The influence of livestock-derived foods on nutrition in the first 1,000 days of life: Research report launch
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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
- 14. New value chains due to rural to urban transformation
- 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
Editor's Notes
- 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.