Presentation by Silvia Alonso, Mats Lannerstad, Paula Dominguez-Salas and Delia Grace at the Agriculture Nutrition and Health Academy Week, Accra, Ghana, 26 June 2018.
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The influence of livestock-derived foods on nutrition in the first 1,000 days of life: Research report launch
1. Research report launch
The influence of livestock-derived foods on nutrition
in the first 1,000 days of life
Silvia Alonso, Mats Lannerstad, Paula Dominguez-Salas and Delia Grace
Agriculture, Nutrition and Health Academy Week
Accra, Ghana
26 June 2018
2. Session Outline
2
Dr Mats Lannerstad Report co-author
Researcher on Sustainable Agriculture and Food Systems, Sweden
Dr Silvia Alonso Report co-author
Scientist, Epidemiologist, ILRI
Dr Namukolo Covic
Research Coordinator in the Poverty, Health and Nutrition Division
International Food Policy Research Institute (IFPRI), Ethiopia
Dr Julia de Bruyn
Researcher and lecturer in nutrition
Natural Resources Institute (NRI), UK
Dr Iain Wright
Deputy Director General - Research
International Livestock Research Institute (ILRI), Kenya
Facilitator:
Report presentation:
Panel discussion:
4. Report research questions
• What impacts do livestock-derived
foods (LDF) have on nutrition?
• How do livestock interventions and
production contribute to nutrition
outcomes?
• What are the health and environment
side effects and risks of consuming
livestock-derived foods?
5. 1669 records identified
(w/o duplicates)
• PubMed, CabDirect, Cochrane
• Double screening
• Double data extraction
13 papers selected
Does an effect of LDF on nutrition exist?
6. Findings - LDF for nutrition
Research evidence
• Few articles; fewer studies (meat, milk)
• Only 3 studies first 1,000 days
• Variable (mostly low) quality
7. Findings - LDF for nutrition
Research evidence
• Few articles; fewer studies (meat, milk)
• Only 3 studies first 1,000 days
• Variable (mostly low) quality
Effects on nutrition
• Milk for linear growth and MUAC
• Meat better than milk for cognitive development
• Higher effect on malnourished
• Effect on micronutrient status: Inconsistent results
8. What can we comfortably say?
More research needed…
of higher quality
Rather positive findings…
enough evidence?
9. Report research questions
• What impacts do livestock-derived
foods (LDF) have on nutrition?
• How do livestock interventions and
production contribute to nutrition
outcomes?
• What are the health and environment
side effects and risks of consuming
livestock-derived foods?
10. Livestock interventions and nutrition
Can livestock interventions (i.e. increasing
productivity, animal transfer…) impact on
nutrition outcomes in first 1,000 days?
Does an evidence base exist to promote livestock
interventions to improve nutrition outcomes?
11. Animals
owned
Land
allocatio
n to feed
-
+
Traction,
nutrient
cycling
-
+
Food
crop
producti
on
+
Animal
and
+ product
sales
+
Food
crop
sales
+
Animal
producti
on
+
+
Labour
allocated to
livestock
+
Food
crop
+
purchases
+
+
Probability
of zoonotic
disease
Health
inputs
+
+
Water
transpo
rt
HH
inco
meChronic
disease risk
+ +
HH LDF
Consump-
tion
+
Environmental
toxin
concentratio
n
Food-
borne
diseases
+
ASF
purcha
ses
+
+
(Female)
caregiver
income
+
Nutrient
interactio
ns-
+ + - - -
- +
+ HH crop
consumpt
ion+ (Child)
dietary
intake
+
+
+ +
+ Cognitive
performan
ce+
Total
labour
demand
s
-
AIDS
complicati
ons
Level of
care/fee
ding
behaviou
r
-
Wage labour
by
(female)
caregiver
-+ +
Hired
labour -
Labour demands on
+ (female) caregiver
Nutritional
(growth)
status
Health
status
Complex pathways
12. Findings – Interventions and nutrition
MAY
CAN
DO
Improve availability of LDF
Increase incomes
Impact malnutrition determinants
Improve diets
Micronutrient intake
Influence nutrition status
13. Greater impact if coupled other interventions
• Women
• WASH/education
Provide enabling environments
• Maximize impact of nutrition-specific interventions
15. Take home messages
1. Let’s keep working!
2. Embrace complexity
3. When is “enough evidence” enough?
16. Panel discussion
16
Dr Namukolo Covic
Senior Research Coordinator in the Poverty, Health and Nutrition Division
International Food Policy Research Institute (IFPRI), Ethiopia
Dr Julia de Bruyn
Researcher and lecturer in nutrition
Natural Resources Institute (NRI), UK
Dr Iain Wright
Deputy Director General - Research
International Livestock Research Institute (ILRI), Kenya
17. Panel discussion
17
1. How relevant is this report and its findings to your field of
expertise, and why?
Dr Namukolo Covic
Research Coordinator in the Poverty, Health and Nutrition Division
International Food Policy Research Institute (IFPRI), Ethiopia
Dr Julia de Bruyn
Researcher and lecturer in nutrition
Natural Resources Institute (NRI), UK
Dr Iain Wright
Deputy Director General - Research
International Livestock Research Institute (ILRI), Kenya
18. Panel discussion
18
2. In your opinion, or based on the report findings, how
securely can we say that pregnant and lactating women
and children under 2 in low- and middle-income countries
NEED LDF in their diets?
Dr Namukolo Covic
Research Coordinator in the Poverty, Health and Nutrition Division
International Food Policy Research Institute (IFPRI), Ethiopia
Dr Julia de Bruyn
Researcher and lecturer in nutrition
Natural Resources Institute (NRI), UK
Dr Iain Wright
Deputy Director General - Research
International Livestock Research Institute (ILRI), Kenya
19. Panel discussion
19
3. If we were to promote increased consumption of LDF
among vulnerable groups in low- and middle-income
countries, how can this be motivated without getting
trapped in heated environmental debates?
Dr Namukolo Covic
Research Coordinator in the Poverty, Health and Nutrition Division
International Food Policy Research Institute (IFPRI), Ethiopia
Dr Julia de Bruyn
Researcher and lecturer in nutrition
Natural Resources Institute (NRI), UK
Dr Iain Wright
Deputy Director General - Research
International Livestock Research Institute (ILRI), Kenya
20. Chatham House | The Royal Institute of International Affairs
Thank you!
Flyers and policy briefs available!
21. This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence.
better lives through livestock
ilri.org
Notas del editor
I will start by telling you what’s the rationale behind having spent 2 years (if not more) working on this topic. This report was commissioned to ILRI by the Centre of Global Health Security at Chatham House (CH a think tank, based in London, an independent policy institute that engages governments, the private sector, academia and civil society in open debate and private discussions about the most significant developments in international affairs).
The centre on global health security had long been concerned about findings approaches to encouraging healthy and environmentally sustainable diets. During the work, those discussions identified a key gap in this area: understanding the impact of the environmental sustainability agenda (that promoted vegetable based diets globally) on vulnerable populations such as pregnant and breastfeeding mothers and children, especially in low to middle income settings. Funded by BMGF and 2 CGIAR programs, this research work aimed to fill this key research gap.
We have explored the influence of livestock derived foods on nutrition during the first 1,000 days of life, with three fundamental questions on the topic in mind.
We have explored the influence of livestock derived foods on nutrition during the first 1,000 days of life. The report explores the existing research on livestock derived foods on pregnant and breastfeeding mothers and children. We have also endeavoured to suggest how this research can be translated into evidence based policy decisions. We have some policy briefs which provides a quick summary of the report and flyers on which you can find the link to the full report so please do help yourself to those.
I have been given 10 minutes to take you through some of the main findings, conclusions and, mostly, open questions. Clearly the aim it is not to show you all its content, but to bring out some of the findings that may be more relevant to our work.
We were set to answer the following question:
‘Do interventions that increase consumption of LDFs among children 0–2y and/or pregnant/lactating women improve nutrition outcomes during the first 1,000 days in southern and southeastern Asian and African countries?’
As scientists, epidemiologist, etc we wanted the best evidence… randomized control trials that can tell about the isolated effect of supplementing diets with LDF. WE conducted a SLR, reviewed almost 2000 abstracts and kept 13 papers… so a bit disappointing…
Few articles, fewer research studies (mostly in milk and meat; only one on eggs, none on poultry meat), diversity in terms of product, administration, location,…
Only 3 covered the first 1000 days
Quality:
Sample sizes, no power calculations
Incomplete or suboptimal reporting
No controlling for multiple comparisons
Prone to bias
Some consistency towards:
Positive role of milk in linear growth and MUAC (not in all) => supported with results from other countries (meta-analysis by de Beer 2011)
Cognitive skills more promoted by meat than by milk
Limited role of egg => New evidence on eggs to be incorporated (Iannotti, 2017)
Lactating women=> milk output, length of breastfeeding???
Not consistency in:
Micronutrient results
Few articles, fewer research studies (mostly in milk and meat; only one on eggs, none on poultry meat), diversity in terms of product, administration, location,…
Only 3 covered the first 1000 days
Quality:
Sample sizes, no power calculations
Incomplete or suboptimal reporting
No controlling for multiple comparisons
Prone to bias
Some consistency towards:
Positive role of milk in linear growth and MUAC (not in all) => supported with results from other countries (meta-analysis by de Beer 2011)
Cognitive skills more promoted by meat than by milk
Limited role of egg => New evidence on eggs to be incorporated (Iannotti, 2017)
Lactating women=> milk output, length of breastfeeding???
Not consistency in:
Micronutrient results
Given the high nutritional profile of LDF (so promising for nutrition) – surprisingly low number of studies available.
Reasons: costly studies, the role was perhaps never questioned, new public health policies demand evidence-based recommendations
Effects of maternal consumption in pregnancy? And in younger infants/lactating women? Effects in sub-groups?
Dose-response effects of LDF intake
We have explored the influence of livestock derived foods on nutrition during the first 1,000 days of life. The report explores the existing research on livestock derived foods on pregnant and breastfeeding mothers and children. We have also endeavoured to suggest how this research can be translated into evidence based policy decisions. We have some policy briefs which provides a quick summary of the report and flyers on which you can find the link to the full report so please do help yourself to those.
(enabling environment to maximise impact of nutrition specific interventions)
Livestock interventions with wider scope (addressing different types of capital: human, natural,…) best placed to impact nutrition
address factors that contribute to malnutrition (enabling environment to maximise impact of nutrition specific interventions)
Limited, weak
very few impact assessments conducted
Poultry and dairy cows
Limited scope (increased animal productivity)
Limited population (farming HH)
Nutrition outcomes, NO NUTRITION STATUS
Weak:
sub-optimal designs (causality / magnitude effect)
Complexity:
hard to “isolate” effects
Most evidence RURAL/farming households
Upcoming evidence on role of value chains to improve nutrition (URBAN/PERI-URBAN households)
Bad news: limited, weak
Good news: Increasing and improving
Rural vs urban households
Unanswered questions:
Impact on nutrition status (rarely measured)
1,000 days unknown
Multiple pathways (not understood)
I want to leave you with some final thoughts/take home messages:
Let’s keep working – we need more interest on the topic, more and better research
Embrace complexity - Work out mechanisms that embrace the complexity and are able to deal with such complexity, to start generating the evidence. I think we asking the right question. Are we using the right methods to answer it? Do we need RCTs? Can RCTs answer the question?
When is “enough evidence” enough? – How much evidence do we need to take action? When can we say access to LDF in first 1,000 days must be (or must not be) a right!? Hopefully our panelist will give us some ideas towards this last question
Thank you for joining us this afternoon. We understand that this is a very complicated issue and there is much work to be done to continue to take this agenda forward.
Chatham House started this process, and we are extremely happy to have played a role in developing this report. We will be continuing to work in a collaborative space with ILRI to push this agenda forward in the near future, ensuring new and developing policies in this field are framed with a One Health lens. We are aware that in any work to translate evidence into policy, context is key and any work driven forward needs to be mindful of local customs and culture, the Centre on Global Health security are therefore keen to work with national governments to ensure national nutrition policies are aligned with the local agriculture and livestock industries.
If you would like to know more about the work we engage in then please feel free to come and talk to myself or Nadeem for more information. Please also remember to pick up the policy briefs and flyers located at the back of this room where you will find guidance on how to locate and read the full report.
This report is also being launched in parallel at the Global Agenda for Sustainable livestock conference in Mongolia this week and also at the Agriculture For Nutrition and Health week in Ghana next week.
Thank you again for joining us this afternoon and I hope you enjoy the rest of the conference.