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Food system innovations will be instrumental to achieving multiple Sustainable Development Goals (SDGs). However, major innovation breakthroughs can trigger profound and disruptive changes, leading to simultaneous and interlinked reconfigurations of multiple parts of the global food system. The emergence of new technologies or social solutions, therefore, have very different impact profiles, with favourable consequences for some SDGs and unintended adverse side-effects for others. Stand-alone innovations seldom achieve positive outcomes over multiple sustainability dimensions. Instead, they should be embedded as part of systemic changes that facilitate the implementation of the SDGs. Emerging trade-offs need to be intentionally addressed to achieve true sustainability, particularly those involving social aspects like inequality in its many forms, social justice, and strong institutions, which remain challenging. Trade-offs with undesirable consequences are manageable through the development of well planned transition pathways, careful monitoring of key indicators, and through the implementation of transparent science targets at the local level., The Lancet Planetary Health, 5 (1), ISSN:2542-5196

The Pacific Guidelines for Healthy Living recommend consuming a minimum of five servings of fruit and/or non-starchy vegetables each day, however, diets in Solomon Islands stray from the regional and global trend of healthy diets high in fresh fruit and vegetables. Our study drew on multiple sources of data and a food systems framework to show a country-wide picture of the role and benefits offered by fruit and non-starchy vegetables in Solomon Islands. First, we analysed data on fruit and non-starchy vegetable consumption and matched this to the data on supply. Second, we used a policy documentary analysis to highlight opportunities for the roles of fruit and non-starchy vegetables in the Solomon Island food system to advance progress in multiple Sustainable Development Goals. Key findings related to supply were the findings that domestic production of fruit and non-starchy vegetables is insufficient to meet per capita requirements, which coupled with our finding that per capita national level supply through imports is inconsequential, thus highlighting important undersupply issues for the nation. The food environment analysis indicated multiple further challenges hampering fruit and non-starchy vegetable consumption. Integrated with our analysis of policy, these revealed several opportunities, including improving affordability of this healthy commodity, enhancing livelihood equitability of supply chains, and strengthening environmentally sustainable agricultural practices that support increased production.

Summary Background Current diets are detrimental to both human and planetary health and shifting towards more balanced, predominantly plant-based diets is seen as crucial to improving both. Low fruit and vegetable consumption is itself a major nutritional problem. We aim to better quantify the gap between future fruit and vegetable supply and recommended consumption levels by exploring the interactions between supply and demand in more than 150 countries from 1961 to 2050. Methods In this global analysis, we use the International Model for Policy Analysis of Agricultural Commodities and Trade, which simulates the global agricultural sector, to explore the role of insufficient production of fruits and vegetables and the effects of food waste and public policy in achieving recommended fruit and vegetable consumption. First, we estimate the average historical (1961–2010) and future (2010–50) national consumption levels needed to meet WHO targets (a minimum target of 400 g/person per day or age-specific recommendations of 330–600 g/person per day) using population pyramids; for future consumption, we use projections from the Shared Socioeconomic Pathways (SSPs), a set of global socioeconomic scenarios characterised by varied assumptions on economic and population growth. We then simulate future fruit and vegetable production and demand to 2050 under three such scenarios (SSP1–3) to assess the potential impacts of economic, demographic, and technological change on consumer and producer behaviour. We then explore the potential effects of food waste applying various waste assumptions (0–33% waste). Finally, we apply two policy analysis frameworks (the NOURISHING framework and the Nuffield ladder) to assess the current state of public policy designed to achieve healthy diets. Findings Historically, fruit and vegetable availability has consistently been insufficient to supply recommended consumption levels. By 2015, 81 countries representing 55% of the global population had average fruit and vegetable availability above WHO's minimum target. Under more stringent age-specific recommendations, only 40 countries representing 36% of the global population had adequate availability. Although economic growth will help to increase fruit and vegetable availability in the future, particularly in lower-income countries, this alone will be insufficient. Even under the most optimistic socioeconomic scenarios (excluding food waste), many countries fail to achieve sufficient fruit and vegetable availability to meet even the minimum recommended target. Sub-Saharan Africa is a particular region of concern, with projections suggesting, by 2050, between 0·8 and 1·9 billion people could live in countries with average fruit and vegetable availability below 400 g/person per day. Food waste is a serious obstacle that could erode projected gains. Assuming 33% waste and socioeconomic trends similar to historical patterns, the global average availability in 2050 falls below age-specific recommendations, increasing the number of people living in countries with insufficient supply of fruits and vegetables by 1·5 billion compared with a zero waste scenario. Interpretation Increasing fruit and vegetable consumption is an important component of a shift towards healthier and more sustainable diets. Economic modelling suggests that even under optimistic socioeconomic scenarios future supply will be insufficient to achieve recommended levels in many countries. Consequently, systematic public policy targeting the constraints to producing and consuming fruits and vegetables will be needed. This will require a portfolio of interventions and investments that focus on increasing fruit and vegetable production, developing technologies and practices to reduce waste without increasing the consumer cost, and increasing existing efforts to educate consumers on healthy diets. Funding The Commonwealth Scientific and Industrial Research Organisation; Climate Change, Agriculture and Food Security (CGIAR) Research Program on Climate Change, Agriculture and Food Security; CGIAR Research Program on Policy, Institutions, and Markets; Bill & Melinda Gates Foundation; and Johns Hopkins University.

Additional co-authors: Prof Corinna Hawkes PhD, Mario Herrero PhD, Prof Peter S Hovmand PhD, Prof Mark Howden PhD, Lindsay M Jaacks PhD, Ariadne B Kapetanaki PhD, Matt Kasman PhD, Prof Harriet V Kuhnlein PhD, Prof Shiriki K Kumanyika PhD, Prof Bagher Larijani MD, Tim Lobstein PhD, Michael W Long PhD, Victor K R Matsudo MD, Susanna D H Mills PhD, Gareth Morgan PhD, Alexandra Morshed, Patricia M Nece JD, Prof An Pan PhD, David W Patterson, Gary Sacks PhD, Meera Shekar PhD, Geoff L Simmons, Warren Smit PhD, Ali Tootee PhD, Stefanie Vandevijvere PhD, Wilma E Waterlander PhD, Luke Wolfenden PhD, Prof William H Dietz MD

Diversity and diversification in agricultural systems are often presented in the literature as having multiple benefits such as enhancing resilience, increasing food production and decreasing risks in production systems and is often postulated to benefit food and nutrition security in low- and middle-income countries. Our study aims to provide an overview of the potential for agricultural diversification to improve food security status as reported in recently published research articles analysing the diversity-food security relationship. We consider results for different scales, from individual to global and for different food security dimensions: availability, access, stability and utilisation.We carried out a literature review that includes exhaustive, comprehensive searching. We search for peer-reviewed publications in the Web of Science core collection (v.5.32) written in English, between 2010 and February 2020 on the association between diversity in agricultural systems and at least one dimension or measure of food security. From the original list of articles we exclude all publications that (1) focus on a study area outside a low- to middle income country; (2) do not include at least one metric of farm-, regional-, or global-level diversity as specified with the search terms; (3) do not explicitly measure at least one food security dimension, or (4) were exclusively focussed on describing drivers and trends in diversity or food security.We find that a total number of 87 research articles assessed a total of 328 diversity-food security relationships using one or more statistical modelling approach. About half of them are positive (54%) and mostly refer to the diversity-food access relationship on the individual, household and farm scale as this was the food security dimension and spatial scale most analysed. Of all results for food access 60% were positive relationships and only 4% were negative relationships with the remainder having no or ambiguous relationships. Twenty-nine studies used household dietary diversity as a measure of food access and 10 studies used at least one food access indicator that is a validated proxy for nutrient adequacy. Positive relationships were more often reported for food availability (65%) than for food utilisation (33%) also because for food utilisation there are a lot of mixed findings for different measures of anthropometric and nutritional status. The most common spatial scale assessed was the household and farm scale (58%).There is no food security dimension that primarily has a negative relationship with agricultural diversity but there is a considerable number of relationships that are found to be neutral or ambiguous. Diversity can be an important driver of food security, but the magnitude of the contribution depends on the socio-economic and biophysical characteristics of the local farming system. We conclude that farmers mostly see diversification as a potential strategy to improve livelihoods, agricultural production and/or food and nutrition security where other strategies are more expensive but not as a desirable characteristic of the agricultural systems at all costs especially in the presence of other strategies that can achieve the same outcome.

Communities across the Pacific are being challenged by the impacts of climate change. Attaining food and nutrition security goals is also a priority for the region, particularly in relation to improving dietary quality and reducing the incidence of non-communicable diseases. Addressing these challenges requires context-specific research that incorporates a realistic understanding of the links between drivers of change, food systems, and how these influence diets and health. Using a case study approach, this study explores links between climate hazards, food systems, and diets in remote coastal villages of Fiji. Livelihood transitions and climate hazards explain why households have become less reliant on local fisheries and agriculture for their dietary needs. Most households are routinely consuming only locally sourced food items from four food groups, meaning dietary diversity is low. In addition, diets are shifting and now include significant quantities of energy-dense processed (imported) foods with lower nutritional value. The study highlights the importance of increasing availability of fruits and vegetables, mainly through local production, and diversifying sustainable sources of animal protein as strategies to increase diet quality. These communities are already implementing strategies to adapt to climate change, yet this study underscores the need to link climate adaptation with changes to food systems and diets, in ways that allow livelihoods to be sustained and the quality of life of rural dwellers to improve.

Technologies and systemic innovation are critical for the transformation of the food system. This Perspective identifies promising technologies, assesses their readiness and proposes eight action points to accelerate innovation.Future technologies and systemic innovation are critical for the profound transformation the food system needs. These innovations range from food production, land use and emissions, all the way to improved diets and waste management. Here, we identify these technologies, assess their readiness and propose eight action points that could accelerate the transition towards a more sustainable food system. We argue that the speed of innovation could be significantly increased with the appropriate incentives, regulations and social licence. These, in turn, require constructive stakeholder dialogue and clear transition pathways.

Reorienting food systems towards improving nutrition outcomes is vital if the global goal of ending all forms of malnutrition is to be achieved. Crucial to transitioning to nutrition-sensitive agriculture is valuing and measuring nutritional quality of the outputs of agricultural production. We review existing indicators which capture an element of nutritional quality applicable to different stages of the food and nutrition system. Applying relevant indicators from the agricultural production stage to selected aquaculture systems, we compare and contrast their strengths and limitations. ‘Nutritional yields’, ‘potential nutrient adequacy’ and ‘Rao's quadratic entropy’ show particular promise in capturing the ability of a production system to nourish the most people and could be useful tools for prioritising investments and decision-making in the public, non-government and private sectors driving agriculture.

Twenty-first-century challenges for food and nutrition security include the spread of obesity worldwide and persistent undernutrition in vulnerable populations, along with continued micronutrient deficiencies. Climate change, increasing incomes and evolving diets complicate the search for sustainable solutions. Projecting to the year 2050, we explore future macronutrient and micronutrient adequacy with combined biophysical and socioeconomic scenarios that are country-specific. In all scenarios for 2050, the average benefits of widely shared economic growth, if achieved, are much greater than the modelled negative effects of climate change. Average macronutrient availability in 2050 at the country level appears adequate in all but the poorest countries. Many regions, however, will continue to have critical micronutrient inadequacies. Climate change alters micronutrient availability in some regions more than others. These findings indicate that the greatest food security challenge in 2050 will be providing nutritious diets rather than adequate calories. Research priorities and policies should emphasize nutritional quality by increasing availability and affordability of nutrient-dense foods and improving dietary diversity. Global environmental change complicates the goal of securing adequate nutrition for a growing world population. This study assesses the per capita availability of food nutrients for various scenarios to the year 2050. Results suggest that economic growth will expand food and macronutrient access more than climate change will suppress it, but that micronutrient inadequacies will plague some regions.

Extensive literature describes the importance of food environments (FEs) as a driver of food choices and nutrition outcomes, yet existing FE frameworks do not adequately capture the diversity of FEs relevant to the Pacific Region. This limits identification of opportunities in food systems to reduce the multiple burden of malnutrition. We present a conceptual typology of FEs including six primary FEs relevant in the Pacific, wild, cultivated, kin and community, informal retail, formal retail, and food aid and services. We then apply this typology to food acquisition data from Solomon Islands 2012/13 Household Income and Expenditure Survey and analyse the relationship between FEs and diet quality. The cultivated FE accounts for 60% of the quantity of food acquired nationally, followed by wild (15%), kin and community (9%), and formal and informal retail FEs (8% each), with wide variation between urban and rural households, provinces and wealth groups. Reliance on different FEs is a significant predictor of diet quality and affirms the importance of subsistence fisheries and agriculture, and community and kinship networks. Integration of a FE typology such as the one presented here in commonly conducted household expenditure surveys offers significant opportunity to advance our understanding of food system leverage points to improve nutrition and health.

In Bangladesh, homestead pond aquaculture currently comprises a polyculture of large fish species but provides an ideal environment to integrate a range of small fish species. Small fish consumed whole, with bones, head and eyes, are rich in micronutrients and are an integral part of diets, particularly for the poor. Results from three large projects demonstrate that the small fish, mola (Amblypharyngodon mola) contributes significantly to the micronutrients produced from all fish, in homestead ponds, in one production cycle. Mola contributed 98%, 56% and 35% of the total vitamin A, iron and zinc produced, respectively, despite comprising only 15% of the total fish production by weight. If consumed within the household, mola could contribute half of the vitamin A and a quarter of the iron intake recommended for a family of four, annually. Homestead ponds are uniquely accessible to women who prepare the household food. Further dissemination of the carp-small fish technology provides opportunities to target women and men together for training on fish production and consumption, nutrition and gender equity. Women only training is also recommended to enable them to engage fully, without feeling dominated by men. Partnering with the fisheries and health sectors will encourage sustainable uptake of this promising technology. Clearly, dissemination could have significant health benefits; however, improved monitoring and evaluation, particularly of dietary diversity and diet quality are essential. Research priorities should also include the production techniques of other small indigenous fish species (SIS), besides mola, and the power dynamics between women and men in operating homestead ponds.

Fish and seafood consumption in Australia has been growing, yet the implications of this trend across the food system, from both a health and sustainability perspective have not been fully explored. This paper aims to map out the fish and seafood food system in Australia, linking production and consumption, to articulate challenges and opportunities for enhancing the sector&rsquo, s contribution to future healthy and sustainable diets. We conducted a secondary analysis of publicly available datasets on fish and seafood production and consumption, triangulated and supplemented with peer-reviewed and grey literature on environmental, economic and social sustainability issues throughout the food system. A key challenge for health is the high proportion of fish and seafood consumed as discretionary food, particularly among children. Key challenges for sustainability include the narrow focus on environmental sustainability (with little consideration of the other domains), and the focus on production with little consideration for sustainability throughout post-harvest handling, processing, retail, distribution and consumption. Key opportunities for health and sustainability include the innovative use of processing and packaging technology to maximise nutritional quality, creation of markets and supply chains for a greater diversity of underutilised fish and seafood species and processing by-products, and reductions in waste and loss throughout the entire supply chain.

The Sustainable Development Goals (SDGs) agenda makes achieving food security and ending malnutrition a global priority. Within this framework, the importance of fisheries in local and global food systems and its contribution to nutrition and health, particularly for the poor are overlooked and undervalued. This paper reviews current fish production and consumption from capture fisheries and aquaculture, highlights opportunities for enhancing healthy diets and outlines key multi-sectoral policy solutions. Mirroring the call for a diversification of agricultural research and investment beyond a few staple grains, it is anticipated that productivity gains for a few farmed aquatic species will not suffice. Capture fisheries and aquaculture have a complementary role to play in increasing fish availability and access, and must be promoted in ways that support measurable nutrition and health gains. This paper argues that the lack of a nutrition-sensitive policy focus on capture fisheries and aquaculture represents an untapped opportunity that must be realised for ensuring sustainable healthy diets for all.

The important role of fish in food and nutrition security is becoming more widely acknowledged by the fishery sector and within food policy. Integration of fish and food policy, at national, regional or global levels, is required to ensure the contribution of fisheries and aquaculture to human health is supported through governance arrangements. We explore this aspect of food policy integration in Timor-Leste, where malnutrition is a critical health problem. Consumption of fish is low by international standards and only a small proportion of the population engages in fishing. We used a mixed method approach involving desktop policy analysis, interviews and social network analysis to explore interactions among sectoral instruments and organisations. Our results show generally good integration of food security into fisheries policies, but a lack of integration of fish into food policies. Policy network analysis revealed evidence of collaboration and cooperation between sectors, however, consideration of fish and food concerns was not well embedded across all organisations. We discuss challenges and options for future integration of fisheries into sustainable food systems in Timor-Leste and more broadly, including the need for greater political will and resources, combined with clearer targets and actions within instruments.

BackgroundMalnutrition and poor quality diets are the leading drivers of the global burden of disease, affecting one in three people globally. Pregnant and lactating women, and infants of complementary feeding age are particularly vulnerable. The fisheries sector is well-placed to contribute to improving malnutrition and food insecurity, particularly in the context of Bangladesh, yet is often overlooked.AimsThe broad aim of this research is to understand how fish contributes to nutrition and food security, how this is changing according to broader trends in aquatic food systems, and how fisheries might be better utilised to reduce malnutrition. The focus is on nutrients known to be significant causes of malnutrition in Bangladesh: iron, zinc, calcium, vitamin A and vitamin B12. This broad aim is addressed through five specific research questions (RQs):RQ1: What is the nutritional value of commonly consumed fish in Bangladesh?RQ2: How could local nutrient-rich foods including fish, be utilised to improve nutritional quality of diets?RQ3: What does fish currently contribute to diets in terms of nutrient intakes?RQ4: How has the transition in aquatic food systems (declining availability of species from capture fisheries, and rapid growth in aquaculture) impacted nutrient intakes?RQ5: How could nutritional quality of fish production systems be measured and used in decision making?MethodsThis research draws on a variety of different methods to address individual RQs. The nutritional value of fish (RQ1) was determined by primary analysis of 55 fish species for composition of protein, fat and selected minerals, vitamins and essential fatty acids using standard analytical methods. Raw, edible parts of individual samples were homogenised then analysed in duplicate. The use of fish to improve diets among vulnerable groups (RQ2) was informed by a review of local food-based approaches including food processing methods, and nutrient composition of local ingredients, followed by laboratory based trial production of recipes. The role of fish in current diets (RQ3) was informed through secondary analysis of intra-household food consumption data (based on 24-hour recall) of a two-stage stratified nationally representative survey of rural Bangladesh (n=5,503 households, 24,198 individuals). Linear regression was used to estimate mean fish consumption, controlling for age, sex, wealth group and geographic region (adjusted by sampling weights). The impact of a shift in fish consumption away from non-farmed towards farmed fish, on nutritional quality of diets (RQ4) was estimated through secondary analysis of food consumption data from nationally representative household income and expenditure surveys in 1991 (n=5,745), 2000 (n=7,440) and 2010 (n=12,240). Linear regression, adjusting for sampling weights and clustering in survey design, was used to estimate mean fish consumption among different population groups. Measurement of nutritional quality of fish production systems (RQ5) was informed through a review of existing indicators and comparison of their strengths and limitations applied to common homestead pond aquaculture systems in Bangladesh.Main findingsThe nutrient composition of fish varies widely across species, particularly for micronutrients. Iron content ranged from 0.34-19 mg/100 g raw, edible parts; zinc from 0.6-4.7 mg/100 g; calcium from 8.6-1900 mg/100 g; vitamin A from 0-2503 mg RAE/100 g; and vitamin B12 from 0.50-14 mg/100 g. Non-farmed fish contribute between 6-35% of daily recommended nutrient intakes for iron, zinc, calcium, vitamin A and vitamin B12, more than farmed fish, despite being consumed in smaller portions (Pl0.0001); and are therefore better placed to contribute to improved micronutrient intakes among vulnerable groups. Adaption of traditional recipes to include these nutrient-rich fish, combined with other local nutrient-rich foods and using simple processing methods, shows great potential to improve nutrient intakes. For example, consumption of the proposed complementary food product could meet g60% of the daily vitamin A and zinc needs for a child. However, such nutrient-rich species are not the current focus of production policies. Aquaculture systems are designed to maximise yields without considering nutritional quality. Growth in aquaculture has allowed fish consumption to increase nationally by 30% between 1991 and 2010, despite a 33% decline in availability of non-farmed fish. However, increased reliance on farmed fish of lower nutritional quality, has led to an overall decrease in micronutrient intakes from fish: iron significantly decreased by 15% (Pl0.01), calcium by 14% (Pl0.01), and zinc, vitamin A andnvitamin B12 remained unchanged despite an increase in total quantity of fish being consumed.ConclusionsFisheries make an important but undervalued contribution to nutrition and food security in Bangladesh. However, the current policy focus on maximising quantity of production from this sector, without considering quality, has had negative impacts on nutritional quality of diets. A nutrition-sensitive approach to fisheries policy is necessary. Such an approach would enable the fisheries sector to make a more substantial contribution to the reduction of malnutrition and food insecurity in Bangladesh. These findings are of great relevance to other countries experiencing this transition in aquatic food systems and malnutrition.

Fish, in Bangladesh where malnutrition remains a significant development challenge, is an irreplaceable animal-source food in the diet of millions. However, existing data on the nutrient composition of fish do not reflect the large diversity available and have focused on only a few select nutrients. The purpose of this study was to fill the gaps in existing data on the nutrient profiles of common fish in Bangladesh by analysing the proximate, vitamin, mineral and fatty acid composition of 55 fish, shrimp and prawn species from inland capture, aquaculture and marine capture fisheries. When comparing species, the composition of nutrients of public health significance was diverse. Iron ranged from 0.34 to 19 mg/100 g, zinc from 0.6 to 4.7 mg/100 g, calcium from 8.6 to 1900 mg/100 g, vitamin A from 0 to 2503 μg/100 g and vitamin B12 from 0.50 to 14 μg/100 g. Several species were rich in essential fatty acids, particularly docosohexaenoic acid in capture fisheries species (86–310 mg/100 g). The potential contribution of each species to recommended nutrient intakes (RNIs) for pregnant and lactating women (PLW) and infants was calculated. Seven species for PLW and six species for infants, all from inland capture, and all typically consumed whole with head and bones, could potentially contribute ≥25% of RNIs for three or more of these nutrients, simultaneously, from a standard portion. This illustrates the diversity in nutrient content of fish species and in particular the rich nutrient composition of small indigenous species, which should guide policy and programmes to improve food and nutrition security in Bangladesh.

Background: Information about the global structure of agriculture and nutrient production and its diversity is essential to improve present understanding of national food production patterns, agricultural livelihoods, and food chains, and their linkages to land use and their associated ecosystems services. Here we provide a plausible breakdown of global agricultural and nutrient production by farm size, and also study the associations between farm size, agricultural diversity, and nutrient production. This analysis is crucial to design interventions that might be appropriately targeted to promote healthy diets and ecosystems in the face of population growth, urbanisation, and climate change. Methods: We used existing spatially-explicit global datasets to estimate the production levels of 41 major crops, seven livestock, and 14 aquaculture and fish products. From overall production estimates, we estimated the production of vitamin A, vitamin B12, folate, iron, zinc, calcium, calories, and protein. We also estimated the relative contribution of farms of different sizes to the production of different agricultural commodities and associated nutrients, as well as how the diversity of food production based on the number of different products grown per geographic pixel and distribution of products within this pixel (Shannon diversity index [H]) changes with different farm sizes. Findings: Globally, small and medium farms (≤50 ha) produce 51–77% of nearly all commodities and nutrients examined here. However, important regional differences exist. Large farms (>50 ha) dominate production in North America, South America, and Australia and New Zealand. In these regions, large farms contribute between 75% and 100% of all cereal, livestock, and fruit production, and the pattern is similar for other commodity groups. By contrast, small farms (≤20 ha) produce more than 75% of most food commodities in sub-Saharan Africa, southeast Asia, south Asia, and China. In Europe, west Asia and north Africa, and central America, medium-size farms (20–50 ha) also contribute substantially to the production of most food commodities. Very small farms (≤2 ha) are important and have local significance in sub-Saharan Africa, southeast Asia, and south Asia, where they contribute to about 30% of most food commodities. The majority of vegetables (81%), roots and tubers (72%), pulses (67%), fruits (66%), fish and livestock products (60%), and cereals (56%) are produced in diverse landscapes (H>1·5). Similarly, the majority of global micronutrients (53–81%) and protein (57%) are also produced in more diverse agricultural landscapes (H>1·5). By contrast, the majority of sugar (73%) and oil crops (57%) are produced in less diverse ones (H≤1·5), which also account for the majority of global calorie production (56%). The diversity of agricultural and nutrient production diminishes as farm size increases. However, areas of the world with higher agricultural diversity produce more nutrients, irrespective of farm size. Interpretation: Our results show that farm size and diversity of agricultural production vary substantially across regions and are key structural determinants of food and nutrient production that need to be considered in plans to meet social, economic, and environmental targets. At the global level, both small and large farms have key roles in food and nutrition security. Efforts to maintain production diversity as farm sizes increase seem to be necessary to maintain the production of diverse nutrients and viable, multifunctional, sustainable landscapes. Funding: Commonwealth Scientific and Industrial Research Organisation, Bill & Melinda Gates Foundation, CGIAR Research Programs on Climate Change, Agriculture and Food Security and on Agriculture for Nutrition and Health funded by the CGIAR Fund Council, Daniel and Nina Carasso Foundation, European Union, International Fund for Agricultural Development, Australian Research Council, National Science Foundation, Gordon and Betty Moore Foundation, and Joint Programming Initiative on Agriculture, Food Security and Climate Change—Belmont Forum.

Background: Information about the global structure of agriculture and nutrient production and its diversity is essential to improve present understanding of national food production patterns, agricultural livelihoods, and food chains, and their linkages to land use and their associated ecosystems services. Here we provide a plausible breakdown of global agricultural and nutrient production by farm size, and also study the associations between farm size, agricultural diversity, and nutrient production. This analysis is crucial to design interventions that might be appropriately targeted to promote healthy diets and ecosystems in the face of population growth, urbanisation, and climate change. Methods: We used existing spatially-explicit global datasets to estimate the production levels of 41 major crops, seven livestock, and 14 aquaculture and fish products. From overall production estimates, we estimated the production of vitamin A, vitamin B₁₂, folate, iron, zinc, calcium, calories, and protein. We also estimated the relative contribution of farms of different sizes to the production of different agricultural commodities and associated nutrients, as well as how the diversity of food production based on the number of different products grown per geographic pixel and distribution of products within this pixel (Shannon diversity index [H]) changes with different farm sizes. Findings: Globally, small and medium farms (≤50 ha) produce 51–77% of nearly all commodities and nutrients examined here. However, important regional differences exist. Large farms (>50 ha) dominate production in North America, South America, and Australia and New Zealand. In these regions, large farms contribute between 75% and 100% of all cereal, livestock, and fruit production, and the pattern is similar for other commodity groups. By contrast, small farms (≤20 ha) produce more than 75% of most food commodities in sub-Saharan Africa, southeast Asia, south Asia, and China. In Europe, west Asia and north Africa, and central America, medium-size farms (20–50 ha) also contribute substantially to the production of most food commodities. Very small farms (≤2 ha) are important and have local significance in sub-Saharan Africa, southeast Asia, and south Asia, where they contribute to about 30% of most food commodities. The majority of vegetables (81%), roots and tubers (72%), pulses (67%), fruits (66%), fish and livestock products (60%), and cereals (56%) are produced in diverse landscapes (H>1·5). Similarly, the majority of global micronutrients (53–81%) and protein (57%) are also produced in more diverse agricultural landscapes (H>1·5). By contrast, the majority of sugar (73%) and oil crops (57%) are produced in less diverse ones (H≤1·5), which also account for the majority of global calorie production (56%). The diversity of agricultural and nutrient production diminishes as farm size increases. However, areas of the world with higher agricultural diversity produce more nutrients, irrespective of farm size. Interpretation: Our results show that farm size and diversity of agricultural production vary substantially across regions and are key structural determinants of food and nutrient production that need to be considered in plans to meet social, economic, and environmental targets. At the global level, both small and large farms have key roles in food and nutrition security. Efforts to maintain production diversity as farm sizes increase seem to be necessary to maintain the production of diverse nutrients and viable, multifunctional, sustainable landscapes. Funding: Commonwealth Scientific and Industrial Research Organisation, Bill & Melinda Gates Foundation, CGIAR Research Programs on Climate Change, Agriculture and Food Security and on Agriculture for Nutrition and Health funded by the CGIAR Fund Council, Daniel and Nina Carasso Foundation, European Union, International Fund for Agricultural Development, Australian Research Council, National Science Foundation, Gordon and Betty Moore Foundation, and Joint Programming Initiative on Agriculture, Food Security and Climate Change—Belmont Forum.

In Chronic Kidney Disease (CKD), management of diet is important in prevention of disease progression and symptom management, however evidence on nutrition prescription is limited. Recent international CKD guidelines and literature was reviewed to address the following question “What is the appropriate nutrition prescription to achieve positive outcomes in adult patients with chronic kidney disease?” Databases included in the search were Medline and CINAHL using EBSCOhost search engine, Embase and the Cochrane Database of Systematic Reviews published from 2000 to 2009. International guidelines pertaining to nutrition prescription in CKD were also reviewed from 2000 to 2013. Three hundred and eleven papers and eight guidelines were reviewed by three reviewers. Evidence was graded as per the National Health and Medical Research Council of Australia criteria. The evidence from thirty six papers was tabulated under the following headings: protein, weight loss, enteral support, vitamin D, sodium, fat, fibre, oral nutrition supplements, nutrition counselling, including protein and phosphate, nutrients in peritoneal dialysis solution and intradialytic parenteral nutrition, and was compared to international guidelines. While more evidence based studies are warranted, the customary nutrition prescription remains satisfactory with the exception of Vitamin D and phosphate. In these two areas, additional research is urgently needed given the potential of adverse outcomes for the CKD patient.

ObjectiveFish is the most important animal-source food (ASF) in Bangladesh, produced from capture fisheries (non-farmed) and aquaculture (farmed) sub-sectors. Large differences in micronutrient content of fish species from these sub-sectors exist. The importance of fish in diets of vulnerable groups compared with other ASF; contribution from non-farmed and farmed species to nutrient intakes; and differences in fish consumption among age, gender, wealth groups and geographic regions were analysed, using quantitative intra-household fish consumption data, focusing on the first 1000 d of life.DesignTwo-stage stratified sample.SettingNationally representative of rural Bangladesh.SubjectsHouseholds (n 5503) and individuals (n 24 198).ResultsFish consumption in poor households was almost half that in wealthiest households; and lower in females than males in all groups, except the wealthiest, and for those aged ≥15 years (P12 intakes than farmed fish (PConclusionsPolicies and programmes aimed to increase fish consumption as a means to improve nutrition in rural Bangladesh should focus on women and young children, and on the poorest households. Aquaculture plays an important role in increasing availability and affordability of fish; however, non-farmed fish species are better placed to contribute to greater micronutrient intakes. This presents an opportunity for aquaculture to contribute to improved nutrition, utilising diverse production technologies and fish species, including small fish.

Background:Within food-based approaches to improve nutrition during the first 1000 days of life, improved formulations of food products and the use of animal source foods, such as fish, are 2 widely cited strategies; however, there are few examples where the 2 strategies are combined. Furthermore, although small indigenous fish are highly nutritious and available to the poor in many regions of the world, their importance is often overlooked.Objective:To document the development of 2 nutritious fish-based food products in Bangladesh: a chutney for pregnant and lactating women (PLW) and a complementary food (CF) for infants and young children (6-23 months), including potential contributions to recommended or desirable nutrient intakes in the first 1000 days, processing methods, and nutrient composition.Methods:Local nutrient-rich ingredients and simple processing methods based on traditional knowledge (for the chutney), and a literature review (for the CF), were selected and trial batches produced. Products were analyzed for nutrient composition using standard analytical procedures and results compared with recommended or desirable nutrient intakes for women and children.Results:Both products could contribute significantly to micronutrient intakes of PLW (24% of iron and 35% of calcium recommended intakes) and macro- and micronutrient intake of infants and young children (≥65% of vitamin A, ≥61% of zinc, and 41% of iron desirable intakes) when consumed in the proposed serving size.Conclusion:Inclusion of small indigenous fish as an underutilized animal source food in combination with other local nutrient-rich ingredients in food products represents a promising food-based strategy to improve nutrition, with many additional potential benefits for communities involved in production, and therefore warrants further investigation.

Malnutrition is one of the biggest challenges of the 21st century, with one in three people in the world malnourished, combined with poor diets being the leading cause of the global burden of disease. Fish is an under-recognised and undervalued source of micronutrients, which could play a more significant role in addressing this global challenge. With rising pressures on capture fisheries, demand is increasingly being met from aquaculture. However, aquaculture systems are designed to maximise productivity, with little consideration for nutritional quality of fish produced. A global shift away from diverse capture species towards consumption of few farmed species, has implications for diet quality that are yet to be fully explored. Bangladesh provides a useful case study of this transition, as fish is the most important animal-source food in diets, and is increasingly supplied from aquaculture. We conducted a temporal analysis of fish consumption and nutrient intakes from fish in Bangladesh, using nationally representative household expenditure surveys from 1991, 2000 and 2010 (n = 25,425 households), combined with detailed species-level nutrient composition data. Fish consumption increased by 30% from 1991–2010. Consumption of non-farmed species declined by 33% over this period, compensated (in terms of quantity) by large increases in consumption of farmed species. Despite increased total fish consumption, there were significant decreases in iron and calcium intakes from fish (P

Twenty-five species of fish, shrimp and prawn from local markets in Bangladesh were analysed for concentrations of total Fe, haem Fe and non-haem Fe by ICP-MS. Total Fe and non-haem Fe concentrations were measured in nitric acid-digested samples and haem Fe was extracted using acidified 80% acetone for 60min. Total Fe concentrations ranged from 0.55–14.43mg/100g FW, and haem Fe% ranged from 18%–93% of total Fe. Repeat extractions with 80% acetone recovered additional haem Fe, suggesting that previous measurement by this technique may have underestimated haem Fe content. Calculation of Fe balance (summing Fe in acetone extracts and Fe in the residue after haem Fe extraction) was not significantly different from total Fe, indicating the two processes recovered the different forms of Fe with similar effectiveness.