Our future: a Lancet commission on adolescent health and wellbeing

Childhood stunting is the best overall indicator of children's well-being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below -2 SD from the length-for-age/height-for-age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length-for-age/height-for-age z-score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post-natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.12231

Childhood stunting: a global perspective.

Food and Agriculture Organization (FAO) The Food and Agriculture Organization (FAO), established in 1945, is a UN specialized agency that provides global data and expertise on agri­ culture and nutrition, fisheries, forestry, and other food and agriculture– related issues. FAO is the UN system’s largest autonomous agency, with headquarters in Rome, 78 country offices and 15 regional, sub–regional, and liaison offices, including one located in Washington, D.C. FAO’s highest policy–making body, the biennial General Conference, comprises all 183 FAO member countries plus the European Commission. The General Conference determines FAO policy and approves FAO’s reg­ ular program of work and budget. The 31st Conference, meeting in November 1999, re–elected Director–General Jacques Diouf (Senegal) to a second six–year term through December 2005. Each biennial Confer­ ence elects a 49–member Council that meets semi–annually to make rec­ ommendations to the General Conference on budget and policy issues. The North America region, which comprises the United States and Can­ ada, is allocated two seats on the Council and one seat each on FAO’s Program, Finance, and Constitutional and Legal Matters (CCLM) Com­ mittees. The United States holds the North American seats on the Finance and Joint Staff Pension Committees through December 2003. Canada holds the North American seat on the CCLM and Program Committees through December 2003. The United States participated at the World Food Summit: Five Years Later meeting held at FAO headquarters June 10–13, 2002, to discuss progress towards attaining the 1996 World Food Summit target of reduc­ ing the world’s number of hungry and malnourished by half by 2015. The United States presented new initiatives to improve agriculture productivity as a significant contribution toward meeting that goal. U.S. Secretary of Agriculture Ann Veneman, leading the U.S. delegation, joined other min­ isters and heads of state and government in adopting a Declaration, “The International Alliance Against Hunger,” which reiterated the goals of the 1996 World Food Summit and stated, inter alia, “we are committed to

https://www.jstage.jst.go.jp/article/jve1997/7/2/7_2_107/_pdf

Food and Agriculture Organization (FAO) ホームページの活用法

Undernutrition and micronutrient malnutrition remain problems of significant magnitude in large parts of the developing world. Improved nutrition requires not only better access to food for poor population segments, but also higher dietary quality and diversity. Because many of the poor and undernourished people are smallholder farmers, diversifying production on these smallholder farms is widely perceived as a useful approach to improve dietary diversity. However, empirical evidence on the link between production and consumption diversity is scarce. Here, this issue is addressed with household-level data from Indonesia, Kenya, Ethiopia, and Malawi. Regression models show that on-farm production diversity is positively associated with dietary diversity in some situations, but not in all. When production diversity is already high, the association is not significant or even turns negative, because of foregone income benefits from specialization. Analysis of other factors reveals that market access has positive effects on dietary diversity, which are larger than those of increased production diversity. Market transactions also tend to reduce the role of farm diversity for household nutrition. These results suggest that increasing on-farm diversity is not always the most effective way to improve dietary diversity in smallholder households and should not be considered a goal in itself. Additional research is needed to better understand how agriculture and food systems can be made more nutrition-sensitive in particular situations.

https://www.pnas.org/content/pnas/112/34/10657.full.pdf

Production diversity and dietary diversity in smallholder farm households

An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short- and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.

/pdf/contextualising-complementary-feeding-in-a-broader-framework-pxwesbctnw.pdf

Contextualising complementary feeding in a broader framework for stunting prevention

In Ghana, stunting rates in children below 5 years of age vary regionally Dietary fatty acids (FAs) are crucial for linear growth The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2⁻6 years of age A drop of blood was collected on an antioxidant treated card and analyzed for FA composition Weight and height were measured and z-scores calculated Relationships between FAs and growth were analyzed by linear regressions and factor analysis Of the 209 subjects, 22% were stunted and 106% were essential FA deficient (triene/tetraene ratio > 002) Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p < 0001) Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions

Association of Whole Blood Fatty Acids and Growth in Southern Ghanaian Children 2–6 Years of Age

Household food insecurity but not dietary diversity is associated with children's mean micronutrient density adequacy in rural communities across Ghana.

The contribution of Street Foods (SF) to the energy and nutrient intakes of young children in rural African communities has been understudied. Under the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project, a microcredit and nutrition education intervention with caregivers of children 2-to 5-years old in rural Ghana, the prevalence of SF consumption by young children and the contribution SF make to children’s energy, nutrient and Animal Source Food (ASF) intakes were assessed. A simple random sample of 172 caregiver-child pairs residing in the ENAM intervention communities in Winneba and Techiman municipalities participated in this study. A semi-structured questionnaire was used to interview caregivers about SF purchased for their 2- to 5-years old children in the previous week. During two non-consecutive 12-hour home observations, all foods consumed by a subsample of the children (n=45) were weighed. Energy and nutrient content of weighed foods were estimated using the Ghanaian food composition table. About 80% of caregivers purchased SF for their child at least once that previous week. Most (76%) SF purchased were grain-based and were purchased as complete meals. The children’s total ASF intake was 69.9 ± 11.0 g; quantity of ASF consumed was similar but their sources of ASF differed between the two municipalities. In Techiman, SF contributed 36% of the ASF consumed over the two observation days compared to 4.2% in Winneba (P=0.003). Overall, SF contributed 35% of energy, 43% of vitamin A, 20% of vitamin B12, 30% of zinc, 34% of iron, and 54% of calcium consumed by children. The contribution of SF to young children’s dietary intakes, especially their ASF intakes and hence micronutrient intakes, may improve overall dietary quality. This study provides evidence that, SF is an important part of children’s diets in rural Ghana and could be an important target for food-based interventions to enhance nutrition in young children.

/pdf/street-foods-contribute-to-nutrient-intakes-among-children-soht8w3alo.pdf

Street foods contribute to nutrient intakes among children from rural communities in Winneba and Techiman municipalities, Ghana

Background. Low caregiver income and poor nutrition knowledge and skills are important barriers to achieving optimal child feeding in rural Ghana. OBJECTIVE: An integrated microcredit and nutrition education intervention was implemented to address these barriers. METHODS: Using a quasi-experimental design 134 caregivers of children 2 to 5 years of age in six intervention communities were enrolled into self-selected savings and loan groups. They received small individual loans over four 16-week cycles to support their income-generating activities. Nutrition and entrepreneurial education was provided during weekly loan repayment meetings. Another 261 caregivers in six comparison communities did not receive the intervention. Data on household sociodemographic and economic characteristics perception of income-generating activity profits and childrens consumption of animal-source foods in the previous week were collected at baseline and at four additional time points. Differences according to group (intervention vs. control) and time (baseline vs. endline) were analyzed with chi-square and Students t-tests. RESULTS: The intervention and comparison groups did not differ by caregivers age and formal education; few (35) had previous experience with microcredit loans. At endline more intervention than comparison caregivers perceived that their business profits had increased (59% vs. 23% p < .001). In contrast to comparison children after 16 months of intervention children consumed more livestock meat (p =.001) organ meat (p = .04) eggs (p = .001) and milk and milk products (p < .0001) in the previous week in comparison with baseline. CONCLUSIONS: Integrated food-centered strategies can improve childrens diets which will enhance their nutritional status health and cognitive outcomes.

Esi K Colecraft

Papers

Association of Whole Blood Fatty Acids and Growth in Southern Ghanaian Children 2–6 Years of Age

Household food insecurity but not dietary diversity is associated with children's mean micronutrient density adequacy in rural communities across Ghana.

Street foods contribute to nutrient intakes among children from rural communities in Winneba and Techiman municipalities, Ghana

Community interventions for dietary improvement in Ghana.

Contribution of animal source foods to total iron intake of children in coastal Ghana