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This Supplement of the Food and Nutrition Bulletin, The Triple Burden of Malnutrition Among Adolescents in Indonesia, is curated a variety of research papers, urging further attention to adolescent nutrition in Indonesia and beyond. 

Click here to read the full Supplement.

As the first comprehensive review of present knowledge on Indonesia’s adolescent nutrition, this Supplement, which is comprised of 9 articles by nutrition experts Kesso Gabrielle van Zutphen and Klaus Kraemer at Sight and Life, as well as from UNICEF, the University of Indonesia and Wageningen University,  addresses the critical gaps in knowledge around adolescent nutrition. The triple burden of malnutrition is distinctly illustrated in Indonesia, where 1 in 3 children under 5 years old is stunted, 1 in ten 10 children has wasting, and a further 8% of children are overweight. But not all demographics are hit equally by malnutrition – adolescents bear the brunt of the consequences, as 1 in 4 adolescent girls suffers from anemia and 1 in 7 adolescents is overweight or obese. The findings of the supplement give the impetus for action in the nutrition community for more evidence-based interventions supported by large-scale implementation research and evaluation.

Policies and programs to tackle the triple burden of malnutrition in Indonesia were scarce, especially for adolescents, until recently. Many gaps in research and understanding of adolescent nutrition in Indonesia persist, including: 

  • The drivers and determinants of the triple burden of malnutrition. 
  • Evidence-based interventions which are supported by large-scale implementation research and evaluation. 
  • Effective delivery platforms capable of reaching vulnerable adolescents. 

As such, authors urge the nutrition community that the time for action is now to make adolescent nutrition the focal point of development; furthermore, it must be drawn into the mainstream within health sector plans, strategies and policies. 

In this Supplement you’ll also discover: Knowledge Gaps in Understanding the Etiology of Anemia in Indonesian Adolescents, co-authored by Kesso Gabrielle van Zutphen, Klaus Kraemer, and Alida Melse-Boonstra.

This article addresses the significant knowledge gaps around the etiology of anemia among Indonesian adolescents and provides a framework highlighting the urgency of additional research across all etiological factors. This framework was developed within the context of a need for strategies targeting anemia among adolescents in Indonesia to be adapted to local conditions and anemia’s specific etiology and prevalence in the particular setting and population.  

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This paper discusses the challenge of the growing triple burden of malnutrition in urban contexts and advocates for the role of secondary cities as game-changers to transform city region food systems. Secondary cities are introduced as emerging players in pioneering nutrition-centered food systems interventions, and in monitoring and evaluating their impacts for later improvements and out-scaling.

Against the context of many of the challenges raised in this paper, the Swiss Agency for Development and Cooperation has initiated and provides funding for a project starting in 2021, that aims to improve nutrition in secondary cities in three countries. The Nutrition in City Ecosystems (NICE) project works with selected secondary cities in Bangladesh (Dinajpur and Rangpur), Kenya (Bungomaand and Busia) and Rwanda (Rubavu and Rusizi) and places a particular focus on women, youth and vulnerable groups in city regions. Key elements of NICE are to: strengthen the supply of and demand for agroecologically-produced, local and nutritious foods; foster multisectoral governance; stimulate greater public and private sector engagement for resilient food systems and improved nutrition outcomes.

NICE is co-financed and implemented by a Swiss consortium comprised of the Swiss Tropical and Public Health Institute, the Swiss Federal Institute of Technology of Zurich (Sustainable Agroecosystems & Food Processing Groups and World Food System Centre), Sight and Life, and the Syngenta Foundation for Sustainable Agriculture. NICE aims to achieve its goals by focusing on four outcome areas: 1) participatory governance and systems, 2) production and availability of agroecological and locally produced foods 3) knowledge and demand generation for nutritious and agroecologically produced food and 4) policy and advocacy.

Learn more in the full publication here.

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On April 20, 2021, the Scientific Group of the United Nations Food Systems Summit 2021 published the paper Foods System Innovation Hubs in Low- and Middle-Income Countries written by Kalpana Beesabathuni, Madhavika Bajoria, Breda Gavin-Smith, Klaus Kraemer, Priyanka Kumari, Srujith Lingala, Anne Milan, Puja Tshering, Kesso Gabrielle van Zutphen, Kris Woltering along with Sufia Askari of Children’s Investment Fund Foundation, Martin Bloem of the Johns Hopkins Center for a Livable Future, and Hamid Hamirani. 

Abstract 

Food Systems Innovation Hubs provide an opportunity to address these challenges. They have the potential to stimulate investments in resilient and responsive food systems with the goal of alleviating malnutrition through corporate partnerships, impact investors and government collaboration. These hubs can encourage food companies to expand into LMICs, facilitate investments in local companies, and stimulate supply chain innovations.

Food Systems Innovation Hubs stimulate economic growth, ensure health benefits for all, protect the environment, and create sustainable societies.

This paper aims to draw attention to the role that Food Systems Innovation Hubs can play in creating healthy, resilient, and inclusive communities in LMICs. First, eight different archetypes of food innovation hubs are described. Future opportunities for these hubs to deliver planet-friendly nutritious and safe foods are then explored. It is argued that the complexity of food systems calls for context-specific transformations and that innovation hubs have a key role to play here. Three key actions are identified as essential for developing effective Food Systems Innovation Hubs in LMICs: Inspire! Invest! and Innovate!

Click here to read the full paper published by the Scientific Group of the United Nations Food Systems Summit 2021 and dive into more details by reading our blog series about the Food System Innovation Hub.

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On March 29, 2021, Nutrients published Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs written by Sight and Life team members: Rebecca Olson, Breda Gavin-Smith, Chiara Ferrabochi and Klaus Kraemer.

The article discusses how to use Sight and Life’s global and national experiences in implementing food fortification efforts. We demonstrate how different programs in low- and-middle income countries have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring. Read the full publication in Nutrients 2021 here.

Olson R, Gavin-Smith B, Ferraboschi C, Kraemer K. Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs. Nutrients. 2021; 13(4):1118. https://doi.org/10.3390/nu13041118

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Prof Adam Drewnowski together with Sight and Life’s Breda Gavin-Smith and Daniel Amanquah, created and wrote Perspective: How to Develop Nutrient Profiling Models Intended for Global Use: A Manual

The initial goal of most NP models was to prevent obesity in high-income countries by penalizing energy-dense foods. New NP models intended for LMIC use need to address the still prevalent vitamin and mineral deficiencies. Assuming access to nutrient composition data, the development of such models can follow already established principles and guidelines.

The manual is a guide for developing a nutrient profile model and shares a case study on Obaasima, a quality seal used in Ghana. Read the full manual here

Adam Drewnowski, Daniel Amanquah, Breda Gavin-Smith, Perspective: How to Develop Nutrient Profiling Models Intended for Global Use: A Manual, Advances in Nutrition, 2021;, nmab018, https://doi.org/10.1093/advances/nmab018

 

 

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Sight and Life, Consumer Insights, magazine, Nutrition, BCCThe NEW Sight and Life Magazine is available now! This edition of the Sight and Life magazine explores various dimensions and applications of consumer insights. 

Each article in this issue of Sight and Life magazine is inspiring and thought-provoking and we very much hope you will enjoy it and trust that it will stimulate new ways of thinking that pave the way for meaningful and lasting change. Our deepest thanks to all of the authors for their contributions! 

Take a look at the magazine HERE.

 

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The third edition of Nutrition and Health in Developing Countries takes on a new context whereby the word ‘developing’ is now a verb and not an adjective.

This 827-page book with 36 chapters provides policy makers, nutritionists, students, scientists, and professionals with the most up-to-date knowledge regarding key nutritional and health problems in developing countries. Unlike its two previous editions, this third edition was written against the backdrop of the Sustainable Development Goals and therefore includes new chapters with various topics which well reflect the interconnectedness and complexity of our world. This requires a new approach to public health which includes, but is not limited to: food value chains, challenges to achieving sustainable food systems, urbanization, food insecurity, climate change and political instability.

This third edition reviews the epidemiology, outcome indicators, policies and programs that are used to determine improvements in nutrition and health that lead to development. Programs and policies that address the social and economic determinants of nutrition and health are increasingly gaining in importance as methods to improve the status of the most vulnerable people in the world. This volume is a great resource that policy-makers, nutritionists, students, scientists, and professionals can use to advance methods for improving the health of the world’s population and the development of nations, and to equip themselves to approach health and nutritional problems in a holistic and integrative way.

Sight and Life authored the chapter on ‘The Role of Foundations and Initiatives by the Private Sector for Improving Health and Nutrition’ (pp.771–790).

You can order your own copy of the book, or specific chapters from it, here

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Maternal undernutrition continues to threaten maternal and child health – particularly in low income and food insecure environments. Despite recent progress, over 30 million babies are still born too small— putting them at an increased risk of infant mortality, childhood stunting and poor cognitive function later in life. Approximately six million of these births are associated with maternal short stature in pregnancy. Low maternal BMI and poor weight gain during pregnancy are other factors that lead to fetal growth restriction. While the importance of the first 1,000 days is widely known, there has been little attention given to a woman’s nutritional status during and following pregnancy. To address this, the Bill & Melinda Gates Foundation convened a group of experts to explore how to best meet the nutritional requirements of vulnerable women during pregnancy and lactation.
 
The consultation set out to capture considerations and consensus for ready-to-use food supplements for pregnant and lactating women who are undernourished and/or at risk of undernutrition in low and middle-income countries. In their report, the expert group assess the daily minimum and maximum macro- and micronutrient consumption amounts for this target demographic—drawing upon recommendations from the US Institute of Medicine, the Food and Agriculture Organization and the World Health Organization (WHO). The group considered the types of foods that can best deliver these nutrients, and consideration of different formats including spreads, biscuits, bars, extruded snacks and instant drink powders. Lastly, they assessed the roles that the public and private sectors could play to create access to and demand for nutritional food supplements during and after pregnancy. The group concluded that both sectors will have an important role to play in moving these products from concept to market, and ultimately getting them to the women who need them most.
 
Dr. Klaus Kraemer, Sight and Life’s Managing Director, was part of the expert panel to advance these pressing topics surrounding women’s nutrition. 
 
“This important and timely document provides a blueprint to develop nutritious foods for women of reproductive age in countries with the highest nutritional needs.” – Dr Klaus Kraemer
 
The new WHO antenatal care guidelines —released shortly after the consultation—filled a gap in guidance for supplementation during pregnancy. The new guidelines include a context-specific recommendation for balanced-energy protein supplementation for pregnant women in undernourished populations. This offers an exciting opportunity to develop an affordable, nutritious food supplement for pregnant women that could also be considered for use by postpartum women to support lactation.
 
Now we must put the consultation’s recommendations into action. The group has outlined a series of next steps, including the development and testing of prototypes in different geographies and contexts. The potential for delivering a nutritious food supplement to undernourished populations is significant, and can help drive progress towards achieving the World Health Assembly’s global nutrition targets on anemia and low birth weight. 

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The new book Good Nutrition: Perspectives of rate 21st Century is well respected by leading experts on global nutrition. 

“This insightful and timely book rightly argues that addressing malnutrition is crucial to achieving sustainable development.”
 – Kofi Annan, Chair of the Kofi Annan Foundation and Former Secretary-General of the United Nations

“Nutrition is a complex subject, affected by many intertwining factors. Good Nutrition: Perspectives for the 21st Century pulls it all together in one easy-to-follow volume.”
 – Anna Lartey, President of the International union of Nutritional Science and Director of Nutrition at the United Nations Food and agriculture Organization (FAO)

“Good Nutrition: Perspectives for the 21st century showcases the thinking of some of today’s most influential and respected scientists from a wide range of fields. With clear presentation and accessible argumentation, it offers a composite view of where global nutrition stands today and outlines a wide range of evidence-based approaches for bringing about positive change. The fact that its scope covers the developed as well as the developing world makes it all the more powerful, for there are no countries in the world today, however affluent they might be, that are not faced with significant malnutrition challenges. I am confident that scientists and policy-makers working in nutrition, food, agriculture and public health, as well as non-specialists, will find this publication informative, useful, and thought provoking, and that it will inspire everyone who reads it to help build a world in which nutrition is indeed recognized as a fundamental human right.”
– Hilal Elver, UN Special Rapporteur on the Right to Food

Click HERE to download the book. 

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Today, some 160 million children under five years of age don’t get the food and nutrients that their bodies need for optimal growth and development. One hundred and sixty million children that are likely to remain trapped in a vicious cycle of malnutrition and poverty. No wonder the ‘new’ Sustainable Development Goals (SDGs) have ‘no poverty’ and ‘zero hunger’ as the first and second of the 17 Global Goals. This makes the eradication of malnutrition, with a special focus on children, a top priority for countries as they turn the SDGs into actions.

Over the last four decades, much of the focus in addressing chronic malnutrition was on ensuring that children received sufficient micronutrients – particularly vitamin A, iodine, iron, zinc, and folate. There was the widespread assumption that they were receiving enough protein from their basic diet. So micronutrient malnutrition also known as ‘hidden hunger‘, because vitamin and mineral deficiencies are not often obvious to the eye, has dominated efforts and innovations to improve the nutrition of children under five.

Potentially important insights going forward have come to light in a paper just published in EBioMedicine. This new research, carried out by scientists at the Johns Hopkins University, the National Institute on Aging, University of Maryland, Washington University in St. Louis, University of Malawi, and the Sight and Life Foundation, analyzed blood samples of over 300 children with and without stunting. The children, aged between one and five years, lived in villages in rural Malawi. Instead of focusing on micronutrients, the research looked at the essential amino acids that are the building blocks of proteins, and must come from the diet.

The striking finding of the study is that all nine essential amino acids were significantly lower in stunted children compared with non-stunted children. In fact, most of the amino acid levels were as much as 15-20% lower in the stunted children. This is important because it tells us that stunted children are in reality not receiving sufficient quality protein from their diet and this lack of essential amino acids means children will not grow normally even if they receive the necessary micronutrients.

How did protein fall off the international development map?

Click here to read the full story in the Huffington Post by Dr Klaus Kraemer together with Dr Richard Semba, JHU.

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Is there a protein crisis?

It used to be common knowledge: Malnourished kids need more protein to thrive. Then came a scathing paper in the Lancet in 1974 called “The Great Protein Fiasco.” Filled with sarcasm, it argued that the nutrition community’s fixation on protein was a waste of time and money.

Click here to read whether now protein should be part of the bigger picture again.

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stuntingWorldwide, one-quarter of children under five years are short for their age (stunted), indicative of chronic malnutrition. Lipid-based nutrient supplements containing micronutrients have little to no effect in reducing child stunting. We examined the relationship between circulating metabolites with stunting in young children in Africa. Stunted children had lower serum levels of all nine essential amino acids compared with non-stunted children. These results challenge the widespread assumption that protein intake is adequate among young children in developing countries. The findings support the idea that children at high risk of stunting are not receiving adequate dietary intake of essential amino acids.

Click here to read full article.

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