NPS1-3 Nutrition and enviromental sustainabili- ty (FAO)
TRADITIONAL FOOD SYSTEMS OF INDIGENOUS PEOPLES
H. Kuhnlein
Centre For Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, Montréal, Québec, Canada
Indigenous Peoples who have cultural homelands in rural areas have knowledge of vast biodiversities that have develo- ped within their heritage regions to provide food resources for food and nutrition security. Despite formidable environmental and cultural challenges to the use of this wealth of knowledge, Indigenous Peoples are aware that their original diets and lo- cal foods can provide cultural expression, self-identity, health and well-being. Research has given recognition to the vast array of unique food species and subspecies/varieties/cultivars within food systems of Indigenous Peoples and the nutritio- nal contributions they make. With focus on 12 cultures in de- fined ecosystems in different parts of the world, participatory research with communities and interdisciplinary scholars was used to document the local food resources and how they have been culturally used. This knowledge was then applied at the community level to develop methods, processes and activities to mobilize leaders and communities to encourage interven- tions and policies that improve health and well-being. Central to Indigenous Peoples using their food resources is attention to environmental integrity and sustainability.
Knowledge on traditional wildlife animal and plant harvests and agriculture based in traditional crops must be promoted within communities and transmitted to youth to ensure future provisioning. This benefits from advocacy to create activities that build local cultural pride, and the development of cross- sectoral government planning and action. Keeping Indigenous Peoples’ food systems vital not only ensures their continuing contribution to community well-being, but also creates the imperative for cultural and ecosystem protection and sustaina- bility. Lessons learned with Indigenous Peoples’ food systems contribute important knowledge on how and why to address
challenges to maintaining ecosystem integrity for environmen- tal sustainability, and for the food and nutrition security of the entire planet.
Key words: Indigenous peoples, food systems, sustainabi- lity.
FOOD-NATURAL RESOURCES NEXUS IN THE ME- DITERRANEAN REGION: EXPLORING THE ENVI- RONMENTAL FOOTPRINTS OF THE CURRENT DIE- TARY PATTERNS
C. Lacirignola, R. Capone, H. El Bilali, P H. Debs, G. Car- done
Mediterranean Agronomic Institute of Bari, Interna- tional Centre for Advanced Mediterranean Agrono- mic Studies (CIHEAM), Italy
Environmental degradation - whose primary driving forces are population, consumption and technology - has reached in the Mediterranean proportions that require immediate action.
Unsustainable food consumption patterns are putting increa- sing stress on ecosystems and human social systems. Food con- sumption patterns are important drivers of land degradation, declining soil fertility, unsustainable water use, marine envi- ronment degradation, climate change, biodiversity loss, etc.
The paper aims at exploring the environmental footprints of the current Mediterranean consumption and production patterns with a particular focus on the current dietary patterns. The work is mainly based on secondary data from different sources e.g. FAOSTAT, the World Development Indicators, the Water Footprint Network (WFN), the Global Footprint Network. The analysis regards 21 Northern, Southern and Eastern Mediterra- nean countries. The paper describes the main environmental challenges in the Mediterranean region e.g. water scarcity, land degradation, climate change and biodiversity loss. It provides an overview of the ecological, carbon and water footprints of the current regional consumption patterns as well as national virtual water balances. The paper characterizes the Mediterra- nean dietary patterns using Food Balance Sheets data. The WF of food supply is calculated for Bosnia, Egypt, Italy, Morocco and Turkey and the contribution of vegetal- and animal-based food product groups is highlighted. The paper compares the WF of the current Italian diet with that of the proposed Me- diterranean one. It also analyses fertilizer consumption and
Paralleled Symposia
Ann Nutr Metab 2013;63(suppl 1): 1-1960 Published online: September 13, 2013
nitrogen fertilizers use trends. High resource use intensity is exacerbated by food waste implying the loss of large amounts of precious resources and inputs such as water, land, energy and fertilisers. The transition to more sustainable diets and food consumption patterns in the Mediterranean – implying an increased adherence to the traditional Mediterranean diet – and the reduction of food losses and waste can contribute to easing pressure on the scarce resources of the region.
Key words: dietary patterns, environmental footprints, na- tural resources, Mediterranean region.
PS2-11 Global challenges in maternal and child nutrition for today and the future
NUTRITION-SENSITIVE INTERVENTIONS AND PROGRAMS: HOW CAN THEY HELP ACCELERA- TE PROGRESS IN IMPROVING MATERNAL AND CHILD NUTRITION?
M. Ruel, H. Alderman
International Food Policy Research Institute (IFPRI), Washington, USA
Accelerating progress in improving nutrition will require effective and large-scale nutrition-sensitive programs that ad- dress key underlying causes of undernutrition and enhance the coverage and effectiveness of nutrition-specific interventions.
We reviewed programs in four sectors - agriculture, social safe- ty nets (SSNs), early child development (ECD) and classroom education. Targeted agricultural programs support livelihoods, food security and diet diversity, but evidence of their impact on child nutritional status is inconclusive, with the exception of vitamin A from biofortification of orange sweet potatoes; poor- quality evaluations prevent firm conclusionson nutritional impact. SSNs are a powerful poverty reduction tool but poo- led estimates show no overall impact on nutrition outcomes;
although some cash transfers have improved nutrition among younger and poorer children exposed for longer durations, the lack of overall impact is attributed to weaknesses in nutrition goals and inputs and in service delivery (supply). Combining ECD and nutrition interventions can have additive or syner- gistic impacts on child development and nutrition outcomes.
Thus, programs combining ECD and nutrition inputs could lead to significant gains in cost, program efficiency and nutri- tion and development outcomes. Parental schooling is a strong determinant of nutrition outcomes, but school curriculum sel- dom includes nutrition training and when it does, evaluations of impacts on knowledge acquisition and future parental skills are lacking. Many of the programs reviewed were not origina- lly designed to improve nutrition, yet they have great potential to do so. Ways to enhancethe nutrition-sensitivity of programs include: improve targeting; useconditionalities if feasible;
strengthen nutrition goals and incorporate well-designed and implemented nutrition-sensitive actions;and focus on optimi- zing women’s nutrition, time allocation, physical and mental health, and social status and empowerment. Nutrition-sensi- tive programs can play a pivotal role in invigorating nutrition- specific interventions and creating a stimulating environment for young children to grow and develop to their full potential.
Key words: Agriculture,early child development, nutrition- sensitive programs, schooling,social safety nets.
THE POLITICS OF REDUCING MALNUTRITION:
BUILDING COMMITMENT AND ACCELERATING IMPACT
S. Gillespie1, L. Haddad2, V. Mannar3, P. Menon1, N. Nis- bett2
1International Food Policy Research Institute, Wash- ington, USA
2Institute of Development Studies, University of Sussex, Brighton,UK
3Micronutrient Initiative, Canada
Political discourse on the challenge of malnutrition has ramped up markedly in recent years, at both national and in- ternational levels. The Scaling Up Nutrition (SUN) movement has both driven, and been driven by, this developing momen- tum. While knowledge of the critical factors and processes for effectively operationalizing and scaling up nutrition-specific and nutrition-sensitive interventions is increasing, we know less about the politics of reducing malnutrition. How can po- litical and policy processes and “enabling environments” be cultivated, sustained and ultimately translated into nutritio- nal impact on the ground? In our review of the limited but growing evidence base we use a six cell framework to structure our discussion of the ways in which three domains (knowled- ge and evidence, politics and governance, and capacity and resources) are pivotal for a) creating and sustaining political momentum, and b) translating it into nutritional impact in high-burden countries. We show how political calculations lie behind effective coordination between sectors, between natio- nal and subnational levels, private sector engagement, resource mobilization, and state accountability to its citizens – all hugely important for nutrition-relevant action. Political commitment can be proactively built—there is no need to wait for it -- but converting such commitment to impact requires a different set of strategies and skills. It will simply not be possible to accele- rate and sustain progress without national and global support to a long-term process of strengthening systemic and organiza- tional capacities, and to nurturing and strengthening leaders- hip in high-burden countries. The private sector has significant positive potential but there remains a lack of trust and a lack of
evidence, both of which need to be addressed. Finally, we ar- gue that operational research on delivery, implementation and upscaling of interventions, and more contextual analyses on how to shape and sustain enabling environments, is essential as the focus shifts toward action.
Key words: Malnutrition, nutrition policies.
PS2-19 Confronting the global epidemic of non- communicable diseases: Findings from the NHL- BI/UHG Global Network
THE NIH NHLBI/UHG CENTERS OF EXCELLENCE: A MODEL FOR INTERNATIONAL RESEARCH COLLA- BORATION
C. Rabadan-Diehl
National Heart, Lung, and Blood Institute/NIH, Bethesda, USA
Chronic non-communicable diseases (NCDs) account for 63% of deaths around the world. In 2008, 80% of NCD-related deaths occurred in low and middle income countries. Cardio- vascular disease (CVD) comprises 30% of global mortality, fo- llowed by cancer, COPD and diabetes. Unhealthy diet has been identified as a risk factor to the four disease categories, provi- ding an opportunity to develop common approaches to NCD prevention. Accumulation of risk for NCDs begins during pre- natal development and continues through early life, childhood, adolescence, and adulthood. In June 2009, The National Heart, Lung and Blood Institute (NHLBI) and UnitedHealth Group (UHG), established a network of eleven Centers of Excellen- ce (COE) across the globe. The Centers are located in develo- ping countries and have strong partnerships with institutions around the world. The goals of this program are to enable re- search capacity building, train future chronic cardiovascular and pulmonary disease investigators and conduct research, programs and measures to prevent or treat chronic cardiovas- cular and pulmonary diseases. The COEs are leveraging their expertise and infrastructures built on the areas of maternal/
child health and infectious diseases, to develop and carry out the NCD agenda. The COEs are key players in the area of nutri- tion and are linked to Birth Cohorts like the Matlab cohort in Bangladesh and the Consortium of Health Oriented Research in Transitional Societies (COHORTS) in Brazil, Guatemala, In- dia, Philippines and South Africa. The COEs are also in close communication with local, state and national governments and policy makers.
The COE program has received international attention and it is considered a unique and innovative model of research collaborations at the global level. The COE program is desig- ned to serve as a platform to develop research-based evidence for strategies that can be implemented not only in developing
countries, but that can also informed research agendas across the world.
Key words: Child heaalth, Infectious diseases, Research co- llaboration, The National Heart, Lung and Blood Institute.
PRIMARY PREVENTION OF NUTRITION-RELATED CHRONIC DISEASES: INNOVATIVE INTERVEN- TIONS IN LATIN AMERICA
M. Ramirez-Zea
INCAP Comprehensive Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Panama
Nutrition-related chronic diseases (NRCD), such as car- diovascular diseases, diabetes, and some types of cancer, are the main cause of mortality and morbidity across all Latin American countries, even exceeding the prevalence of many developed countries. Even worse, age at onset of NRCD risk factors and death is declining, due to early and rapid changes in lifestyle patterns. Population-based innovative strategies for preventing NRCD risk factors in developing countries are scar- ce. The INCAP Comprehensive Center for the Prevention of Chronic Diseases (CIIPEC) has recently leaded few interven- tion studies on NRCD prevention in Latin America. We have developed a culturally appropriate, community-based inter- vention to improve cardiovascular health in elementary school- age Guatemalan children through the promotion of healthful eating behaviors and physical activity, as well as the prevention of tobacco use and alcohol consumption. We have also evalua- ted the effectiveness of an affordable and sustainable primary health care intervention, based on mobile health (mHealth) technology, to reduce blood pressure and prevent progression from pre-hypertensive status to hypertension in individuals at poor urban clinics in three Latin American countries (Argen- tina, Guatemala, and Peru). Another two projects have asses- sed intervention models to determine how well primary health care (PHC) workers can correctly identify and refer subjects at high risk of cardiovascular diseases in Guatemala, and to im- prove adherence to treatment and healthy lifestyles in diabe- tic and/or hypertensive patients who assist to PHC facilities in Costa Rica and Southern Mexico. Main preliminary results of those studies will be presented in this session.
Acknowledgements: This work was supported by the National Heart, Lung and Blood Institute (NHLBI, HHS- N268200900028C) and the UnitedHealth Group Chronic Di- sease Initiative.
Key words: Nutrition, chronic diseases, intervention, Latin America.
CHINA RURAL HEALTH INITIATIVE – SODIUM REDUCTION STUDY: A CLUSTER RANDOMIZED TRIAL ON A COMMUNITY-BASED DIETARY SO- DIUM REDUCTION PROGRAM
L L. Yan1, N. Li1, W. Niu2, H. Chu3, J. Zhang1, Z. Hao1, D. Labarthe4, X. Feng5, J. Shi6, J. Zhang7, R. Zhang8, Y.
Zhang9, Z. Li5, B. Zhou6, Z. Li5, J. Sun10
1The George Institute For Global Health At Peking University Health Science Center
2School of Public Health, Peking University Health Science Center, Beijing, China
3Peking University Clinical Research Institute, Bei- jing, China
4Department of Preventive Medicine, Northwestern University, Chicago, USA
5Changzhi Medical College, Changzhi, China
6First Hospital of China Medical University, Liaoning, China
7Hebei Province Center for Disease Prevention and Control, Shijiazhuang, China
8Xian Jiaotong University, Xian, China
9Ningxia Medical University, Yinchuan, China
10Hebei Province Center for Disease Prevention and Control, Shijiazhuang, China
Background and objectives:Cardiovascular diseases are the leading cause of death in rural China with high bloodpres- sure being a major determinant of risk. Excess intake of die- tary sodium, a modifiable risk factor for high blood pressure, is widespread with most added as salt during the cooking or preservation of food in the home. The aim of this study is to determine the effects of a multi-faceted community-based so- dium reduction program on sodium and blood pressure.
Methods: The China Rural Health Initiativeis a large-scale, cluster-randomized, trial done in five Northern Chinese pro- vinces. Two counties have been selected from each province and 12 townships enrolled in each county making a total of 120 clusters. One village from each township was selected for par- ticipation in the study. Randomization was stratified by county with 60 villages receiving the intervention and 60 continuing with usual practices.The sodium reduction program comprises community health education and a food supply strategy desig- ned to promote the use of salt substitute through the village convenience stores.Subsidization of the price of salt-substitute is provided to 30 intervention villages. The primary outcomes for the study is dietary sodium intake levels estimated from as- says of 24-hour urine samples and blood pressure.
Results: The trial randomized 120 villages in April 2011 and the intervention was implemented from May 2011 to October 2012. All data have been collected and are currently being clea- ned and analyzed. We expect to have trial results to share by August 2013.
Conclusions: This sodium reduction study is a major new initiative designed to identify a nutrition-based, practical, sca- lable strategy for vascular disease prevention in rural China. If proved effective, this sodium reduction program will provide an evidencebase for policy and programs in China and poten- tially other countries and substantial health gains when scaled up.
Key words: Sodium reduction, cardiovascular disease, health education, salt substitute, community-based program.
BASELINE CHARACTERISTICS OF A SCHOOL BA- SED INTERVENTION TO PROMOTE HEALTHY DIET IN SOUSSE, TUNISIA
H. Ghannem1, J. Maatoug1, I. Harrabi1, M. Belkacem1, S.
Hmad1, R. Ghammam1, S. Slama2
1Chronic Disease Prevention Research Center of Sousse, Tunisia
2Department of Community medicine, Primary care and emergency, Geneva University Hospitals, Switzerland
Background and objectives: In this study, we will focus on diet habits among schoolchildren. This is a component of a community based intervention to promote healthy lifestyles in school settings. It consists on a school based intervention with the aim to improve knowledge, attitudes and behaviors concerning healthy diet. The study design, implementation and baseline results are presented.
Methods: The study design was a quasi experimental de- sign, intervention with pre post assessment and control group.
The study concerned pupils of colleges of Sousse aged 11 to 16 years old in 7th and 9th grade. The pre-assessment concerned a random sample of schoolchildren. The proportional and stra- tified sample was composed of 4003 schoolchildren with 1929 and 2074 respectively in intervention and control groups. We used chi square test to compare prevalences with 0.05 as level of significance.
Results: Sex ratio was respectively 1 in the intervention group and 0.87 in control group. The mean age of the study po- pulation was 13.48±1.29 and 13.24±1.25 respectively in inter- vention and control groups. The proportion of schoolchildren who knew that it’s recommended to eat at least 5 fruits and vegetables daily was 35.6% in intervention group and 23.6% in control group. Concerning eating habits, the schoolchildren reported frequency (number of days per week) of consuming various foods and beverages included respectively in the inter- vention and control group: vegetables 3.9 days/week and 4.81 days/week, fruits 5.41 days/week and 5.7 days/week, high fat food 2.49 days/week and 2.48 days/week, sweetened beverage 3.84 days/week and 3.3 days/week, sweets 4.33 days/week and 4.57 days/week.
Conclusion: Integrated and sustainable interventions to promote healthy diet in this region are needed to prevent obe- sity and non communicable diseases early in childhood. Ack- nowledgment: This project is funded by UnitedHealth Group.
The intervention is cofunded by Geneva University Hospitals Key words: Diet intervention, lifestyles, prevention, schools.
PS3-27 Community-based programme to pre- vent obesity: Lessons and perspectives from 20 years of experience (EPODE International Net- work)
EFFECT OF VITAMIN B12 AND N-3 POLYUNSA- TURATED FATTY ACIDS ON PLASMA HOMOCYS- TEINE, AND OTHER CARDIOVASCULAR RISK FAC- TORS: A RANDOMIZED CONTROLLED TRIAL T. Huang3, K L. Li1,2, M. Asimi1,2, Q. Chen1,2, D. Li1,2
1Zhejiang University, China
2APCNS Centre of Nutrition and Food Safety
3Johns Hopkins Bloomberg School of Public Health, USA
Background and objectives: Vitamin B12and n-3 polyun- saturated fatty acids (PUFA) decrease blood homocysteine (Hcy) concentration. However, the combined effect of these nutrients on Hcy and ferritin, and C-reactive protein is limited and inconclusive. The objective was to examine the synergistic effect of vitamin B12 in combination of n-3 PUFA on plasma Hcy, ferritin, and other biochemical markers.
Methods: In a randomized controlled trial, thirty eligible subjects were randomly divided into three groups, and assig- ned to receive 1000 µg of vitamin B12, 2g fish oil, or 1000 µg vitamin B12 and 2g fish oil respectively for 8 weeks. Plasma phospholipid (PL) fatty acids and biochemical markers were determined.
Results: Plasma PL 20:5n-3, 22:6n-3 and n-3 PUFA were increased after 4 and 8 week supplementation of fish oil, and vitamin B12+fish oil. Plasma concentrations of triacylglycerol, uric acid, and ferritin were significantly decreased after 4 and 8 week supplementation of fish oil, and vitamin B12+fish oil.
In all groups, significant changes in plasma Hcy were obser- ved during the study period. Vitamin B12, fish oil, and vitamin B12+fish oil supplementation lowered plasma Hcy concentra- tions by 22%, 19%, and 39%, respectively. Conclusions: Com- bination of vitamin B12 and fish oil have synergistic effect on lowering plasma concentrations of Hcy and ferritin.
Key words: Homocysteine, fish oil, vitamin B12.
COMMUNITY-BASED PROGRAMMES TO PREVENT OBESITY
J M. Borys4, H. Ruault du Plessis4, T. Huang1, B. Swin- burn2, J. Seidell3, A. Barriguete4
1University of Nebraska Medical Center College of Public Health, Nebraska, USA
2The University of Auckland, Auckland, New Zea- land
3VU University of Amsterdam, Amsterdam, The Netherlands
4EPODE International Network, Brussels, Belgium
Childhood obesity is one of the main public health cha- llenges of the 21th century. Preventive efforts should include community-based interventions (CBIs) using social marketing campaigns targeting families, children and key stakeholders within the community and the broader environment of the child.Indeed, childhoodobesityis a complexissue and needs- complexsystemwith a multistakeholderinvolvement at allle- velstofosterhealthierlifestyles in a sustainableway. The EPODE methodologycontributestothisapproach.
Withnow 20 years of experience,thismethodologyisnowim plemented in more than 300 towns in 8 countries (France, Bel- gium, Spain, Greece, TheNetherlands, South Australia, Mexi- co and Romania) and concerns more than 20 millionpeople.
Theaddedvalue of themethodologyisbasedon a strongscien- tific input, institutional and politicalendorsement, evidence- base and social marketing techniques, sustainableresources, branddynamics and evaluation.
At childleveltheprevalence of overweight and obesity in childrenaged 5 to 12 ismonitored. In the 8 French pilottowns, theprevalence of childrenoverweightincludingobesityde- creasedby 10% between 2005 and 2009 (p<0.0001). In Bel- giumpilottowns, theprevalence of childrenoverweightsigni- ficantlydecreasedby 22% between 2008 and 2010 (p<0,04) in comparisonwith control towns.
The EPODE International Network (EIN) is a non-govern- mental organization which has been created to support Com- munity-Based Programmes (CBPs) aimed at preventingobesi- ty. Today, 29 CBPs are memberof thisnetwork (10 in Europe, 13 in America and 6 in Asia-Pacificregion).
Key words: Prevention, obesity, social marketing, nutrition, diet, lifestyle, community-basedprogramme, sustainability.