Presented by Delia Grace, Paula Dominguez-Salas, Silvia Alonso, Mats Lannerstad, Mishal Khan at the Workshop on One Health Colloquium: Sustainable Livestock and Disease Control—Exploring the Links to Climate Change, Improving Human Nutrition and the Refugee Crisis, London, 31 May–1 June 2016

1. The influence of livestock products (LP) on
nutrition during the first 1000 days
Delia Grace, Paula Dominguez-Salas, Silvia Alonso, Mats Lannerstad, Mishal Khan
One Health Colloquium: Sustainable livestock and disease control -
exploring the links to climate change, improving human nutrition and
the refugee crisis, London, 31 May – 1 June 2016

2. Overview
• Why livestock products (LP) and the first 1000 days?
• LP and nutrition: biology
• LP and nutrition: current importance
• Empirical evidence on LP and livestock interventions
• LP risk: foodborne disease
• LP constraints: environmental impacts
• Study conclusions
• Reflections for future research & policy agenda

3. Why livestock products and the first 1,000
days?
• Stunting - a grave and persistent problem
• First 1,000 days key to growth & cognitive
development
• Many attempts to address systemically
• Nutrition specific
• Nutrition sensitive
• Livestock products (LP)
• High potential
• High risk

4. LP and nutrition: biology
LP nutritional benefits
• Preferred, palatable
• Nutritionally dense
• Nutritionally rich: high biological
value protein, vitamins, minerals
LP nutritional risks
• Associated with excessive calorie and
excessive animal fat consumption
• Associated with non communicable
disease

5. The double burden: hunger & obesity
• 2.1 billion people are
overweight or obese
• Two thirds of obese
people live in poor
countries
• No country has had
significant decreases
in obesity in the last
33 years
Underweight females Overweight females
Ethiopia
Nigeria
South Africa

6. Interactions are complex

7. Overview
• LP and nutrition in the first 1000 days: biology
• LP and nutrition: current role
• Empirical evidence on LP
• LP risk: Foodborne disease
• LP constraints: Environmental impacts
• Conclusions

8. LP a minor part of developing country diets
0 500 1000 1500 2000 2500
Africa
Southern Asia
South east Asia
China
Europe
Food types (gram per capita per day)
Livestock
Fish
Cereals
Pulses
Tree nuts
Vegetables
Fruits
Oils
Starch roots
Sugars
Europeans eats five times as much LP as Africans

9. But LP an important source of protein in
developing country diets
0 10 20 30 40 50 60 70 80 90 100
Africa
Southern Asia
South east Asia
Protein (grams per capita per day)
Livestock
Aquatic
Pulses
cereals

10. And LP the major source of high quality
protein
0 5 10 15 20 25 30 35 40
Africa
Southern Asia
South east Asia
Protein (grams per capita per day)
Livestock
Aquatic
Pulses

11. Livestock trending up, fish slower, pulses down
0
10
20
30
40
50
60
70 1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
Protein(gramspercapitaperday)
Livestock
Aquatic
Pulses

12. Drivers of LP consumption trending up
50
55
60
65
70
75
80
85
90
95
Not extremely poor (%)
Retail price for meat in China vs GDP
Retail
price meat
GDP
0
20
40
60
80
100
0 20,000 40,000 60,000 80,000
Meatconsumptionkgper
capitaperyear
GDP in $ 2012

13. Infants 0-6 months: too much LP!
Recommended level = 0
0
5
10
15
20
25
30
35
Dairy Meat, fish,
poultry
Eggs Dairy Meat, fish,
poultry
Eggs Dairy Meat, fish,
poultry
Eggs
Sub-Saharan Africa South Asia South East Asia
Infants (%) fed LP in last 24
hours
DHS surveys

14. Infants 6-18 months: not enough LP!
Recommended level = 100%
DHS surveys
Infants (%) fed LP in last 24
hours
0
10
20
30
40
50
60
70
Dairy Meat, fish,
poultry
Eggs Dairy Meat, fish,
poultry
Eggs Dairy Meat, fish,
poultry
Eggs
Sub-Saharan Africa South Asia South East Asia

15. Overview
• LP and nutrition in the first 1000 days: biology
• LP and nutrition: current role
• Empirical evidence on LP
• LP risk: Foodborne disease
• LP constraints: Environmental impacts
• Conclusions

16. Systematic literature review
Research question: Do interventions that increase consumption of
livestock-derived foods (meat and derived products, milk and dairy
products and eggs) during the first 1000 days (children 0-2 years or
pregnant and lactating women) improve nutrition outcomes in LMIC
• Eligibility criteria for literature search
• Interventions during the first 1,000 days with LP supplementation and a
control group
• South and Southeast Asian and African countries
• Non fortified, non-mixed LP interventions

17. PRISMA Flow chart for paper selection (SR)
1679 records identified through database
after removal of duplicates
PubMed, CabDirect,
Cochrane libraries
ABSTRACT
IDENTIFICATION
SCREENING
68 abstracts identified for consideration
Double blind screening
of abstracts
(4 reviewers)
47 Full text articles obtained to assess
eligibility
37 excluded for not
meeting eligibility
criteria
PAPER
OBTENTION
INCLUSION/DATA
EXTRACTION Double data extraction
(4 reviewers)
Ongoing process

18. Narrative literature review
Research question: Do livestock interventions improve nutrition in the
first 1,000 days?
• Eligibility criteria for literature search
• Type of articles: reviews (systematic, scoping, narrative,….), including
interventions with nutrition outcomes during the first 1,000 days
• In South and Southeast Asian and African countries since 2005
• Search in PubMed and CabDirect library databases.
• 268 titles/abstracts identified in the search
• Double blind screening of titles/abstracts finalised (2 reviewers): 15
documents for assessment

19. Initial results
• Lack of experimental evidence (trials) on the
nutritional impact of LP consumption in LMIC, and
particularly during the first 1,000 days
• Some specific studies are being conducted at present
e.g. a multicentre study on meat consumption that
might provide interesting results from toddlers
• The impact on nutrition of agriculture (livestock)
interventions and the relevant impact pathways are
still poorly understood, mostly due to the lack of
evidence from specifically, well-designed projects.

20. Overview
• LP and nutrition in the first 1000 days: biology
• LP and nutrition: current role
• Empirical evidence on LP
• LP risk: Foodborne disease
• LP constraints: Environmental impacts
• Conclusions

21. Causes of foodborne disease
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Microbes Helminths Aflatoxins Other toxins
Burden in developing countries in DALYs
per year
zoonoses
non
zoonoses
Havelaar et al., 2015

22. Foodborne disease and the first 1,000 days
Havelaar et al., 2015
0
2
4
6
8
10
12
Bacteria
Parasite
Virus
Aflatoxin
Protozoa
Chemical
Healthburden(DALYSmillionperyear)
Older (>5 yrs)
Infants (<5 years)

23. LP most often implicated in FBD
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
UK
Netherlands
India
Vietnam
USA
China
Animal source food
Produce
Other
Foods causing illnesses

24. LP, safety and nutrition in the first 1,000 days
• Diarrhoea a risk factor for stunting – perhaps 10-20%?
• Ingestion of faecal material on food or in the environment may contribute to
environmental enteropathy leading to stunting
• Associations between aflatoxins and stunting
• Regulations aimed to improve food safety may decrease the availability
and accessibility of foods for infants
• Food scares decrease consumption for all

26. Overview
• LP and nutrition in the first 1000 days: biology
• LP and nutrition: current role
• Empirical evidence on LP
• LP risk: Foodborne disease
• LP constraints: Environmental impacts
• Conclusions

27. Meat higher environmental cost than
pulses; chicken lower or comparable

28. Difficulty
Job loss
More GHG
Worse
animal
welfare
Pandemics
NCD
More
intensive
Beef free
No LP
Comprehensive sustainability

29. Meeting infants needs for protein is
compatible with large reductions in LP
If infants (6-24 months) got all their protein needs from meat they would
need just 0.6% of the world’s meat production each year; if from milk
they would need 3% of the world’s production
0
10
20
30
40
50
60
70
80
90
100
Meat Milk Eggs
Worldproduction(%)
Infants need
World produces

30. ‘Goldilocks solution’

31. Conclusions
LP have an important role in nutrition but are under-evidenced – “livestock chill”
Drivers of LP consumption more powerful than drivers of LP restriction
Infants are eating too much and too little LP
FBD has a health burden equivalent to malaria, HIV/AIDs or TB: infants are worst affected
FBD harms nutrition through direct (disease) and indirect (disease control) pathways
Meat has a higher environmental cost than pulses; poultry is lower or comparable
Sustainability depends on product and scope
 When making policy for diets, first 1000 days should be privileged

32. Future research and policy agenda
• Livestock inherently complex and contradictory – assessment and interventions
require sophisticated multi-sectoral approaches that are rarely available
• People reliably consume more LP when available and affordable: reducing and
shifting consumption more challenging
• Nutrition-specific, and agriculture for nutrition interventions have successes but
limitations. Focus shifting to livestock value chains and market-driven approaches
• Women manage 1,000 day consumption but gender has yet to be harnessed as a
transformative force
• Overcoming externalities and negative perceptions can unleash the nutritional
power of livestock products
• Many studies but little evidence: need to invest in high quality research to answer
important questions
• Ask the audience?

33. This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence.
better lives through livestock
ilri.org