natalia Arau
´jo. Fruit of S.obtusifolium by Gilda
´sio Oli-
veira. Nut of S.cearensis by Michelle Jacob. H.courbaril by Neide Rigo.
In energy terms, the most significant contribution is from H.courbaril with 431 Kcal for
every 100 g of seeds. In protein, L.ferrea is ranked first, with approximately 43% protein in its
seeds. In total energy and protein, top ranked is D.grandiflora.
D.grandiflora is cited by Teixeira et al. [38] in her research on famine foods, that is, plants
used as food in times of scarcity. In her study, six people mentioned the use of the seeds of this
species in periods of extreme drought to produce flour, prepared as couscous. The consump-
tion of 100 g of mucunã seeds provides approximately 62% and 18% of the daily protein and
energy requirements, respectively [24].
Teixeira et al. [27], Cruz et al. [25,26] and Nunes et al. [31] reported the consumption of H.
courbaril, in rural communities in the semiarid regions of Pernambuco and Paraı
´ba. The
authors mentioned the use of fresh fruit, especially in the form of flour. The intake of 100 g of
this fruit contributes to about 22% of the daily requirements for both protein and energy [24].
L.ferrea is also reported by Nunes et al. [31], who described the use of seeds in the form of
flour in rural communities in the semiarid region of Paraı
´ba. For every 100 g of seeds, the pro-
tein supply is 42.7 g, which corresponds to more than 85% of the daily recommendation. In
Table 1. (Continued )
Study
number
Data on
publication
(authors, year
and journal)
Setting Objective Design Participants Outcomes
investigated
Outcomes
measurement
method
Outcomes Quality
15 Roque; Loiola,
2013 (32)
Revista
Caatinga
Caico
´, RN,
Brazil
To identify the
main categories
of use of native
plants in a rural
community in
the Caatinga
Ethnobotanical,
observational,
cross-sectional
study
23 local
experts, >35
years, living
in one
Caatinga
rural
community
Categories of use
of native species—
medicinal, food,
timber, mystical,
fuel, forage,
domestic use
Semi-
structured and
structured
interviews
The use of 69
species has been
described.
Medicinal
potential related
to almost 90% of
the plants.11%
were food, with
emphasis on
Ziziphus joazeiro
Mart. and S.
obtusifolium
Moderate
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Table 2. Synthesis of food plants and potentially edible plants occurring in the Caatinga.
Number Scientific name Popular name Reporting studies Origin Edible part Culinary uses
ANACARDIACEAE
1Commiphora leptophloeos (Mart.) J.B.
Gillett
umburana et (#14) native fruit raw (spice)
2Spondias tuberosa Arruda umbu; umbuzeiro; imbu et (#4 #5 #8 #9 #11
#13 #14)
native fruit; tuber;
leaf
raw (juice); cooked
(umbuzada
i
); preserve (jam)
APOCYNACEAE
3Mandevilla tenuifolia (J.C. Mikan)
Woodson
manofêet (#4 #5 #8); mx
(#7)
native tuber raw (salad; juice); preserve
(pickles)
AQUIFOLIACEAE
4Ilex paraguariensis L. erva-mate et (#8) native leaf na
ARECACEAE
5Copernicia prunifera (Mill.) H.E.
Moore
carnau
´ba et (#14 #15) native fruit raw
6Syagrus cearensis Noblick coco-catole
´; catole
´; coco-babão et (#4 #5 #8); fc
(#6)
native fruit na
7Syagrus coronata (Mart.) Becc. licuri; licurizeiro et (#13) native seed na
8Syagrus oleracea (Mart.) Becc. coco-catole
´et (#14) native fruit raw
BORAGINACEAE
9Varronia globosa (Jacq.) Kunth moleque-duro et (#8) native fruit na
BROMELIACEAE
10 Bromelia laciniosa Mart. ex Schult. &
Schult.f.
macambira; macambira-roxa;
macambira-de-porco
et (#8); fc (#12) native leaf cooked (flour/bread)
11 Encholirium spectabile Mart. ex Schult.
& Schult.f.
macambira-de-flexa; macambira-
de-pedra
mx (#7); et (#8); fc
(#12)
native leaf cooked (flour/couscous
ii
)
12 Neoglaziovia variegata (Arruda) Mez caroa
´fc (#12) native leaf; fruit leaf: cooked (flour/
couscous
ii
); fruit: cru
CACTACEAE
13 Cereus jamacaru DC. mandacaru; cardeiro; babão et (#4 #5 #8 #13
#15); fc (#6)
native cladode; fruit cladode: cooked; fruit: raw;
cooked; preserve
14 Melocactus zehntneri (Britton & Rose)
Luetzelb.
coroa-de-frade et (#8) native fruit na
15 Pilosocereus gounellei (F.A.C.Weber)
Byles & Rowley
xique-xique fc (#6); mx (#7); et
(#8 #15)
native cladode; fruit cooked (flour/couscous
ii
);
baked
16 Pilosocereus pachycladus subsp.
pernambucoensis (Ritter) Zappi
facheiro et (#4 #5 #8); fc
(#6)
native cladode; fruit raw; preserve (candy)
17 Tacinga inamoena (K.Schum.) N.P.
Taylor & Stuppy
cumbeba fc (#6); et (#8) native cladode; fruit raw; preserve (jam)
CAESALPINIACEAE
18 Bauhinia cheilantha (Bong.) Steud. mororo
´et (#8) native leaf; seed na
CAPPARACEAE
19 Capparis flexuosa (L.) L. feijão-de-boi et (#8) native seed na
20 Crataeva tapia L. trapia
´et (#4 #5 #8 #13
#14)
native fruit raw
21 Neocalyptrocalyx longifolium (Mart.)
Cornejo & Iltis
inco
´et (#4 #5 #8) native fruit na
CELASTRACEAE
22 Monteverdia rigida (Mart.) Biral bom-nome et (#8) native fruit na
EUPHORBIACEAE
23 Cnidoscolus quercifolius Pohl favela-branca; faveleira fc (#3); et (#11
#14)
native seed cooked (flour)
24 Cnidoscolus urens (L.) Arthur urtiga; cansanc¸ão et (#8) native seed na
(Continued)
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Table 2. (Continued )
Number Scientific name Popular name Reporting studies Origin Edible part Culinary uses
25 Croton blanchetianus Baill marmeleiro et (#11) native na na
26 Manihot dichotoma Ule. manic¸oba mx (#7); et (#8) native raw cooked (flour/beiju
iii
)
27 Manihot glaziovii Mu¨ll.Arg. purnunc¸a; manic¸oba mx (#7); et (#8
#13)
native raw cooked (flour/beiju
iii
)
28 Ricinus communis L. mamona; azeite et (#10) exotic leaf; flower;
fruit; seed
na
FABACEAE
raw Amburana cearensis (Allemão) A.C.
Sm.
cumaru et (#14) native fruit raw
30 Cajanus cajan (L.) Huth. feijão-guandu; feijão-andu et (#13) exotic seed cooked
31 Dimorphandra gardneriana Tul. fava-d’anta fc (#2) native seed na
32 Dioclea grandiflora Mart. ex Benth mucunãmx (#7) native seed cooked (flour/couscous
ii
)
33 Dioclea megacarpa Rolfe mucunã; olho-de-boi fc (#2) native seed na
34 Enterolobium contortisiliquum (Vell.)
Morong
orelha-de-macaco; orelha-de-negro fc (#2) native seed na
35 Erythrina velutina Willd. mulungu fc (#2) native seed cooked
36 Hymenaea courbaril L. jatoba
´#2 #4 #5 #8 #14 native fruit raw (flour)
37 Inga edulis Mart. inga
´et (#8) native fruit na
38 Lablab purpureus (L.) Sweet feijão-cabricuc¸o; mandatia #13 exotic fruit; flower cooked; raw
39 Libidibia ferrea (Mart. ex Tul.) L.P.
Queiroz
juca
´; pau-ferro #14 #2 native seed cooked (flour)
40 Lonchocarpus sericeus (Poir.) Kunth ex
DC.
inga
´fc (#2) native seed na
41 Parkia platycephala Benth. visgueiro fc (#2) native seed na
42 Phaseolus lunatus L. fava et (#8) exotic seed na
43 Piptadenia moniliformis Benth. catanduva fc (#2) native seed na
44 Pterogyne nitens Tul. madeira-nova fc (#2) native seed na
45 Senegalia bahiensis (Benth.) Seigler &
Ebinger
espinheiro et (#8) native fruit na
46 Senna obtusifolia (L.) H.S.Irwin &
Barneby
mata-pasto fc (#2) native seed na
47 Senna occidentalis (L.) Link manjiroba #9 native na na
48 Senna rugosa (G.Don) H.S.Irwin &
Barneby
lagarteiro fc (#2) native seed na
49 Caesalpinia bracteosa Tul. catingueira; catinga-de-porco fc (#2) native seed na
MYRTACEAE
50 Myrciaria cauliflora (C. Martius) O.
Berg
jabuticaba et (#8) native fruit na
51 Psidium schenckianum Kiaersk. pirim; arac¸a
´-do-cerrado et (#4 #5 #8); fc
(#6)
native fruit na
OLACACEAE
52 Ximenia americana L. ameixa-do-mato; ameixa-silvestre fc (#1); et (#14) native fruit raw (juice)
PASSIFLORACEAE
53 Passiflora cincinnata Mast. maracuja
´-do-mato; maracuja
´-
brabo; maracuja
´-de-boi; murucuja
´
et (#8 #10 #13) native fruit; flower;
leaf; seed
na
54 Passiflora foetida L. maracuja
´-de-estralo; canapu
´;
maracuja
´; maracuja
´-do-mato
et (#8 #9 #14 #15) native fruit raw
PIPERACEAE
55 Piper marginatum Jacq. capeba et (#13) native fruit raw (spice)
PORTULACACEAE
(Continued)
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energy, the contribution is around 12% [24]. These data highlight the potential nutritional
value of plants in this biome.
The other two species in our ranking are S.cearensis and S.obtusifolium. Cruz et al. [25,26]
and Nascimento et al. [27,36] reported S.cearensis consumption in rural communities of Caa-
tinga in the state of Pernambuco. The edible part is the fruit, without specification of culinary
use. Analysis of its endosperm reveals a contribution of 394 kcal for every 100 g of material
analyzed, which corresponds to almost 20% of the daily energy recommendation.
Several ethnobotanical studies in the semiarid region of Pernambuco, Paraı
´ba, and Rio
Grande do Norte [27,31,32,36] report the consumption of fresh fruit of S.obtusifolium. Its
energy, 212 kcal per 100 g, or approximately 11% of the daily recommendation, positions it as
a potential species to integrate into FNS programs in the region [36].
Although our analysis focuses on energy and protein, several plants on our list are signifi-
cant sources of antioxidants, such as S.obtusifolium analyzed by Teixeira et al. [39]. The same
author and her colleagues in a later study [38] analyzed the flavonoid content of D.grandilflora
and found significant quercetin values. These studies also highlight the content of bioactive
compounds from fruits of Cactacea species, such as P.pachycladus subsp. pernambucoensis
(facheiro), T.inamoena (cumbeba), and P.gounellei (xique-xique).
Table 2. (Continued )
Number Scientific name Popular name Reporting studies Origin Edible part Culinary uses
56 Portulaca oleracea L. beldroega; bredoe
´gua; caaponga et (#10 #13) exotic leaf; stalk;
flower
cooked
RHAMNACEAE
57 Ziziphus joazeiro Mart. jua
´; juazeiro fc (#6); et (#8 #14
#15)
native fruit raw
RUBIACEAE
58 Genipa americana L. genipapo; ianupaba; ienipapo et (#13) native fruit raw; preserve (liquor)
SAPINDACEAE
59 Talisia esculenta (Cambess.) Radlk. pitomba; nhua et (#8 #13) native fruit na
SAPOTACEAE
60 Sideroxylon obtusifolium (Roem. &
Schult.) T.D.Penn.
quixabeira; quixaba fc (#6); et (#8 #14
#15)
native fruit raw
SOLANACEAE
61 Physalis angulata L. canapu
´et (#15) exotic na na
62 Solanum agrarium Sendtn. gogo
´ia; melancia-da-praia et (#9 #15) native na na
63 Solanum americanum Mill. erva-moura; maria-pretinha et (#10) native leaf; fruit na
64 Solanum rytidoandrum Sendtn jurubeba; jurubeba-de-espinho;
espinho
et (#10) exotic leaf na
VERBENACEAE
65 Lantana camara L. chumbinho et (#9 #10) native stalk; flower;
leaf; fruit
na
#: revised study number (see Table 1)
na: not available
et: ethnobotanical study
fc: food composition study
mx: mixed method study.
i
Typical drink from the Northeast region, prepared with the fruit of the cooked umbu, mixed with milk, and sugar.
ii
Sweet or salty dish prepared with steamed vegetable flour.
iii
Cooked pasta dish prepared from vegetable flour of the genus Manihot.
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Discussion
The main objective of this SR was to identify plants occurring in the Caatinga that could be
strategic in the promotion of FNS. For this, we listed and characterized the species occurring
in the biome and produced a list of strategic plants with nutritional data. Based on our analysis,
we highlighted the energy and protein potential of native legumes.
Table 3. Nutritional data of strategic food plants to promote food and nutrition security in the Caatinga.
Food plant Part analyzed Energy
(Kcal)
i
Protein (g)
i
Protein energy
(Kcal)
Protein energy + energia
(Kcal)
Data
source
Dioclea grandiflora Mart. ex Benth seed 367 30,90 124 491 #7
Hymenaea courbaril L. fruit 431 10,9 44 475 #2
Syagrus cearensis Noblick endosperm 394 8,95 36 430 #6
Libidibia ferrea (Mart. ex Tul.) L.P.Queiroz seed 239 42,7 171 410 #2
Sideroxylon obtusifolium (Roem. & Schult.) T.D.Penn. fruit 212 2,86 11 223 #6
Psidium schenckianum Kiaersk. fruit 125 1,64 7 132 #6
Encholirium spectabile Mart. ex Schult. & Schult.f. leaf 125 0,70 3 127 #7
Pilosocereus gounellei (F.A.C.Weber) Byles & Rowley fruit 102 2,65 11 113 #6
Ziziphus joazeiro Mart. fruit 96 2,19 9 105 #6
Manihot dichotoma Ule. root 104 0,10 0 104 #7
Manihot glaziovii Mu¨ll.Arg. root 80 1,01 4 84 #7
Tacinga inamoena (K.Schum.) N.P.Taylor & Stuppy fruit 72 0,97 4 76 #6
Pilosocereus pachycladus (Ritter) Zappi subsp.
pernambucoensis
fruit 67 2,10 8 76 #6
Cereus jamacaru DC. fruit 64 1,80 7 71 #6
Mandevilla tenuifolia (J.C. Mikan) Woodson root 63 0,70 3 66 #7
Pilosocereus gounellei (F.A.C.Weber) Byles & Rowley cladode 28 0,40 2 30 #6
Pilosocereus pachycladus (Ritter) Zappi subsp.
pernambucoensis
cladode 25 0,25 1 26 #6
#: revised study number (see Table 1).
i
Reference Daily Intake– 2000 kcal and 50g of protein (39)
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Fig 2. Strategic biodiverse food plants to promote food and nutrition security.
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We believe that the species richness surveyed in this review (n65) underestimates the
potential of BFP in the Caatinga. A search of the Flora do Brazil database in February 2020, for
a listing of Angiosperms occurring in this environment, returns 4,890 species. Consider the
fact, for example, that of the eight ethnobotanical studies that we analyzed, five of them were
Fig 3. Top five food plants of strategic species ranking.
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performed in the same community (Carão, Altinho, PE). Our data possibly underestimate the
state of food biodiversity in the biome, because, in addition to having the same community as
a source of information, they do not include information on BFP from the provinces of Mar-
anhão, Piauı
´, Sergipe, and northern Minas Gerais, which are also areas of Caatinga. These geo-
graphic gaps strongly suggest the need for more ethnobotanical studies in the region.
The fact that most species are native indicates they could be positively related to sustainable
diets. We have at least five arguments to sustain this thesis. First, from the environmental
point of view, the native species listed as strategic are recognized for their ability to cope with
drought, requiring few water resources. The consumption of Euphorbiaceae roots, for exam-
ple, is typical in scenarios of water scarcity, since these plants can remain intact in the soil for a
long time, even in periods of drought [40]. Ecophysiology studies done with palm trees (Areca-
ceae) also describe species tolerant to water stress [41,42]. Similarly, Fabaceae have several
strategies for adapting to drought, including shortening the growth period, maintaining high
tissue water potential, reducing water loss, and improving water uptake [43]. About Fabaceae,
we realized that the three legumes leading our ranking are arboreal. Dubeux Ju
´nior et al. [44]
state that in the current climate change condition, tree legumes are an essential component for
strengthening FNS. One of the authors’ arguments is the resilience of these species, which tend
to be more perennial than most herbaceous legumes. This characteristic is relevant in areas of
the Caatinga, recognized by their long periods of rain scarcity.
Consequently, our second argument is that positive economic effects, such as saving water
inputs, tend to enhance the local supply of food to local communities, to facilitate the opening
of local-based markets, and to increase economic resilience in family farmers [45].
Third, nutritionally, low-diversity diets are a challenge to public health at a global level. As a
matter of availability, native plants have the potential to increase the diversity of food in local
communities [10]. Besides, encouraging conscious diets including native plants also is sup-
ported by an environmental argument: It is a path to make BFP known and, thus, increase pos-
sibilities for their conservation [46].
Fourth, there is a cultural reason. Native plants are part of the cultural heritage of local pop-
ulations. Preserving them means safeguarding the traditional knowledge associated with these
plants and, consequently, cultural diversity [47].
Finally, we add the fifth argument, which is political: food sovereignty. To food sovereignty,
native plants have both cultural and genetic heritage roles. Safeguarding native species, knowl-
edge associated with them, and biological property is part of the process of people taking con-
trol of their food heritage [48].
We do not disregard, however, that the introduction of exotic species may have a rational
basis, as proposed by Albuquerque et al. [49] with the diversification hypothesis. This hypothe-
sis posits that local systems can introduce exotic plants to expand the repertoire of communi-
ties. In the case of food, for example, naturalized exotic species, in the absence of native
species, can be rationally included to expand the diversity of diets and, consequently, their
quality.
The Fabaceae, among the plants we analyzed, are especially good for their nutritional qual-
ity. We add two points to the discussion on food legumes and nutrition: antinutritional factors
and protein quality.
First, presence of antinutritional factors (such as glucosinolates, trypsin inhibitors, hemag-
glutinins, tannins, phytates, and gossypol) is one of the biggest limitations on the use of
legumes by humans [50,51]. In the analysis by Carvalho et al. [24] antinutritional and toxic fac-
tors detected in legumes are not a problem for humans if the seeds are correctly processed.
They also argue that similar factors are present in popular legumes (e.g., beans and soybeans)
before the application of heat treatment. However, we argue that there are other
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phytochemicals with high toxicity not tested by the authors (e.g., alkaloids, cyanogenic glyco-
sides) that should be considered. For example, D.grandiflora is one of the plants that appear in
Carvalho’s study as potentially safe after processing. However, local communities [49] claim
that the consumption of this species can cause intestinal problems, or even death, due to its
toxicity. According to residents, in addition to heat treatment, one of the ways to mitigate, and
even eliminate these effects, is washing the flour several times before using it in food process-
ing [38]. Grant et al. [52] affirm that the exhaustive dialysis procedure of mucunã’s seed flour
helps to eliminate soluble components of small molecular weight potentially related to its tox-
icity. These data show the relevance of new studies to list compounds related to toxicity, as
well as studies to gather processing techniques used in local food systems (e.g., bleaching,
cooking, washing, fermentation, and dehydration, among others) to inactivate or reduce spe-
cies’ toxicity [5355]. We do not recommend the consumption of D.grandiflora and L.ferrea
until new research provides additional evidence.
A second point, which concerns protein quality: plant-based proteins have a lower anabolic
potential than those animal-based [56]. Two strategies can be useful to ensure the intake of
essential amino acids in plant-based diets: increase the intake of proteins and improve the
quality of those present in the diet [57]. The Acceptable Macronutrient Distribution Range
(AMDR) suggests that protein intake should provide between 10% and 35% of the daily dietary
calorie recommendation. Thus, a plant-based diet should be more aligned with the upper limit
of this recommendation, that is, 35%. To improve the quality of the ingested proteins, one of
the possibilities is to expand the diversity of plant proteins, blending species with different lim-
iting amino acids [57]. Diets that include a variety of vegetable protein sources consistently
demonstrate nutritional adequacy when it comes to providing sufficient amounts of essential
amino acids [58,59]. Because of these characteristics, the Food and Agriculture Organization
recommends that legumes should be consumed daily as part of a healthy diet, which simulta-
neously prevents undernutrition, obesity, and non-communicable diseases [60].
In addition to nutritional quality and the ability to adapt to water scarcity, we added three
other advantages that serve to consolidate the potential of legumes in the Caatinga region.
First, legumes’ potential to fix nitrogen in the soil enriches it without the need for commer-
cial chemical fertilizers and, consequently, offers economic and environmental advantages for
sustainable agriculture [61]. Second, legumes are related to smaller land footprints when com-
pared to vegetable proteins and, besides, they do not reduce their nutritional potential when
stored for long periods. Thus, they can simultaneously reduce indicators of food loss and food
waste [62]. Finally, the third reason is that legumes allow for various culinary applications,
ranging from stews and flours to dumplings, as is the case of acarajé (fried dumpling made
with beans, Vigna unguiculata (L. Walp., common in Bahia, Brazil), and desserts, like paçoca
(Brazilian candy made with peanuts, Arachis hypogaea L., common in the Southeast region).
The other two species in our ranking are S.cearensis and S.obtusifolium, which in addition
to their energy content, contribute with other nutrients. S.cearensis shows, for example, its fat
profile of 69.33 g or approximately 107% of the daily intake recommendation [63,39]. Also,
the species, being a typical palm that grows in semiarid regions, is a strategic source of provita-
min A for rural communities in the Caatinga [64]. Each 100 g of the endosperm contains 456
mcg of REA, which corresponds to approximately 91% of the daily needs established for
women and 73% for men [65]. Besides, the content of bioactive compounds of S.obtusifolium
corresponds to almost 12 times the amount of beta-carotene in acerola (Malpighia glabra L.),
83% of quercetin present in the same portion of red onions (Allium cepa L.), and ten times the
anthocyanins content found in jabuticaba (Myrciaria cauliflora (Mart.) O. Ber) [6668]. These
data reinforce the potential of native Brazilian flora as a source of nutrients and bioactive
compounds.
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However, studies report a decrease in consumption and knowledge associated with these
plants [2527,38]. We list here some reasons to explain this phenomenon. First, an increase in
temperature and a decrease in precipitation in the Caatinga is associated with the rise of
income transfer by government programs that, in turn, boosts the popularity of acquiring pro-
cessed food in supermarkets, leading to a decrease in the availability of food produced from
local plants [27,69]. Second, the dynamics of globalized agri-food systems tend to uniformity:
monocultures, concentration of supply and distribution centers, and monotonous dietary pat-
terns [70]. Thus, the closer these communities are to urban centers, the higher their permeabil-
ity to this process of standardization [71]. Third, there is a stigma related to these plants as
"poor people’s food" [25,38]. Cruz et al. [25], in her study of the perception about native plants
in Pernambuco, associated the consumption of these species with low social status. Thus, there
is a stigma related to their use. Other studies report the same stigma [38,72,73]. Together,
these factors collaborate to increase the presence of processed and ultra-processed food prod-
ucts in people’s diets, with negative impacts on their nutritional status [1,74]. These arguments
indicate the role of intersectoral FNS policies, which involve not only income transfer, but
access to food and nutrition education programs and policies to promote family farming and
local markets. The FNS implied by resilience and food sovereignty of local food systems is a
matter of intersectoral policies.
We started the paper, considering, above all, nutritional aspects of the plants listed in the
studies we analyzed. Thus, our ranking was created based on biological criteria. Human diets,
however, are complex and also involve cultural factors. Diets are located between nature and
culture, as the anthropologist Claude Le
´vi-Strauss asserted [75]. Considering this fact, we sug-
gest that campaigns to promote the use of BFP cannot be based only on the plant’s nutrient
profiles. They should also consider if the plants are recognized and appreciated by local cul-
ture. In this sense, we highlight H.courbaril and S.cearensis as crucial plants, as they are simul-
taneously in the ranking of strategic plants and among the most cited in studies.
Finally, we add that the promotion of these plants, in the context of food systems, also
depends on broader actions. Some of them are to integrate food biodiversity in government
policies and programs, to provide agricultural incentives to family farmers, to register tradi-
tional knowledge, to promote sustainable use of species with consumers, and to foster multi-
disciplinary research [76].
Limitations
First, the number of plants we examined was reduced by including only species with composi-
tion data available in the studies we reviewed. To analyze the others, we could have performed
Food Matching, a strategy to match composition data available in tables and other databases.
However, we made the decision not to perform it and focus our analysis on plants with data
available in the review, considering that the nutritional composition varies depending on envi-
ronmental and cultural factors (terroir, climate, soil) [77]. The authors who analyzed the plants
in the original studies collected them in the Caatinga, which allows us to recognize their real
contribution to local communities in nutritional terms. Another limitation was the lack of spe-
cific protocols for assessing the overall quality of observational ethnobotanical studies and
qualitative studies focusing on documentary analysis. To address this limitation, we used con-
solidated protocols, and adapted them. Finally, the third limitation is the fact that we set cutoff
points in the quality assessment, due to the lack of consensus in the literature on the issue. In
order to minimize biases, we analyzed review studies in relevant databases to adopt approxi-
mate assessment categories used in other studies.
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Conclusion
Based on this review, the food resources available in the Caatinga offer diversity and quality to
address the challenges posed in the characteristics of the region and by current food systems.
We suggest that scientific researchers focus their efforts on Fabaceae, especially tree legumes,
which, due to their physiological, nutritional, and culinary qualities, simultaneously articulate
human and environmental health, economic resilience, and sustainable agriculture. We advo-
cate the recognition of these plants as strategic in building a research agenda on food
biodiversity.
We highlight the need for researchers to collect information on culinary uses of species in
ethnobotanical studies on food plants. In our analysis, half of the studies did not present this
data. This information will make it possible for us to advance collectively in the discussion
about antinutritional factors and toxicity associated with these plants. In this sense, we also
emphasize the need for ethnoculinary studies with a focus on legumes.
The consumption of BFP is one of the pillars of sustainable diets. We hope that the data pre-
sented in this review can encourage the study of these plants. Thus, provided with evidence
about their potential and safety, we will be able to support the formulation of food and agricul-
ture policies, as well as sustainable diet guidelines based on local plants.
Supporting information
S1 Checklist. PRISMA 2009 checklist.
(DOC)
S1 File. Research strategy for systematic review.
(DOCX)
Acknowledgments
To Luciana Medeiros Souto (LMS) for her collaboration in data collection. To Ivanilda Soares
Feitosa for the support in checking occurrence data. To Samile Laura Dias Barros, Alice
Medeiros Souza, Giovanna Guadalupe Cordeiro de Oliveira, Andre
´Luiz Dadona Benedito,
Fillipe Oliveira Pereira, and Elias Jacob de Menezes Neto for having collaborated with the con-
struction of the methodology. We also thank Thiago Perez Jorge, Adriana Monteiro de
Almeida, Ce
´lia Marcia Medeiros Morais, Cle
´lia de Oliveira Lyra, Severina Carla Vieira Cunha
Lima, and Fernanda Antunes Carvalho for exchanging ideas in the construction of the
umbrella project. To teacher Jonathan that reviewed our English and polished our writing.
Author Contributions
Conceptualization: Michelle Cristine Medeiros Jacob, Maria Fernanda Arau
´jo de Medeiros,
Ulysses Paulino Albuquerque.
Data curation: Michelle Cristine Medeiros Jacob, Maria Fernanda Arau
´jo de Medeiros.
Formal analysis: Michelle Cristine Medeiros Jacob.
Investigation: Michelle Cristine Medeiros Jacob, Maria Fernanda Arau
´jo de Medeiros.
Methodology: Michelle Cristine Medeiros Jacob, Maria Fernanda Arau
´jo de Medeiros, Ulys-
ses Paulino Albuquerque.
Project administration: Michelle Cristine Medeiros Jacob.
Supervision: Ulysses Paulino Albuquerque.
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Writing original draft: Michelle Cristine Medeiros Jacob, Maria Fernanda Arau
´jo de
Medeiros.
Writing review & editing: Michelle Cristine Medeiros Jacob, Ulysses Paulino Albuquerque.
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PLOS ONE
Biodiverse food plants have unknown potential
PLOS ONE | https://doi.org/10.1371/journal.pone.0230936 May 7, 2020 24 / 24
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We conducted a floristic survey of Non-Conventional Food Plants (Plantas Alimentícias Não Convencionais (PANC)) on the trail of Travessia Petrópolis–Teresópolis in Serra dos Órgãos National Park, in the state of Rio de Janeiro, Brazil. Wild food plants with food potential were collected along a sinuous transect of 27 km in length and 3 m in width. The collected material was identified in virtual herbariums by specialists, and later, a literature review on the food use of the identified plants was carried out. Thus, 90 food and potential food species were identified, belonging to 54 genera and distributed in 34 families present along the trail, including the Asteraceae (10), Begoniaceae (9), Passifloraceae (8), Piperaceae (7), and Cactaceae (6) families, which showed the greatest species richness. We conclude that the diversity of the PANC found in a protected area demonstrates enormous potential for future domestication to produce food from the native flora of Brazil. Another potential use is in educational activities and pedagogical tourism, highlighting the gastronomic dimension of plant diversity present in protected areas.
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Wild food plants can contribute to improving the food and nutrition security of local populations by promoting diet diversification and increasing the intake of micro- and macronutrients. However, many of these plants are also used as timber. Wild food species need to be identified and their food–wood use interactions need to be well understood for the development of conservation strategies, as species with the potential to improve food and nutrition security may be threatened by destructive extraction. This systematic review recorded and compiled nutritional information on woody plant species native to Brazil that are used by local populations for food and timber purposes, seeking to identify which species have a high overlap between food and timber uses as well as a high nutritional potential. A total of 635 woody species with timber and/or food uses were identified. Of this total, at least 42 species find application in all timber use categories analyzed in this study, being considered versatile. Comparison of ethnobiological and nutritional data revealed nine versatile species for which nutritional composition information was available, among which three stood out in terms of macronutrient contents, namely Anacardium occidentale L., Bauhinia cheilantha (Bong.) Steud., and Eugenia pyriformis Cambess. Many versatile species classified as threatened or in decline have not been the focus of nutritional studies, which signals the need for greater nutritional research efforts. It is also necessary to investigate whether food importance exerts any protective effect on these species, reducing timber use pressure (protection hypothesis).
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Overlooked in national reports and in conservation programs, wild food plants (WFPs) have been a vital component of food and nutrition security for centuries. Recently, several countries have reported on the widespread and regular consumption of WFPs, particularly by rural and indigenous communities but also in urban contexts. They are reported as critical for livelihood resilience and for providing essential micronutrients to people enduring food shortages or other emergency situations. However, threats derived from changes in land use and climate, overexploitation and urbanization are reducing the availability of these biological resources in the wild and contributing to the loss of traditional knowledge associated with their use. Meanwhile, few policy measures are in place explicitly targeting their conservation and sustainable use. This can be partially attributed to a lack of scientific evidence and awareness among policymakers and relevant stakeholders of the untapped potential of WFPs, accompanied by market and non-market barriers limiting their use. This paper reviews recent efforts being undertaken in several countries to build evidence of the importance of WFPs, while providing examples of cross-sectoral cooperation and multi-stakeholder approaches that are contributing to advance their conservation and sustainable use. An integrated conservation approach is proposed contributing to secure their availability for future generations.
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Plant-sourced proteins offer environmental and health benefits, and research increasingly includes them in study formulas. However, plant-based proteins have less of an anabolic effect than animal proteins due to their lower digestibility, lower essential amino acid content (especially leucine), and deficiency in other essential amino acids, such as sulfur amino acids or lysine. Thus, plant amino acids are directed toward oxidation rather than used for muscle protein synthesis. In this review, we evaluate the ability of plant- versus animal-based proteins to help maintain skeletal muscle mass in healthy and especially older people and examine different nutritional strategies for improving the anabolic properties of plant-based proteins. Among these strategies, increasing protein intake has led to a positive acute postprandial muscle protein synthesis response and even positive long-term improvement in lean mass. Increasing the quality of protein intake by improving amino acid composition could also compensate for the lower anabolic potential of plant-based proteins. We evaluated and discussed four nutritional strategies for improving the amino acid composition of plant-based proteins: fortifying plant-based proteins with specific essential amino acids, selective breeding, blending several plant protein sources, and blending plant with animal-based protein sources. These nutritional approaches need to be profoundly examined in older individuals in order to optimize protein intake for this population who require a high-quality food protein intake to mitigate age-related muscle loss.
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Plant-based diets provide well-established physical and environmental health benefits. These benefits stem in part from the degree of restriction of animal-derived foods. Historically, meat and other animal-derived proteins have been viewed as an integral component of athletes’ diets, leading some to question the adequacy of vegetarian or vegan diets for supporting athletic performance. The purpose of this review is to examine the impact of plant-based diets on human physical health, environmental sustainability, and exercise performance capacity. Based on currently available literature, it is unlikely that plant-based diets provide advantages, but do not suffer from disadvantages, compared to omnivorous diets for strength, anaerobic, or aerobic exercise performance. However, plant-based diets typically reduce the risk of developing numerous chronic diseases over the lifespan and require fewer natural resources for production compared to meat-containing diets. As such, plant-based diets appear to be viable options for adequately supporting athletic performance while concurrently contributing to overall physical and environmental health. Given the sparse literature comparing omnivore, vegetarian, and vegan athletes, particularly at the elite level, further research is warranted to ascertain differences that might appear at the highest levels of training and athletic performance.
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Significance Current research linking biodiversity and human diets has used metrics without justification from a nutritional point of view. Diet species richness, or a count of the number of different species consumed per day, assesses both nutritional adequacy and food biodiversity of diets for women and children in rural areas. The positive association of food species richness with dietary quality was observed in both the wet and the dry season. Food biodiversity contributes to diet quality in vulnerable populations in areas with high biodiversity. Reporting the number of species consumed during dietary assessment provides a unique opportunity to cut across two critical dimensions of sustainable development—human and environmental health—and complements existing indicators for healthy and sustainable diets.
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Background Within systematic reviews, when searching for relevant references, it is advisable to use multiple databases. However, searching databases is laborious and time-consuming, as syntax of search strategies are database specific. We aimed to determine the optimal combination of databases needed to conduct efficient searches in systematic reviews and whether the current practice in published reviews is appropriate. While previous studies determined the coverage of databases, we analyzed the actual retrieval from the original searches for systematic reviews. Methods Since May 2013, the first author prospectively recorded results from systematic review searches that he performed at his institution. PubMed was used to identify systematic reviews published using our search strategy results. For each published systematic review, we extracted the references of the included studies. Using the prospectively recorded results and the studies included in the publications, we calculated recall, precision, and number needed to read for single databases and databases in combination. We assessed the frequency at which databases and combinations would achieve varying levels of recall (i.e., 95%). For a sample of 200 recently published systematic reviews, we calculated how many had used enough databases to ensure 95% recall. Results A total of 58 published systematic reviews were included, totaling 1746 relevant references identified by our database searches, while 84 included references had been retrieved by other search methods. Sixteen percent of the included references (291 articles) were only found in a single database; Embase produced the most unique references (n = 132). The combination of Embase, MEDLINE, Web of Science Core Collection, and Google Scholar performed best, achieving an overall recall of 98.3 and 100% recall in 72% of systematic reviews. We estimate that 60% of published systematic reviews do not retrieve 95% of all available relevant references as many fail to search important databases. Other specialized databases, such as CINAHL or PsycINFO, add unique references to some reviews where the topic of the review is related to the focus of the database. Conclusions Optimal searches in systematic reviews should search at least Embase, MEDLINE, Web of Science, and Google Scholar as a minimum requirement to guarantee adequate and efficient coverage. Electronic supplementary material The online version of this article (10.1186/s13643-017-0644-y) contains supplementary material, which is available to authorized users.
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For addressing potential food shortages, a fundamental tradeoff exists between investing more resources to increasing productivity of existing crops, as opposed to increasing crop diversity by incorporating more species. We explore ways to use local plants as food resources and the potential to promote food diversity and agricultural resilience. We discuss how use of local plants and the practice of local agriculture can contribute to ongoing adaptability in times of global change. Most food crops are now produced, transported, and consumed long distances from their homelands of origin. At the same time, research and practices are directed primarily at improving the productivity of a small number of existing crops that form the cornerstone of a global food economy, rather than to increasing crop diversity. The result is a loss of agro-biodiversity, leading to a food industry that is more susceptible to abiotic and biotic stressors, and more at risk of catastrophic losses. Humans cultivate only about 150 of an estimated 30,000 edible plant species worldwide, with only 30 plant species comprising the vast majority of our diets. To some extent, these practices explain the food disparity among human populations, where nearly 1 billion people suffer insufficient nutrition and 2 billion people are obese or overweight. Commercial uses of new crops and wild plants of local origin have the potential to diversify global food production and better enable local adaptation to the diverse environments humans inhabit. We discuss the advantages, obstacles, and risks of using local plants. We also describe a case study—the missed opportunity to produce pine nuts commercially in the Western United States. We discuss the potential consequences of using local pine nuts rather than importing them overseas. Finally, we provide a list of edible native plants, and synthesize the state of research concerning the potential and challenges in using them for food production. The goal of our synthesis is to support more local food production using native plants in an ecologically sustainable manner.
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Efforts have been made to understand the processes that lead to the introduction of exotic species into local pharmacopoeias. Among those efforts, the diversification hypothesis predicts that exotic plants are introduced in local medical systems to amplify the repertoire of knowledge related to the treatment of diseases, filling blanks that were not occupied by native species. Based on such hypothesis, this study aimed to contribute to this discussion using the context of local Brazilian populations. We performed a systematic review of Brazilian studies up to 2011 involving medicinal plants, excluding those studies that presented a high risk of bias (because of sampling or plant identification problems). An analysis of similarities (ANOSIM) was conducted in different scales to test for differences in the repertoire of therapeutic indications treated using native and exotic species. We have found that although there is some overlap between native and exotic plants regarding their therapeutic indications and the body systems (BSs) that they treat, there are clear gaps present, that is, there are therapeutic indications and BSs treated that are exclusive to exotic species. This scenario enables the postulation of two alternative unfoldings of the diversification hypothesis, namely, (1) exotic species are initially introduced to fill gaps and undergo subsequent expansion of their use for medical purposes already addressed using native species and (2) exotic species are initially introduced to address problems already addressed using native species to diversify the repertoire of medicinal plants and to increase the resilience of medical systems. The reasons why exotic species may have a competitive advantage over the native ones, the implications of the introduction of exotic species for the resilience of medical systems, and the contexts in which autochthonous plants can gain strength to remain in pharmacopoeias are also discussed.
Article
Executive summary Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. In the near future, the health effects of climate change will considerably compound these health challenges. Climate change can be considered a pandemic because of its sweeping effects on the health of humans and the natural systems we depend on (ie, planetary health). These three pandemics—obesity, undernutrition, and climate change—represent The Global Syndemic that affects most people in every country and region worldwide. They constitute a syndemic, or synergy of epidemics, because they co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers. This Commission recommends comprehensive actions to address obesity within the context of The Global Syndemic, which represents the paramount health challenge for humans, the environment, and our planet in the 21st century. The Global Syndemic Although the Commission's mandate was to address obesity, a deliberative process led to reframing of the problem and expansion of the mandate to offer recommendations to collectively address the triple-burden challenges of The Global Syndemic. We reframed the problem of obesity as having four parts. First, the prevalence of obesity is increasing in every region of the world. No country has successfully reversed its epidemic because the systemic and institutional drivers of obesity remain largely unabated. Second, many evidence-based policy recommendations to halt and reverse obesity rates have been endorsed by Member States at successive World Health Assembly meetings over nearly three decades, but have not yet been translated into meaningful and measurable change. Such patchy progress is due to what the Commission calls policy inertia, a collective term for the combined effects of inadequate political leadership and governance to enact policies to respond to The Global Syndemic, strong opposition to those policies by powerful commercial interests, and a lack of demand for policy action by the public. Third, similar to the 2015 Paris Agreement on Climate Change, the enormous health and economic burdens caused by obesity are not seen as urgent enough to generate the public demand or political will to implement the recommendations of expert bodies for effective action. Finally, obesity has historically been considered in isolation from other major global challenges. Linking obesity with undernutrition and climate change into a single Global Syndemic framework focuses attention on the scale and urgency of addressing these combined challenges and emphasises the need for common solutions. Syndemic drivers The Commission applied a systems perspective to understand and address the underlying drivers of The Global Syndemic within the context of achieving the broad global outcomes of human health and wellbeing, ecological health and wellbeing, social equity, and economic prosperity. The major systems driving The Global Syndemic are food and agriculture, transportation, urban design, and land use. An analysis of the dynamics of these systems sheds light on the answers to some fundamental questions. Why do these systems operate the way they do? Why do they need to change? Why are they so hard to change? What leverage points (or levers) are required to overcome policy inertia and address The Global Syndemic? The Commission identified five sets of feedback loops as the dominant dynamics underlying the answers to these questions. They include: (1) governance feedback loops that determine how political power translates into the policies and economic incentives and disincentives for companies to operate within; (2) business feedback loops that determine the dynamics for creating profitable goods and services, including the externalities associated with damage to human health, the environment, and the planet; (3) supply and demand feedback loops showing the relationships that determine current consumption practices; (4) ecological feedback loops that show the unsustainable environmental damage that the food and transportation systems impose on natural ecosystems; and (5) human health feedback loops that show the positive and negative effects that these systems have on human health. These interactions need to be elucidated and methods for reorienting these feedback systems prioritised to mitigate The Global Syndemic. Double-duty or triple-duty actions The common drivers of obesity, undernutrition, and climate change indicate that many systems-level interventions could serve as double-duty or triple-duty actions to change the trajectory of all three pandemics simultaneously. Although these actions could produce win-win, or even win-win-win, results, they are difficult to achieve. A seemingly simple example shows how challenging these actions can be. National dietary guidelines serve as a basis for the development of food and nutrition policies and public education to reduce obesity and undernutrition and could be extended to include sustainability by moving populations towards consuming largely plant-based diets. However, many countries' efforts to include environmental sustainability principles within their dietary guidelines failed due to pressure from strong food industry lobbies, especially the beef, dairy, sugar, and ultra-processed food and beverage industry sectors. Only a few countries (ie, Sweden, Germany, Qatar, and Brazil) have developed dietary guidelines that promote environmentally sustainable diets and eating patterns that ensure food security, improve diet quality, human health and wellbeing, social equity, and respond to climate change challenges. The engagement of people, communities, and diverse groups is crucial for achieving these changes. Personal behaviours are heavily influenced by environments that are obesogenic, food insecure, and promote greenhouse-gas emissions. However, people can act as agents of change in their roles as elected officials, employers, parents, customers, and citizens and influence the societal norms and institutional policies of worksites, schools, food retailers, and communities to address The Global Syndemic. Across systems and institutions, people are decision makers who can vote for, advocate for, and communicate their preferences with other decision-makers about the policies and actions needed to address The Global Syndemic. Within the natural ecosystems, people travel, recreate, build, and work in ways that can preserve or restore the environment. Collective actions can generate the momentum for change. The Commission believes that the collective influence of individuals, civil society organisations, and the public can stimulate the reorientation of human systems to promote health, equity, economic prosperity, and sustainability. Changing trends in obesity, undernutrition, and climate change Historically, the most widespread form of malnutrition has been undernutrition, including wasting, stunting, and micronutrient deficiencies. The Global Hunger Index (1992–2017) showed substantial declines in under-5 child mortality in all regions of the world but less substantial declines in the prevalence of wasting and stunting among children. However, the rates of decline in undernutrition for children and adults are still too slow to meet the Sustainable Development Goal (SDG) targets by 2030. In the past 40 years, the obesity pandemic has shifted the patterns of malnutrition. Starting in the early 1980s, rapid increases in the prevalence of overweight and obesity began in high-income countries. In 2015, obesity was estimated to affect 2 billion people worldwide. Obesity and its determinants are risk factors for three of the four leading causes of non-communicable diseases (NCDs) worldwide, including cardiovascular diseases, type 2 diabetes, and certain cancers. Extensive research on the developmental origins of health and disease has shown that fetal and infant undernutrition are risk factors for obesity and its adverse consequences throughout the life course. Low-income and middle-income countries (LMICs) carry the greatest burdens of malnutrition. In LMICs, the prevalence of overweight in children less than 5 years of age is rising on the background of an already high prevalence of stunting (28%), wasting (8·8%), and underweight (17·4%). The prevalence of obesity among stunted children is 3% and is higher among children in middle-income countries than in lower-income countries. The work of the Intergovernmental Panel on Climate Change (IPCC), three previous Lancet Commissions related to climate change and planetary health (2009–15), and the current Lancet Countdown, which is tracking progress on health and climate change from 2017 to 2030, have provided extensive and compelling projections on the major human health effects related to climate change. Chief among them are increasing food insecurity and undernutrition among vulnerable populations in many LMICs due to crop failures, reduced food production, extreme weather events that produce droughts and flooding, increased food-borne and other infectious diseases, and civil unrest. Severe food insecurity and hunger are associated with lower obesity prevalence, but mild to moderate food insecurity is paradoxically associated with higher obesity prevalence among vulnerable populations. Wealthy countries already have higher burdens of obesity and larger carbon footprints compared with LMICs. Countries transitioning from lower to higher incomes experience rapid urbanisation and shifts towards motorised transportation with consequent lower physical activity, higher prevalence of obesity, and higher greenhouse-gas emissions. Changes in the dietary patterns of populations include increasing consumption of ultra-processed food and beverage products and beef and dairy products, whose production is associated with high greenhouse-gas emissions. Agricultural production is a leading source of greenhouse-gas emissions. The economic burden of The Global Syndemic The economic burden of The Global Syndemic is substantial and will have the greatest effect on the poorest of the 8·5 billion people who will inhabit the earth by 2030. The current costs of obesity are estimated at about 2trillionannuallyfromdirecthealthcarecostsandlosteconomicproductivity.Thesecostsrepresent28Economiclossesattributabletoundernutritionareequivalentto112 trillion annually from direct health-care costs and lost economic productivity. These costs represent 2·8% of the world's gross domestic product (GDP) and are roughly the equivalent of the costs of smoking or armed violence and war. Economic losses attributable to undernutrition are equivalent to 11% of the GDP in Africa and Asia, or approximately 3·5 trillion annually. The World Bank estimates that an investment of 70billionover10yearsisneededtoachieveSDGtargetsrelatedtoundernutrition,andthatachievingthemwouldcreateanestimated70 billion over 10 years is needed to achieve SDG targets related to undernutrition, and that achieving them would create an estimated 850 billion in economic return. The economic effects of climate change include, among others, the costs of environmental disasters (eg, drought and wildfires), changes in habitat (eg, biosecurity and sea-level rises), health effects (eg, hunger and diarrhoeal infections), industry stress in sectors such as agriculture and fisheries, and the costs of reducing greenhouse-gas emissions. Continued inaction towards the global mitigation of climate change is predicted to cost 5–10% of global GDP, whereas just 1% of the world's GDP could arrest the increase in climate change. Actions to address The Global Syndemic Many authoritative policy documents have proposed specific, evidence-informed policies to address each of the components of The Global Syndemic. Therefore, the Commission decided to focus on the common, enabling actions that would support the implementation of these policies across The Global Syndemic. A set of principles guided the Commission's recommendations to enable the implementation of existing recommended policies: be systemic in nature, address the underlying causes of The Global Syndemic and its policy inertia, forge synergies to promote health and equity, and create benefits through double-duty or triple-duty actions. The Commission identified multiple levers to strengthen governance at the global, regional, national, and local levels. The Commission proposed the use of international human rights law and to apply the concept of a right to wellbeing, which encompasses the rights of children and the rights of all people to health, adequate food, culture, and healthy environments. Global intergovernmental organisations, such as the World Trade Organization, the World Economic Forum, the World Bank, and large philanthropic foundations and regional platforms, such as the European Union, Association of Southeastern Nations, and the Pacific Forum, should play much stronger roles to support national policies that address The Global Syndemic. Many states and municipalities are leading efforts to reduce greenhouse-gas emissions by incentivising less motorised travel and improving urban food systems. Civil society organisations can create a greater demand for national policy actions with increases in capacity and funding. Therefore, in addition to the World Bank's call for 70billionforundernutritionandtheGreenClimateFundof70 billion for undernutrition and the Green Climate Fund of 100 billion for LMICs to address climate change, the Commission calls for 1billiontosupporttheeffortsofcivilsocietyorganisationstoadvocateforpolicyinitiativesthatmitigateTheGlobalSyndemic.Aprincipalsourceofpolicyinertiarelatedtoaddressingobesityandclimatechangeisthepowerofvestedinterestsbycommercialactorswhoseengagementinpolicyoftenconstitutesaconflictofinterestthatisatoddswiththepublicgoodandplanetaryhealth.Counteringthispowertoassureunbiaseddecisionmakingrequiresstrongprocessestomanageconflictsofinterest.Onthebusinessside,newsustainablemodelsareneededtoshiftoutcomesfromaprofitonlymodeltoasociallyandenvironmentallyviableprofitmodelthatincorporatesthehealthofpeopleandtheenvironment.ThefossilfuelandfoodindustriesthatareresponsiblefordrivingTheGlobalSyndemicreceivemorethan1 billion to support the efforts of civil society organisations to advocate for policy initiatives that mitigate The Global Syndemic. A principal source of policy inertia related to addressing obesity and climate change is the power of vested interests by commercial actors whose engagement in policy often constitutes a conflict of interest that is at odds with the public good and planetary health. Countering this power to assure unbiased decision making requires strong processes to manage conflicts of interest. On the business side, new sustainable models are needed to shift outcomes from a profit-only model to a socially and environmentally viable profit model that incorporates the health of people and the environment. The fossil fuel and food industries that are responsible for driving The Global Syndemic receive more than 5 trillion in annual subsidies from governments. The Commission recommends that governments redirect these subsidies into more sustainable energy, agricultural, and food system practices. A Framework Convention on Food Systems would provide the global legal structure and direction for countries to act on improving their food systems so that they become engines for better health, environmental sustainability, greater equity, and ongoing prosperity. Stronger accountability systems are needed to ensure that governments and private-sector actors respond adequately to The Global Syndemic. Upstream monitoring is needed to measure implementation of policies, examine the commercial, political, economic and sociocultural determinants of obesity, evaluate the impact of policies and actions, and establish mechanisms to hold governments and powerful private-sector actors to account for their actions. Similarly, platforms for stakeholders to interact and secure funding, such as that provided by the EAT Forum for global food system transformation, are needed to allow collaborations of scientists, policy makers, and practitioners to co-create policy-relevant empirical, and modelling studies of The Global Syndemic and the effects of double-duty and triple-duty actions. Bringing indigenous and traditional knowledge to this effort will also be important because this knowledge is often based on principles of environmental stewardship, collective responsibilities, and the interconnectedness of people with their environments. The challenges facing action on obesity, undernutrition, and climate change are closely aligned with each other. Bringing them together under the umbrella concept of The Global Syndemic creates the potential to strengthen the action and accountabilities for all three challenges. Our health, the health of our children and future generations, and the health of the planet will depend on the implementation of comprehensive and systems-oriented responses to The Global Syndemic.
Article
The scope of this article was to estimate the prevalence of severe food insecurity (SFI) in Brazilian municipalities in 2013. A logistic regression model was used to predict SFI. To construct the model, the 2013 National Household Sample Survey (PNAD) was used. SFI was measured using the Brazilian Food Insecurity Scale (EBIA). The final model was applied to the 2010 Census, predicting the municipal prevalence. The highest prevalence values were concentrated in the North and Northeast of Brazil, which also showed the highest municipality prevalence disparities. The highest municipal prevalence value of SFI was in the state of Maranhão and the lowest in Rio Grande do Sul. Maranhão was also the State with the largest intrastate disparities in the prevalence of SFI. Spatial analysis showed a higher prevalence of SFI in the North and Northeast regions. Acre had 100% of its municipalities presenting a very high prevalence of SFI. By contrast in the State of São Paulo, 59.1% of the municipalities have a low prevalence of SFI. The prevalence of municipal SFI was higher in Brazil’s North and Northeast and there were major disparities in intraregional and intrastate distribution. These prevalence values could assist in improving the targeting of policies to combat food insecurity in Brazil. © 2018, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.