evidence-based blog of Filippo Dibari

Posts Tagged ‘health’

Nature: “Global diets link environmental sustainability and human health”

In Over-nutrition, Under-nutrition on November 20, 2014 at 11:03 am

by David Tilman & Michael Clark

From Nature – 12 November 2014


Diets link environmental and human health. Rising incomes and urbanization are driving a global dietary transition in which traditional diets are replaced by diets higher in refined sugars, refined fats, oils and meats.

By 2050 these dietary trends, if unchecked, would be a major contributor to an estimated 80 per cent increase in global agricultural greenhouse gas emissions from food production and to global land clearing.

Moreover, these dietary shifts are greatly increasing the incidence of type II diabetes, coronary heart disease and other chronic non-communicable diseases that lower global life expectancies.

Alternative diets that offer substantial health benefits could, if widely adopted, reduce global agricultural greenhouse gas emissions, reduce land clearing and resultant species extinctions, and help prevent such diet-related chronic non-communicable diseases.

The implementation of dietary solutions to the tightly linked diet–environment–health trilemma is a global challenge, and opportunity, of great environmental and public health importance.

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LSHTM: free online training on “Agriculture, Nutrition and Health”

In Uncategorized on September 3, 2014 at 7:21 pm

from the the web site of the London School Hygiene and Tropical Medicine:

Enhancing Nutrition: A New Tool for Ex-Ante Comparison of Commodity-based Vouchers and Food Transfers

In Under-nutrition on September 26, 2013 at 2:25 pm

by David Ryckembusch, Romeo Frega, Marcio Guilherme Silva, Ugo Gentilini, Issa Sanogo, Nils Grede, and Lynn Brown

from World Development, Volume 49, September 2013, Pages 58–67

(download for free here)


This article presents a new analytical tool for ex-ante comparison of the cost-effectiveness of two transfer modalities in pursuing specific nutritional objectives. It does so by introducing a metric to score the nutrient value of a food basket—the Nutrient Value Score (NVS)—and explains how this metric can be combined with full supply chain analysis and costing to generate a new tool, the Omega Value. The use of the Omega Value allows policy-makers who design a program with nutrition objectives to compare direct food transfers and commodity-based food vouchers in terms of both cost efficiency and cost effectiveness.

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What linear programming contributes: world food programme experience with the “cost of the diet” tool.

In Under-nutrition on July 14, 2013 at 9:41 am

by Frega RLanfranco JGDe Greve SBernardini SGeniez PGrede NBloem Mde Pee S.

Food Nutr Bull. 2012 Sep;33(3 Suppl):S228-34.

Background – Linear programming has been used for analyzing children’s complementary feeding diets, for optimizing nutrient adequacy of dietary recommendations for a population, and for estimating the economic value of fortified foods.

Objective – To describe and apply a linear programming tool (“Cost of the Diet”) with data from Mozambique to determine what could be cost-effective fortification strategies.

Methods – Based on locally assessed average household dietary needs, seasonal market prices of available food products, and food composition data, the tool estimates the lowest-cost diet that meets almost all nutrient needs. The results were compared with expenditure data from Mozambique to establish the affordability of this diet by quintiles of the population.

Results – Three different applications were illustrated: identifying likely “limiting nutrients,” comparing cost effectiveness of different fortification interventions at the household level, and assessing economic access to nutritious foods. The analysis identified iron, vitamin B2, and pantothenic acid as “limiting nutrients.” Under the Mozambique conditions, vegetable oil was estimated as a more cost-efficient vehicle for vitamin A fortification than sugar; maize flour may also be an effective vehicle to provide other constraining micronutrients. Multiple micronutrient fortification of maize flour could reduce the cost of the “lowest-cost nutritious diet” by 18%, but even this diet can be afforded by only 20% of the Mozambican population.

Conclusions – Within the context of fortification, linear programming can be a useful tool for identifying likely nutrient inadequacies, for comparing fortification options in terms of cost effectiveness, and for illustrating the potential benefit of fortification for improving household access to a nutritious diet.

You can find more posts about linear programming clicking here.

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Anthropometric predictors of mortality in undernourished adults in the Ajiep Feeding Programme in Southern Sudan

In Under-nutrition on July 8, 2013 at 8:03 pm

In Uncategorized on July 8, 2013 at 8:00 pm

by Abel H Irena, David A Ross, Peter Salama, and Steve Collins

Am J Clin Nutr August 2013


Background: Various nutritional assessment tools are available to assess adult undernutrition, but few are practical in poorly served areas of low-income countries.

Objective: The objective was to assess the relation between midupper arm circumference (MUAC), weight, body mass index (BMI), and clinical assessment for edema in predicting mortality in adults with severe acute undernutrition.

Design: Demographic and anthropometric data that were collected in an observational study of 197 adults were analyzed. Participants were aged 18–59 y and were admitted to a therapeutic feeding center in Ajiep, Southern Sudan, during the height of the 1998 famine. Receiver operating curves were calculated and compared.

Results: The mean (±SD) age of the participants was 40.1 ±10.8 y, and the mean (±SD) MUAC, weight, and BMI (in kg/m2) were 16.4 ± 1.3 cm, 35.1 ± 5.2 kg, and 12.6 ± 1.5, respectively. The area under the receiver operating curve for MUAC (0.71) was higher (P = 0.01) than those of BMI (0.57) and weight (0.51). Mean age, weight, and BMI on admission did not differ between survivors and nonsurvivors (P > 0.17). MUAC and edema were independently associated with mortality. For every 1-cm increase in admission MUAC, the odds of subsequent mortality decreased by 58% (adjusted OR: 0.42; 95% CI: 0.28, 0.63; P < 0.001).

Conclusions: In this study, which was conducted at the height of a major famine among adults with extremely severe grades of undernutrition, MUAC and edema were better indicators of short-term prognosis than was BMI. Further studies are needed to define a critical MUAC threshold for the diagnosis of acute adult undernutrition.

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New on The Lancet: Maternal and Child Nutrition

In Over-nutrition, Under-nutrition on June 8, 2013 at 6:33 am

from The Lancet website – Published June 6, 2013

Executive summary

Maternal and child undernutrition was the subject of a Series of papers in The Lancet in 2008. Five years after the initial series, we re-evaluate the problems of maternal and child undernutrition and also examine the growing problems of overweight and obesity for women and children, and their consequences in low-income and middle-income countries. Many of these countries are said to have the double burden of malnutrition: continued stunting of growth and deficiencies of essential nutrients along with the emerging issue of obesity. We also assess national progress in nutrition programmes and international efforts toward previous recommendations. Read the entire Executive Summary here.

For more about this new Lancet Series click here.

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The State of Food and Agriculture 2013: Food systems for better nutrition

In Over-nutrition, Under-nutrition on June 4, 2013 at 8:19 pm

From the FAO web site.

Malnutrition in all its forms – undernutrition, micronutrient deficiencies, and overweight and obesity – imposes unacceptably high economic and social costs on countries at all income levels. Improving nutrition and reducing these costs requires a multisectoral approach that begins with food and agriculture and includes complementary interventions in public health and education. The traditional role of agriculture in producing food and generating income is fundamental, but the entire food system – from inputs and production, through processing, storage, transport and retailing, to consumption – can contribute much more to the eradication of malnutrition.

Agricultural policies and research must continue to support productivity growth for staple foods while paying greater attention to nutrient-dense foods and more sustainable production systems. Traditional and modern supply chains can enhance the availability of a variety of nutritious foods and reduce nutrient waste and losses. Governments, international organizations, the private sector and civil society can help consumers choose healthier diets, reduce waste and contribute to more sustainable use of resources by providing clear, accurate information and ensuring access to diverse and nutritious foods.

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Nutrition for a Better Tomorrow: Scaling Up Delivery of Micronutrient Powders for Infants and Young Children

In Under-nutrition on April 19, 2013 at 10:55 am

Results for Development Institute

By Kanika Bahl, Emilia Toro, Claire Qureshi, and Pooja Shaw

Click to download the summary or the entire document.



The Relevance of Micronutrients to the Prevention of Stunting

In Under-nutrition on April 16, 2013 at 9:17 pm

Ellie Souganidis, Johns Hopkins University School of Medicine

(download the paper)

stunted children

Key messages from the paper:

01. Previous studies investigating the role of micronutrient supplements such as vitamin A and zinc in combating stunting have failed to establish a clear connection.

02. The focus of research has therefore expanded to include multiple micronutrient interventions and other comprehensive approaches.

03. It has been proposed that in populations with multiple micronutrient deficiencies, the effect of multiple micronutrient supplementation on linear growth will be more significant than single nutrient supplementation.

04. However, the results of multiple micronutrient intervention studies have also been mixed.

05. The variable success of single and multiple micronutrient interventions in improving linear growth have encouraged the development of new multifaceted approaches.

06. These strategies typically address holistic nutritional issues, as well as combating disease.

07. Because stunting is more difficult to reverse after 36 months of age, such comprehensive approaches require participation from the mother and the child.

08. Further research is necessary to better understand the various factors that contribute to stunting.

09. Ultimately, stunting cannot be adequately addressed without taking into account socioeconomic factors such as disease and poverty.

10. Nonetheless, the role of nutrition continues to warrant additional attention.

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Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

In Under-nutrition on April 13, 2013 at 8:03 am

Engy Alia, Rony Zachariaha, Zubair Shamsb, Lieven Vernaeveb, Petra Aldersc, Flavio Saliob,  Marcel Manzia, Malik Allaounac, Bertrand Draguezc, Pascale Delchevaleriec and Anthony D. Harries

Trans R Soc Trop Med Hyg (2013)


Objectives Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<–3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality.

Methods Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored.

Results Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to <115 mm (5/9 children), weight loss ≥10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of <–3. Cough was less frequent among those whose nutritional status improved.

Conclusions It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.

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