The Convergence of COVID-19, Climate Change and Malnutrition

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When I set out to write this piece about COVID-19, climate change and malnutrition, I asked myself whether there might be anything new that I could add to the debate, given the myriad blogs, commentaries and webinars already proliferating on the subject. In my quest for lasting solutions to the global scourge of malnutrition, it is important for me not to lose sight of the big picture, to learn from the past, and not to jump on the bandwagon when global priorities change.

In my hometown in Germany, from where I am writing these lines, the lockdown following the outbreak of the COVID-19 pandemic has been relaxed slightly this week; in addition to grocery stores and pharmacies, small shops are now permitted to open again. We have not been hit really hard here in terms of food supply over the past weeks. Following the initial wave of panic buying, the supermarket shelves are now restocked, and innovations are occurring in the supply chain. Besides home delivery, a drive-in system for purchasing fruit and vegetables has been set up. You order and pay at a booth, and the guys take the pre-packed box with fresh produce from the ramp and load it into the trunk of your car. This development allows certain businesses to keep trading during this difficult time, certain jobs to be protected, and the supply of fresh produce to the population to be continued.

Nevertheless, in Germany ­– a country well known for its generous social security system ­– even before the crisis, no fewer than 1.65 million people were dependent on food banks. Many food banks in the country have temporarily stopped operating in order to protect their employees and volunteers, with the inevitable effect of depriving customers of essential food supplies.

So much for the situation in Germany. To reflect on the situation in the USA – which is in consequence of COVID-19 is experiencing job losses of 26.4 million, unprecedented since the Great Depression – would far exceed the scope of this commentary.

The potential for a new global food and nutrition crisis

COVID-19 is having its most devastating impact, however, on low-wage and migrant laborers (and their families) in low- and middle-income countries (LMICs) as a result of the lockdowns and border closures imposed to contain the spread of the virus. When these workers lose their jobs, they don’t get paid, and neither they nor their families can eat. The expected economic downturn triggered by COVID-19 will exacerbate this dire situation all around the world. It will come as no surprise that there are people already today who claim that they are more scared to die of hunger than of COVID-19. In 2019, according to the 2020 Global Report on Food Crises, 135 million people were affected by acute food insecurity, with an additional 183 million people subsisting on its fringes. These individuals are likely to slide into hunger and even starvation due to the COVID-19 outbreak this year. Moreover, according to the World Food Programme (WFP), some 300 million primary school children have been robbed of their regular, and often sole, daily nutritious meal at school due to school closures.

Although the UN Food and Agriculture Organization (FAO) expects a record wheat harvest in 2020 and reported low food commodity prices for March of this year, countries in Southeast Asia have increased trade barriers and imposed export bans on food items such as eggs (Thailand) and rice (Vietnam and Cambodia, on a temporary basis). Moreover, the lockdown has already led to rioting in the streets in some countries. There is an uncomfortable sense of reliving the 2007­–2008 food price crisis when “…weather shocks, greater demand for grain-fed livestock among a growing global middle class, biofuel development from grain crops, food stock hoarding, and globalized trade in food commodities … increased prices and dwindling grain stockpiles have caused civil strife and political instability.”

‘Nutrition in the Perfect Storm’

This quote is taken from an article entitled ‘Nutrition in the Perfect Storm’ that we published in Sight and Life Magazine in 2008, raising concerns about widespread micronutrient deficiencies during the food price crisis and the detrimental consequences of this development for nutritional status, health and wellbeing. During crises such as drought, flooding and locust plagues, poor families suffer reduced dietary diversity and forgo the consumption of relatively expensive micronutrient-rich foods such as eggs, meat, fruit and vegetables in order to fill their bellies with empty calories from starchy staples and energy-dense processed foods. The recommendations provided in our 2008 paper are still relevant for the current crisis: “… support micronutrient supplementation, fortification and food-based strategies to address micronutrient malnutrition among vulnerable population groups…” to mitigate the development of “a potential ‘lost generation’ of unhealthy children, and irreversible economic loss.”

The food price crisis of 2007–2008 was a contributory factor in the Arab Spring in the early 2010s – a protest movement across North Africa and the Middle East that in many cases triggered violent crackdowns whose long-term consequences are still being felt around the world today. With its power to destroy lives and livelihoods, COVID-19 has the potential not just to damage the health and wellbeing of populations but to trigger civil unrest, violence, new wars and increased tides of migration unless it is tackled effectively not only in the wealthy West but particularly in LMICs. Its effects are insidious and its ramifications far-reaching.

In this context, it is also worrying that the COVID-19 pandemic has led to the deferral of measles immunization campaigns even in countries that are experiencing a measles outbreak. This will likely be compounded by the UN recommendation to suspend planned mass vitamin A supplementation for children under 5. It is questionable how well alternative distribution routes will work as suggested. The re-emergence of vitamin A deficiency-related blindness and mortality in children will be the grim consequences. Granaries may be full for the moment at least, but the expected supply chain disruptions caused by the COVID-19 pandemic will probably cause more severe malnutrition than was witnessed in the aftermath of the 2007–2008 crisis. Sight and Life has responded to the COVID-19 pandemic by coordinating demand for food, with a supply of fortified food and supplements to a number of grassroots NGOs in India, Rwanda and South Africa and with a GoFundMe crowdfunding page to raise additional resources.

The compounding effect of climate change

The COVID-19 pandemic would seem to overshadow previous global priorities. This week’s 50th Earth Day, with its theme of climate action, has reminded me of a silent disaster that has the potential to compound the present situation. Rising levels of carbon dioxide in the atmosphere not only heat up the globe, creating drought and other weather shocks, but also reduce the concentrations of essential micronutrients in major food crops such as rice, wheat, maize, pluses and potatoes, potentially compromising the nutritional intake and consequent health of future generations.  In the wake of the 2019 EAT-Lancet Report on Food, Planet and Health, Greg Garret and colleagues raised an intriguing concept: Can Food Fortification Help Tackle Climate Change? Data to support this notion is still limited, but given the massive contribution of food (and micronutrient) production to greenhouse gas (GHG) emissions, along with the fact that food and micronutrient production will need to increase in order to meet the needs of 10 billion people by 2050, this question certainly deserves further exploration. Relevant approaches involve analyzing agricultural and food value chains, assessing losses during food production, and identifying entry points to improve food quality and safety, including biofortification and post-harvest fortification.

Interest in climate-smart innovations is rising rapidly among the young entrepreneurs. At Sight and Life, we nurture and encourage such enthusiastic and passionate young professionals through the Elevator Pitch Contest by Sight and Life (EPC). Our most recent  EPC attracted entries from 45 countries and three times more applications than previous contests.

The time to act was yesterday

The time to act to mitigate the consequences that the combination of COVID-19 and climate change will have on nutrition was yesterday. Many countries around the world have policies in place for micronutrient supplementation and food fortification, but in many cases these are not well implemented or effectively enforced. A considerable increase of effort is required, despite the pressing challenges of COVID-19. This will be more than a stop-gap solution: it will also be an investment for the long-term future of individuals, societies, and economies as a whole – even, I have no doubt, of the global economy itself. For all we know, adequate micronutrient intakes as part of nutritious and safe diets can only increase population resilience in the face of crises – present and future.

COVID-19, climate change and malnutrition have converged to create an unprecedented challenge for the global nutrition community. The dangers for millions of people around the world are imminent and very real. More than ever before, the knowledge, insight and commitment of nutrition professionals are in demand. In crisis, however bleak, there is always a sliver of opportunity. We may be obliged to distance ourselves physically at this challenging time, but we stand united as never before in our passion to end malnutrition in all its forms.

Our nutrition community has successfully engaged with other disciplines and sectors in the past decade, turning exciting new scientific insights into policies and programs that have the potential to deliver better nutrition for everyone on the planet. Now, as we face a universal enemy in the form of COVID-19, is the time for us to truly act as one to combat its effects.

The Role of Nutrition in the Immune System

Should we pay more attention? Part I of II

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As the coronavirus (COVID-19) is spreading rapidly across the globe, it is important to take note of the approaches that can help prevent and fight infections, particularly viral infections. Evidence already suggests that viral infections are one of the world’s greatest public health challenges (WHO, 2020). The World Health Organization (WHO) estimates seasonal influenza results in 3-5 million cases annually. Today we understand hygiene and social distancing play a key role in protecting yourself and others from contracting a virus while also slowing the spread of infections. Here are a few simple ways to reduce your risk to infections:

– Wash your hands regularly for 20 seconds with soap and water or alcohol-based hand rub.
– Cover your nose and mouth when you sneeze or cough with a disposable tissue or flexed elbow.
– Avoid close contact with people who are sick.
– Stay at home and self-isolate from others if you feel unwell.

Incorporating nutrition

Good nutrition is fundamental to improving immunity. The immune system is the body’s defense against disease and infection and it has long been established that several factors influence the function of the immune system including stress, sleep and nutrition (Song et al, 2019; Patel et al 2012 and Gombart et al 2020). The WHO guidance on diet, especially during the current pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back” (WHO, 2020). Providing a diet high in nutritious foods rich in vitamins and minerals supports optimal function of the immune system by providing antioxidants to slow damage of cells caused by free radicals (Lobo 2010) or assisting in T-cell production (Cohen 2017). 

Although, presently, we do not have data concerning nutritional factors in relation to the risk and severity of viral diseases such as COVID-19 the role of nutrition in immunity has been well established. For example, a study on the role of vitamin A in the treatment of measles in children found a reduced risk of mortality and pneumonia when vitamin A was administered over two days (D’Souza and D’Souza, 2002). The European Journal of Clinical Nutrition concluded that “Without adequate nutrition, the immune system is clearly deprived of the components needed to generate an effective immune response” (Marcos et al, 2003). Good nutrition is thus important in supporting an optimum immune system which can reduce the risk of viral infections (Beck and Levander, 2000).

It is now recognized that the complex, integrated immune system requires several micronutrients that have essential, often synergistic roles at every phase of the immune response (Gombart et al, 2020). In fact, even marginal deficiencies in certain nutrients have been shown to impair the immune system (Gombart et al, 2020). Micronutrients are believed to work collectively to support an optimum immune system. Based on a variety of systematic and clinical data, vitamins AB6, B12C, D, E, folate, zinc, iron, copper, and selenium (read our Vitamin and Mineral: a brief guide) are particularly important to boosting immune response.

The chart below identifies the role of these vitamins in immunity and shares recommended amounts and sources in the diet. In a forthcoming post, we will highlight the important minerals supporting the immune system and the work Sight and Life has achieved over the past 30 years to ensure access to vital nutrients, especially for children and women of childbearing age.

*Current advice on supplementation concludes that consuming a balanced diet provides all the necessary nutrition required but where there are challenges in meeting dietary recommendations, supplements are a useful addition in helping meet our nutritional needs (EUFIC, 2020).

*Please note these are approximate values and can vary based on recommended reference values employed.

Interested in learning more, read Part II HERE.

References

Beck,MA and Levander, OA (2000) Host Nutritional Status and Its Effect on a Viral Pathogen The Journal of Infectious Diseases, Volume 182, Issue Supplement_1, Pages S93–S96 [Online] Available at: https://academic.oup.com/jid/article/182/Supplement_1/S93/2191642) (Accessed on 1st April 2020)

Cohen S, Danzaki K, MacIver NJ. Nutritional effects on T-cell immunometabolism. Eur J Immunol. 2017;47(2):225–235. doi:10.1002/eji.201646423

Charan, J; Goyal JP; Saxena, D and Yadav, P (2012) Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother.3(4): 300–303. [Online] Available at:http://www.jpharmacol.com/article.asp?issn=0976-500X;year=2012;volume=3;issue=4;spage=300;epage=303;aulast=Charan (Accessed on 30th March 2020)

D’Souza RM and D’Souza R(2002). Vitamin A for treating measles in children. Cochrane Database Syst Rev.(1) [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/11869601 (Accessed on 8th April 2020)

EUFIC (2020) Food and coronavirus (COVID-19): what you need to know [Online] Available at: https://www.eufic.org/en/page/food-and-coronavirus-covid-19-what-you-need-to-know (Accessed on 2nd April 2020)

Gombart AFPierre A and Maggini S (2020). A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients, Vol 12 (1) [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/31963293. (Accessed on 29th March 2020)

Gysin DV, Dao D, Gysin CM, Lytvyn L, Loeb M (2016). Effect of vitamin D3 supplementation on respiratory tract infections in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. PloS one.11(9).[Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025082/ (Accessed on 1st April 2020)

Hemilä H, Louhiala P (2013). Vitamin C for preventing and treating pneumonia. Cochrane database of systematic reviews (Issue 8) [Online] Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005532.pub3/abstract (Accessed 2nd April 2020)

Song, H  Fall,K; Fang,F; Erlendsdóttir,H; Lu, D; Mataix-Cols, D; Fernández de la Cruz, L;  D’Onofrio; BM; Gottfreðsson,M; Almqvist, C; Unnur A Valdimarsdóttir (2019) Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study. BMJ 367: l5784 [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812608/ (Accessed of 7th April 2020)

Charan, J; Goyal JP; Saxena, D and Yadav, P (2012) Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother.3(4): 300–303. [Online] Available at:http://www.jpharmacol.com/article.asp?issn=0976-500X;year=2012;volume=3;issue=4;spage=300;epage=303;aulast=Charan  (Accessed on 30th March 2020)

Lee, GY and Nim Han, S (2018) The role of Vitamin E in Immunity. Nutrients 10(11): 1614 [Online] Available at :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266234/ (Accessed on 2nd April 2020)

Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: Impact on human health. Pharmacogn Rev. 2010;4(8):118–126. doi:10.4103/0973-7847.70902

Marcos, A., Nova, E. & Montero, A (2003). Changes in the immune system are conditioned by nutrition. Eur J Clinical Nutrition 57, S66–S69 [Online] Available at: https://www.nature.com/articles/1601819 (Accessed on 7th April 2020)

Meydani SN1, Han SN, Wu D. Vitamin E and immune response in the aged: molecular mechanisms and clinical implications. Immunol Rev.205pp:269-84.[Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/15882360 (Accessed on 8th April 2020)

Mikkelsen K., Apostolopoulos V. (2019) Vitamin B12, Folic Acid, and the Immune System. In: Mahmoudi M., Rezaei N. (eds) Nutrition and Immunity. Springer, Cham

Moriguchi S and Muraga M (2000) Vitamin E and immunity. Vitam Horm.(Vol 59) pp:305-36 [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/10714244  (Accessed on 1st April 2020)

Patel SRMalhotra AGao XHu FBNeuman MIFawzi WW (2012) A prospective study of sleep duration and pneumonia risk in women. Sleep1;35(1):97-101 [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/22215923(Accessed on 8th April 2020)

Rall LC  and Meydani SN (1993) Vitamin B6 and immune competence. Nutr Rev. Vol 51(8):217-25 [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/8302491 (Accessed on 2nd April 2020)

Tamure; J; Kubota,K; Murakami H; Sawamura, M; Matsushima T; T;Tamura, Saitoh, T; Kurabayshi, H and Naruse, T(1999)  Immunomodulation by vitamin B12: augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment Clin Exp Immunol Vol 116(1): 28–32.[Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905232/ (Accessed on 13th April 2020)

WHO (2020) Food and Nutrition tips during self-quarantine [Online] Available at: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance/food-and-nutrition-tips-during-self-quarantine  (Accessed on 2nd April 2019)

World Health Organization (2020) WHO launches new global influenza strategy [Online] Available at: https://www.who.int/news-room/detail/11-03-2019-who-launches-new-global-influenza-strategy (Accessed on April 7th2020)

WHO (1998) Vitamin and mineral requirements in human nutrition Second edition. https://apps.who.int/iris/bitstream/handle/10665/42716/9241546123.pdf?ua=1

Zhiyi Huang;Yu Liu;Guangying Qi; David Brand and Song Guo Zheng (2018) Role of Vitamin A in the Immune System. J Clin Med  7(9): 258. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162863/(Accessed on 28th March 2020)

Zhou, Jian MD*; Du, Juan MD*; Huang, Leting MD; Wang, Youcheng MD; Shi, Yimei MD; Lin, Hailong MD(2018) Preventive Effects of Vitamin D on Seasonal Influenza A in Infants – A Multicenter, Randomized, Open, Controlled Clinical Trial The Pediatric Infectious Disease Journal Vol 37 (8) pp 749-754 [Online] https://journals.lww.com/pidj/fulltext/2018/08000/Preventive_Effects_of_Vitamin_D_on_Seasonal.5.aspx (Accessed on 2nd April 2011)

Spotlight: Gratitude to frontline workers at the time of coronavirus

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At nearly six months pregnant, Vidyarani learned that her neighborhood anganwadi center was closing due to the coronavirus (COVID-19) control measures. She depends on the anganwadi for a daily hot cooked meal to feed herself and her two-year-old daughter. Adding to her growing concerns, the lockdown caused her husband to lose his job. 

Anganwadis, or courtyard shelters, are primary childcare centers providing basic health care activities and nutritious meals for families while also serving as a pre-school for young children. Across all states in India, anganwadis serve either hot cooked meals or provide monthly rations that can be cooked at home. The Telangana state government, for instance, serves approximately half a million hot cooked nutritious meals daily to pregnant and lactating women through the anganwadis. As a part of this program, all beneficiaries also receive one egg every day. Here at Sight and Life, we know the importance of including eggs in a diet.

As COVID-19 quickly spreads around the globe, India has enforced a nation-wide lockdown to contain the disease creating unprecedented challenges for people like Vidyarani and their families. In addition to the closure of primary schools and anganwadi centers, children in rural India are now not attending school and therefore have to do without their guaranteed school meal, potentially worsening an already “severe” malnutrition problem in India. Even though the government has ordered state authorities to ensure provision of take-home rations and cash allowance during the lockdown, efforts to tackle acute malnutrition could still take a hit. It is in times like these that India’s frontline workers are making sure that no one in their communities goes hungry. Many anganwadi teachers are going door-to-door to deliver their weekly rations of rice, lentils, oil and eggs to beneficiaries.

COVID-19 Essentials Delivery

In this photo, tweeted by the Women and Child Development Ministry of Telangana, an anganwadi teacher delivers take-home rations including eggs to the homes of lactating mothers in the tribal region of Mulugu district via her scooter. Women like Vidyarani and their families are grateful for these workers delivering essential food items.