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The specific aim was to characterize retail purchases of red and processed meat and other major protein-rich foods in the U.S. and by state. Supermarket scanner data from grocery stores, supermarkets, and big box stores collected from 2017-2019 (NielsenIQ, New York, NY) was used to characterize retail purchases of red meat, processed meat, and other protein-rich foods in thirty-one states representative of US retail food sales. Red meat, processed meat, poultry, seafood, eggs, other meats, and non-meat foods (beans, nuts, seeds, meat alternatives) by weight accounted for 25.9%, 20.4%, 25.8%, 5.9%, 12.6%, 1.3%, and 10.1%, respectively of total sales in 2017-2019. Mean per capita purchases of red meat by weight was 30.1 g/d, ranging from 45.4 g/d in Mississippi to 21.9 g/d in New York. Mean per capita purchases of processed meat by weight was 23.8 g/d, ranging from 36.6 g/d in Mississippi to 15.2 g/d in California. We observed statistically significant correlations between red and processed meat purchases with cardiovascular mortality and colorectal cancer by state. Per capita retail purchases of red and processed meat appear to reflect a dietary pattern that is not consistent with current national and international dietary recommendations.

While a large number of studies have investigated seafood consumption in various markets, surprisingly little is known about the types of seafood sold in retail outlets or their product forms in th...

Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereafter village A and B) in Western Kenya in 2013. The mean (SD) age was 11.6 (2.2) years in village A (n = 759) and 12.6 (2.2) years in village B (n = 1143). We evaluated dietary diversity using the 10-food-group-based women’s dietary diversity score (WDDS) and found a mean (SD) WDDS of 4.1 (1.4) in village A and 2.6 (0.9) in village B. We identified three distinct dietary patterns in each village using latent class analysis. In both villages, the most diverse pattern (28.5% in A and 57.8% in B) had high consumption of grains, white roots and tubers, and plantains; dairy; meat, poultry, and fish; and other vegetables. Despite variation for some children, dietary diversity was relatively low for children overall, supporting the need for additional resources to improve the overall diet of children in western Kenya.

The value of animal-sourced foods (ASFs) in providing key nutrients, particularly for child growth and where diets are of low quality, is understood mainly from cross-sectional assessment of current consumption. Longitudinal panel data from Nepal, Bangladesh and Uganda were used here to assess associations among previous (lagged) and contemporaneous ASF intake with linear growth of children aged 6–24 months. Lagged ASF consumption was significantly correlated with a 10% decline in stunting in Nepali children who consumed any ASF in the previous year, while current intake was associated with a 9% decline in stunting in Uganda. Previous consumption of two or more ASFs showed a stronger association, ranging from a 10% decline in stunting in Bangladesh to a 16% decline in Nepal. This novel lagged analysis emphasizes the need for regular and appropriate levels of ASF intake by young children to support healthy growth in resource-constrained settings. The effects of previous and contemporaneous consumption of animal-sourced foods on stunting in children under two years in Nepal, Uganda and Bangladesh are studied here, with implications for contextualizing the interpretation of sustainable, healthy diets.

Fish are an important source of bioavailable micronutrients and essential fatty acids, and capture fisheries have potential to substantially reduce dietary deficiencies. Vigorous debate has focused on trade and fishing in foreign waters as drivers of inequitable distribution of volume and value of fish, but their impact on nutrient supplies from fish is unknown. We analyze global catch, trade, and nutrient composition data for marine fisheries to quantify distribution patterns among countries with differing prevalence of inadequate nutrient intake. We find foreign fishing relocates 1.5 times more nutrients than international trade in fish. Analysis of nutrient flows among countries of different levels of nutrient intake shows fishing in foreign waters predominantly (but not exclusively) benefits nutrient-secure nations, an outcome amplified by trade. Next, we developed a nutritional vulnerability framework that shows those small island developing states and/or African nations currently benefiting from trade and foreign fishing, and countries with low adaptive capacity, are most vulnerable to future changes in nutrient supplies. Climate change exacerbates vulnerabilities for many nations. Harnessing the potential of global fisheries to address dietary deficiencies will require greater attention to nutrition objectives in fisheries’ licensing deals and trade negotiations.

The “second 1000 days” is a period of rapid brain growth which consolidates developmental foundations and establishes school readiness. Understanding the relation between household characteristics, child diet, and child development remains incomplete, especially in resource-poor settings where >250 million children risk not achieving their full developmental potential. Child developmental performance was assessed (Ages & Stages Questionnaire [ASQ]) at ages 2 and 5 years in a cohort of Nepali children (n = 207) whose families participated in a nutrition/livestock management+community development intervention trial. Relationships between child developmental performance and mother’s education, family wealth, child diet (animal source food [ASF] consumption, dietary diversity score [DDS]), school attendance, and intervention group were examined by adjusted linear regressions. These relationships varied at the 2 ages. At age 2 years, ASQ scores related positively to “Full Package Intervention” and negatively to “Partial Package Intervention” membership. At age 5 years, intervention group did not relate to ASQ scores. Mother’s education did not relate to developmental findings for 2-year-olds. Mother’s education, wealth, and school attendance positively predicted ASQ scores for these same children as 5-year-olds. Animal source food consumption was related to child development more strongly at age 5 than at 2 years. DDS had a less pronounced relationship to development than ASF consumption at both ages. Over this time span bracketing the second 1000 days, household characteristics and child diet related differentially to developmental performance depending on child age. Better understanding of the timing and mechanisms of these relationships is needed to effectively design interventions targeting improved child development in resource-poor settings.

Background The 2020 US Dietary Guidelines for Americans recommend that the US population consume more seafood. Most analyses of seafood consumption ignore heterogeneity in consumption patterns by species, nutritional content, production methods, and price, which have implications for applying recommendations. Objectives We assessed seafood intake among adults by socioeconomic and demographic groups, as well as the cost of seafood at retail to identify affordable and nutritious options. Methods NHANES 2011–2018 dietary data (n = 17,559 total, n = 3285 eating seafood) were used to assess adult (≥20 y) intake of seafood in relation to income and race/ethnicity. Multivariable linear regression assessed the association between seafood consumption and income, adjusted for age, sex, and race/ethnicity, and the association between nutrients and seafood price, using Nielsen 2017–2019 retail sales data, adjusted for sales volume. Results Low-income groups consume slightly less seafood than high-income groups [low income: mean 120.2 (95% CI: 103.5, 137.2) g/wk; high income: 141.8 (119.1, 164.1) g/wk] but substantially less seafood that is high in long-chain n–3 (ω-3) PUFAs [lower income: 21.3 (17.3, 25.5) g/wk; higher income: 46.8 (35.4, 57.8) g/wk]. Intake rates, species, and production method choices varied by race/ethnicity groups and within race/ethnicity groups by income. Retail seafood as a whole costs more than other protein foods (e.g., meat, poultry, eggs, beans), and fresh seafood high in n–3 PUFAs costs more (P < 0.002) than fresh seafood low in n–3 PUFAs. Retail seafood is available in a wide range of price points and product forms, and some lower-cost fish and shellfish were high in n–3 PUFAs, calcium, iron, selenium, and vitamins B-12 and D. Conclusions New insights into the relation between seafood affordability and consumption patterns among income and ethnicity groups suggest that specific policies and interventions may be needed to enhance the consumption of seafood by different groups.

Seasonality is a natural feature of wild caught fisheries that introduces variation in food supply, and which often is amplified by fisheries management systems. Seasonal timing of landings patterns and linkages to consumption patterns can have a potentially strong impact on income for coastal communities as well as import patterns. This study characterizes the relationship between seasonality in seafood production and consumption in the United States by analyzing monthly domestic fisheries landings and imports and retail sales of farmed and wild seafood from 2017 to 2019. Analyses were conducted for total seafood sales, by product form, by species group, and by region of the United States. The data reveal strong seasonal increases in consumption around December and March. Seasonal increases in consumption in Spring and Summer occurred in parallel with domestic fishing production. Domestic landings vary by region, but most regions have peak fishing seasons between May and October. Alaska has the largest commercial fishery in the United States and seasonal peaks in Alaska (July/August, February/March) strongly influence seasonality in national landings. Misalignment between domestic production and consumption in some seasons and species groups creates opportunities for imports to supplement demand and lost opportunities for domestic producers.

Background: Preschool child anthropometric status has been assessed nationally in Nepal since 1975, with semi-decadal surveys since 1996, plus several recent, short-interval surveys to track progress toward achieving a World Health Assembly (WHA) goal to reduce stunting to 24% by 2025. Objective: We report prevalence of preschool child stunting and wasting from a national survey in 2016 and place findings into the context of national trends and alignment for Nepal to attain its WHA 2025 goal. Methods: A representative, midyear Policy and Science for Health, Agriculture and Nutrition (PoSHAN) survey was conducted in 2016 on 5479 children Results: Nationally, in 2016, 34.1% of preschoolers were stunted and 13.7% wasted. Stunting was highest in the Mountains (40.6%) and wasting highest in the Tarai (18.9%). Trend analysis revealed a steady decline (3.8% AARR) in stunting from 2001 to 2013, with virtually no decline from 2013 to 2016. Wasting has been continually high and variable, at ≥8%, since 1975. Conclusions: Following a steady decline in prevalence, preschool child stunting has plateaued at ∼35% in Nepal, while wasting has changed little over time, offering the opportunity to inform, reassess, and adjust, as needed, efforts to reach WHA 2025 goals.

Large scale surveys such as the Demographic and Health Surveys (DHS) are used to measure the coverage and quality of antenatal care (ANC)-related services. Studies have increasingly validated questions from these surveys, though few have explored respondent comprehension or associated thought processes. This study aimed to use cognitive testing and validation approaches to understand how survey respondents understand questions related to ANC-related nutrition services. The study was nested within a larger validation study in southern Nepal. Pregnant women's receipt of ANC related services was directly observed at five health posts followed by a recall interview at 6 months postpartum. A week later, a survey module was re-administered to 30 women containing 15 questions about receipt of ANC care and specifically nutrition-related services. Detailed probing was used to identify cognitive challenges related to comprehension, retrieval, judgement, and response. Respondents accurately recalled the four specific ANC visits recommended by the government of Nepal but those with more visits struggled to estimate the total number of ANC visits they had made. A number of terms including "antenatal care, "nutrition" and "breastfeeding" were challenging for many respondents to understand. Visits to private providers including for ultrasounds were inconsistently included in ANC visit counts suggesting that question wording could better specify the type of care. Many respondents over-estimated the number of iron folic acid (IFA) supplements taken during pregnancy, and recall was challenging. Calculations were based on estimating the number of months between first ANC visit to delivery, and only sometimes factored in missed tablets. Opportunities exist to improve questions to facilitate better comprehension by respondents through a combination of using local terms and explanations, reordering some questions, and adapting questions to better match respondents' approaches to estimating numeric responses.

Maternal depression has been associated with adverse child growth and development; less is known about its relation to children's diet. In a cross‐sectional study embedded at endline of a longitudinal community development intervention, mothers of 629 children (age 23–66 months) in rural Nepal responded to household and children's diet questionnaires and were screened for depression. Child anthropometry and development (Ages and Stages Questionnaire) were assessed. Regression models examined children's diet, growth and development, adjusting for household, child and maternal characteristics. The prevalence of maternal depression was 21%. Maternal depression was associated with 11% lower likelihood that the child consumed one additional food group [Poisson regression, adjusted relative risk (aRR) 0.89, 95% confidence intervals (95% CI 0.81, 0.99), p = 0.024] and 13% lower likelihood that the child consumed one additional animal source food (ASF) [aRR 0.87, (95% CI 0.76, 1.01), p = 0.061] compared with children of nondepressed mothers. However, maternal depression was not associated with either child anthropometry or development: these outcomes were strongly associated with better home child‐rearing quality. Stunting also related to child age and intervention group; child development related to mother's education and household wealth. This study suggests a correlation between maternal depression and child dietary diversity. This association could be due to unmeasured confounders, and therefore, further research is warranted. Understanding the relationship of depression to child outcomes—and the role of other potentially compensatory household factors—could help address some of the earliest, modifiable influences in a child's life and contribute to innovative approaches to improve child well‐being.

Background Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development. Methods We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants

Seafood is a highly traded commodity and 71% of the United States (U.S.) supply is imported. This study addresses questions about imported seafood safety and compares risks of outbreaks and recalls across countries of origin, species, and stages of the supply chain. We found that where seafood comes from does not play a major role in risk. Risk is a function of the activities happening at each stage of the supply chain, inherent riskiness of some products or processes, and “pass through” risks introduced at upstream and midstream stages of the supply chain. Dominant farmed species (shrimp, tilapia, catfish) became less risky as they move along the supply chain toward consumers. We recommend investments in agencies overseeing food safety and health, enhanced traceability within supply chains, and more open government datasets that support systems-level analyses.

This study aimed to describe the timing and patterns of pubertal maturation of girls living in rural Bangladesh. Starting in September 2015, a total of 15,320 girls from a birth cohort, aged 9 to 15 years at initial encounter, were visited twice at about a one year interval, typically in their birth month. Participants were asked to self-report extent of pubertal maturation, including breast development, pubic hair growth and age at menarche, if applicable. Pubertal stage (abbreviated as B2 and B3-4 for breast development and PH2 and PH3-4 for pubic hair growth) was assigned. Data from both visits were pooled, yielding a total of 29,377 age-related observations per pubertal characteristic. Probit regression models were used to estimate distributions of age at which each stage of pubertal development was attained. Before age 8

Background Dietary diversity can play an important role in providing essential nutrients for both mother and fetus during pregnancy. This study aimed to assess the factors associated with dietary diversity during pregnancy in the western hill region of Nepal. Methods A cross-sectional study of 327 pregnant women was conducted in an urban municipality of Baglung district in the western hill region of Nepal. A semi-structured questionnaire was used to collect information on household demographic and socioeconomic status, food taboos, household food security status, nutrition-related knowledge in pregnancy, and women’s empowerment. Women consuming ≥5 of 10 food groups in the past 24 hours were defined as consuming a diverse diet using the Minimum Dietary Diversity Score for Women (MDD-W) tool. Bivariate and multivariate logistic regression was used to estimate crude odds ratio (cOR) and adjusted odds ratios (aOR) and 95% confidence intervals (CIs) to understand factors associated with dietary diversity. Results Almost 45% (95% CI: 39.6–50.4) of the participants did not consume a diverse diet and the mean dietary diversity score was 4.76 ± 1.23. Multivariable analysis revealed that women with greater empowerment (aOR = 4.3, 95% CI: 1.9–9.9), from wealthier households (aOR = 5.1, 95% CI: 2.7–9.3), joint families (aOR = 2.7, 95% CI: 1.4–5.1), employment (aOR = 2.2, 95% CI: 1.2–4.1), and had adequate nutrition knowledge (aOR: 1.9, 95% CI 1.1–3.4) had higher odds of dietary diversity. Conclusion Along with socioeconomic status, women’s empowerment and nutrition knowledge were modifiable risk factors that should be considered as targets for programs to improve women’s health during pregnancy.

Background There is growing global demand for country-specific information to track nutritional status and its determinants, including intervention coverage. Periodic population-based surveys form the backbone of most national nutrition information systems. However, data on the coverage of many nutrition specific and sensitive interventions remain sparse. Methods An online survey was administered to the international nutrition community in 2018 through relevant listservs and professional networks to characterize their use of nutrition-related indicators and data sources. Respondents were asked about their professional background, access and use of specific indicators and data sources in the previous year, and unmet data needs. Results were tabulated by respondent characteristics and χ2 tests used for statistical testing. Results Complete survey responses were received from 235 respondents, the majority from non-governmental organizations and research communities, and few from governments. Demographic Health Surveys (DHS) were the most frequently accessed country-specific data source and the Global Nutrition Report (GNR) was the most accessed consolidated data source, each accessed by approximately 75% of respondents. Respondents with a multi-country focus were more likely to have accessed DHS than those with a single-country focus (85% vs 60%, P

In resource constrained countries, animal-sourced foods (ASFs) are an important nutrient-dense source of vitamins, minerals and macronutrients. While several studies have suggested the value of ASFs to child growth, most empirical evidence is based on cross-sectional data which can only provide information about the contemporaneous relationship between diet and anthropometric outcomes. This study uses longitudinal panel data for Nepal, Bangladesh, and Uganda to assess the association between contemporaneous as well as past ASF consumption and linear growth of children aged 6-24 months. Fixed effects models found that ASF consumption was significantly correlated with lower stunting, with a decline in stunting prevalence as high as 10% in Nepali children who had consumed any ASF in the previous year. Consuming two or more ASFs showed an even higher magnitude of association, ranging from a 10% decline in prevalence of stunting associated with lagged consumption in Bangladesh to a 16% decline in Nepal.

The COVID-19 pandemic and subsequent lockdowns are creating health and economic crises that threaten food and nutrition security. The seafood sector provides important sources of employment and nutrition, especially in low-income countries, and is highly globalized, allowing shocks to propagate internationally. We use a resilience ‘action cycle’ framework to study the first five months of COVID-19-related disruptions, impacts, and responses to the seafood sector. Looking across high- and low-income countries, we find that some supply chains, market segments, companies, small-scale actors and civil society have shown initial signs of greater resilience than others. For example, frozen Ecuadorian shrimp and Chinese tilapia exports were diverted to alternative markets, while live-fresh supply chains were more impacted. COVID-19 has also highlighted the vulnerability of certain groups working in- or dependent on the seafood sector. We discuss early coping and adaptive responses, combined with lessons from past shocks, that could be considered when building resilience in the sector.

Background Seafood has a nutritional profile that can be beneficial to human health, which gives it a role to play in healthy diets. In addition, because its production and harvesting can have fewer environmental impacts than some forms of animal protein, it can contribute to sustainable diets. However, the positive health and environmental outcomes are not guaranteed-they depend on how seafood is prepared and served and whether it is sourced from sustainable fisheries and aquaculture industries. Objectives We examined the availability and nutritional attributes of seafood meals at chain restaurants in the United States. We assessed nutritional attributes by store type and geography. We also assessed menu labeling for species, production methods, and origin. Methods The study population was 159 chain restaurants with 100,948 branch locations in the United States. Data were harvested from online restaurant menus, and the nutritional profile of seafood meals was calculated. Results The average seafood menu item provides up to 49-61% of the total daily limit of saturated fat, 65% of the total daily limit of sodium, and 58-71% of total daily protein requirement for adult men and women. Restaurant chains located in the Deep South and Ohio River Valley, and casual dining chains nationally, carry seafood meals with more total calories and saturated fat per 100 g than other regions or chain types. Most menu items did not list origin or production methods, which is information that would help consumers make informed decisions. Conclusions The added ingredients and cooking methods used at chain restaurants can attenuate the health benefits of seafood. We recommend reformulating menus to reduce portion sizes, total calories, added fat, and sodium content per meal and to improve consumer-facing information about origin and production methods.

Minimum dietary diversity (MDD), a population-level dietary quality indicator, is commonly used across low- and middle-income countries to characterize diets of children aged 6–23 mo. The WHO and UNICEF recently updated the MDD definition from consumption of ≥4 of 7 food groups in the previous 24 h (MDD-7) to ≥5 of 8 food groups (MDD-8), adding a breastmilk group. The implications of this definition change were examined across 14 countries in Eastern and Southern Africa where improving complementary feeding is a policy priority. A lower MDD-8 score was found compared with MDD-7 across all countries; in 3 countries the difference between indicators was >5 percentage points. Country-level variability is driven by differences in breastfeeding rates and dietary diversity score. As countries transition to the new indicator it is important to actively publicize changes and to promote valid interpretation of MDD trends., We examine the implications of recent changes in indicator definition for national estimates of dietary quality among children aged 6–23 mo in countries where improving child feeding is a policy priority.

The aim of this study was to explore United States (U.S.) seafood consumption patterns, food sourcing, expenditures, and geography of consumption. We analyzed seafood intake and food sourcing using the National Health and Nutrition Examination Survey (NHANES) cycles 2007&ndash, 2008 to 2015&ndash, 2016 for US adults &ge, 19 years old (n = 26,743 total respondents, n = 4957 respondents consumed seafood in the past 24 h). Seafood expenditures were extrapolated by combining NHANES with three other public datasets. U.S. adults consumed 63% of seafood (by weight) at home. The top sources of seafood (by weight) were food retail (56%), restaurants (31%), and caught by the respondent or someone they know (5%). Sixty-five percent of consumer expenditures for seafood were at restaurants and other &ldquo, away from home&rdquo, sources while 35% were at retail and other &ldquo, at home&rdquo, sources. Slightly less than half of overall U.S. food expenditures are &ldquo, away from home,&rdquo, which is much lower than for seafood, suggesting that consumers have very different spending habits for seafood than for an aggregate of all foods.

OBJECTIVES: Linear growth failure is often assessed as a height-for-age z-score (HAZ) < −2, which defines stunting. Faltering growth velocity on the other hand reveals a dynamic process, for which improving risk factors could help prevent poor growth, regardless of HAZ. Our aim was to reveal rates and risk factors of growth faltering in Nepali preschool children using a novel linear growth velocity (LGV) reference. METHODS: We assessed length/height in children under-five from 2013–16 during the same season in 21 wards across the plains (Tarai) of Nepal (n = 4439). Annualized LGVs were calculated from paired measures and stratified into interval-initiating ages of 2. RESULTS: LGV faltering affected 29.8% and 34.8% of boys and girls the WHO median had lower odds of faltering than thinner children (OR: 0.25 - 0.40, all upper 95% CLs

OBJECTIVES: To assess the association between exposure to prelacteal feeding and infant growth from birth to 3 months of age. METHODS: We analyzed data from a cohort of mothers and infants (n = 2569) identified as part of ongoing pregnancy and birth surveillance in rural Gaibandha, Bangladesh. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within three days post-partum, at one-week, and at three months. At each visit, interviewers collected detailed data on breastfeeding, any foods provided to the infant other than breast milk, and morbidity. Infant weight, length, and mid-upper arm circumference were measured according to standardized protocols at birth and three months of age. For analysis, we defined exposure to prelacteal feeding (PLF) as giving infants any food or liquid other than breastmilk within first 3 days of life. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. Stunting, wasting, and underweight were defined as a LAZ, WLZ, or WAZ < −2, respectively. We used multiple linear regression and multiple logistic regression to assess the association between anthropometric indices and PLF practices, controlling for low birthweight, infant sex, infant age, maternal education, maternal age, and wealth. RESULTS: The prevalence of PLF was 25.2%. The prevalence of stunting, wasting and underweight was 29.0%, 3.8% and 22.3%, respectively. For stunting (adjusted risk ratio (ARR) = 1.02 [95% CI: 0.89–1.16]) and wasting (ARR = 0.97 [95% CI: 0.63–1.50]), there were no differences between infants who received PLF and infants who did not receive any PLF. Infants who received PLF tended to have higher risk of underweight (ARR = 1.10 [95% CI: 0.95–1.28]). For LAZ, WAZ, and WLZ score, no differences were observed in the adjusted analysis between infants who received PLF and those who did not receive any PLF. CONCLUSIONS: There was no association between exposure to PLF and infant growth from birth to 3 months of age. More research is needed to explore the potential effect of PLF on other outcomes. FUNDING SOURCES: Bill & Melinda Gates Foundation; Johnson & Johnson; UBS Optimus Foundation.

OBJECTIVES: National food-based dietary guidelines (FBDGs) are adapted by governments reflecting their nation's food system and specific nutrition context, with varied approaches by country. Seafood is commonly included as one of many items in a “meat” or “animal-source” food group. It is currently unclear whether FBDG recommendations for seafood are achievable for the food supply, equitable for people, or sustainable for the planet. We seek to (1) Review the specific recommendations of national FBDGs related to seafood intake, quantifying the amount of seafood recommended for adults (2) Document the rationale for seafood consumption and mentions of sustainability (3) Estimate the supply required to meet recommendations and compare it with national fish production for each country. METHODS: The Food and Agriculture Organization (FAO) FBDG database was used to identify 92 countries with officially recognized FBDGs. Extracted data include (1) Recommended consumption of seafood (amounts, standard portion size, frequency of consumption and species/type) and (2) Mentions of sustainability. To calculate the fish supply needed to fulfill recommendations, conversions from cooked portions to raw (grams) seafood weights were used. These converted figures were then compared against that from FAO FishStat and the Sea Around Us database, and gaps/surpluses by country were identified. Mentions of sustainability were evaluated in terms of specific mention of fish vs. more generic recommendations. RESULTS: Out of 92 FBDGs, 77 mentioned seafood. Out of 40 high-income country's FBDG, 35 countries have a seafood servings per week recommendation, but only 23 provide serving size recommendations. Final presented results will illustrate the differences in the supply of seafood needed to meet recommended consumption levels. Sustainability was mentioned in eight guidelines independently of seafood and five additional mentioned seafood and sustainability together. Implications for sustainability of seafood production and global trade and nutritional status of populations will be discussed. CONCLUSIONS: Seafood is systematically noted for healthy diets but rarely based on sustainable limits nor linked to sustainable goals. FUNDING SOURCES: Johns Hopkins Bloomberg Distinguished Professor Fund, Johns Hopkins Center for a Livable Future.

Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized trials; (b) strong political and donor support; (c) positioning local female community health volunteers as key operatives; (d) nationwide community mobilization and demand creation for the programme; and (e) gradual expansion of the programme over a period of several years, conducting and integrating delivery research, and monitoring to allow new approaches to be tested and adapted to available resources. The VAS network has served as a platform for delivering other services, including anthelmintic treatment and screening for acute malnutrition. We estimate that VAS has saved over 45,000 young lives over the past 15 years of attained national coverage. Consumption of vitamin A‐ and carotenoid‐rich foods by children and women nationally remains low, indicating that supplementation is still needed. Current challenges and opportunities to improving vitamin A status include lower VAS coverage among younger children (infants 6–11 months of age), finding ways to increase availability and access to dietary vitamin A sources, and ensuring local programme investments given the recent decentralization of the government.

Developmental delays affect between 150 and 200 million children

Achieving Sustainable Development Goal 2 of zero hunger and malnutrition by 2030 will require dietary shifts that include increasing the consumption of nutrient dense foods by populations in low- and middle-income countries. Animal source foods are known to be rich in a number of highly bioavailable nutrients that otherwise are not often consumed in the staple-food based diets of poorer populations throughout the world. Fish is the dominant animal source food in many low- and middle-income countries in the global south and is available from both fisheries and aquaculture. Consumers often perceive that wild caught fish have higher nutritional value than fish produced through aquaculture, and this may be true for some nutrients, for example omega-3 fatty acid content. However, there is potential to modify the nutritional value of farmed fish through feeds and through production systems, illustrated by the common practice of supplementing omega-3 fatty acids in fish diets to optimize their fatty acid profile. This manuscript reviews the evidence related to fish feeds and the nutritional composition of fish with respect to a number of nutrients of interest to human health, including iron, zinc, vitamins A and D, selenium, calcium, and omega-3 fatty acids, with low- and middle-income country populations in mind. In general, we find that the research on fortification of fish diet particularly with vitamins and minerals has not been directed toward human health but rather toward improvement of fish growth and health performance. We were unable to identify any studies directly exploring the impact of fish feed modification on the health of human consumers of fish, but as nutrition and health rises in the development agenda and consumer attention, the topic requires more urgent attention in future feed formulations.

Animal source foods (ASF) provide nutrients essential to child growth and development yet remain infrequently consumed in rural Nepal. Agriculture and nutrition programs aim to increase ASF intake among children through small-scale animal husbandry projects. The relationship between livestock ownership and children&rsquo, s consumption of ASF, however, is not well established. This study examined associations between livestock ownership and the frequency with which Nepali children consume eggs, dairy, and meat. We analyzed longitudinal 7-day food frequency data from sentinel surveillance sites of the Policy and Science of Health, Agriculture and Nutrition (PoSHAN) study. Data consisted of surveys from 485 Nepali farming households conducted twice per year for two years (a total of 1449 surveys). We used negative binomial regression analysis to examine the association between the number of cattle, poultry, and meat animals (small livestock) owned and children&rsquo, s weekly dairy, egg, and meat intakes, respectively, adjusting for household expenditure on each food type, mother&rsquo, s education level, caste/ethnicity, agroecological region, season, and child age and sex. We calculated predicted marginal values based on model estimates. Children consumed dairy 1.4 (95% CI 1.1&ndash, 2.0), 2.3 (1.7&ndash, 3.0) and 3.0 (2.1&ndash, 4.2) more times per week in households owning 1, 2&ndash, 4 and &gt, 4 cattle, respectively, compared to children in households without cattle. Children consumed eggs 2.8 (2.1&ndash, 3.7) more times per week in households owning 1 or 2 chickens compared to children in households without chickens. Child intake of meat was higher only in households owning more than seven meat animals. Children&rsquo, s intakes of dairy, eggs, and meat rose with household expenditure on these foods. Small-scale animal production may be an effective strategy for increasing children&rsquo, s consumption of eggs and dairy, but not meat. Increasing household ability to access ASF via purchasing appears to be an important approach for raising children&rsquo, s intakes of all three food types.

Fish oil supplementation has been shown to delay spontaneous delivery, but the levels and clinical significance remain uncertain. We examined the association between plasma fatty acids quantified in pregnancy and subsequent risk of early preterm birth.In a case-control design nested in the Danish National Birth Cohort, we identified 376 early preterm cases (34 gestational weeks, excluding preeclampsia cases) and 348 random controls. Plasma eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA% of total fatty acids), were measured twice in pregnancy, at gestation weeks 9 and 25 (medians). Odds ratios and 95% confidence intervals (CI's) for associations between EPA+DHA and early preterm risk were estimated by logistic regression, adjusted for the woman's age, height, pre-pregnancy BMI, parity, smoking, and socioeconomic factors. Hypotheses and analytical plan were defined and archived a priori.Analysis using restricted cubic splines of the mean of 1st and 2nd sample measurements showed a strong and significant non-linear association (p 0.0001) in which the risk of early preterm birth steeply increased when EPA+DHA concentrations were lower than 2% and flattened out at higher levels. Women in the lowest quintile (EPA+DHA 1.6%) had 10.27 times (95% confidence interval 6.80-15.79, p 0.0001) increased risk, and women in the second lowest quintile had 2.86 (95% CI 1.79-4.59, p 0.0001) times increased risk, when compared to women in the three aggregated highest quintiles (EPA+DHA ≥ 1.8%).Low plasma concentration of EPA and DHA during pregnancy is a strong risk factor for subsequent early preterm birth in Danish women.

Pathways through which agricultural production may influence markets, household food security, dietary patterns and nutritional status remain incompletely understood. While cross-sectional surveys are common, national, population-based, standardized data collection systems that annually monitor markets, local services, food security, dietary intake and nutritional status may be needed to understand time trends and relationships. We describe the design and methods of an annual nationally representative series of surveys of households with preschool aged children in 7 Village Development Committees (VDCs) sampled across each agroecological zone (mountains, hills and plains) in Nepal. Our sampling methodology yielded 21 VDCs, 63 wards (3 per VDC) and 40 markets in 2013, 2014 and 2016. Each year between ~ 4286-5097 consenting households were assessed for agricultural practices, socioeconomic conditions and food security; diet by 7-day food frequency and nutritional status by anthropometry (weight, height and arm circumference) of women (n=4509-5458) and children (n=5401-5468) using standardized procedures. Due to a major earthquake in April 2015, a truncated sample (wards n=27) was reached in 2015. Three VDCs, each representing a centroid of surveyed VDCs in each zone, served as year-round sentinel sites in which we conducted six surveys of seasonal conditions from 2013-2015. Representative, same-season, same-site surveys offer a feasible national framework for assessing annual status and trends in agricultural, food security and nutritional conditions to identify opportunities for policy and program interventions and observe population responses along a continuum leading from agriculture to nutrition.

BACKGROUND: Many children worldwide have poor vitamin B12 status. The objective of this study was to estimate association between maternal and infant vitamin B12 status and long-term growth. METHODS: We randomly selected 500 Nepali mother-infant pairs and measured maternal intake and infant and maternal vitamin B12 status using plasma cobalamin, total plasma homocysteine, and methylmalonic acid concentrations. We revisited available children when they were 5 years old and measured growth. The associations between intake and maternal and infant markers of vitamin B12 and growth were estimated in multiple linear regression models adjusting for relevant confounders (n = 331). RESULTS: Maternal vitamin B12 intake and status and vitamin B12 status in infancy predicted linear growth at 5 years of age, but not during infancy. Each microgram increase in the vitamin B12 intake of the mother during infancy was associated with an increase in height of 0.4 (0.2, 0.6) height-for-age z-scores and 1.7 (0.7, 2.7) cm around the child's fifth birthday. CONCLUSION: Vitamin B12 status and intake in early life is an important determinant for linear growth at school age. Our findings should be verified in randomized, placebo controlled trials before translated into public health recommendations. We are grateful for the contributions of the field supervisor Chandrawati Chitrakar and data managers Pravin Rajbhandari and Uma Regmi, and the children and mothers for their invaluable contribution to the study. The present study was funded through grants from the Research Council of Norway (project no. 234495), from the GCRieber Funds, and the South-Eastern Norway Regional Health Authority (grant no. 2012090).

Existing literature suggests that farm production diversification has the potential to influence the diet diversity of farmers, but that the magnitude of the association is likely to vary by context and the underlying causal mechanisms are not well understood. This study analyzed the nexus between farm diversification and diet diversity using two round of nationally representative panel data from the Bangladesh Integrated Household Survey (BIHS), collected in 2011/12 and 2015. We used several indicators of dietary diversity including the Household Dietary Diversity Score (HDDS), Women’s Dietary Diversity Score (WDDS), and the Food Variety Score (FVS). To measure farm diversification we used the total number of crop, vegetable and fruit species, the number of food crop species only, and the Margalef species richness index. We found robust evidence for a positive association between farm diversification and diet diversity, even when controlling for unobserved heterogeneity across households using the conditional fixed effect Poisson model in order to take advantage of the panel structure of the data. The magnitude of the estimated effect was small. Analysis of other factors indicates that market access, commercialization of farms, diversification of income towards off farm sources and women’s empowerment also have positive and significant effects on household dietary diversity. These findings suggest that it may be necessary to couple efforts to increase farm diversity, market access, farm commercialization and income diversification with women’s empowerment in order to improve dietary diversity in Bangladesh. Further research is needed to better understand these complex relationships including their ultimate associations with nutritional status.

People in fragile environments face various shocks that negatively affect their nutrition. Many governments put policy mechanisms in place to promote recovery of households after adverse shocks; however, resilience is difficult to measure because some apparent recovery could be the result of statistical randomness and reversion to trends. This paper demonstrates a new approach to measuring nutritional resilience in a population. As our starting point, we use the common definition of resilience as ‘recovery after decline’, but also require that the degree of recovery should exceed stochastic expectations. Using maternal and child nutrition data from Nepal, Bangladesh, and Uganda, we find that observed recovery is not always statistically significant and does not always satisfy this definition of resilience. We identify household and community factors that are correlated with measurable nutritional resilience, and recommend points of entry for policies designed to enhance resilience in resource-constrained settings.

The diversity of aquaculture production systems in Bangladesh may be calibrated to provide food and nutrition security without negative environmental impact, aligning multiple interests of the United Nations Sustainable Development Goals.

Background Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue. Objectives This study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013 to 2016 in Nepal. Methods Same-season national surveys were administered in 2013, 2014, and 2016 in 63 sites across 21 districts, selected using multistage random sampling, representing the mountains, hills, and Tarai (plains). Among consenting households with children aged 6–59 mo, a random sample of capillary blood was selected each year for anemia assessment using an Hb 201+ hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin

OBJECTIVES: Improving child diet diversity is a policy priority in many settings. Multiple factors influence complementary feeding practices in low-income countries including household food access, caregiver-level factors and cultural practices. Child's dietary data is often available in national surveys (i.e., Demographic and Health Surveys, DHS), but they typically lack diet data from adults. The 2018 Nigeria DHS was among the first to measure food group intake in both young children and women. We describe the relationship between child and maternal diet diversity in Nigeria and highlight implications for design of infant and young child feeding (IYCF) programs. METHODS: Using the Nigeria DHS 2018 dataset, we estimated consumption of individual food groups in the previous 24 hours as well as minimum dietary diversity for children 6–23 months (MDD-C) and their mothers, women 15–49 years (MDD-W) using WHO-UNICEF definitions. We compare rates of concordance and discordance between n = 8975 mother-child pairs for individual food groups and MDD using McNemar's tests. Probit regression was used to identify drivers of MDD-C. RESULTS: Nationally, 22% of children achieve MDD-C; 51% of mothers achieve MDD-W. For both populations, the most commonly consumed group is grains, roots and tubers (>80%) Dairy and eggs are the least consumed. Maternal-child (age 12–23 months) discordance is highest for consumption of legumes and nuts (36%), vitamin A rich fruits and vegetables (39%) and other fruits and vegetables (57%); mothers consume these more frequently. Children are more likely than mothers to consume dairy (19% vs 8%) and eggs (8% vs 4%). Maternal-child food group discordance is consistently higher for children 6–11months than children 12–23 months. Results vary at state level and by maternal age group. Children's MDD probability is increased by MDD-W (27%, P

Purpose Essential fatty acids play a critical role in the growth and development of infants, but little is known about the fatty acid status of populations in low-income countries. The objective was to describe the fatty acid composition of red blood cells (RBC) in breastfeed Nepali infants and a subsample of their mothers and to identify the main sources of fatty acids in the mother’s diet, as well as the fatty acid composition of breast milk. Methods RBC fatty acid composition was analyzed in a random sample of 303 infants and 72 mother, along with 68 breastmilk samples. Fatty acid profiles of the most important dietary fat sources were analyzed. Information on mother’s diet and intake of fat was collected by three 24-h dietary recalls. Results In infant RBC’s, docosahexaenoic acid (DHA) was the main n-3 fatty acid, and arachidonic acid (AA) was the major n-6 fatty acid. Total n-6 PUFA was three times higher than total n-3 PUFA. Height-for-age (HAZ) was positively associated with DHA status and AA status in multivariable models. The concentration of all fatty acids was higher in children, compared to mothers, except Total n-6 PUFA and Linoleic acid (LA) where no differences were found. The mother’s energy intake from fat was 13% and cooking oil (sesame, mustard, soybean or sunflower oil) contributed 52% of the fat intake. Conclusions RBC-DHA levels in both infants and mother was unexpected high taking into account few dietary DHA sources and the low DHA concentrations in breastmilk.

Poverty adversely affects child development through multiple pathways in low- and middle-income countries. Relationships between diet and child development are poorly understood. In this study, we aimed to explore these associations in a longitudinal cohort of 305 children in rural Nepal (baseline mean age 14 months), evaluating dietary diversity and the consumption of specific food groups at three timepoints over 1.5 years. Child development was assessed using the Ages and Stages questionnaire-version 3 (ASQ-3). Associations between the number of days that children consumed minimum dietary diversity (MDD) (&ge, 4/8 items) and specific food groups over time (range 0&ndash, 3) and total and subscale ASQ scores at age 23&ndash, 38 months were estimated using multiple linear and logistic regression, dichotomizing scores at the lowest quartile. After adjusting for confounders, each additional day of consuming MDD was associated with a 35% reduction in the odds of low total ASQ score [OR 0.65, 95% CI (0.46, 0.92)]. The consumption of animal source foods [OR 0.64, (0.46, 0.89)], and vegetables/fruits [OR 0.60, (0.41, 0.90), but not processed foods [OR 0.99, (0.62, 1.59)] was associated with lower odds of low total development. Vegetables, fruits and animal source foods may be important for child development in this setting.

OBJECTIVES: Estimate the national and agro-ecological zonal prevalence of preschool child undernutrition and review temporal trends in the prevalence of undernutrition. METHODS: In 2016, we conducted the last in a series of 3 (also 2013 and 2014) nationally representative, annual, same-season, mixed-longitudinal nutrition surveys – PoSHAN Community Studies – in the same 21 Village Development Committees sampled across the Mountains, Hills and Tarai of Nepal. Height/length and weight measurements of 5479 children

OBJECTIVES: Growth faltering in relation to the WHO reference is common in the first 2 years of life in South Asia. Stunting, defined as an attained height/length-for-age (H/LA) 0.5 Z, corresponding to a ∼ >1 cm/year slower rate of linear growth than an estimated median velocity on the WHO referent growth curve for children 0 (acceleration) was observed in 85.8% and 3.6%, respectively. CONCLUSIONS: Growth faltering, expressed as an annualized decrement in HAZ >0.5 likely reflects biologically relevant deceleration before children reach