[Show abstract][Hide abstract] ABSTRACT: Objectives To determine the relationship between global dietary energy availability and dietary quality, and nutrition-related health outcomes.
Design A worldwide longitudinal modelling study using country-level data. Data on total dietary energy availability and dietary energy from 10 distinct food groups (as a proxy for dietary quality) were obtained from the FAO Food Balance Sheets database. Indicators of development were abstracted from the World Bank's World Development Indicators database. Data on nutrition and health outcomes were taken from the WHO mortality database and major cross-country analyses. We investigated associations of energy availability from food groups and health and nutrition outcomes in the combined data set using mixed effects models, while adjusting for measures of development.
Population 124 countries over the period 1980–2009.
Main outcome measures Prevalence of stunting in children under 5 years and mortality rate from ischaemic heart disease (IHD) in adults aged 55+ years.
Results From 1980 to 2009, global dietary energy availability increased, and rates of child stunting and adult IHD mortality declined. After adjustment for measures of development, increased total dietary energy availability was significantly associated with reduced stunting rates (−0.84% per 100 kcal increase in energy, 95% CI −0.97 to −0.72) and non-significantly associated with increased IHD mortality rates (by 4.2 deaths per 100 000/100 kcal increase, 95% CI −1.85 to 10.2). Further analysis demonstrated that the changing availability of energy from food groups (particularly fruit, vegetables, starchy roots, meat, dairy and sugar) was important in explaining the associations with health outcomes.
Conclusions Our study has demonstrated that by combining large, publicly available data sets, important patterns underlying trends in diet-related health can be uncovered. These associations remain even after accounting for measures of development over a 30-year period. Further work and joined-up multisectoral thinking will be required to translate these patterns into policies that can improve nutrition and health outcomes globally.
[Show abstract][Hide abstract] ABSTRACT: Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals.
Full-text · Article · Nov 2015 · Advances in Nutrition
[Show abstract][Hide abstract] ABSTRACT: Low vitamin B12 status is common in older people; however, its public health significance in terms of neurological manifestations remains unclear. The present systematic review evaluated the association of vitamin B12 status with neurological function and clinically relevant neurological outcomes in adults aged 50+ years. A systematic search of nine bibliographic databases (up to March 2013) identified twelve published articles describing two longitudinal and ten cross-sectional analyses. The included study populations ranged in size (n 28-2287) and mean/median age (range 65-81 years). Studies reported various neurological outcomes: nerve function; clinically measured signs and symptoms of nerve function; self-reported neurological symptoms. Studies were assessed for risk of bias, and results were synthesised qualitatively. Among the general population groups of older people, one longitudinal study reported no association, and four of seven cross-sectional studies reported limited evidence of an association of vitamin B12 status with some, but not all, neurological outcomes. Among groups with clinical and/or biochemical evidence of low vitamin B12 status, one longitudinal study reported an association of vitamin B12 status with some, but not all, neurological outcomes and three cross-sectional analyses reported no association. Overall, there is limited evidence from observational studies to suggest an association of vitamin B12 status with neurological function in older people. The heterogeneity and quality of the evidence base preclude more definitive conclusions, and further high-quality research is needed to better inform understanding of public health significance in terms of neurological function of vitamin B12 status in older people.
No preview · Article · Jul 2015 · The British journal of nutrition
[Show abstract][Hide abstract] ABSTRACT: More than one-fifth of the United Kingdom population has poor vitamin D status (serum 25-hydroxyvitamin D [25(OH)D] concentration <25 nmol/L), particularly individuals with low sun exposure or poor dietary intake.
We identified the fortification vehicle and concentration most likely to safely increase population vitamin D intakes and vitamin D status.
Wheat flour and milk were identified as primary fortification vehicles for their universal consumption in population groups most at risk of vitamin D deficiency including children aged 18-36 mo, females aged 15-49 y, and adults aged ≥65 y. With the use of data from the first 2 y (2008-2010) of the National Diet and Nutrition Survey Rolling Program, we simulated the effect of fortifying wheat flour and milk with vitamin D on United Kingdom food consumption. Empirically derived equations for the relation between vitamin D intake and the serum 25(OH)D concentration were used to estimate the population serum 25(OH)D concentration for each fortification scenario.
At a simulated fortification of 10 μg vitamin D/100 g wheat flour, the proportion of at-risk groups estimated to have vitamin D intakes below United Kingdom Reference Nutrient Intakes was reduced from 93% to 50%, with no individual exceeding the United Kingdom tolerable upper intake level; the 2.5th percentile of the population winter serum 25(OH)D concentration rose from 20 to 27 nmol/L after fortification. The simulation of the fortification of wheat flour at this concentration was more effective than that of the fortification of milk (at concentrations between 0.25 and 7 mg vitamin D/100 L milk) or of the fortification of milk and flour combined.
To our knowledge, this study provides new evidence that vitamin D fortification of wheat flour could be a viable option for safely improving vitamin D intakes and the status of United Kingdom population groups at risk of deficiency without increasing risk of exceeding current reference thresholds.
No preview · Article · Jul 2015 · American Journal of Clinical Nutrition
[Show abstract][Hide abstract] ABSTRACT: Moderate vitamin B-12 deficiency is relatively common in older people. However, there is little robust evidence on the effect of vitamin B-12 supplementation on neurologic and cognitive outcomes in later life.
We investigated whether vitamin B-12 supplementation benefits neurologic and cognitive function in moderately vitamin B-12-deficient older people.
We conducted a double-blind, randomized, placebo-controlled trial in 7 general practices in South East England, United Kingdom. Study participants were aged ≥75 y and had moderate vitamin B-12 deficiency (serum vitamin B-12 concentrations: 107-210 pmol/L) in the absence of anemia and received 1 mg crystalline vitamin B-12 or a matching placebo as a daily oral tablet for 12 mo. Peripheral motor and sensory nerve conduction, central motor conduction, a clinical neurologic examination, and cognitive function were assessed before and after treatment.
A total of 201 participants were enrolled in the trial, and 191 subjects provided outcome data. Compared with baseline, allocation to vitamin B-12 was associated with a 177% increase in serum concentration of vitamin B-12 (641 compared with 231 pmol/L), a 331% increase in serum holotranscobalamin (240 compared with 56 pmol/L), and 17% lower serum homocysteine (14.2 compared with 17.1 μmol/L). In intention-to-treat analysis of covariance models, with adjustment for baseline neurologic function, there was no evidence of an effect of supplementation on the primary outcome of the posterior tibial compound muscle action potential amplitude at 12 mo (mean difference: -0.2 mV; 95% CI: -0.8, 0.3 mV). There was also no evidence of an effect on any secondary peripheral nerve or central motor function outcome, or on cognitive function or clinical examination.
Results of the trial do not support the hypothesis that the correction of moderate vitamin B-12 deficiency, in the absence of anemia and of neurologic and cognitive signs or symptoms, has beneficial effects on neurologic or cognitive function in later life. This trial was registered at www.isrctn.com as ISRCTN54195799.
Full-text · Article · Jul 2015 · American Journal of Clinical Nutrition
[Show abstract][Hide abstract] ABSTRACT: Dietary changes which improve health are also likely to be beneficial for the environment by reducing emissions of greenhouse gases (GHG). However, previous analyses have not accounted for the potential acceptability of low GHG diets to the general public. This study attempted to quantify the health effects associated with adopting low GHG emission diets in the UK.
Epidemiological modelling study.
Adoption of diets optimised to achieve the WHO nutritional recommendations and reduce GHG emissions while remaining as close as possible to existing dietary patterns.
Changes in years of life lost due to coronary heart disease, stroke, several cancers and type II diabetes, quantified using life tables.
If the average UK dietary intake were optimised to comply with the WHO recommendations, we estimate an incidental reduction of 17% in GHG emissions. Such a dietary pattern would be broadly similar to the current UK average. Our model suggests that it would save almost 7 million years of life lost prematurely in the UK over the next 30 years and increase average life expectancy by over 8 months. Diets that result in additional GHG emission reductions could achieve further net health benefits. For emission reductions greater than 40%, improvements in some health outcomes may decrease and acceptability will diminish.
There are large potential benefits to health from adopting diets with lower associated GHG emissions in the UK. Most of these benefits can be achieved without drastic changes to existing dietary patterns. However, to reduce emissions by more than 40%, major dietary changes that limit both acceptability and the benefits to health are required.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
[Show abstract][Hide abstract] ABSTRACT: The UK has committed to reduce greenhouse gas (GHG) emissions by 80 % relative to 1990 levels by 2050, and it has been suggested that this should include a 70 % reduction in emissions from food. Meeting this target is likely to require significant changes to diets, but the likely effect of these changes on population nutritional intakes is currently unknown. However, the current average UK diets for men and women do not conform to WHO dietary recommendations, and this presents an opportunity to improve the nutritional content of diets while also reducing the associated GHG emissions. The results of this study show that if, in the first instance, average diets among UK adults conformed to WHO recommendations, their associated GHG emissions would be reduced by 17 %. Further GHG emission reductions of around 40 % could be achieved by making realistic modifications to diets so that they contain fewer animal products and processed snacks and more fruit, vegetables and cereals. However, our models show that reducing emissions beyond 40 % through dietary changes alone will be unlikely without radically changing current consumption patterns and potentially reducing the nutritional quality of diets.
[Show abstract][Hide abstract] ABSTRACT: The quantity as well as the quantity of diets is essential in tackling both undernutrition and NCDs. Availability of some foods (fruits in particular) is associated with reductions in both undernutrition and chronic disease.
[Show abstract][Hide abstract] ABSTRACT: Food composition tables require updating regularly to keep abreast of the periodic reformulation of fortified foods and dietary supplements. This paper describes a process undertaken to update the vitamin D content of fortified foods and supplements consumed in the UK, and the impact this may have on reported vitamin D intake.In 2011, the vitamin D content of the 289 vitamin D fortified foods and vitamin D containing supplements recorded in the National Diet and Nutrition Survey (NDNS) Nutrient Databank (last updated in 2008) was compared to data from industry websites, trade associations and manufacturers, and nutrition labelling on pack. Typical ‘overages’ (the additional amount added to account for any processing loss or degradation) applied during vitamin D fortification were also obtained. This information was used to update the NDNS Nutrient Databank, and applied to NDNS food consumption data (2008/2010) to determine the impact of the composition update on reported population vitamin D intakes.Up-to-date vitamin D values were obtained for 257 (89%) of the 289 items in the NDNS databank; the remainder were no longer available on the market. The vitamin D content of 31 (11%) of the items had changed, and these were most commonly breakfast cereals, fat spreads and powdered malt drinks. A further eight food items were identified as newly fortified with vitamin D. Calculation of mean vitamin D intakes using updated data identified that use of out-of-date food composition data may lead to an underestimation of UK vitamin D intakes of around 3% (0.1 μg/day). When a blanket 12.5% ‘overage’ was applied to all items, this underestimate increased to 6% (0.2 μg/day).Even though the absolute impact of updating the vitamin D content of fortified foods and supplements on population mean intakes is relatively small, our analysis suggests it is important that nutrient databases are regularly updated. The new estimates of the vitamin D content of foods and supplements should be used for future estimates of vitamin D intake in the UK until a further periodic update is conducted.
No preview · Article · Sep 2014 · Nutrition Bulletin
[Show abstract][Hide abstract] ABSTRACT: We have previously reported low concentrations of plasma ascorbate and low dietary vitamin C intake in the older Indian population and a strong inverse association of these with cataract. Little is known about ascorbate levels in aqueous humor and lens in populations habitually depleted of ascorbate and no studies in any setting have investigated whether genetic polymorphisms influence ascorbate levels in ocular tissues. Our objectives were to investigate relationships between ascorbate concentrations in plasma, aqueous humor and lens and whether these relationships are influenced by Single Nucleotide Polymorphisms (SNPs) in sodium-dependent vitamin C transporter genes (SLC23A1 and SLC23A2). We enrolled sixty patients (equal numbers of men and women, mean age 63 years) undergoing small incision cataract surgery in southern India. We measured ascorbate concentrations in plasma, aqueous humor and lens nucleus using high performance liquid chromatography. SLC23A1 SNPs (rs4257763, rs6596473) and SLC23A2 SNPs (rs1279683 and rs12479919) were genotyped using a TaqMan assay. Patients were interviewed for lifestyle factors which might influence ascorbate. Plasma vitamin C was normalized by a log10 transformation. Statistical analysis used linear regression with the slope of the within-subject associations estimated using beta (β) coefficients. The ascorbate concentrations (μmol/L) were: plasma ascorbate, median and inter-quartile range (IQR), 15.2 (7.8, 34.5), mean (SD) of aqueous humor ascorbate, 1074 (545) and lens nucleus ascorbate, 0.42 (0.16) (μmol/g lens nucleus wet weight). Minimum allele frequencies were: rs1279683 (0.28), rs12479919 (0.30), rs659647 (0.48). Decreasing concentrations of ocular ascorbate from the common to the rare genotype were observed for rs6596473 and rs12479919. The per allele difference in aqueous humor ascorbate for rs6596473 was −217 μmol/L, p < 0.04 and a per allele difference in lens nucleus ascorbate of −0.085 μmol/g, p < 0.02 for rs12479919. The β coefficients for the regression of log10 plasma ascorbate on aqueous humor ascorbate were higher for the GG genotype of rs6596473: GG, β = 1460 compared to carriage of the C allele, CG, β = 1059, CC, β = 1132, p interaction = 0.1. In conclusion we found that compared to studies in well-nourished populations, ascorbate concentrations in the plasma, aqueous humor and lens nucleus were low. We present novel findings that polymorphisms in SLC23A1/2 genes influenced ascorbate concentration in aqueous humor and lens nucleus.
No preview · Article · Jul 2014 · Experimental Eye Research
[Show abstract][Hide abstract] ABSTRACT: Background: Elevated plasma homocysteine is a risk factor for Alzheimer disease, but the relevance of homocysteine lowering to slow the rate of cognitive aging is uncertain.
Objective: The aim was to assess the effects of treatment with B vitamins compared with placebo, when administered for several years, on composite domains of cognitive function, global cognitive function, and cognitive aging.
Design: A meta-analysis was conducted by using data combined from 11 large trials in 22,000 participants. Domain-based z scores (for memory, speed, and executive function and a domain-composite score for global cognitive function) were available before and after treatment (mean duration: 2.3 y) in the 4 cognitive-domain trials (1340 individuals); Mini-Mental State Examination (MMSE)–type tests were available at the end of treatment (mean duration: 5 y) in the 7 global cognition trials (20,431 individuals).
Results: The domain-composite and MMSE-type global cognitive function z scores both decreased with age (mean ± SE: −0.054 ± 0.004 and −0.036 ± 0.001/y, respectively). Allocation to B vitamins lowered homocysteine concentrations by 28% in the cognitive-domain trials but had no significant effects on the z score differences from baseline for individual domains or for global cognitive function (z score difference: 0.00; 95% CI: −0.05, 0.06). Likewise, allocation to B vitamins lowered homocysteine by 26% in the global cognition trials but also had no significant effect on end-treatment MMSE-type global cognitive function (z score difference: −0.01; 95% CI: −0.03, 0.02). Overall, the effect of a 25% reduction in homocysteine equated to 0.02 y (95% CI: −0.10, 0.13 y) of cognitive aging per year and excluded reductions of >1 mo per year of treatment.
Conclusion: Homocysteine lowering by using B vitamins had no significant effect on individual cognitive domains or global cognitive function or on cognitive aging.
Full-text · Article · Jun 2014 · American Journal of Clinical Nutrition
[Show abstract][Hide abstract] ABSTRACT: Increasing prevalence of overweight and obesity has led policy-makers to consider health-related taxes to limit the consumption
of unhealthy foods and beverages. Such taxes are currently already in place in countries in Europe (e.g. Hungary, France and
Finland) and in various states in the USA. Although these taxes are possibly efficient in reducing by a small amount the consumption
of targeted products if the tax is fully transmitted to the consumer, there is too little available evidence on what will
be consumed instead and whether these food substitutions undermine the hoped-for health benefits of the tax. We also know
very little on how the food supply side will respond and what overall impact this will have. Without a proper appreciation
of the potential indirect impacts we do not know the overall impact of taxes foods on unhealthy foods and beverages and further
that there is a very real possibility that they may not be beneficial for health after all.
No preview · Article · May 2014 · Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: Objective
To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases.Methods
For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.ResultsIn 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 million diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group.Conclusions
This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.
Full-text · Article · Apr 2014 · Tropical Medicine & International Health
[Show abstract][Hide abstract] ABSTRACT: Despite some recent progress, the global burden of undernutrition remains high and falls disproportionately on women and young children. In Asia and Africa approximately 10% of women have a low body mass index (a measure of body thinness), an estimated 165 million children under the age of five years are stunted (too short for their age) and 52 million children under the age of five years are wasted (dangerously thin). Undernutrition is a cause of 3.1 million child deaths annually, equivalent to 45% of all child deaths in 2011. It has lifelong negative consequences on the health, development and wellbeing of children, and cripples the economic growth and development of nations.
Current expert consensus suggests that a set of specific nutrition interventions if delivered at scale could reduce the rate of stunting by 20% and the rate of child mortality by 15%. There is a growing interest in identifying whether agricultural interventions can reduce the burden of undernutrition.
A developed agriculture sector can improve nutrition and health outcomes directly, for example, through the production and consumption by small-scale farmers of an energy sufficient and nutritionally diverse diet, or indirectly, for example through changing the price of foods through increased market supply, or through enhanced household and national income by means of increased agricultural productivity. Agriculture may also have negative impacts on health and wellbeing, for example through higher work-loads (especially for women), raised risks of environmental contamination, and increased potential for infection with diseases which are transferable from animals to humans.
Evidence paper scope
This evidence paper provides a critical review of the strength and quality of the evidence base linking agriculture-based interventions and nutrition outcomes. In total, 38 studies published over the period 1980-2013 are included: 15 on home gardens, five on aquaculture, six on livestock, eight on cash crops and eight on biofortified crops (some studies address more than one intervention). The evidence base is derived roughly equally from Africa and Asia with one study from Latin America.
The primary nutrition outcomes of interest are biochemical measures of micronutrient (vitamin and mineral) status and measures of physical growth in childhood. The review also reports on multiple secondary outcomes including dietary consumption, income and morbidity.
Summary of findings
In general, the agricultural interventions reviewed in this evidence paper have inconsistent or mixed effects on nutritional outcomes in women and children, although there is evidence for a positive impact of biofortified crops on micronutrient status in children. The review recognises that the evidence base on which these conclusions are drawn is limited in both size and quality. Significant research efforts are currently underway that may provide robust evidence further to inform these conclusions.
Specific findings on primary outcomes
Home garden interventions:
- effect on micronutrient status is inconsistent (7 studies)
- effect on child growth is inconsistent (7 studies)
- effect on maternal iron status is mixed (1 study)
- effect on child growth is inconsistent (2 studies)
- no evidence of an effect on micronutrient status (2 studies)
- effect on child growth is inconsistent (4 studies)
- no studies report effect on micronutrient status
- effect on child growth is inconsistent (7 studies)
- evidence of positive effect on micronutrient status in children (3 studies)
- effect on micronutrient status in women is mixed (2 studies)
- moderate evidence of positive effect on child growth (3 studies).
[Show abstract][Hide abstract] ABSTRACT: Background: For the poor, a diverse, locally acceptable, nutrient-rich food supply is often inaccessible, leading to the consumption of low quality diets. Value chain analysis (VCA) has been proposed to support the identification of solutions to food supply problems, however little evidence of its usefulness for this purpose exists. This case study aimed to determine how fruit and vegetable value chains in Fiji where poor diets and high rates of diet-related disease have been identified contribute to product accessibility and acceptability in urban areas and to assess the benefit of VCA in identifying opportunities for intervention. Methods: Focus groups were used to establish the fruit and vegetable attributes acceptable to and valued by consumers. Following this, a series of workshops, interviews, and observations with chain actors and stakeholders were used to map three exemplar fruit and vegetable chains and assess their ability to make acceptable and valued fresh products accessible to the urban population. Results: Urban Fijians are motivated to consume fresh, local produce, but often find the supply to be inconsistent, low quality, and unaffordable. Value chain characteristics that contribute to these supply challenges include poor infrastructure (e.g. roads and water supplies), limited access to agricultural inputs, sub-optimal post-harvest care and handling, and strained relationships between chain actors. Discussion: Several points in the exemplar chains where targeted intervention could lead to improved accessibility and acceptability were identified. These findings suggest a benefit to the use of VCA as a tool for identifying promising solutions to nutrition problems.
[Show abstract][Hide abstract] ABSTRACT: We employ a single-country dynamically-recursive Computable General Equilibrium model to make health-focussed macroeconomic assessments of three contingent UK Greenhouse Gas (GHG) mitigation strategies, designed to achieve 2030 emission targets as suggested by the UK Committee on Climate Change. In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures are included; our household energy efficiency strategy is likely to breakeven only over the long term after the investment programme has ceased (beyond our 20 year time horizon). We conclude that UK policy makers will, most likely, have to adopt elements which involve initial net societal costs in order to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote internalization of externalities. Health co-benefits can play a crucial role in bringing down net costs, but our results also suggest the need for adopting holistic assessment methodologies which give proper consideration to welfare-improving health co-benefits with potentially negative economic repercussions (such as increased longevity).
Electronic supplementary material
The online version of this article (doi:10.1007/s10584-013-0881-6) contains supplementary material, which is available to authorized users.