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Background: Evidence of the effectiveness of biofortified maize with higher provitamin A (PVA) to address vitamin A deficiency in rural Africa remains scant., Objectives: This study projects the impact of adopting PVA maize for a diversity of households in an area typical of rural Zimbabwe and models the cost and composition of diets adequate in vitamin A., Methods: Household-level weighed food records were generated from 30 rural households during a week in April and November 2021. Weekly household intakes were calculated, as well as indicative costs of diets using data from market surveys. The impact of PVA maize adoption was modeled assuming all maize products contained observed vitamin A concentrations. The composition and cost of the least expensive indicative diets adequate in vitamin A were calculated using linear programming., Results: Very few households would reach adequate intake of vitamin A with the consumption of PVA maize. However, from a current situation of 33%, 50%-70% of households were projected to reach ≥50% of their requirements (the target of PVA), even with the modest vitamin A concentrations achieved on-farm (mean of 28.3 μg RAE per 100 g). This proportion would increase if higher concentrations recorded on-station were achieved. The estimated daily costs of current diets (mean ± standard deviation) were USD 1.43 ± 0.59 in the wet season and USD 0.96 ± 0.40 in the dry season. By comparison, optimization models suggest that diets adequate in vitamin A could be achieved at daily costs of USD 0.97 and USD 0.79 in the wet and dry seasons, respectively., Conclusions: The adoption of PVA maize would bring a substantial improvement in vitamin A intake in rural Zimbabwe but should be combined with other interventions (e.g., diet diversification) to fully address vitamin A deficiency., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Agricultural water requirements differ between foods. Population-level dietary preferences are therefore a major determinant of agricultural water use. The "water footprint" (WF) represents the volume of water consumed in the production of food items, separated by water source; blue WF represents ground and surface water use, and green WF represents rain water use. We systematically searched for published studies using the WF to assess the water use of diets. We used the available evidence to quantify the WF of diets in different countries, and grouped diets in patterns according to study definition. "Average" patterns equated to those currently consumed, whereas "healthy" patterns included those recommended in national dietary guidelines. We searched 7 online databases and identified 41 eligible studies that reported the dietary green WF, blue WF, or total WF (green plus blue) (1964 estimates for 176 countries). The available evidence suggests that, on average, European (170 estimates) and Oceanian (18 estimates) dietary patterns have the highest green WFs (median per capita: 2999 L/d and 2924 L/d, respectively), whereas Asian dietary patterns (98 estimates) have the highest blue WFs (median: 382 L/d per capita). Foods of animal origin are major contributors to the green WFs of diets, whereas cereals, fruits, nuts, and oils are major contributors to the blue WF of diets. "Healthy" dietary patterns (425 estimates) had green WFs that were 5.9% (95% CI: -7.7, -4.0) lower than those of "average" dietary patterns, but they did not differ in their blue WFs. Our review suggests that changes toward healthier diets could reduce total water use of agriculture, but would not affect blue water use. Rapid dietary change and increasing water security concerns underscore the need for a better understanding of the amount and type of water used in food production to make informed policy decisions., (Copyright © American Society for Nutrition 2019.)

Agriculture is a major contributor to India's environmental footprint, particularly through greenhouse gas (GHG) emissions from livestock and fresh water used for irrigation. These impacts are likely to increase in future as agriculture attempts to keep pace with India's growing population and changing dietary preferences. Within India there is considerable dietary variation, and this study therefore aimed to quantify the GHG emissions and water usage associated with distinct dietary patterns. Five distinct diets were identified from the Indian Migration Study - a large adult population sample in India - using finite mixture modelling. These were defined as: Rice & low diversity, Rice & fruit, Wheat & pulses, Wheat, rice & oils, Rice & meat. The GHG emissions of each dietary pattern were quantified based on a Life Cycle Assessment (LCA) approach, and water use was quantified using Water Footprint (WF) data. Mixed-effects regression models quantified differences in the environmental impacts of the dietary patterns. There was substantial variability between diets: the rice-based patterns had higher associated GHG emissions and green WFs, but the wheat-based patterns had higher blue WFs. Regression modelling showed that the Rice & meat pattern had the highest environmental impacts overall, with 0.77 (95% CI 0.64-0.89) kg CO 2 e/capita/day (31%) higher emissions, 536 (95% CI 449-623) L/capita/day (24%) higher green WF and 109 (95% CI 85.9-133) L/capita/day (19%) higher blue WF than the reference Rice & low diversity pattern. Diets in India are likely to become more diverse with rising incomes, moving away from patterns such as the Rice & low diversity diet. Patterns such as the Rice & meat diet may become more common, and the environmental consequences of such changes could be substantial given the size of India's population. As global environmental stress increases, agricultural and nutrition policies must recognise the environmental impacts of potential future dietary changes., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Dietary zinc (Zn) deficiency is a global problem, particularly in low-income and middle-income countries where access to rich, animal-source foods of Zn is limited due to poverty. In Pakistan, Zn deficiency affects over 40% of the adult female population, resulting in suboptimal immune status and increased likelihood of complications during pregnancy., Methods and Analysis: We are conducting a double-blind, randomised controlled feeding study with cross-over design in a low-resource setting in Pakistan. Households were provided with flour milled from genetically and agronomically biofortified grain (Zincol-2016/NR-421) or control grain (Galaxy-2013). Fifty households were recruited. Each household included a woman aged 16-49 years who is neither pregnant nor breastfeeding, and not currently consuming nutritional supplements. These women were the primary study participants. All households were provided with control flour for an initial 2-week baseline period, followed by an 8-week intervention period where 25 households receive biofortified flour (group A) and 25 households receive control flour (group B). After this 8-week period, groups A and B crossed over, receiving control and biofortified flour respectively for 8 weeks. Tissue (blood, hair and nails) have been collected from the women at five time points: baseline, middle and end of period 1, and middle and end of period 2., Ethics and Dissemination: Ethical approval was granted from the lead university (reference no. STEMH 697 FR) and the collaborating institution in Pakistan. The final study methods (including any modifications) will be published in peer-reviewed journals, alongside the study outcomes on completion of the data analysis. In addition, findings will be disseminated to the scientific community via conference presentations and abstracts and communicated to the study participants through the village elders at an appropriate community forum., Registration Details: The trial has been registered with the ISRCTN registry, study ID ISRCTN83678069., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: Undernutrition and non-communicable disease (NCD) are important public health issues in India, yet their relationship with dietary patterns is poorly understood. The current study identified distinct dietary patterns and their association with micronutrient undernutrition (Ca, Fe, Zn) and NCD risk factors (underweight, obesity, waist:hip ratio, hypertension, total:HDL cholesterol, diabetes)., Design: Data were from the cross-sectional Indian Migration Study, including semi-quantitative FFQ. Distinct dietary patterns were identified using finite mixture modelling; associations with NCD risk factors were assessed using mixed-effects logistic regression models., Setting: India., Subjects: Migrant factory workers, their rural-dwelling siblings and urban non-migrants. Participants (7067 adults) resided mainly in Karnataka, Andhra Pradesh, Maharashtra and Uttar Pradesh., Results: Five distinct, regionally distributed, dietary patterns were identified, with rice-based patterns in the south and wheat-based patterns in the north-west. A rice-based pattern characterised by low energy consumption and dietary diversity ('Rice & low diversity') was consumed predominantly by adults with little formal education in rural settings, while a rice-based pattern with high fruit consumption ('Rice & fruit') was consumed by more educated adults in urban settings. Dietary patterns met WHO macronutrient recommendations, but some had low micronutrient contents. Dietary pattern membership was associated with several NCD risk factors., Conclusions: Five distinct dietary patterns were identified, supporting sub-national assessments of the implications of dietary patterns for various health, food system or environment outcomes.

Agriculture accounts for ~90% of India's fresh water use, and there are concerns that future food production will be threatened by insufficient water supply of adequate quality. This study aimed to quantify the water required in the production of diets in India using the water footprint (WF) assessment method. The socio-demographic associations of dietary WFs were explored using mixed effects regression models with a particular focus on blue (irrigation) WF given the importance for Indian agriculture. Dietary data from ~7000 adults living in India were matched to India-specific WF data for food groups to quantify the blue and green (rainfall) WF of typical diets. The mean blue and green WF of diets was 737l/capita/day and 2531l/capita/day, respectively. Vegetables had the lowest WFs per unit mass of product, while roots/tubers had the lowest WFs per unit dietary energy. Poultry products had the greatest blue WFs. Wheat and rice contributed 31% and 19% of the dietary blue WF respectively. Vegetable oils were the highest contributor to dietary green WF. Regional variation in dietary choices meant large differences in dietary blue WFs, whereby northern diets had nearly 1.5 times greater blue WFs than southern diets. Urban diets had a higher blue WF than rural diets, and a higher standard of living was associated with larger dietary blue WFs. This study provides a novel perspective on the WF of diets in India using individual-level dietary data, and demonstrates important variability in WFs due to different food consumption patterns and socio-demographic characteristics. Future dietary shifts towards patterns currently consumed by individuals in higher income groups, would likely increase irrigation requirements putting substantial pressure on India's water resources., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Food production is a major driver of greenhouse gas (GHG) emissions, water and land use, and dietary risk factors are contributors to non-communicable diseases. Shifts in dietary patterns can therefore potentially provide benefits for both the environment and health. However, there is uncertainty about the magnitude of these impacts, and the dietary changes necessary to achieve them. We systematically review the evidence on changes in GHG emissions, land use, and water use, from shifting current dietary intakes to environmentally sustainable dietary patterns. We find 14 common sustainable dietary patterns across reviewed studies, with reductions as high as 70-80% of GHG emissions and land use, and 50% of water use (with medians of about 20-30% for these indicators across all studies) possible by adopting sustainable dietary patterns. Reductions in environmental footprints were generally proportional to the magnitude of animal-based food restriction. Dietary shifts also yielded modest benefits in all-cause mortality risk. Our review reveals that environmental and health benefits are possible by shifting current Western diets to a variety of more sustainable dietary patterns., Competing Interests: The authors have declared that no competing interests exist.

Dietary patterns analysis is an emerging area of research. Identifying distinct patterns within a large dietary survey can give a more accurate representation of what people are eating. Furthermore, it allows researchers to analyse relationships between non-communicable diseases (NCD) and complete diets rather than individual food items or nutrients. However, few such studies have been conducted in developing countries including India, where the population has a high burden of diabetes and CVD. We undertook a systematic review of published and grey literature exploring dietary patterns and relationships with diet-related NCD in India. We identified eight studies, including eleven separate models of dietary patterns. Most dietary patterns were vegetarian with a predominance of fruit, vegetables and pulses, as well as cereals; dietary patterns based on high-fat, high-sugar foods and more meat were also identified. There was large variability between regions in dietary patterns, and there was some evidence of change in diets over time, although no evidence of different diets by sex or age was found. Consumers of high-fat dietary patterns were more likely to have greater BMI, and a dietary pattern high in sweets and snacks was associated with greater risk of diabetes compared with a traditional diet high in rice and pulses, but other relationships with NCD risk factors were less clear. This review shows that dietary pattern analyses can be highly valuable in assessing variability in national diets and diet-disease relationships. However, to date, most studies in India are limited by data and methodological shortcomings.

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) 'cut-point' approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita(-1) day(-1). Deficiency risks for Fe are lower than expected (5%). However, 'cut-point' approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting HarvestPlus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks., (© 2013 The Authors. Physiologia Plantarum published by John Wiley & Sons Ltd on behalf of Scandinavian Plant Physiology Society.)

Mineral malnutrition is widespread in sub-Saharan Africa but its extent is difficult to quantify. Using Malawi as a case study, the aim of this work was to investigate the adequacy of calcium (Ca) and magnesium (Mg) nutrition by combining national food supply and food composition data with a new spatial survey of maize grain. Non-maize dietary sources of Ca and Mg were estimated using existing food supply and composition data. Calcium and Mg concentrations in maize grain were determined at 88 field sites, representing > 75 % of Malawi’s land area in terms of soil classification. Median maize grain concentrations from the survey were 34 and 845 mg kg(-1), representing a per capita supply of 12 and 299 mg d(-1) of Ca and Mg, respectively. Combining these data with food supply and composition data reveals that average Ca nutrition is likely to be inadequate for many individuals, whereas average Mg nutrition appears adequate. Optimal supply of Ca per capita depends critically on balanced food availability and choice. Since maize grain sourced from highly calcareous soils is still unlikely to deliver > 5 % of estimated average requirements, agronomic solutions to rectify Ca malnutrition via maize are limited, in comparison with strategies for dietary diversification.

There is a deficit of mineral micronutrients in global food systems, known as ‘hidden hunger’, especially in the global south. This review focuses on zinc (Zn) and iron (Fe), whose entry into food systems depends primarily on soil and crop factors. Approaches to increase dietary supplies of Zn and Fe include: (1) supplementation, (2) food fortification, (3) dietary diversification, and (4) crop biofortification, including breeding and fertilizer-based approaches. Supply-based estimates indicate that Zn deficiency might be more widespread than Fe deficiency in sub-Saharan Africa, although there are major knowledge gaps at an individual biomarker level. Recent analytical advances, including the use of stable isotopes of Zn and Fe, can play an increasing role in improving our understanding of the movement of micronutrients in food systems, and thereby help to reduce the immense human cost of ‘hidden hunger’. [ABSTRACT FROM AUTHOR]

Moringa oleifera (MO) and M. stenopetala (MS) are two commonly cultivated species of the Moringaceae family. Some households in southern Ethiopia (S. ETH) and Kenya (KEN) plant MS and MO, respectively. The edible parts of these species are rich in amino acids, vitamins and minerals, especially selenium. Despite their nutritional value, Moringa is sometimes considered as a “famine food”. The aim of this study was to determine the extent of dietary utilization of these plants by Moringa Growing Households (MGHs). Moringa growing households were surveyed in 2015. Twenty-four and 56 heads of MGHs from S. ETH and KEN, respectively, were interviewed using semi-structured questionnaires. Subsistence agriculture was the main source of livelihood for all MGHs in S. ETH and 71% of those in KEN. All MGHs in S. ETH cultivated MS while those in KEN cultivated MO. Of the MGH heads in S. ETH, 71% had grown MS as long as they remember; the median cultivation period of MO in KEN was 15 years. All MGHs in S. ETH and 79% in KEN used Moringa leaves as a source of food. Forms of consumption of leaves were boiled fresh leaves, and leaf powder used in tea or mixed with other dishes. Other uses of Moringa include as medicine, fodder, shade, agroforestry, and as a source of income. Although MO and MS have multiple uses, MGHs face several challenges, including a lack of reliable information on nutritional and medicinal values, inadequate access to markets for their products, and pest and disease stresses to their plants. Research and development to address these challenges and to promote the use of these species in the fight against hidden hunger are necessary. [ABSTRACT FROM AUTHOR]