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PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all; CRP4; DCA, Development Strategies and Governance (DSG); Transformation Strategies; Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

PR, IFPRI3; ISI, PHND, Exclusive breastfeeding (EBF) for the first 6 months has established benefits, yet had slow improvements globally. Little is known about electronic job aid-assisted counselling to support EBF. As a secondary outcome of a cluster randomized controlled trial in Bangladesh, we assessed the effect of electronic job aid-supported nutrition counselling and practical demonstration on EBF. We randomized pregnant women to one of five study arms in the trial and followed mother–child dyads until 2 years of age. Community health workers (CHWs) provided breastfeeding counselling with or without prenatal and complementary nutrient supplements in all four intervention arms. The comparison arm continued with the usual practice where mothers could receive nutrition counselling at routine antenatal and postnatal care, and during careseeking for childhood illnesses. We assessed breastfeeding indicators at birth and monthly until the child was 6 months old, in both intervention and comparison arms. To evaluate the effect of nutrition counselling on breastfeeding, we combined all four intervention arms and compared them with the comparison arm. Intervention newborns had half the risk (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.39, 0.76) of receiving prelacteal feeds than those in the comparison arm. EBF declined steeply in the comparison arm after 3 months of age. EBF was 16% higher in the intervention than the comparison arm at 4 months (RR: 1.16, 95% CI: 1.08, 1.23) and 22% higher at 5 months of age (RR: 1.22, 95% CI: 1.12, 1.33). Maternal background and household characteristics did not modify the intervention effect, and we observed no difference in EBF among caesarean versus vaginal births. Breastfeeding counselling and practical demonstration using an electronic job aid by CHWs are promising interventions to improve EBF and are scalable into existing community-based programmes.

PR, IFPRI3; ISI; CRP4, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, th

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; ISI, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), Actual or perceived conflict of interests (COIs) among public and private actors in the field of nutrition must be managed. Ralston et al expose sharply contrasting views on the new World Health Organization (WHO) COI management tool, highlighting the contested nature of global debates. Both the WHO COI tool and the Ralston et al paper are largely quiet on aspects of power among different actors, however, which we argue is integral to these conflicts. We suggest that power needs to be acknowledged as a factor in COI; that it needs to be systematically assessed in COI tools using approaches we outline here; and that it needs to be explicitly addressed through COI mechanisms. We would recommend that all actors in the nutrition space (not only private companies) are held to the same COI standards, and we would welcome further studies such as Ralston et al to further build accountability.

PR, IFPRI5; CRP4; ISI; Capacity Strengthening; DCA; 2 Promoting Healthy Diets and Nutrition for all; UNFSS, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; CRP4; ISI; 2 Promoting Healthy Diets and Nutrition for all; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low‐ and middle‐income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10–19 years of age) or women of reproductive age (15–49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty‐two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.

PR, IFPRI3; ISI; CRP4; CRP7; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH); CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), Climate change poses a growing threat to the achievement of optimal nutritional status, both directly through affecting food production and indirectly through altering social and economic influences in people's lives. These adverse nutrition outcomes are not evenly distributed across the world, and vulnerable populations are the most impacted. Understanding how different forms of inequity interact with climate change and adverse nutritional outcomes is a novel area of research in today's challenging environment of increased climate change pressures. This article presents the results of a systematic literature search undertaken to identify the connections, trends and pathways between climate change, inequity and nutrition outcomes. Forty‐six peer‐reviewed studies are identified that explore these complex interactions with a specific focus on the extent to which equity is a fundamental component of climate change and nutrition research. The pathways captured in this body of evidence are mapped to current framework thinking to identify trends and gaps. While there is a trend for studies to acknowledge an unfair distribution of vulnerability to adverse nutrition outcomes, there is less attention given to the (lack of) recognition of the social situations which increase these groups' vulnerability and the absence of representation or inclusion of these groups as vital decision‐makers. Studies that do incorporate these core dimensions of equity take mixed‐method and qualitative approaches. This highlights an inherent value in stepping outside the usual scope of empirical climate change research, one that incorporates the voices of those most affected.

PR, IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; ISI, PHND, Concentration of power among transnational ‘Big Food’ companies has contributed to food systems that are unsustainable, unhealthy and inequitable for people and planet. Given these commercial determinants of health, if ‘food systems transformation’ is to be authentic—more than a passing narrative—then leveraging Big Food is paramount. To this end, researchers, practitioners and policy-makers are increasingly encouraged to engage with these powerful entities. However, given the conflicts of interest at stake, engagement relies on trust and transparency, that all stakeholders take responsibility for their actions and demonstrate commitment to do no harm. Given Big Food’s track record in influencing policy, shifting costs and responsibility for their harms—and while profit primarily drives business decision making—we question whether it is logical to expect trust. This analysis explores concepts of responsibility and trust in relation to food systems transformation involving public-private partnerships. Through short cautionary case studies—looking at the United Nations Food Systems Summit, and Big Food’s plastic burden—it argues that unless such companies take responsibility for their cross-cutting effects and earn authentic trust through demonstrably doing no harm, their participation in evidence generation and policy processes should be limited to responding to information requests and adhering to regulation. Any involvement in research agenda-setting or formulating policy solutions introduces conflicts of interest, legitimises corporate irresponsibility and jeopardises scientific integrity. Big Food has dynamism and power to address food system problems, but while it contributes to so many of these problems it should follow—not formulate—transformational evidence, policies and regulations.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The COVID-19 pandemic has provoked a range of economic shocks, food systems shocks, public health crises and political upheavals across the globe, prompting a rethink of associated global systems. Prepandemic anticolonial movements that challenged hierarchies of race, space, gender and expert knowledge in global health took on new meaning in the context of the unequal impacts of the SARS-CoV-2 virus as it moved through different kinds of spaces and distinct political contexts. In light of these dynamics, and the desire of many current practitioners in global health to reimagine the future, the need for critical analyses of the recent past have become more urgent. Here we challenge linear understandings of progress in global health—with a focus on the field of nutrition—by returning to consider a previous cycle of dramatic social, political and economic change that prompted serious challenges to the dominance of Western powers and US-based philanthro-capitalists. With a ‘global’ health and nutrition audience in mind, we put forward considerations on why a better understanding of the continuities and divergences between this past and the present moment are necessary to challenge a status quo that was, and is, highly flawed.

PR, IFPRI3; Transform Nutrition West Africa; ISI; CRP4, PHND; A4NH, There is consensus that policy coherence is necessary for implementing effective and sustainable approaches to tackle malnutrition. We look at whether policies and programmes provide a coherent pathway to address nutrition priorities and if programmes are designed to deliver interventions aligned to the nutrition policy agenda in Nigeria and Burkina Faso. A systematic desk review was performed on nutrition-relevant policy and programme documents, obtained through grey literature searches and expert recommendations. We developed a framework with an impact pathway structure that includes five process steps, which was used to guide coding, data reduction and synthesis and structure the analysis. We assessed internal coherence along process steps within a given document and external coherence across process steps for explicitly linked policy/programme pairs. The majority of policies and programmes had partial internal coherence for both countries. The identification of relevant nutrition interventions to address challenges and reach objectives was the strongest connection within policies (16 out of 45 had complete coherence) while among programmes the strongest connection was coverage indicators that measure interventions (9 out of 21 had complete coherence). Eight programmes explicitly referenced at least one nutrition-relevant policy with a total of 16 linked policy/programme pairs (13 pairs for Burkina Faso and 3 for Nigeria) across health, nutrition, agriculture, and social focus areas. However, none of the linked pairs were assessed to have complete external coherence suggesting that priorities at policy level are not fully realised nor translated at programme level. This study offers a new approach for assessment of policy and program coherence and specifically examines policy and program linkages. We conclude that improved leadership on country priority setting and better alignment for nutrition within and across sectors is needed to enhance the effectiveness of

PR, IFPRI3; ISI; POSHAN; Transform Nutrition West Africa; CRP4; Stories of Change in Nutrition, PHND; A4HN; SAR, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Malnutrition in all its forms continues to be a massive global challenge, and the past decade has seen a growing political attention to addressing malnutrition in different contexts. What has been largely missing so far, and is in growing demand from countries, is tangible, practical and rigorous insights and lessons (from other countries or contexts) on how to translate this burgeoning political momentum into effective policies and programme implementation strategies – and ultimately impact on the ground. This new climate of learning from experience and evidence led to the launch in 2015 of the Stories of Change initiative. This series presents a second wave of studies from six countries (Tanzania, Rwanda, Vietnam, Ghana, Burkina Faso, Nigeria,) and three Indian states (Chhattisgarh, Gujarat, Tamil Nadu). These provide clear evidence combined with compelling narratives on what drives success in addressing all forms of malnutrition – evidence that is necessary for turning global momentum into actual results on the ground. This introductory Opinion is published with the first set of papers. It will be followed by a thorough synthesis of papers as a conclusion of the Series. We hope that the lessons embedded in these Stories of Change will inform and inspire the deliberations and outcomes of the UN Food Systems Summit and the second Nutrition for Growth Summit to be held this year, and the actions of those in the global food and nutrition system working for positive change.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; POSHAN; Transform Nutrition West Africa, PHND; SAR; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda—now amplified by the COVID-19 crisis.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Measures to slow down the spread of Covid-19 have had profound effects on the food and nutrition security of poor and marginalised households and communities. This article provides an overview of the effects of Covid-19 on food systems across low- and middle-income countries using resilience and political economy lenses, before proposing approaches to build back resilient and equitable food systems. First, future interventions need to target structural issues that limit people’s agency in accessing nutritious and diverse food and production capital. Second, local innovation systems and institutions require investment to create a market environment that benefits domestic (small and medium) enterprises and agri‑food supply chain workers without jeopardising the environment. Third, interventions need to be informed by a diverse set of opinions that include the voices of the most marginalised.

PR, IFPRI5; CRP4; 2 Promoting Healthy Diets and Nutrition for all; UNFSS, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Measures that have been put in place across the world to slow down the spread of coronavirus (Covid-19) have had profound effects on food and nutrition security for those furthest behind. In the short run, many have experienced increased commodity prices, decreased access to food through schools and markets, disrupted agri-food supply chains, and loss of livelihoods. It is feared that these short-term effects will have a long-term impact on poverty, intergenerational malnutrition among vulnerable people (in particular, pregnant and lactating women), agricultural productivity reduction, and increased conflicts and displacement. How can we build back food systems better after Covid-19 so that they serve the needs of those furthest behind? To guide this decision, we employ the following concept of food systems resilience: ‘Capacity over time of a food system and its units at multiple levels, to provide sufficient, appropriate and accessible food to all, in the face of various and even unforeseen disturbances’. In applying this concept to the post-Covid-19 response, we supplement this with a political economy angle that critically examines whose resilience is and should be prioritised in humanitarian aid and donor-funded interventions. In line with international and Ireland’s commitments, the aim is to build back food systems that ‘leave no one behind’.

Non-PR, IFPRI5; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), In his 2019 book “Upheaval: How Nations Cope with Crises and Change”, Jared Diamond starts by interrogating the word ‘crisis’. Coming from the Greek noun ‘krisis’ and the verb ‘krino’ there are several meanings — to separate, decide, a turning point. Crises differ in terms of the way they emerge, their scale, duration, and impact. Some come as a shock, some are slow-burn — though in reality this distinction may be blurred once we look below the surface. The COVID-19 pandemic is a sudden-onset crisis, while climate change is slow-burn (albeit linked to increasing shocks like floods and droughts). The biggest cause of global ill-health and premature mortality – malnutrition — is also slow-burn. All three crises are massive in scale, they overlap and interact, and they share many drivers. In 2019, a Lancet Commission delivered an incisive analysis of the global syndemic of obesity, undernutrition, and climate change. This was a year before the pandemic. COVID-19 has since added another crisis into this toxic mix.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; UNFSS, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This brief article aims to interrogate some widely used concepts in framing the interactions between disease epidemics, food systems and nutrition, with a particular focus on the COVID-19 crisis. How should we conceptualize vulnerability in such situations – both with regard to viral exposure and to subsequent nutrition-relevant impacts of epidemics and responses (including lockdowns)? Is it possible to simultaneously pursue strategies aimed at strengthening resilience and driving transformation (‘building back better’)? What type of framing and conceptualization can help illuminate entry points and options for responding effectively to interacting crises? In addressing these questions, it’s important to re-visit lessons from past attempts to address the impacts of epidemics on food and nutrition security.

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: This paper investigates actions that combine nutrition and physical activity which hold potential for ‘double duty action’ to tackle multiple forms of malnutrition simultaneously. Expanding on previous research on single component actions, we assessed the state of the literature to map integrated interventions across the life course to analyse potential double duty effects, and identify knowledge gaps and needs for future design, implementation, evaluation and research for effective double duty action. Methods: A scoping review of peer-reviewed and grey literature was conducted to explore the pathways that extend from combined physical activity and nutrition promotion interventions, with potential synergistic effects on outcomes other than obesity. Electronic databases were searched for studies published between 1 January 2010 and 31 January 2020. Out of 359 articles retrieved, 31 peer-reviewed and 5 grey literature sources met inclusion criteria. Findings from 36 papers reporting on 34 interventions/initiatives were organised into 6 categories, based on implementation across multiple stages of the life course. Double-duty potential was assessed through a further stage of analysis. Findings: This review has identified actions that hold potential for tackling not only obesity, but healthy diets, sedentary behaviour and quality of life more generally, as well as actions that explicitly tackle multiple forms of malnutrition. Importantly, it has identified crucial gaps in current methods and praxis that call for further practice-oriented research, in order to better understand and exploit the synergistic effects of integrated interventions on outcomes other than obesity. Conclusions: Findings from across implementation settings suggest that even in situations where interventions are aimed at, or framed in terms of, obesity prevention and control, there are unexploited pathways for broader outcomes of relevance to nutrition and health and wellbeing more gener

Non-PR, IFPRI1; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), La malnutrición es un problema de desarrollo lento que mata a millones de personas cada año. La pandemia de la covid-19 ha creado una onda expansiva con enormes ramificaciones para los sistemas sanitarios y alimentarios, y para la economía en general. Ambos desafíos tienen carácter mundial e interactúan en un círculo vicioso. La malnutrición (incluida la obesidad) está asociada a un mayor riesgo de morir de covid-19. A su vez, el virus amenaza los sistemas alimentarios y sanitarios y aumenta el riesgo de hambre de millones de personas. Como siempre, los que más van a sufrir son los que tienen menos capacidad de hacerle frente; es decir, los más pobres y vulnerables.

Non-PR, IFPRI5; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Malnutrition is by far the biggest driver of ill-health and premature mortality in every region of the world. A slow-burn attritional problem, it does enormous damage. The COVID-19 epidemic that’s sweeping the world, meanwhile, brings a series of massive short-wave shocks. Both the epidemic and malnutrition will generate long-wave impacts, for years to come. They are also likely to interact with each other – badly. This will be particularly true in countries in sub-Saharan Africa and South Asia. Many of these countries’ governments, health and food systems, communities and households have limited capacity to respond to nutritional challenges or to an epidemic. This means that the potential exists for malnutrition to exacerbate the health consequences of the COVID-19 epidemic, and vice versa.

PR, IFPRI3; POSHAN; Alive and Thrive; CRP4; Transform Nutrition; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The global community is committed to addressing malnutrition. And yet, coverage data for high-impact interventions along the continuum of care remain scarce due to several measurement and data collection challenges. In this analysis paper, we identify 24 nutrition interventions that should be tracked by all countries, and determine if their coverage is currently measured by major household nutrition and health surveys. We then present three case studies, using published literature and empirical data from large-scale initiatives, to illustrate the kind of data collection innovations that are feasible. We find that data are not routinely collected in a standardised way across countries for most of the core set of interventions. Case studies—of growth monitoring and screening for acute malnutrition, infant and young child feeding counselling, and nutrition monitoring in India—highlight both challenges and potential solutions. Advancing the nutrition intervention coverage measurement agenda is essential for sustained progress in driving down rates of malnutrition. It will require (1) global consensus on a core set of validated coverage indicators on proven, high-impact nutrition-specific interventions; (2) the inclusion of coverage measurement and indicator guidance in WHO intervention recommendations; (3) the incorporation of these indicators into data collection mechanisms and relevant intervention delivery platforms; and (4) an agenda for continuous measurement improvement.

PR, IFPRI2; CRP4, DGO; CPA; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This chapter first reviews the relationship between governance systems and processes (at various levels) and the nutrition sensitivity of agri-food systems, before reviewing the role of leadership in orienting such systems toward nutrition goals.

PR, IFPRI3; ISI; CRP4; DCA; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Despite significant improvements over recent decades, rates of undernutrition remain high in South Asia, with adverse impacts on morbidity and mortality. Overweight/obesity, among children and adults, is now an additional and major public health concern. While agriculture has the potential to improve nutrition through several pathways, this potential is currently not being realised in the region. The Leveraging Agriculture for Nutrition in South Asia (LANSA) research consortium (2012–2018) set out to improve understanding about how agriculture and related food policies and programs in South Asia (specifically in India, Bangladesh, Pakistan and Afghanistan) can be better conceptualised and implemented in order to enhance impacts on nutrition outcomes, especially those of young children and adolescent girls. This paper provides a snapshot of the agriculture-nutrition nexus in the region, outlines the pathways through which agriculture can influence nutrition outcomes, elaborates on the objectives of the LANSA research consortium within this context, and highlights the core findings of the six papers that form the body of this Special Issue. The paper ends with five key lessons that have emerged from this research, during this decade.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 5 Strengthening Institutions and Governance, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Malnutrition is a multicausal challenge that requires multisectoral responses to make comprehensive and sustainable progress, over the long term. How is agriculture and the wider agri-food system positioned within the constellation of factors and processes that determine nutrition outcomes in different contexts and countries? What is known about the role of enabling environments and the governance of agri-food systems in driving nutrition outcomes, for better or worse? In this paper we will highlight the findings of a systematic review that focuses on this question, drawing on work from the South Asian region including research undertaken by LANSA. We conclude with a discussion of the major implications and recommendations for future policy and practice.

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

PR, IFPRI3; ISI; CRP4; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), In this review, the influence of seasonal variation on undernutrition during the first 1000 days of life of life inrural South Asia is conceptualized using a modified framework developed under the “Tackling the Agricultureand Nutrition Disconnect in India” project. Evidence for the existence and extent of seasonality is summarizedfrom 14 studies reporting on six proximal determinants of undernutrition. A limited number of studies examineseasonal variation in risk factors for this age group. All available studies, however, report a compelling finding ofsignificant seasonal variation for at least one determinant of undernutrition. Research to clarify mechanisms forpotentially adverse effects of seasonal variation on health and nutritional status during the first 1000 days of lifeis needed

PR, IFPRI3; ISI; Transform Nutrition; CRP4; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The Transform Nutrition (Transform) research consortium (2012-2017), led by the International Food Policy Research Institute, sought to generate evidence to inform and inspire action to address undernutrition in 4 high-burden countries (India, Bangladesh, Kenya, and Ethiopia) and globally. Within the context of the literature, this synthesis article brings together core findings of Transform, highlighting priorities for future research.

Non-PR, IFPRI1; CRP4; Stories of Change in Nutrition; Transform Nutrition; LANSA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), After several years of growing political commitment, with more and more pledges and declarations and an increasing focus on data and on evidence, the international nutrition community has come to recognise the power of narrative. Knowledge that is practically useful needs to encompass a lot more than data and evidence – it needs to include experience. To meet this growing demand for experiential learning, Transform Nutrition developed the Stories of Change (SoC) initiative. The goal was to systematically assess and analyse drivers of change in six high-burden countries – Bangladesh, India (Odisha), Ethiopia, Nepal, Senegal, and Zambia – that have had some success in accelerating improvements in nutrition. From 2014–16, country teams undertook analysis of changes over time in nutrition outcomes, in nutrition-specific and nutrition-sensitive drivers, and changes in nutrition-relevant policies and programs. Semi-structured key informant interviews (434 in total) were carried out with a range of stakeholders at different levels.

PR, IFPRI3; ISI; CRP4; Transform Nutrition; Capacity Strengthening; B Promoting healthy food systems; F Strengthening institutions and governance; Stories of Change in Nutrition, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; POSHAN; Stories of Change in Nutrition, PHND; A4NH; SAO, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; Transform Nutrition; Capacity Strengthening; B Promoting healthy food systems; F Strengthening institutions and governance; DCA; Stories of Change in Nutrition, A4NH; PHND, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; Transform Nutrition; Capacity Strengthening; B Promoting healthy food systems; F Strengthening institutions and governance; DCA; Stories of Change in Nutrition, A4NH; PHND; SAO, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI1; Urban food systems for better diets, nutrition, and health, DGO; CPA; PHND, Diets are changing with rising incomes and urbanization— people are consuming more animal-source foods, sugar, fats and oils, refined grains, and processed foods. This “nutrition transition” is causing increases in overweight and obesity and diet-related diseases such as diabetes and heart disease. Urban residents are making the nutrition transition fastest— but it is occurring in rural areas too. Urban food environments—with supermarkets, food vendors, and restaurants—facilitate access to unhealthy diets, although they can also improve access to nutritious foods for people who can afford them. For the urban poor, the most easily available and affordable diets are often unhealthy.

PR, IFPRI3; CRP4; B Promoting healthy food systems; Urban food systems for better diets, nutrition, and health, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI1; Transform Nutrition; compact2025; F Strengthening institutions and governance; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), 近年来，营养不良问题引发了国际社会空前的关注， 各国也相应做出了解决营养不良问题的政治承诺。增强营养( S U N ) 行动、《柳叶刀》 （Lancet ）孕产妇及儿童营养目标系列以及第二届国际营养大会(ICN2)等里程碑标志着营养问题在全球政策和研究议程中的受重视程度已得到了快速提升。 这些进展扭转了国际社会多年来对营养问题相对忽视的局面。营养不良问题已成为一个全球性挑战，造成了巨大的社会和经济负担。 每年有数以百万计的儿童因营养不良而死亡，不仅如此，营养不良还 阻碍儿童生长，影响儿童发育，降低儿童入学率并且使他们成年时陷入贫困的可能性大大增加。发育迟缓不仅影响人一生，而且影响后代：体重过轻的母亲生出体重过轻的孩子的几率更高，导致营养不良跨代延续。营养不良每年造成全球GDP损失高达1.4-2.1万亿美元，相当于撒哈拉以南非洲地区的经济总量。

PR, IFPRI1; Transform Nutrition; compact2025, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Сes dernières années, le monde a été témoin d’une attention et d’un engagement politique sans précédent à l’égard de la lutte contre la malnutrition. Des étapes clés comme le Mouvement pour le renforcement de la nutrition (SUN), la série The Lancet consacrée à la nutrition maternelle et infantile et la Deuxième Conférence internationale sur la nutrition (CIN2) ont marqué l’ascension rapide de la nutrition dans le programme mondial de politique et de recherche.

PR, IFPRI1; Transform Nutrition; compact2025; F Strengthening institutions and governance; B Promoting healthy food systems; E Building Resilience; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Malnutrition costs the world trillions of dollars, but global commitment to improving people’s nutrition is on the rise, and so is our knowledge of how to do so. Over the past 50 years, understanding of nutrition has evolved beyond a narrow focus on hunger and famine. We now know that good nutrition depends not only on people’s access to a wide variety of foods, but also on the care they receive and the environment they live in. A number of countries and programs have exploited this new understanding to make enormous strides in nutrition. Nourishing Millions: Stories of Change in Nutrition brings together the most intriguing stories from the past five decades to show what works in nutrition, what does not, and the factors that contribute to success. The stories gathered here examine interventions that address nutrition directly—such as community nutrition programming and feeding programs for infants and young children—as well as nutrition-sensitive policies related to agriculture, social protection, and clean water and sanitation. The authors consider efforts to combat the severest forms of acute malnutrition as well as overweight and obesity. They shed light on nutrition success stories on the ground in places ranging from Bangladesh, Brazil, Nepal, Peru, Thailand, and Vietnam to Ethiopia and the state of Odisha in India. The book also examines how nutrition “champions” emerge and drive change. Altogether, Nourishing Millions is a unique look at past and emerging nutrition successes and challenges around the world.

PR, IFPRI4; CRP4; B Promoting healthy food systems, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI1; ReSAKSS, DSGD; WCAO; ESAO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The food and agriculture sector is pivotal not only to addressing undernutrition but also to containing and preventing the spread of diet-related noncommunicable disease. This context requires action throughout the food system, from sustainably managing natural resources and input supplies to enabling consumption of healthy diets and promoting gender equity. Political commitment is growing, but much remains to be done in terms of strengthening the information base to support strategic decision making, and developing capacities for implementation at scale. In April 2016, the UN General Assembly enacted a Decade of Action for Nutrition, and nutrition is directly or indirectly related to all of the Sustainable Development Goals. This enabling environment at the global level should foster further progress in the region, and conversely, African countries can inspire other regions of the world by pursuing innovative approaches for unleashing the latent potential of the agrifood sector to drive positive change in nutrition.

PR, IFPRI1; Transform Nutrition; compact2025; F Strengthening institutions and governance; B Promoting healthy food systems; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), THAILAND REDUCED CHILD undernutrition by more than half within one decade—an achievement recognized by the nutrition community as one of the best examples of a successful national nutrition program. Underweight rates among children under five decreased from more than 50 percent to less than 20 percent from 1982 to 1991, and severe and moderate underweight rates were nearly eliminated. The underweight rate was further reduced to 10 percent by 1996 and to 9 percent by 2012. Maternal care interventions were also successful. Thailand improved the reach of antenatal care—coverage increased from 35 percent in 1981 to near 95 percent in 2006. And iron-deficiency anemia prevalence among pregnant women was reduced from nearly 60 percent in the 1960s to 10 percent in 2005.

PR, IFPRI1; Transform Nutrition; compact2025; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This book is an attempt to meet for narratives of what has worked well by combining a review of various analyses and studies with a narrative approach to convey the drivers and pathways of success in nutrition in different contexts and at different times. It seeks to inspire as well as to inform. In recent years, there has been a growing focus on the potential of narrative and storytelling to inspire and promote change.4 Stories can turn the key in ways that help the reader intuitively grasp why change is needed, what it involves, how it happens, and—crucially—how it can be made to happen. Stories enable listeners to extrapolate from case studies and to see analogies with their own backgrounds, their own contexts, and their own fields of expertise. Research has shown that stories catalyze change because they are natural and easy to tell, they show connections between things, and they cut through complexity. They are memorable, non-adversarial, non-hierarchical

PR, IFPRI1; Transform Nutrition; compact2025, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), En los últimos años, el mundo ha dedicado una atención y un compromiso político sin precedentes para tratar la malnutrición. El Movimiento para el fomento de la nutritición (SUN), la serie sobre nutrición materno-infantil de la revista científica The Lancet y la Segunda Conferencia Internacional sobre Nutrición (ICN2) constituyen etapas clave que han marcado el rápido surgimiento de la nutrición en la agenda política y de investigación a nivel mundial.

PR, IFPRI1; Transform Nutrition; compact2025; B Promoting healthy food systems; F Strengthening institutions and governance; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), BY WEAVING STORIES together with analysis and description in this book, we have sought to convey the variety of experiences in tackling malnutrition in different contexts throughout the past five decades. This narrative approach is intended to help the reader translate an experience into his or her own context, showing many examples of what can be done and how success can be achieved. Our aim is not only to inform action, but to inspire.

PR, IFPRI1; Transform Nutrition; compact2025; F Strengthening institutions and governance; B Promoting healthy food systems; E Building Resilience; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), In recent years, the world has seen unprecedented attention and political commitment to addressing malnutrition. Milestones such as the Scaling Up Nutrition (SUN) Movement, the Lancet Maternal and Child Nutrition Series, and the Second International Conference on Nutrition (ICN2) have marked the rapid rise of nutrition on the global policy and research agenda. These developments reverse years of relative neglect for nutrition. Undernutrition is a global challenge with huge social and economic costs. It kills millions of young children annually, stunts growth, erodes child development, reduces the amount of schooling children attain, and increases the likelihood of their being poor as adults, if they survive. Stunting persists through a lifetime and beyond—underweight mothers are more likely to give birth to underweight children, perpetuating undernutrition across generations. Undernutrition reduces global gross domestic product by US$1.4–$2.1 trillion a year—the size of the total economy of Africa south of the Sahara.

PR, IFPRI1; Transform Nutrition; compact2025; F Strengthening institutions and governance; Stories of Change in Nutrition, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Whatever advances have been made in terms of technologies, interventions, and their delivery platforms in recent decades, it is households and communities that remain on the front lines in combating malnutrition. During the past half century, several significant attempts have been made to initiate and implement community-based nutrition programs. This chapter assesses the evolution and performance of

Non-PR, IFPRI3; CRP4, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; B Promoting healthy food systems; DCA, DGO; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Non-PR, IFPRI5; F Strengthening institutions and governance, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; Capacity Strengthening, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Non-PR, IFPRI1; CRP4; B Promoting healthy food systems, A4NH; PHND; DGO, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This paper brings structure to the discussion of private-sector engagement in nutrition by clarifying different models of engagement, reviews the evidence base on public-private partnerships (PPPs) for the reduction of undernutrition, and outlines some potential ways forward. We find that there are few independent, rigorous assessments of the impact of commercial-sector engagement in nutrition. Considerable caution is thus warranted when assessing PPPs in nutrition. Looking forward, future progress requires that the private sector recognize that past and current actions by some firms have created an environment of mistrust. It requires that the public sector accept that sustainable PPPs are those which permit private firms to generate profits. There is significant scope for the private sector to drive innovations that could reduce undernutrition, and, more speculatively, there may be scope for the private sector to act as a financier. Underpinning all these efforts must lie open discussions of the objectives, roles, and expectations of all parties along with potential conflicts of interest; an open space or platform where issues and challenges can be discussed and addressed; incentives for the private sector to take on pro-nutrition roles; strong, transparent, and well-enforced monitoring processes; and serious, independent evaluations of these activities.

Non-PR, IFPRI1; CRP4; Transform Nutrition; Capacity Strengthening; B Promoting healthy food systems; F Strengthening institutions and governance; Stories of Change in Nutrition, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This paper—which draws on inputs to, and discussions at, a methods development workshop—highlights the various concepts, methods, and tools that SoC researchers are considering to measure nutrition-relevant change in their respective countries. The focus is on nutrition-relevant policy and practice. These tools apply to 11 subthemes, which are to some extent sequential within policy/programming cycles: (1) assessing the nutrition problem, (2) stakeholder and institutional analysis/mapping, (3) understanding enabling environments for nutrition, (4) agenda setting and political commitment for nutrition, (5) policy formulation and policy processes, (6) multisectoral coordination, (7) implementation and vertical coherence, (8) scaling up, (9) assessing capacity, (10) assessing finance, and (11) monitoring, evaluation, and accountability. Examining these various methods and tools together allows for a holistic consideration of the processes that—while challenging to document and measure—play a key role in improving nutrition-relevant policy and practice, which, in turn, drives national achievement in reducing malnutrition.