Using Nuclear Techniques to Assess the Role of Nutrition-Sensitive Agri-Food Systems in Improving Diet, Health and Nutritional Status of Vulnerable Populations
Closed for proposals
Project Type
Project Code
E43029CRP
1987Approved Date
Start Date
Expected End Date
Completed Date
13 November 2019Description
The proposed CRP will contribute to better understanding of the effect of nutrition-sensitive agri-food systems on the diet, health, and nutritional status of vulnerable populations. These findings will inform stakeholders influencing public health and agricultural policies in the design of effective interventions to combat malnutrition in all its forms. Malnutrition is a significant public health problem in low- and middle-income countries. It includes both undernutrition, especially among women and children, as well as overnutrition, leading to overweight and obesity. Improving health and nutrition of vulnerable populations will require not only direct “nutrition-specific” interventions, but also indirect “nutrition-sensitive” action addressing the underlying determinants of nutrition and inputs from multiple sectors. Nutrition-sensitive, biodiverse, and sustainable agri-food systems improve nutritional status through increased access to and consumption of high quality diets; however there is a need for further research in this area that includes rigorous design and appropriate measurement techniques for assessing health and nutritional impacts. Body composition divides weight into fat mass and fat-free mass and, compared to total body weight, will provide a more sensitive means of assessing changes in nutritional status in response to nutrition-sensitive agricultural interventions and changes in consumption. It can thus help to improve or optimize intervention strategies and understand the impact of dietary transitions. The deuterium dilution stable isotope technique, which will be used in this CRP, is among the most accurate techniques for assessing body composition. It involves the estimation of fat-free mass by measuring total body water (TBW) and provides reliable information on changes in body composition in individuals. This CRP will provide important information on the role of structural outcome measures such as body composition in understanding the link between agriculture and nutrition and in strengthening the evidence in support of nutrition-sensitive agricultural policies and practices. Studies to be included in this CRP may be stand-alone projects, or, perhaps more appropriately, build on existing research agendas (e.g. added on to a larger study). Doctoral students are encouraged to participate.
Objectives
To provide the evidence base of the application of stable isotope techniques to describe and assess the role of nutrition-sensitive agri-food systems in health and nutrition.
Specific objectives
To assess the role of stable isotope techniques to further the understanding of the effect of agricultural bioversity on nutrition
To assess the role of stable isotope techniques to further the understanding of nutritional consequences (including unintended ones) of dietary shifts or changes in nutrition-sensitive agri-food systems
To assess the role of stable isotope techniques to further understand the effects of nutrition-sensitive agriculture systems/interventions that aim to improve diet quality on nutrition status
To further the understanding of the correlation between body composition and dietary diversity scores, meal frequency, and other indicators of dietary intake and quality
To improve the knowledge of additional costs and benefits of including isotopic measures of body composition as a nutritional outcome
Impact
The primary objective of the CRP was to investigate if body composition data can be used as indicators on the nutrition impacts of nutrition-sensitive agricultural programs. The secondary objective of the project was to assess the complementarity of information on body composition, anthropometric measurements and dietary diversity for monitoring the impact of nutrition-sensitive agricultural interventions with optimal completeness and precision. Challenges and lessons learnt under this CRP may be used to improve future design of similar studies. Despite numerous challenges faced the CRP produced some good outcomes:
1. Capacity in successful countries, Haiti, Myanmar, Peru and Senegal was greatly enhanced including contribution to training at BSc (Haiti), Masters (Peru, Haiti) and PhD (Senegal) levels and strengthening of ability to use the deuterium dilution technique among health care and nutrition professionals.
2. The project generated body composition data for the first time in Myanmar and Peru.
3. An innovative sub-study in Haiti compared serum retinol concentration obtained in the field using iCheckFluoro® against the standard method HPLC and found no significant differences between the two methods. This will enable easier measurement of serum retinol in large studies.
4. Another important outcome was the development and validation of Bio-electrical Impedance (BIA) equations and validation against deuterium dilution in Haiti. In future studies in the same population group, the simpler BIA method can be used to assess body composition.
5. Myanmar and Peru already have plans to use the capacity gained in future nutrition projects.
6. Projects have already produced scientific publications and shared results at conferences nationally, regionally and internationally.
7. A joint publication on comparative body composition in children aged 2-5 years from Mexico, Myanmar, Peru and Senegal is planned.
Relevance
Undernutrition remains a highly prevalent and pervasive problem in low- and middle-income countries, particularly among women and children. The direct or immediate causes of undernutrition include inadequate dietary intake and disease, which can lead to such consequences as poor growth and micronutrient deficiencies. Agricultural policies and interventions can impact both the underlying and immediate determinants of nutrition by altering the availability of and accessibility to nutrient-rich foods at the household, community and national level. This CRP aimed to contribute data on the effect of various nutrition-sensitive interventions on maternal and child nutritional status using body composition as the primary outcome. Although there was no overall measurable impact on child growth, some countries found improved iron and vitamin A status among mothers consuming vegetables produced under the CRP. There is a lack of normative reference data on body composition. It is hoped that the body composition data obtained by the successful participants in this CRP can contribute to a future global database of body composition information. The CRP provided an opportunity to apply the minimum dietary diversity score (MDD-W) for women in other populations; the MDD-W was developed by FAO and has been tested in several settings.