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Food system innovations will be instrumental to achieving multiple Sustainable Development Goals (SDGs). However, major innovation breakthroughs can trigger profound and disruptive changes, leading to simultaneous and interlinked reconfigurations of multiple parts of the global food system. The emergence of new technologies or social solutions, therefore, have very different impact profiles, with favourable consequences for some SDGs and unintended adverse side-effects for others. Stand-alone innovations seldom achieve positive outcomes over multiple sustainability dimensions. Instead, they should be embedded as part of systemic changes that facilitate the implementation of the SDGs. Emerging trade-offs need to be intentionally addressed to achieve true sustainability, particularly those involving social aspects like inequality in its many forms, social justice, and strong institutions, which remain challenging. Trade-offs with undesirable consequences are manageable through the development of well planned transition pathways, careful monitoring of key indicators, and through the implementation of transparent science targets at the local level., The Lancet Planetary Health, 5 (1), ISSN:2542-5196

Summary Background Current diets are detrimental to both human and planetary health and shifting towards more balanced, predominantly plant-based diets is seen as crucial to improving both. Low fruit and vegetable consumption is itself a major nutritional problem. We aim to better quantify the gap between future fruit and vegetable supply and recommended consumption levels by exploring the interactions between supply and demand in more than 150 countries from 1961 to 2050. Methods In this global analysis, we use the International Model for Policy Analysis of Agricultural Commodities and Trade, which simulates the global agricultural sector, to explore the role of insufficient production of fruits and vegetables and the effects of food waste and public policy in achieving recommended fruit and vegetable consumption. First, we estimate the average historical (1961–2010) and future (2010–50) national consumption levels needed to meet WHO targets (a minimum target of 400 g/person per day or age-specific recommendations of 330–600 g/person per day) using population pyramids; for future consumption, we use projections from the Shared Socioeconomic Pathways (SSPs), a set of global socioeconomic scenarios characterised by varied assumptions on economic and population growth. We then simulate future fruit and vegetable production and demand to 2050 under three such scenarios (SSP1–3) to assess the potential impacts of economic, demographic, and technological change on consumer and producer behaviour. We then explore the potential effects of food waste applying various waste assumptions (0–33% waste). Finally, we apply two policy analysis frameworks (the NOURISHING framework and the Nuffield ladder) to assess the current state of public policy designed to achieve healthy diets. Findings Historically, fruit and vegetable availability has consistently been insufficient to supply recommended consumption levels. By 2015, 81 countries representing 55% of the global population had average fruit and vegetable availability above WHO's minimum target. Under more stringent age-specific recommendations, only 40 countries representing 36% of the global population had adequate availability. Although economic growth will help to increase fruit and vegetable availability in the future, particularly in lower-income countries, this alone will be insufficient. Even under the most optimistic socioeconomic scenarios (excluding food waste), many countries fail to achieve sufficient fruit and vegetable availability to meet even the minimum recommended target. Sub-Saharan Africa is a particular region of concern, with projections suggesting, by 2050, between 0·8 and 1·9 billion people could live in countries with average fruit and vegetable availability below 400 g/person per day. Food waste is a serious obstacle that could erode projected gains. Assuming 33% waste and socioeconomic trends similar to historical patterns, the global average availability in 2050 falls below age-specific recommendations, increasing the number of people living in countries with insufficient supply of fruits and vegetables by 1·5 billion compared with a zero waste scenario. Interpretation Increasing fruit and vegetable consumption is an important component of a shift towards healthier and more sustainable diets. Economic modelling suggests that even under optimistic socioeconomic scenarios future supply will be insufficient to achieve recommended levels in many countries. Consequently, systematic public policy targeting the constraints to producing and consuming fruits and vegetables will be needed. This will require a portfolio of interventions and investments that focus on increasing fruit and vegetable production, developing technologies and practices to reduce waste without increasing the consumer cost, and increasing existing efforts to educate consumers on healthy diets. Funding The Commonwealth Scientific and Industrial Research Organisation; Climate Change, Agriculture and Food Security (CGIAR) Research Program on Climate Change, Agriculture and Food Security; CGIAR Research Program on Policy, Institutions, and Markets; Bill & Melinda Gates Foundation; and Johns Hopkins University.

Additional co-authors: Prof Corinna Hawkes PhD, Mario Herrero PhD, Prof Peter S Hovmand PhD, Prof Mark Howden PhD, Lindsay M Jaacks PhD, Ariadne B Kapetanaki PhD, Matt Kasman PhD, Prof Harriet V Kuhnlein PhD, Prof Shiriki K Kumanyika PhD, Prof Bagher Larijani MD, Tim Lobstein PhD, Michael W Long PhD, Victor K R Matsudo MD, Susanna D H Mills PhD, Gareth Morgan PhD, Alexandra Morshed, Patricia M Nece JD, Prof An Pan PhD, David W Patterson, Gary Sacks PhD, Meera Shekar PhD, Geoff L Simmons, Warren Smit PhD, Ali Tootee PhD, Stefanie Vandevijvere PhD, Wilma E Waterlander PhD, Luke Wolfenden PhD, Prof William H Dietz MD

Twenty-first-century challenges for food and nutrition security include the spread of obesity worldwide and persistent undernutrition in vulnerable populations, along with continued micronutrient deficiencies. Climate change, increasing incomes and evolving diets complicate the search for sustainable solutions. Projecting to the year 2050, we explore future macronutrient and micronutrient adequacy with combined biophysical and socioeconomic scenarios that are country-specific. In all scenarios for 2050, the average benefits of widely shared economic growth, if achieved, are much greater than the modelled negative effects of climate change. Average macronutrient availability in 2050 at the country level appears adequate in all but the poorest countries. Many regions, however, will continue to have critical micronutrient inadequacies. Climate change alters micronutrient availability in some regions more than others. These findings indicate that the greatest food security challenge in 2050 will be providing nutritious diets rather than adequate calories. Research priorities and policies should emphasize nutritional quality by increasing availability and affordability of nutrient-dense foods and improving dietary diversity. Global environmental change complicates the goal of securing adequate nutrition for a growing world population. This study assesses the per capita availability of food nutrients for various scenarios to the year 2050. Results suggest that economic growth will expand food and macronutrient access more than climate change will suppress it, but that micronutrient inadequacies will plague some regions.

Technologies and systemic innovation are critical for the transformation of the food system. This Perspective identifies promising technologies, assesses their readiness and proposes eight action points to accelerate innovation.Future technologies and systemic innovation are critical for the profound transformation the food system needs. These innovations range from food production, land use and emissions, all the way to improved diets and waste management. Here, we identify these technologies, assess their readiness and propose eight action points that could accelerate the transition towards a more sustainable food system. We argue that the speed of innovation could be significantly increased with the appropriate incentives, regulations and social licence. These, in turn, require constructive stakeholder dialogue and clear transition pathways.

Background: Information about the global structure of agriculture and nutrient production and its diversity is essential to improve present understanding of national food production patterns, agricultural livelihoods, and food chains, and their linkages to land use and their associated ecosystems services. Here we provide a plausible breakdown of global agricultural and nutrient production by farm size, and also study the associations between farm size, agricultural diversity, and nutrient production. This analysis is crucial to design interventions that might be appropriately targeted to promote healthy diets and ecosystems in the face of population growth, urbanisation, and climate change. Methods: We used existing spatially-explicit global datasets to estimate the production levels of 41 major crops, seven livestock, and 14 aquaculture and fish products. From overall production estimates, we estimated the production of vitamin A, vitamin B12, folate, iron, zinc, calcium, calories, and protein. We also estimated the relative contribution of farms of different sizes to the production of different agricultural commodities and associated nutrients, as well as how the diversity of food production based on the number of different products grown per geographic pixel and distribution of products within this pixel (Shannon diversity index [H]) changes with different farm sizes. Findings: Globally, small and medium farms (≤50 ha) produce 51–77% of nearly all commodities and nutrients examined here. However, important regional differences exist. Large farms (>50 ha) dominate production in North America, South America, and Australia and New Zealand. In these regions, large farms contribute between 75% and 100% of all cereal, livestock, and fruit production, and the pattern is similar for other commodity groups. By contrast, small farms (≤20 ha) produce more than 75% of most food commodities in sub-Saharan Africa, southeast Asia, south Asia, and China. In Europe, west Asia and north Africa, and central America, medium-size farms (20–50 ha) also contribute substantially to the production of most food commodities. Very small farms (≤2 ha) are important and have local significance in sub-Saharan Africa, southeast Asia, and south Asia, where they contribute to about 30% of most food commodities. The majority of vegetables (81%), roots and tubers (72%), pulses (67%), fruits (66%), fish and livestock products (60%), and cereals (56%) are produced in diverse landscapes (H>1·5). Similarly, the majority of global micronutrients (53–81%) and protein (57%) are also produced in more diverse agricultural landscapes (H>1·5). By contrast, the majority of sugar (73%) and oil crops (57%) are produced in less diverse ones (H≤1·5), which also account for the majority of global calorie production (56%). The diversity of agricultural and nutrient production diminishes as farm size increases. However, areas of the world with higher agricultural diversity produce more nutrients, irrespective of farm size. Interpretation: Our results show that farm size and diversity of agricultural production vary substantially across regions and are key structural determinants of food and nutrient production that need to be considered in plans to meet social, economic, and environmental targets. At the global level, both small and large farms have key roles in food and nutrition security. Efforts to maintain production diversity as farm sizes increase seem to be necessary to maintain the production of diverse nutrients and viable, multifunctional, sustainable landscapes. Funding: Commonwealth Scientific and Industrial Research Organisation, Bill & Melinda Gates Foundation, CGIAR Research Programs on Climate Change, Agriculture and Food Security and on Agriculture for Nutrition and Health funded by the CGIAR Fund Council, Daniel and Nina Carasso Foundation, European Union, International Fund for Agricultural Development, Australian Research Council, National Science Foundation, Gordon and Betty Moore Foundation, and Joint Programming Initiative on Agriculture, Food Security and Climate Change—Belmont Forum.

Background: Information about the global structure of agriculture and nutrient production and its diversity is essential to improve present understanding of national food production patterns, agricultural livelihoods, and food chains, and their linkages to land use and their associated ecosystems services. Here we provide a plausible breakdown of global agricultural and nutrient production by farm size, and also study the associations between farm size, agricultural diversity, and nutrient production. This analysis is crucial to design interventions that might be appropriately targeted to promote healthy diets and ecosystems in the face of population growth, urbanisation, and climate change. Methods: We used existing spatially-explicit global datasets to estimate the production levels of 41 major crops, seven livestock, and 14 aquaculture and fish products. From overall production estimates, we estimated the production of vitamin A, vitamin B₁₂, folate, iron, zinc, calcium, calories, and protein. We also estimated the relative contribution of farms of different sizes to the production of different agricultural commodities and associated nutrients, as well as how the diversity of food production based on the number of different products grown per geographic pixel and distribution of products within this pixel (Shannon diversity index [H]) changes with different farm sizes. Findings: Globally, small and medium farms (≤50 ha) produce 51–77% of nearly all commodities and nutrients examined here. However, important regional differences exist. Large farms (>50 ha) dominate production in North America, South America, and Australia and New Zealand. In these regions, large farms contribute between 75% and 100% of all cereal, livestock, and fruit production, and the pattern is similar for other commodity groups. By contrast, small farms (≤20 ha) produce more than 75% of most food commodities in sub-Saharan Africa, southeast Asia, south Asia, and China. In Europe, west Asia and north Africa, and central America, medium-size farms (20–50 ha) also contribute substantially to the production of most food commodities. Very small farms (≤2 ha) are important and have local significance in sub-Saharan Africa, southeast Asia, and south Asia, where they contribute to about 30% of most food commodities. The majority of vegetables (81%), roots and tubers (72%), pulses (67%), fruits (66%), fish and livestock products (60%), and cereals (56%) are produced in diverse landscapes (H>1·5). Similarly, the majority of global micronutrients (53–81%) and protein (57%) are also produced in more diverse agricultural landscapes (H>1·5). By contrast, the majority of sugar (73%) and oil crops (57%) are produced in less diverse ones (H≤1·5), which also account for the majority of global calorie production (56%). The diversity of agricultural and nutrient production diminishes as farm size increases. However, areas of the world with higher agricultural diversity produce more nutrients, irrespective of farm size. Interpretation: Our results show that farm size and diversity of agricultural production vary substantially across regions and are key structural determinants of food and nutrient production that need to be considered in plans to meet social, economic, and environmental targets. At the global level, both small and large farms have key roles in food and nutrition security. Efforts to maintain production diversity as farm sizes increase seem to be necessary to maintain the production of diverse nutrients and viable, multifunctional, sustainable landscapes. Funding: Commonwealth Scientific and Industrial Research Organisation, Bill & Melinda Gates Foundation, CGIAR Research Programs on Climate Change, Agriculture and Food Security and on Agriculture for Nutrition and Health funded by the CGIAR Fund Council, Daniel and Nina Carasso Foundation, European Union, International Fund for Agricultural Development, Australian Research Council, National Science Foundation, Gordon and Betty Moore Foundation, and Joint Programming Initiative on Agriculture, Food Security and Climate Change—Belmont Forum.

In Chronic Kidney Disease (CKD), management of diet is important in prevention of disease progression and symptom management, however evidence on nutrition prescription is limited. Recent international CKD guidelines and literature was reviewed to address the following question “What is the appropriate nutrition prescription to achieve positive outcomes in adult patients with chronic kidney disease?” Databases included in the search were Medline and CINAHL using EBSCOhost search engine, Embase and the Cochrane Database of Systematic Reviews published from 2000 to 2009. International guidelines pertaining to nutrition prescription in CKD were also reviewed from 2000 to 2013. Three hundred and eleven papers and eight guidelines were reviewed by three reviewers. Evidence was graded as per the National Health and Medical Research Council of Australia criteria. The evidence from thirty six papers was tabulated under the following headings: protein, weight loss, enteral support, vitamin D, sodium, fat, fibre, oral nutrition supplements, nutrition counselling, including protein and phosphate, nutrients in peritoneal dialysis solution and intradialytic parenteral nutrition, and was compared to international guidelines. While more evidence based studies are warranted, the customary nutrition prescription remains satisfactory with the exception of Vitamin D and phosphate. In these two areas, additional research is urgently needed given the potential of adverse outcomes for the CKD patient.

Twenty-five species of fish, shrimp and prawn from local markets in Bangladesh were analysed for concentrations of total Fe, haem Fe and non-haem Fe by ICP-MS. Total Fe and non-haem Fe concentrations were measured in nitric acid-digested samples and haem Fe was extracted using acidified 80% acetone for 60min. Total Fe concentrations ranged from 0.55–14.43mg/100g FW, and haem Fe% ranged from 18%–93% of total Fe. Repeat extractions with 80% acetone recovered additional haem Fe, suggesting that previous measurement by this technique may have underestimated haem Fe content. Calculation of Fe balance (summing Fe in acetone extracts and Fe in the residue after haem Fe extraction) was not significantly different from total Fe, indicating the two processes recovered the different forms of Fe with similar effectiveness.