evidence-based blog of Filippo Dibari

Posts Tagged ‘review’

Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence

In Under-nutrition on June 3, 2019 at 9:49 am

by Jef L LeroyEdward A Frongillo on Advance in Nutrition journal

Advances in Nutrition, Volume 10, Issue 2, March 2019, Pages 196–204,


The past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition.

Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting.

Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting.

First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker.

Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value.

In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy.

We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.

Literature Review and Institutional Analysis: Toward an Integrated Approach for Addressing Malnutrition in Zambia (IFPRI)

In Under-nutrition on August 28, 2012 at 8:09 pm

by Jody Harris and Scott Drimie

IFPRI Discussion Paper 01200 – August 2012



Due to the predominance of direct, specific interventions in nutrition for development, the health sector tends to own nutrition, with interventions customarily implemented through health programs. That the agriculture sector should also be a vehicle for improved nutrition is intuitive, but this sector often delivers neither good nutrition nor food security to the most vulnerable in the population. The complex and multisectoral nature of malnutrition may explain why it has not been effectively addressed, even though we know many of the solutions; intersectoral action is critical to addressing this complexity, but to date there is no consensus on how intersectoral solutions are best implemented or institutionalized. This review brings together experiences from across Sub-Saharan Africa in order to draw out recommendations for improved intersectoral implementation going forward, and assesses how these findings apply specifically to the Zambian context.

The experiences reviewed suggest three broad barriers to intersectoral collaboration for nutrition: low political commitment and mobilization; sector-bound organizational structures and weak coordinating bodies; and lack of human resources and capacity. Key lessons for improved intersectoral implementation include the role of advocacy in framing the problem in context and highlighting mutual gains for different sectors, to create the political will and working space for nutrition action; the importance of organizational arrangements, including convening or coordinating bodies with multisectoral credibility to facilitate mobilizing and resourcing power; and the importance of building not only technical but also strategic capacity to manage multisectoral relationships for improved nutrition outcomes. Ultimately, these solutions will have to be tailored to country contexts.

Zambia is an ideal candidate for a country that could make a significant impact on its malnutrition problem. With the emergence of the Scaling Up Nutrition (SUN) movement in the country, nutrition has received some high-level political attention, and the multi-sectoral nature of nutrition is recognized in overarching development policies and strategies. However, political attention has not moved into concrete action, and nutrition strategies, policies, and plans are essentially wish lists noting best practice, confined mainly to the health sector, created with substantial input from external actors, and without the backing of political commitment, budgetary or human resources, or capacity; implementation of these grand ideas is severely lacking. Several vital but attainable processes would improve intersectoral coordination for nutrition in Zambia and enable its potentially strong policy to be implemented across sectors. These include strategic lobbying for real political and social commitment to nutrition in sectors outside of health; strengthening the National Food and Nutrition Commission both in terms of its power to convene the different actors and the strategic capacity of its leadership; and improved technical training outside of core nutrition competencies in nutrition workers in general. These recommendations are interlinked; one cannot happen without the other, and all are necessary but not sufficient to improve the nutrition situation in Zambia. Movement should start in all areas at once, and the high-level momentum created by the SUN movement is an opportunity, providing the potential for cross-sectoral dialogue and increased resources, that should not be missed.

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Taste preferences and food intake

In Over-nutrition on May 16, 2012 at 8:03 am

Annual Review of Nutrition, Vol. 17: 237-253

Drewnowski A. (1997).


“Sensory responses to the taste, smell, and texture of foods help determine food preferences and eating habits. However, sensory responses alone do not predict food consumption. The view that a “sweet tooth” leads to obesity through excess sugar consumption is overly narrow. In reality, there are multiple links between taste perceptions, taste preferences, food preferences, and food choices and the amount of food consumed. Taste responses are influenced by a range of genetic, physiological, and metabolic variables. The impact of taste factors on food intake further depends on sex and age and is modulated by obesity, eating disorders, and other pathologies of eating behavior. Food preferences and food choices of populations are further linked to attitudinal, social, and—probably most important—economic variables such as income. Nutrition education and intervention strategies aimed at improving population diets ought to consider sensory pleasure response to foods, in addition to a wide range of demographic and socio-cultural variables.”

My comment: this paper has profoundly influenced my understanding of how taste preferences may increase or decrease the intake of lipid based, ready-to-use food in the management of undernutrition, chronic, acute, and/or due to infections (HIV/TB).

Essential fats for mothers and infants: Another dimension of dietary quality

In Under-nutrition on May 14, 2012 at 11:07 am

Publication Date: Thursday, May 3, 2012 from Alive and Thrive.

by Bineti Vitta and Kathryn Dewey

“This technical brief explains how the Intake of essential fats in the last trimester of pregnancy and the first 2 years after birth is critical for the development of the brain and nervous system”.

Click here to download the report. More Technical Briefs and Papers are available here.

How ready-to-use therapeutic food shapes a new technological regime to treat child malnutrition

In Under-nutrition on May 13, 2012 at 7:19 am

José GuimónPablo Guimón

on Technological Forecasting and Social Change, 2012 – Elsevier


“Since the turn of the 21st century ready-to-use therapeuticfood (RUTF) has emerged as the preferred solution to treat acute malnutrition without complications. RUTF is a more appropriate technology than formerly prevalent powdered milk solutions because it enables outpatient care, simpler treatment protocols and production in the field. In this paper we analyze the forces driving the diffusion of RUTF as an innovation to treat child malnutrition and discuss the main features characterizing the new technological regime that results from its wide adoption. We combine the theoretical discussion and the review of secondary sources with insights from field research in Ethiopia, encompassing personal interviews with relevant parties and direct observation of how RUTF works in practice. This technology assessment exercise enables us to suggest some opportunities for policy intervention.”

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