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PR, IFPRI3; OA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, We write in response to the commentary by Gupta et al. (2023) on small-quantity lipid-based nutrient supplements (SQ-LNS) for infants and young children 6 to 24 months of age, which was prompted by the recent brief guidance note from UNICEF (2023) explaining when, why and how SQ-LNS are being prioritized as part of their package of preventive actions to combat early childhood malnutrition. The UNICEF document was disseminated shortly after publication of a correspondence in Nature Food (Aguayo et al. 2023), authored by nutrition leaders from several organizations, that summarized the evidence on the benefits of SQ-LNS and called for this intervention to be scaled up and integrated into programs for populations in which child undernutrition is prevalent and dietary quality is very poor.

PR, IFPRI3; ISI; Cross-cutting gender theme; 2 Promoting Healthy Diets and Nutrition for all, Development Strategies and Governance (DSG); Transformation Strategies; Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, The 21st Century has been marked by increased volatility in food prices, with global price spikes in 2007-08, 2010-11, and again in 2021-22. The impact of food inflation on the risk of child undernutrition is not well understood, however. This study explores the potential impacts of food inflation on wasting and stunting among 1.27 million pre-school children from 44 developing countries. On average, a 5 percent increase in the real price of food increases the risk of wasting by 9 percent and severe wasting by 14 percent. These risks apply to young infants, suggesting a prenatal pathway, as well as to older children who typically experience a deterioration in diet quality in the wake of food inflation. Male children and children from poor and rural landless households are more severely impacted. Food inflation during pregnancy and the first year after birth also increases the risk of stunting for children 2-5 years of age. This evidence provides a strong rationale for interventions to prevent food inflation and mitigate its impacts on vulnerable children and their mothers.

Non-PR, IFPRI4; Food Security Portal, Development Strategies and Governance (DSG); Transformation Strategies; Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Frequent food crises with spiking prices have become the new normal in the 21st century, bringing urgency to the task of understanding their nutritional impacts on poor and food insecure populations. In a new analysis of 1.27 million children in 44 low- and middle-income countries (LMICs), we show that exposure to food inflation in the womb and first years of life is associated with greater risks of child wasting in the short run and stunting in the long run. Food inflation also poses larger wasting risks for children of poor and landless rural households, exacerbating existing inequalities. These results show the urgency of policies focused on improving maternal and young child nutrition, and the importance of broadening actions to reduce food price volatility and boost access to nutritious foods.

PR, IFPRI3; ISI; DCA; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all; CRP4, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Nutrition-sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition- and gender-sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2−4 years in Burkina Faso. A 3-year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15−49 years with an index child aged 2−4 years. We assessed the effects 1.5-years (WASH substudy) and 3-years (endline) post-intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH-livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04−0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03−0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock-related risks and improve livestock-hygiene-related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children.

PR, IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; Advancing Research on Nutrition and Agriculture (ARENA), Foresight and Policy Modeling (FPM); Development Strategies and Governance (DSG); Transformation Strategies; Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Suboptimal diets are the most important preventable risk factor for the global burden of non-communicable diseases. The EAT-Lancet reference diet was therefore developed as a benchmark for gauging divergence from healthy eating standards. However, no previous research has comprehensively explored how and why this divergence exists in poorer countries undergoing nutrition transitions. This study therefore analyzes dietary patterns and drivers of the demand for nutritious foods using nationally representative household surveys from Ethiopia, Kenya, Tanzania, and Uganda. We show how barriers to dietary convergence stem from combinations of poverty, high relative food prices and weak preferences for some specific healthy foods. The article concludes by discussing interventions for strengthening consumer demand for healthy diets in Africa.

PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all, PHND, Background: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. Objective: We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3). Methods: We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.

PR, IFPRI4; 2 Promoting Healthy Diets and Nutrition for all, PHND, One of the most significant challenges for food systems today is ensuring that every individual has access to — and consumes — sustainable healthy diets. These are defined as nutritious, healthy (meaning they help prevent disease), safe, affordable, and culturally acceptable diets that support optimal nutrition and health and cause low environmental pressure and impact. The food systems tasked with producing these healthy diets are under significant stress due to environmental and natural resource constraints, as well as climate change. Moreover, the types and amounts of foods we consume — and the way we produce, process, and move these foods — compromise the stability and resilience of natural resources and biodiverse ecosystems and contribute to climate change.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; ISI, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: The Lives Saved Tool (LiST) is a mathematical modelling tool for estimating the survival, health, and nutritional impacts of scaling intervention coverage in low- and middle-income countries (LMICs). Various nutrition interventions are included in LiST and are regularly (and independently) reviewed and updated as new data emerge. This manuscript describes our latest in-depth review of nutrition evidence, focusing on intervention efficacy, appropriate population-affected fractions, and new interventions for potential inclusion in the LiST model. Methods: An external advisory group (EAG) was assembled to review evidence from systematic reviews on intervention-outcome (I-O) pairs for women and children under five years of age. GRADE quality was assigned to each pair based on a LiST-specific checklist to facilitate consistent decisions during the consideration. For existing interventions with new information, the EAG was asked to recommend whether to update the default efficacy values and population-affected fractions. For the new interventions, the EAG decided whether there was sufficient evidence of benefit, and in affirmative cases, information on the efficacy and affected fraction values that could be used. Decisions were based on expert group consensus. Results: Overall, the group reviewed 53 nutrition-related I-O pairs, including 25 existing and 28 new ones. Efficacy and population-affected fractions were updated for seven I-O pairs; three pairs were updated for efficacy estimates only, three were updated for population-affected fractions only; and nine new I-O pairs were added to the model, bringing the total of nutrition-related I-O pairs to 34. Included in the new I-O pairs were two new nutrition interventions added to LIST: zinc fortification and neonatal vitamin A supplementation. Conclusions: For modelling tools like LiST to be useful, it is crucial to update interventions, efficacy and population-affected fractions as new evidence becomes availa

Non-PR, IFPRI1; 2 Promoting Healthy Diets and Nutrition for all, DSGD; PHND, The 21st Century has been marked by increased volatility in food prices, with global price spikes in 2007-08, 2010-11, and again in 2021-22. The impact of food inflation on the risk of child undernutrition is not well understood, however. This study explores the potential impacts of food inflation on wasting and stunting among 1.27 million pre-school children from 44 developing countries. On average, a 5 percent increase in the real price of food increases the risk of wasting by 9 percent and severe wasting by 14 percent. These risks apply to young infants, suggesting a prenatal pathway, as well as to older children who typically experience a deterioration in diet quality in the wake of food inflation. Male children and children from poor and rural landless households are more severely impacted. Food inflation during pregnancy and the first year after birth also increases the risk of stunting for children 2-5 years of age. This evidence provides a strong rationale for interventions to prevent food inflation and mitigate its impacts on vulnerable children and their mothers.

PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all, DSGD; MTID; PHND, Governments, donors and others must step up to protect current and future generations from the devastating effects of malnutrition, as well as to prevent acute food insecurity.

PR, IFPRIOA; IFPRI3; ISI; CRP4; Advancing Research on Nutrition and Agriculture (ARENA); 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH; DSGD, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), In low and middle income countries macroeconomic volatility is common, and severe negative economic shocks can substantially increase poverty and food insecurity. Less well understood are the implications of these contractions for child acute malnutrition (wasting), a major risk factor for under-5 mortality. This study explores the nutritional impacts of economic growth shocks over 1990–2018 by linking wasting outcomes collected for 1.256 million children from 52 countries to lagged annual changes in economic growth. Estimates suggest that a 10% annual decline in national income increases moderate/severe wasting prevalence by 14.4–17.8%. An exploration of possible mechanisms suggests negative economic shocks may increase risks of inadequate dietary diversity among children. Applying these results to the latest economic growth estimates for 2020 suggests that COVID-19 could put an additional 9.4 million preschoolers at risk of wasting, net of the effects of preventative policy actions.

PR, IFPRI3; ISI; GAAP; CRP4; G Cross-cutting gender theme; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Non-PR, IFPRI4; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; DGO; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), In a pair of commentaries published in The Lancet in August 2020, we and our colleagues in the Standing Together for Nutrition Consortium (STfN) and the leaders of four UN agencies called for immediate action to address the escalating problems of child malnutrition and excess mortality triggered by the COVID-19 pandemic (Fore et al. 2020; Headey et al. 2020). Although child mortality from the virus itself is low compared to other age groups, the social, economic, and health systems crises it has prompted pose a serious threat to young children’s nutrition, health, and survival in low- and middle-income countries (LMICs).

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all; CRP4, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)