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2. Estimating national and subnational nutrient intake distributions of global diets.

Author

Passarelli, Simone, Free, Christopher, Allen, Lindsay, Batis, Carolina, Beal, Ty, Biltoft-Jensen, Anja, Bromage, Sabri, Cao, Ling, Castellanos-Gutiérrez, Analí, Christensen, Tue, Crispim, Sandra, Dekkers, Arnold, De Ridder, Karin, Kronsteiner-Gicevic, Selma, Lee, Christopher, Li, Yanping, Moursi, Mourad, Moyersoen, Isabelle, Schmidhuber, Josef, Shepon, Alon, Viana, Daniel, and Golden, Christopher

Subjects
dietary data, distribution, epidemiology, global health, intake, methods, nutrient, nutrient intake, nutrition, subgroup, Diet, Diet Surveys, Eating, Energy Intake, Female, Humans, Male, Micronutrients, Nutritional Requirements
Abstract

BACKGROUND: Access to high-quality dietary intake data is central to many nutrition, epidemiology, economic, environmental, and policy applications. When data on individual nutrient intakes are available, they have not been consistently disaggregated by sex and age groups, and their parameters and full distributions are often not publicly available. OBJECTIVES: We sought to derive usual intake distributions for as many nutrients and population subgroups as possible, use these distributions to estimate nutrient intake inadequacy, compare these distributions and evaluate the implications of their shapes on the estimation of inadequacy, and make these distributions publicly available. METHODS: We compiled dietary data sets from 31 geographically diverse countries, modeled usual intake distributions for 32 micronutrients and 21 macronutrients, and disaggregated these distributions by sex and age groups. We compared the variability and skewness of the distributions and evaluated their similarity across countries, sex, and age groups. We estimated intake inadequacy for 16 nutrients based on a harmonized set of nutrient requirements and bioavailability estimates. Last, we created an R package-nutriR-to make these distributions freely available for users to apply in their own analyses. RESULTS: Usual intake distributions were rarely symmetric and differed widely in variability and skewness across nutrients and countries. Vitamin intake distributions were more variable and skewed and exhibited less similarity among countries than other nutrients. Inadequate intakes were high and geographically concentrated, as well as generally higher for females than males. We found that the shape of usual intake distributions strongly affects estimates of the prevalence of inadequate intakes. CONCLUSIONS: The shape of nutrient intake distributions differs based on nutrient and subgroup and strongly influences estimates of nutrient intake inadequacy. This research represents an important contribution to the availability and application of dietary intake data for diverse subpopulations around the world.

Published
2022

4. Aquatic foods to nourish nations.

Author

Golden, Christopher, Koehn, J, Shepon, Alon, Passarelli, Simone, Free, Christopher, Viana, Daniel, Matthey, Holger, Eurich, Jacob, Gephart, Jessica, Fluet-Chouinard, Etienne, Nyboer, Elizabeth, Lynch, Abigail, Kjellevold, Marian, Bromage, Sabri, Charlebois, Pierre, Barange, Manuel, Vannuccini, Stefania, Cao, Ling, Kleisner, Kristin, Rimm, Eric, Danaei, Goodarz, DeSisto, Camille, Kelahan, Heather, Fiorella, Kathryn, Little, David, Allison, Edward, Fanzo, Jessica, and Thilsted, Shakuntala

Subjects
Animals, Diet, Healthy, Female, Fishes, Food Supply, Health, Humans, Internationality, Male, Nutritive Value, Red Meat, Seafood, Vulnerable Populations
Abstract

Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type (seafood or fish)1-4. Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases5,6 while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms.

Published
2021

11. Women's input and decision-making in agriculture are associated with diet quality in rural Tanzania

Author

Madzorera, Isabel, primary, Bliznashka, Lilia, additional, Blakstad, Mia M., additional, Bellows, Alexandra L., additional, Canavan, Chelsey R., additional, Mosha, Dominic, additional, Bromage, Sabri, additional, Noor, Ramadhani A., additional, Webb, Patrick, additional, Ghosh, Shibani, additional, Kinabo, Joyce Ludovick, additional, Masanja, Honorati, additional, and Fawzi, Wafaie W., additional

Published
2023
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12. Bronze Age population dynamics and the rise of dairy pastoralism on the eastern Eurasian steppe

Author

Jeong, Choongwon, Wilkin, Shevan, Amgalantugs, Tsend, Bouwman, Abigail S., Taylor, William Timothy Treal, Hagan, Richard W., Bromage, Sabri, Tsolmon, Soninkhishig, Trachsel, Christian, Grossmann, Jonas, Littleton, Judith, Makarewicz, Cheryl A., Krigbaum, John, Burri, Marta, Scott, Ashley, Davaasambuu, Ganmaa, Wright, Joshua, Irmer, Franziska, Myagmar, Erdene, Boivin, Nicole, Robbeets, Martine, Rühli, Frank J., Krause, Johannes, Frohlich, Bruno, Hendy, Jessica, and Warinner, Christina

Published
2018

21. Women's input and decision-making in agriculture are associated with diet quality in rural Tanzania

Author

Madzorera, Isabel; Bliznashka, Lilia; Blakstad, Mia M.; Bellows, Alexandra L.; Canavan, Chelsey R.; Mosha, Dominic; Bromage, Sabri; Noor, Ramadhani; Webb, Patrick; Ghosh, Shibani; Kinabo, Joyce L.; Masanja, Honorati; Fawzi, Wafaie W., http://orcid.org/0000-0002-2671-0786 Bliznashka, Lilia, Madzorera, Isabel; Bliznashka, Lilia; Blakstad, Mia M.; Bellows, Alexandra L.; Canavan, Chelsey R.; Mosha, Dominic; Bromage, Sabri; Noor, Ramadhani; Webb, Patrick; Ghosh, Shibani; Kinabo, Joyce L.; Masanja, Honorati; Fawzi, Wafaie W., and http://orcid.org/0000-0002-2671-0786 Bliznashka, Lilia

Abstract

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Background: Women’s empowerment is one critical pathway through which agriculture can impact women’s nutrition; however, empirical evidence is still limited. We evaluated the association of women’s participation, input, and decision-making in key agricultural and household activities with women’s diet quality. Methods: We analyzed data from a cross-sectional study of 870 women engaged in homestead agriculture. We used food frequency questionnaires to assess women’s diets and computed women’s diet quality using the Prime Diet Quality Score (PDQS) (range 0-42), which captures healthy and unhealthy foods. We evaluated women’s decision-making in 8 activities, food crop farming, cash crop farming, livestock raising, non-farm economic activities, wage/salary employment, fishing, major household expenditures and minor household expenditures. Generalized estimating equations (GEE) linear models were used to evaluate associations between (a) women’s participation, (b) decision-making, (c) adequate input, (d) adequate extent of independence in decision-making in agriculture, and (e) adequate input in use of agricultural income with their PDQS. Adequate input was defined as input into some, most or all decisions compared to input into few decisions or none. Adequate extent of independence was defined as input to a medium or high extent compared to input to a small extent or none. Findings: Median PDQS was 19 (IQR: 17-21). Women’s adequate input in decision-making on wage and salary employment (estimate: 4.19, 95% CI: 2.80, 5.57) and minor expenditures were associated with higher PDQS vs. inadequate input. Women with independence in decision-making on livestock production (estimate: 0.97, 95% CI: 0.05, 1.90) and minor household expenditures, and women with adequate decision-making in the use of income from wages/salaries (estimate: 3.16, 95% CI: 2.44, 3.87) had higher PDQS. Participation in agricultural activities was positively associated with PDQS. Conclusions: Women’s partic

Published
2023

22. Climate change, nutrition and Mongolia: A risk profile

Author

Ringler, Claudia; Bellisario, Kristen; Fanzo, Jessica; Bromage, Sabri; Perez, Nicos; Bater, Jorick; Bakey, A.; Kadirbyek, Dagys; Chimed-Ochir, B.; Ganbat, D.; Soninkhishig, Ts.; Thomas, Timothy S., UNICEF Mongolia; FAO; International Food Policy Research Institute, http://orcid.org/0000-0002-8266-0488 Ringler, Claudia; http://orcid.org/0000-0003-3030-4710 Perez, Nicostrato; http://orcid.org/0000-0002-7951-8157 Thomas, Tim, Ringler, Claudia; Bellisario, Kristen; Fanzo, Jessica; Bromage, Sabri; Perez, Nicos; Bater, Jorick; Bakey, A.; Kadirbyek, Dagys; Chimed-Ochir, B.; Ganbat, D.; Soninkhishig, Ts.; Thomas, Timothy S., UNICEF Mongolia; FAO; International Food Policy Research Institute, and http://orcid.org/0000-0002-8266-0488 Ringler, Claudia; http://orcid.org/0000-0003-3030-4710 Perez, Nicostrato; http://orcid.org/0000-0002-7951-8157 Thomas, Tim

Abstract

Non-PR, IFPRI5; 1 Fostering Climate-Resilient and Sustainable Food Supply; DCA, Natural Resources and Resilience (NRR); Transformation Strategies, Mongolia is severely affected by adverse climate change impacts, including substantially higher temperatures that have contributed to increased evapotranspiration and the drying up of the country’s water resources. Moreover, the number and intensity of extreme events--especially droughts--is growing, with largest impacts on the poorer population employed in agriculture. At the same time, nutrition security remains out of reach with the co-existence of multiple forms of malnutrition, including obesity. The Mongolian pastoral culture is important to consider in balancing nutritional requirements, health risks, economics, sustainability of food production, including greenhouse gas emissions. While linkages between climate change and food security are increasingly understood, in particular the direct impacts of climate change on crop yields, associated higher food prices, and increased costs of healthy diets resulting in higher levels of malnutrition, other linkages between climate change and nutrition have been barely studied. Mongolia thus suffers from the syndemic of climate change, obesity and undernutrition, which are three co-occurring and interlinked epidemics. A better and more comprehensive understanding of the linkages between climate change and nutrition is key to developing effective interventions to ensure that Mongolia’s population has access to sufficient, safe and nutritious food despite adverse climate outcomes. Importantly, climate change does not only affect food production but can exacerbate malnutrition by removing food and nutrients in all stages of the food value chain. Finally, given the important contribution of food systems to climate change, nutrition policy in Mongolia should more proactively consider environmental impacts.

Published
2023

28. Randomised trial to determine the effect of vitamin D and zinc supplementation for improving treatment outcomes among patients with COVID-19 in India: trial protocol

Author

Sharma, Kamal Kant, primary, Partap, Uttara, additional, Mistry, Nerges, additional, Marathe, Yogesh, additional, Wang, Molin, additional, Shaikh, Sanaa, additional, D'Costa, Pradeep, additional, Gupta, Gaurav, additional, Bromage, Sabri, additional, Hemler, Elena C, additional, Kain, Kevin C, additional, Dholakia, Yatin, additional, and Fawzi, Wafaie W, additional

Published
2022
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32. Anemia Etiology in Ethiopia: Assessment of Nutritional, Infectious Disease, and Other Risk Factors in a Population-Based Cross-Sectional Survey of Women, Men, and Children

Author

Andersen, Christopher T, primary, Tadesse, Amare Worku, additional, Bromage, Sabri, additional, Fekadu, Habtamu, additional, Hemler, Elena C, additional, Passarelli, Simone, additional, Spiegelman, Donna, additional, Sudfeld, Christopher R, additional, Worku, Alemayehu, additional, Berhane, Yemane, additional, and Fawzi, Wafaie W, additional

Published
2022
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34. The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults

Author

Bromage, Sabri, Andersen, Christopher T, Tadesse, Amare W, Passarelli, Simone, Hemler, Elena C, Fekadu, Habtamu, Sudfeld, Christopher R, Worku, Alemayehu, Berhane, Hanna, Batis, Carolina, Bhupathiraju, Shilpa N, Fung, Teresa T, Li, Yanping, Stampfer, Meir J, Deitchler, Megan, Willett, Walter C, and Fawzi, Wafaie W

Abstract

BACKGROUND: Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. OBJECTIVES: To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. METHODS: We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. RESULTS: In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P

Published
2021

35. Exploration of Machine Learning and Statistical Techniques in Development of a Low-Cost Screening Method Featuring the Global Diet Quality Score for Detecting Prediabetes in Rural India

Author

Birk, Nick, Matsuzaki, Mika, Fung, Teresa T, Li, Yanping, Batis, Carolina, Stampfer, Meir J, Deitchler, Megan, Willett, Walter C, Fawzi, Wafaie W, Bromage, Sabri, Kinra, Sanjay, Bhupathiraju, Shilpa N, and Lake, Erin

Abstract

BACKGROUND: The prevalence of type 2 diabetes has increased substantially in India over the past 3 decades. Undiagnosed diabetes presents a public health challenge, especially in rural areas, where access to laboratory testing for diagnosis may not be readily available. OBJECTIVES: The present work explores the use of several machine learning and statistical methods in the development of a predictive tool to screen for prediabetes using survey data from an FFQ to compute the Global Diet Quality Score (GDQS). METHODS: The outcome variable prediabetes status (yes/no) used throughout this study was determined based upon a fasting blood glucose measurement ≥100 mg/dL. The algorithms utilized included the generalized linear model (GLM), random forest, least absolute shrinkage and selection operator (LASSO), elastic net (EN), and generalized linear mixed model (GLMM) with family unit as a (cluster) random (intercept) effect to account for intrafamily correlation. Model performance was assessed on held-out test data, and comparisons made with respect to area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. RESULTS: The GLMM, GLM, LASSO, and random forest modeling techniques each performed quite well (AUCs >0.70) and included the GDQS food groups and age, among other predictors. The fully adjusted GLMM, which included a random intercept for family unit, achieved slightly superior results (AUC of 0.72) in classifying the prediabetes outcome in these cluster-correlated data. CONCLUSIONS: The models presented in the current work show promise in identifying individuals at risk of developing diabetes, although further studies are necessary to assess other potentially impactful predictors, as well as the consistency and generalizability of model performance. In addition, future studies to examine the utility of the GDQS in screening for other noncommunicable diseases are recommended.

Published
2021

36. Anemia Etiology in Ethiopia: Assessment of Nutritional, Infectious Disease, and Other Risk Factors in a Population-Based Cross-Sectional Survey of Women, Men, and Children

Author

Andersen, Christopher T, Tadesse, Amare Worku, Bromage, Sabri, Fekadu, Habtamu, Hemler, Elena C, Passarelli, Simone, Spiegelman, Donna, Sudfeld, Christopher R, Worku, Alemayehu, Berhane, Yemane, and Fawzi, Wafaie W

Abstract

BACKGROUND: While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. OBJECTIVES: We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia. METHODS: A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models. RESULTS: The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases. CONCLUSIONS: Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.

Published
2021

38. Application of the Global Diet Quality Score in Chinese Adults to Evaluate the Double Burden of Nutrient Inadequacy and Metabolic Syndrome

Author

He, Yuna, primary, Fang, Yuehui, additional, Bromage, Sabri, additional, Fung, Teresa T, additional, Bhupathiraju, Shilpa N, additional, Batis, Carolina, additional, Deitchler, Megan, additional, Fawzi, Wafaie, additional, Stampfer, Meir J, additional, Hu, Frank B, additional, Willett, Walter C, additional, and Li, Yanping, additional

Published
2021
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39. Changes in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women

Author

Angulo, Erick, primary, Stern, Dalia, additional, Castellanos-Gutiérrez, Analí, additional, Monge, Adriana, additional, Lajous, Martín, additional, Bromage, Sabri, additional, Fung, Teresa T, additional, Li, Yanping, additional, Bhupathiraju, Shilpa N, additional, Deitchler, Megan, additional, Willett, Walter C, additional, and Batis, Carolina, additional

Published
2021
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41. The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries

Author

Bromage, Sabri, primary, Zhang, Yiwen, additional, Holmes, Michelle D, additional, Sachs, Sonia E, additional, Fanzo, Jessica, additional, Remans, Roseline, additional, Sachs, Jeffrey D, additional, Batis, Carolina, additional, Bhupathiraju, Shilpa N, additional, Fung, Teresa T, additional, Li, Yanping, additional, Stampfer, Meir J, additional, Deitchler, Megan, additional, Willett, Walter C, additional, and Fawzi, Wafaie W, additional

Published
2021
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42. Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS)

Author

Bromage, Sabri, primary, Batis, Carolina, additional, Bhupathiraju, Shilpa N, additional, Fawzi, Wafaie W, additional, Fung, Teresa T, additional, Li, Yanping, additional, Deitchler, Megan, additional, Angulo, Erick, additional, Birk, Nick, additional, Castellanos-Gutiérrez, Analí, additional, He, Yuna, additional, Fang, Yuehui, additional, Matsuzaki, Mika, additional, Zhang, Yiwen, additional, Moursi, Mourad, additional, Kronsteiner-Gicevic, Selma, additional, Holmes, Michelle D, additional, Isanaka, Sheila, additional, Kinra, Sanjay, additional, Sachs, Sonia E, additional, Stampfer, Meir J, additional, Stern, Dalia, additional, and Willett, Walter C, additional

Published
2021
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44. Validation of Global Diet Quality Score Among Nonpregnant Women of Reproductive Age in India: Findings from the Andhra Pradesh Children and Parents Study (APCAPS) and the Indian Migration Study (IMS)

Author

Matsuzaki, Mika, primary, Birk, Nick, additional, Bromage, Sabri, additional, Bowen, Liza, additional, Batis, Carolina, additional, Fung, Teresa T, additional, Li, Yanping, additional, Stampfer, Meir J, additional, Deitchler, Megan, additional, Willett, Walter C, additional, Fawzi, Wafaie W, additional, Kinra, Sanjay, additional, and Bhupathiraju, Shilpa N, additional

Published
2021
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45. There’s an App for That: Development of an Application to Operationalize the Global Diet Quality Score

Author

Moursi, Mourad, primary, Bromage, Sabri, additional, Fung, Teresa T, additional, Isanaka, Sheila, additional, Matsuzaki, Mika, additional, Batis, Carolina, additional, Castellanos-Gutiérrez, Analí, additional, Angulo, Erick, additional, Birk, Nick, additional, Bhupathiraju, Shilpa N, additional, He, Yuna, additional, Li, Yanping, additional, Fawzi, Wafaie, additional, Danielyan, Armen, additional, Thapa, Sachit, additional, Ndiyoi, Liseteli, additional, Vossenaar, Marieke, additional, Bellows, Alexandra, additional, Arsenault, Joanne E, additional, Willett, Walter C, additional, and Deitchler, Megan, additional

Published
2021
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