Глобальный форум по продовольственной безопасности и питанию (Форум FSN)

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    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      This V0 draft synthetizes properly the present situation of inequalities for food security and nutrition in the World.

      As regards the guide to the e-consultation on the V0 draft,  the issue # 7 (Are there any other issues concerning…) there is, in my opinion,  an aspect that merits further consideration. I e  Inequalities in FSN and Food Systems when related to the double (under and overnutrition) burden of malnutrition in impoverished populations of high and middle income countries. Due to the growing prevalence of obesity, in comparison to steady status of underweight,  the overweight has  an important relationship with  (up)biased  food systems. Therefore it is important to consider the consequences of obesity in view of the risk on: Cardiometabolic disease (1), Colorectal cancer (2), Vascular diseases (3), Type 2 diabetes (4 ), Hyperuricemia (5), Cognitive impairment and dementia (6), this is particularly important due to brain damage already present and its image evaluated in adolescence (7, 8). Apart from these initially subtle clinical conditions, there are two social conditions that require a wider approach for controlling them; The first is the obesity trends and socioeconomic status (9, 10) and the second is the disparity on life expectancy when the Body Mass Index increases (11).

      Probably these nutritional deviations are of greater importance and of greater extent in the whole world  after their  upward trends even in low income countries

      References

      1. Cheng HL, Garden FI, Skilton MR et al. Impact of growth , gonadal hormones, adiposity and the sodium to potassium ratio on longitudinal adolescent measures of blood pressure at puberty. J Hum Hypertens 2022 Nov 14, doi: 10.1038/s41371-022-00774-x
      2. Chen X, Li H, Mandik M et al. Assessment of Body Mass Index, Polygenic Risk Score and Development of Colorectal Cancer. JAMA Network Open 2022; 5(12): e2248447. Doi: 10.1001/jamanetworkopen.2022.48447
      3. Xie W, Wang Y, Xiao S et al. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ 2022;378: e070244. Doi: 10.1136/bmj-2022-070244
      4. Jiang C, Cifu AS, Sam S. Obesity and Weight Management for Prevention and Treatment of Type 2 Diabetes. JAMA 2022 July 26; 328(4): 389-390. Doi: 10.1001/jama.2022.10338
      5. Qian YI, Kong YW, Wan NJ et al. Associations between body mass index in different childhood age periods and hyperuricemia in young adulthood: the China Health and Nutrition Survey cohort study. World J Pediatrics 2022; 18: 680-686. Doi: 10.1007/s12519-022-00573-x
      6. Guo J, Wang J, Dove A et al. Body Mass Index Trajectories Preceding Incident  Mild Cognitive Impairment and Dementia, JAMA Psychiatry 2022 Oct 26. Doi: 10.1001/jamapsychiatry .2022.3446
      1. Casey BJ, Cannonier T, Conley MI et al The Adolescent Brain Cognitive Development (ABCD) study: Imaging  acquisition across 21 sites. Developmental Cognitive Neuroscience 2018; 32: 13-34- www. Elsevier.com/locate/dcn
      2. Lisdahl KM, Sher KJ, Conway KP et al. Adolescent brain cognitive development (ABCD) : Overview of substance use assessment methods. Developmental Cognitive Neuroscience 2018; 32: 80-96. Doi: 10.1016/j.dcn.2018.02.007
      3. Goto R, Nianogo R, Okubo Y et al. Evaluation of Obesity Trends Among US Adolescents by Socioeconomic Status. 1999-2018. JAMA Pediatrics 2022; 176(9): 937-940. Doi: 10.1001/jamapediatrics.20221838
      4. Aris IM, Perng W, Dabelea D et al Associations of Neighborhood Opportunity and Social Vulnerability with Trajectories of Childhood Body Mass Index and Obesity Among US Children. JAMA Network Open 2022: 5(12): e2247957. Doi: 10.1001/jamanetworkopen.2022.47957
      5. Dwyer-Lindgren L and the GBD US Health Disparities Collaborators. Life expectancy by county, race, and ethnicity in the USA, 2000-2019: a systematic analysis of health disparities, Lancet 2022; 400(10345); 25-38. Doi: 10.1016/S0140-6736(22)00876-S

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      FSN FORUM. Reducing inequalities for food security and nutrition ( U 15 04 22)

      Taking into account the CFS workstream on inequalities on food security and nutrition, the present contribution will focus on the following points, linked to my medical nutrition background:

      1. Despite well-established food supply chains in HIC, food insecurity does exist, especially in urban low socioeconomic areas with demonstrated  negative nutritional issues, being the most  relevant overweight an obesity (Report A. iii)
      2. Solving food insecurity does not require only the necessary  adequate physical and finance resources, for ensuring success  equally requires education. This  point should be evaluated under two circumstances, a) the greater required time and b) the setting up of an action for early prevention starting in  pediatric ages ( Report 1. B. ii). Concerning nutritional education, last stage for food security,  it is advisable to change the  classical concept of nutrient diets  for this of food diets, considerably easier to apply (Report C.). Supporting agroecological practices at small scale agriculture (Report Introduction, penultimate para) it will be helpful because implies also education.
      3. References (If required more specific references can be supplied):
      • Warnick J, Cardel M, Jones L, Gonzalez-Louis R, Janicke D. Impact of mothers' distress and emotional eating  on calories served to themselves and their young children: an experimental study. Pediatric Obesity 2022 Jan 05. doi: 10.1111/ijpo.12886                  
      • Daniels L, Taylor RW, Williams SM, Gibson RS, Fleming EA, Wheelet BJ. Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial. BMJ Open. 2018; 8: e019036.
      • Crofts SJC, Lam J, Scurrah K, Dite GS. Association of Adult Socioeconomic Status with Body Mass Index: A Within- and Between- Twin Study. Twin Res Hum Genet 2021; 24(2): 123-129;  doi: 10.1017/thg.2021.14.Epub2021Apr14
      • CDC. Age at first solid foods has no effect on childhood obesity. UPI.com. Published: 11 May 2016.
      • Tester JM, Phan TLP, Tacker JM, Leung CW, Dreyer Gillete ML, Sweeney BR, et al. Characteristics of children 2 to 5 years of age with severe obesity. Pediatrics. 2018; 141: e20173228.
      • Hilpert M, Brockmeier K, Dordel S, Koch B, Weiss V, Ferrari N. Sociocultural influence on obesity and  lifestyle in children: A study of daily activities, leisure time behavior, motor skills and weight status. Obes Facts. 2017; 10: 168-78.
      • Zou X, Wang L, Xiao L, Xu Z, Yao T, Shen M. Deciphering the Irregular Risk of Stroke Increased by Obesity Classes: A stratified Mendelian Randomization Study. Front Endocrinol (Lausasanne) 2021; 12: 750999; doi: 10.3389/fendo.2021.750999.  

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      This comment will be focused mainly on human antimicrobial resistance (AMR). This can be a small contribution to the general problem but as it has been deeply studied in clinical ground, some issues merit to be considered. Antibiotics have reduced mortality in LMIC, but their misuse has contributed to the present problem, clearly expressed in the Spread cycle appearing in the Topic introduction. Specific rules for antibiotics uses are beyond this comment.

      One of the starting points to consider is primary care for non-severe infections such as the common upper respiratory tract infections (URTIs) and acute diarrhea especially in children and youths. Only a minority of URTIs are of bacterial origin, despite this they frequently attract antibiotic prescription which can lead to a more severe and difficult to treat situation (1). Acute diarrhea is another generalized condition that frequently still receives antibiotics despite proven inefficacy (2, 3). It is important to spread the concept that acute fever rarely requires antibiotic administration. This knowledge should be enrooted both in the population and in primary care providers. Also  basic information on adequate nutrition is most likely to be the best preventive circumstance at any age but especially in the first year of life  by promoting a more generalized breast feeding, it should be taken into account that bovine lactoferrin does not prevent infections in early life (4).  As important as this is the hand-hygiene. Additionally, providing information about antibiotic use risks (allergies, hardly recovery of microbiota…) whenever possible would be helpful. Development of ‘Antimicrobial stewardship’ programs (5) by (human and veterinary) Health Departments could be the first step for improving the use of this important tool so easily  misused. 

      Answers to questions:

      1: To reach individuals

      2: Same way as antibiotics, but explaining that presently their resistance is not so widespread.

      3: -

      4: Ministry of Health and specific section/ persons dealing with health care providers (Med and Vet)

      5: Ex-aequo Simple legislation and Primary Care Delivering local organization.

      6: Ex-aequo Ministries of Health and the Regional Tripartite (FAO, OIE, WHO)

      1. Harris C, Mills R, Seager E et al. Pediatric Deaths in Tertiary Government Hospital Setting, Malawi. Paediatr Int Child Health 2019; 39(4): 240-8.
      2. Reiner RC and Local Burden of Disease Diarrhoea Collaborators. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries 2000-2017: analysis for the Global Burden of Disease Study 2017.  Lancet 2020; 395: 1779-801.
      3. Florez ID, Veroniki AA, Al-Khalifah R. et al. Comparative effectiveness and safety of Interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis. PLoS ONE Dec 5 2018, doi: 10.1371/journal.pone.0207701.
      4. Doyle L, Cheong J. Does bovine lactoferrin prevent late-onset neonatal sepsis? Lancet 2019; 393: 382-4
      5. Septimus EJ. Antimicrobial Resistance: An Antimicrobial/Diagnostic Stewardship and Infection Prevention Approach. Med Clin North Am 2018; 102(5): 819-29.

      Manuel Moya MD

      University Miguel Hernández. Campus de S. Juan. Alicante. Spain

            

       

       

      MM

      See the attachments:

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Zero Hunger and Child Hospitalization.

      When visiting the pediatric section of two teaching hospitals in the central parts of Nigeria and Sudan, I was initially upset at the sight of a child of around 7 years suffering from malaria at an advanced stage, his clear undernutrition I thought was consequent to the ill course of the main disease. As the visits were going on, again a quite relevant proportion of undernutrition appeared in acute patients suffering from limb fractures, acute respiratory infections or common surgery. Two small for gestational age newborn babies in an open cot showed also a slow growth rate

      It is clear that the clinical status of certain diseases was aggravated by underweight with the consequence of a greater recovery time greater than in normal weight children. It is well known that underweight (> -2 SD) is associated to: Unduly hospitalization, painful hospitalization (the malaria child was mostly alone) and disadvantageous long term prognosis.

      Zero Hunger policies if widespread would lead to a situation where the number of (pediatric) diseases requiring hospitalization would decrease and for a greater efficacy the earlier they are established (pregnancy) the better. Quality of food can also be beneficed through producing lysine enriched cereals in wide areas of the world.

      Manuel Moya, MD

      University Miguel Hernández. Spain  

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      General Comments

      If this publication is for FAO, then certainly it is OK, but if its target is wider (stakeholders…) then some modifications would be advisable:

      • A hierarchy for the related organizations and very similar terms (SFS followed by Program, SCP…) would improve the text comprehension.
      • Avoid redundancies mainly appearing in section 2.1 and 2.2
      • In general the content of the boxes is very clear and concise but the subsequent comments are longer than the required explanation or support.

       

      Specific Comments

      2.  (Page 4) SFS Key Concepts.

      In my opinion it is ok in all its entries including figure 1.

      The reasons (political, scientific) for CFS presence in the draft (p 9) is not clear to me, is it perhaps the ‘boss’ ?

      2.1.2 (p 12) SFS Approach

      Definition OK. Comments a little long, because of the good footnotes and references, the text could be reduced, thus gaining readability. I.e. the para ending with reference 31 is very informative and perhaps should be expanded.

      The next paragraph is to me mainly focused on LMIC, nevertheless Food insecurity affect 12.7 % of hospitalized people in US (Leung C et al. JAMA Internal Medicine 2017; doi: 10.1001/jamainternmed.2017.0239), maternal food insecurity creates a barrier for exclusive breastfeeding (Orr SK et al. CMAJ 2018; doi: 10.1503/cmaj.170880), or a more general view the problem of poor urban children (UNICEF)

      2.2 (p 16) Definitions and discussion of key concepts (in relation to SFS). If the content is added in brackets perhaps the following text can be reduced or even erased

      2.2.1. (p 17)   Sustainable diets. In the comment after the box and in the second para I would suggest to quote the Alternative for proteins (from FAO Health & Sustainability) following, or instead of seafood. This comment could be reduced by avoiding redundancies.

      2.2.2. (p 19) Sustainable Value Chain (FVC). FVC and FSFVC are mere concepts or planned actions? I’d suppress history

      2.2.2.1 (p21) Sustainable Food Value Chains Approach. This is very well designed and could include the content of 2.2.2. Explain the evaluation possibilities for Circuits courts.  Because of the similarities with SFS Approach, could it be referred to its content and decrease repetitions?

       2.2.3. (p23) Food Loss and Waste.

      Perfect, clear, very informative

      2.2.4. (p26) Resilient Production. Definition OK. Comment a little bit long.

      3 (p 29) Different Roads leading to Sustainability

      Introduction and comment very clear. My comment only on:

      3.1.4. (p36) Public health approaches.

      Check content with SFS Approach (p 13).

      4 Further definitions of relevance to SFS

      Determinants of Health (p 51). In the clinical and practical grounds is considered the A. Smith (1987) health definition: ‘Individuals are healthy insofar they can function in their context’. That has been increasing the field of health (for example type 1 diabetes perfectly controlled individuals can be acting as normal healthy subjects apart from the daily insulin administration). Then the determinants can be: Adequate and sustainable food availability, Avoidance of alcohol and unhealthy substances, Reasonable physical activity, Adequate treatment and control of chronic diseases. These determinant should be implemented along the whole vital circle.

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Food insecurity has a proved negative effect on cognitive development in children even in high-income countries. The insufficient, lack and/ or low quality of food increased the risk for lower reading, math comprehension and emotional scores present already in young children. This effect is greater according to the precocity and intensity of food insecurity.

      As the change from rural to urban grounds will probably aggravate food insecurity, every initiative taken will contribute to a latter success in life gained through better academic achievements.

      Manuel Moya

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      One main issue of Nutrition Decade is to end hunger and all forms of malnutrition, undernutrition and obesity will be mainly considered  due to the fact that micronutrient malnutrition deserves specific actions nor always feasible. Undernutrition and obesity are quite different or even antagonist situations but their origin is the same: inappropriate nutrition which enables us to deal with both in a general and individual preventive frame. In high-income countries (HIC) overweight and obesity are the predominant form, in low-and middle-income countries (LMIC) traditionally undernutrition in all its forms has been the foremost one, but presently this coexists with a steady trend in obesity , ie the ‘double burden’. Because of the long term consequences of malnutrition adequate nutrition should be a target in the first 1000 days of life that could be extended to all children under five.

      As said by the FAO Director-General (UN General Assembly, 20th September 2016, New York) the preventive action ‘start at country level’. This is a crucial point and many of the individual four preventive points that should be carried out by the primary health care provider acting directly on malnourished people are hardly impaired without this national support.

      There have been significant advances related to malnutrition in the last decades (UN Agencies) as is the pediatric undernutrition recoil (1990 30.2%; 2015 19.3%)  (1), although this not occurring with obesity. It is worth considering that if there are good preventive programs why has obesity been increasing until now and will continue up to 2030 or even 2060 (2): Probably the reasons are: Too many plans/ guidelines not all with the desirable quality and wide covering, the flow from global directions to individual level is slow moving even in HIC with integrative approaches, the difficulty of applying evidence criteria for assessing preventive effectivity. Therefore the continuous evaluation of the applied procedures is far from generalized. Labeling (Flabel in EU), fast food advertising, taxes for sugary drinks, school-lunch programs for malnutrition, epigenome-wide association study (EWAS) and so many others, still have an unknown impact on obesity reduction. In HIC the specific budget for prevention is considerably lower than that of acute care. In LMIC nothing is done apart from punctual and small actions, consequently in a few decades obesity there will be an added problem to the treatment lag of these regions. The country-driven plans are probably the top priority.

      1. Unicef, WHO, World Bank Group. Levels and trends in child malnutrition. Key findings of the 2015 edition. Unicef/jmedashboard 2015.
      2. Sabin MA, Kao KT, Juonala M, Baur LA, Wake M. Viewpoint article: Childhood Obesity-looking back over 50 years to begin to look forward. Journal of Pediatrics and Child Health S1 (2015) 82-86. Doi: 10.1111/ipc.12819.               

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Good nutrition is not evenly adequate in the world because malnutrition is increasing at the expense of overweight and obesity and although its other component undernutrition is receding it is a quanti and qualitatively reality still too important in Low- and Middle-Income Countries (LMIC). The absolute figures and trends are a matter of concern at individual, national and international level.

      Another relevant aspect is the specific prevalence of undernutrition in children under five years, a period of special health relevance according to the WHO Global Health Observatory in which infections are a real threat with a higher mortality rate especially in LMIC. The good news is that this  pediatric health problem is receding all over the world: In 1960 there were 300 million that in 2015 had gone down to 113 million (-33%), but the problem is still important especially in South Asia with 28.7 million and Sub-Saharan Africa (> 50 countries) with 51.3 million (1) These worrying figures will continue because the world population by 2050 will be of 9.1 billion, whereas the developed countries  will increase by 6%, South Asia will do by 48% and Sub-Saharan Africa by 130%. Consequently malnutrition as the present double burden that is the coexistence of underweight and overweight will go on according to the United Nations Population Division (2).

      Essential amino acids (not synthesized by humans) are not completely present in plants or crops that are important, if not the only food available for people living in certain wide areas such as Sub-Saharan Africa or South-Central Asia. Basic genetic and genetic engineering technologies initiated in the middle of the past century have evolved at a fast rate allowing the improvement of this lacking problem. This can be the solution at mid or long term but in the meantime mixes of plant foods adapted to local climate arid conditions can be a feasible solution.

      Chickpea seeds (3) or flours (4, 5) are a reasonable food resource but their low content in the essential amino acid tryptophan (Table) is a nutritional risk especially for weaned infants and underfives (6). On the other hand sorghum flour a cereal with similar nutritional capacities, has also the very low content of another essential amino acid (lysine) with well stablished consequences in neurodevelopment and growth (7.8). The mixture of both flours (~20/80 %) will provide a complete protein, the fact of small losses (9) of essential amino acids as consequence of food processing (even by microwaves) is an added advantage. Because of the pragmatic idea of this Forum digest the possibility of having both flours or preferably crops, both being resilient to dry conditions, in these vast rural areas of LMIC could help to improve nutrition in general and especially in this crucial age which affects the rest of life.          

       

      REFERENCES

      1. De Onis ; Dewey KG, Borghi E, Onyango AW, Blössner M, Daelmans B. The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions. Maternal & Child Nutrition 2013; 9(Suppl 2): 6-26.
      2. UN Department of Economics and Social Affairs. World Population Prospect: The2015 Revision www.un.org/eng/development/desa/population
      3. World healthiest food. www. whfoods.com
      4. Angulo-Bejarano PI, Verdugo-Montoya NM, Cuevas-Rodriguez EO, Milan-Carrillo J, Mora-Escobedo R, Lopez-Valenzuela JA. Tempeh flour from chickpea (Cicer arietinum) Nutritional and physicochemical properties. Food Chemistry 2008; 106: 106-12.
      5. Arab EAA, Helmy IMF, Barch GF.Nutritional evaluation and functional properties of chickpea (Cicer arietinum L) flour and the improvement of spaghetti produced from its. J Amer Science 2010; 6(10): 1055-72.
      6. Malunga LN, Bar-ElDadon S, Zinal E, Berkovich Z, Abbo S, Reifen S. The potential use of chickpeas in development of infant follow-on formula. Nutrition Journal 2014; 13(8): 1-8.
      7. Suri DJ, Tano-Debrah K, Ghosh SA. Optimization of the nutrient content and protein quality of cereal-legume blends for use as complementary foods in Ghana. Food Nutr Bull 2014; 35(2): 372-81.
      8. Moya M. Lysine genetically enriched cereals for improving nutrition in children under 5 yearsin low- and middle-income countries, J Nutr Health Food Engineer 2016 (in press).
      9. El-Adawy TA. Nutritional composition and antinutritional factors of chickpeas (Cicer arietinum L.) undergoing different cooking methods and germination. Plant Food 2002; 57: 83-97.  

      TABLE.  Essential amino acids and protein content in chickpea flour and different

      Cereal products in comparison to the complete protein pattern.

       
       

       
       
       
       
       
       

      ESSENTIAL

      COMPLETE

      CHICKPEA

      SOYBEAN

      SORGHUM

      MAIZE

      AMINO ACIDS

      PROTEIN

      FLOUR

      FLOUR

      GRAIN

      WHOLE

       

      mg/g prot

      mg/g prot

      mg/g prot

      mg/g prot

      mg/g prot

       
       
       
       
       
       

      Trp

      7

      1.1

      14

      10,2

      9

      Thr

      27

      38

      42

      31,2

      37

      Ile

      25

      47

      50

      42,1

      38

      Leu

      55

      76

      85

      140,8

      133

      Lys

      51

      60

      70

      20,2

      27

      Met + Cys

      25

      29

      28

      16,6

      41

      Phe + Tyr

      47

      91

      88

      53,3

      92

      Val

      32

      56

      53

      52,2

      46

      His

      18

      29

      28

      20,6

      27

       
       
       
       
       
       

      Prot g/100g

       

      22

      36

      10,4

      8

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear FSN Forum,

      I thank you for the extended deadline. Really it is very appropriate to approach obesity prevention in LMIC, because it is a fast growing problem particularly in growing urban areas and  before overweight grows up to the HIC rates something must be done. Once obesity has been established in children (and adults) treatment is disappointing in spite of using all the facilities given by specialized units that even include bariatric surgery. In the annexed document some new actions addressed to interrupt the  obesity circle of maternal , offspring, mature girls are approached.

      Please find in it our program for prevention of pediatric overweight and obesity in low- and middle-income countries.

      This is an easy to run and low cost program and that can indicate the basic food changes according to the country (and child population) possibilities.

      With my kindest regards

       

      Manuel Moya

      Catedrático E/ E Professor & Head

      Editor in Chief of the Newsletter. International Pediatric Asociation (IPA)

      Chair of the IPA Technical Advisory Group on Nutrition

      Board of Directors of IPA Foundation

      Academician of the Real Academia de Medicina

      Pediatric Dept. University Miguel Hernández

      Ctra Valencia s/n, 03550 S.Juan. Alicante. Spain

      See the attachments:

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      The approach from childhood of this important food type is based in the high number of under –fives all over the world especially in low- meddle-income countries (1) and because the long lasting consequences (growth and cognitive) that undernutrition can have at these ages (2, 3).

      In LMIC after the first year of life gruel/ congee is widely and almost exclusively used. These normally coming from flours from cereals which are poor in essential amino acids such as lysine and to a lesser extent tryptophan and phenylalanine. If we take into account that cooked chickpeas (protein 8.4 g/100 g) and lentils (protein 8.8 g/100 g) contain lysine respectively 485 mg/ 100 g and 613 mg/ 100 g, the combination of pulses with local and culturally rooted gruels could improve the protein quality consumed. Other pulses should not be neglected, particularly if they are local crops, but they should only be recommended if protein and essential amino acids content is acceptable. This protein improvement cannot be taken as definitive, other nutrient needs at these ages such as fat, Ca, P, Na, K, Fe and niacin should also be planned.

      As regards the fourth question ‘How could we increase their use?’ The response is planning and education. Governments should locally incentivate the crops of pulses due to their resilience in the strict rain fed lands and the elusive import of these products. Their availability in the local shops should be promoted.   Education has two main targets: famers and parents, for growing them and for using at home in a rotating way.

      HIC also require a redesign action to increase the consumption of pulses due to the fact that processed food and refined carbohydrates are taking over the traditional plant food.           

      Manuel Moya

      References

      1. Unicef, WHO, World Bank Group. Levels and trends in child malnutrition. 2015 edition. www.who.int/nutrition.
      2. Boyd A, GoldingJ, Mcleod J ent al. Cohot profile: the children of the 90s’- the index offspring of the Avon Longitudinal Study of Parents and Children. Int J Epidemiol 2013; 2: 111-27.
      3. Galler J, Bryce C, Waber DP et al. Socioeconomic Outcomes in Adult Malnourished in the First Year of Life: A 40-Year study. Pediatrics 201; 130:e1-e7                                                                                                                                       

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Ms. Demeranville,

      From the medical field, I’m afraid that there is little can be done to this important and perhaps neglected action of ‘Youth- feeding the future’. Nevertheless let me express that:

      The selection of ages 15 to 17 years is appropriate because corresponds to middle and late adolescence (17 to 18 yr.) This latter period is characterized, apart from biologic maturation, by a psychosocial development in which peer values go down in favor of individual thinking. This point is crucial because it encompasses  the steps of breaking away (family model separation), career decision and realistic planning for economic independence. All this, in the frame of changes in affection and idealism is, let me say, the most favorable scenario  for the proposed action.

      The six precise challenges (paragraph 3 of the topic note) are most appropriate, but from my own adolescence point of view, the first (Education) and the third (Finance) deserve special dedication because they would attach youths to the agriculture way of living.

      Due to possible gender discrimination, I would suggest to stress a special consideration for females.

      Yours Sincerely

       

      Manuel Moya

      Catedrático E/ E Professor & Head

      Editor in Chief of the Newsletter. International Pediatric Asociation (IPA)

      Chair of the IPA Technical Advisory Group on Nutrition

      Board of Directors of IPA Foundation

      Academician of the Real Academia de Medicina

      Pediatric Dept. University Miguel Hernández

      Ctra Valencia s/n, 03550 S.Juan. Alicante. Spain

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Ms. Fulton,

      Please find below my comment and answers to this new topic.

      General Comment:

      In my opinion the Draft (14 03 16) contains all the issues inherent to U-R transformation and it is a very good base for the forthcoming CFS 44 (2017). Having a medical background I am no prepared to answer all four questions. Only the following ones:

      Q 1 Are the key challenges…

      Yes, the changing urban-rural dynamics are well addressed. A new issue could be to demand that the processors of food to follow the high income countries’ rules. Probably some big companies have a double threshold depending of on the country’s status. Special attention should be paid to the sugary beverages and food. The problem of ‘Urbanization’ or U-R interlinkages merits special attention and care and perhaps the classical division between LM- and H-IC should include the interlinkage. Also from the beginning the concept of ‘malnutrition’ should be clear to avoid confusion with undernutrition/ underweight.

      Q 4. Where /how do you think…

      In my opinion voluntary rural organizations could contribute importantly to maintain the as yet not so contaminated  rural food patterns.

      Manuel Moya

      IPA TAG-Nutrition 

      With my kindest regards

      Manuel Moya

      Catedrático E/ E Professor & Head

      Editor in Chief of the Newsletter. International Pediatric Asociation (IPA)

      Chair of the IPA Technical Advisory Group on Nutrition

      Board of Directors of IPA Foundation

      Academician of the Real Academia de Medicina

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Sirs,

      This is just a general comment. In my opinion it is very important to introduce a formal and structured nutrition program in the agriculture curricula. Apart from the logical advantages it could avoid important biases. These occur in some medical pre-graduate medical studies: Pediatric nutrition (first year of life); Endocrinological nutrition (diabetes, obesity); Cardiovascular nutrition (hyper LDL cholesterolemia);  Gastroenterological nutrition ( intestinal malabsorption), etc. The problem is that  real bases and   guidance about correct  nutrition is missing for the moment and there seems to be no firm possibilities of including this in the medical studies.

      As only unsafe food causes 2 million people to die per year (WHO) a general approach, in this case at food production level is more than welcome.

      Manuel Moya

      Catedrático E/ E Professor & Head

      Chair of the Technical Advisory Group on Nutrition of International Pediatric Association (IPA)

      Editor in Chief of IPA Newsletter

      Board of Directors of IPA Foundation

      Vice-President of European Pediatric Association

      Academician of the Real Academia de Medicna

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Ms Basset, Dear Mr Raza,

      Below are my comments on the suggested five questions, which certainly approach the widespread problem of nutrition- sensitive issues.

      Setting the stage: Because of my position of Chair of the Technical Advisory Group on Nutrition of the International Pediatric Association (IPA) nutrition-sensitive issues are of main concern and activity. We were able to detect in LMIC the coexistence of undernutrition and increasing overweight. The last situation went unrecognized by the family and health care and we think it was related to inappropriate promotion of infant formula feeding in the first year of life and later on the dense caloric food consumption.

      Nutrition-sensitive programs: In the Sub-Saharan countries we couldn’t detect the presence of such programs in the places where the health care provider cared/ listened the child and mother. Programs are certainly in the high health offices but not at this important step.

      Nutrition sensitive aspects: Food industry with its marketing actions among other better known, are using new ways such as the  pseudoscientific information for promoting their products.

      Institutional arrangements:  We were not able to find the actors from any agency for improving Nutrition- sensitive programs whose results are clearly expressed  in the last para of  your Digest Nº 1185 of 26 August. This empty space is a target for marketing people.

      Monitoring and evaluation: Monitoring is difficult because health care providers are not enough motivated, for doing this extra work. Our impression is that Health Authorities are more concerned with acute situation, mainly infectious diseases. Evaluation is more difficult even. We tried a simple program for identifying houses with under/ overweight and giving very basic food information, our feedback was disappointing.

      In conclusion:In our opinion the situation is improving concerning underweight ( food access and sanitation) but food education and very basic nutritional principles goes clearly behind.  Education should be focused on health care providers but to the general population specially mothers. The open question is:  Who is going to plan and deliver this knowledge to this target population?

      Should you require additional information, please let me know

      With my kindest regards

      Manuel Moya

      Catedrático E/ E Professor & Head

      Chair of the Technical Advisory Group on Nutrition of International Pediatric Association (IPA)

      Editor in Chief of IPA Newsletter

      Board of Directors of IPA Foundation

      Vice-President of European Pediatric Association

      Academician of the Real Academia de Medicna

      Pediatric Dept. University Miguel Hernández

      Ctra Valencia s/n. 03550 S Juan. Alicante. Spain 

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Professor Swaminathan, Dear Dr. Dangour,

      As a doctor I have no personal stories to relate but as dealing with Undernutrition in under 5s, we are really worried about the low content of essential amino acids in common grains. Therefore I should answer your two first questions as ‘not aware’.

      In respect to the third one I must say that one of the problems using maize or sorghum (Africa) grains is the lack of Lysine in them. As there is a gene (cordapA) that increases the production of Lys and also of other amino acids already tested in maize and available from ISAAA.org, I bring to your consideration the possibility to start a pilot progam using these genetically modified grains.

      Should you require further information please contact me again.

      Yours sincerely

       

      Manuel Moya

      Catedrático E/ E Professor & Head

      Chair of the Technical Advisory Group on Nutrition of International Pediatric Association (IPA)

      Editor in Chief of IPA Newsletter

      Board of Directors of IPA Foundation

      Vice-President of European Pediatric Association

      Academician of the Real Academia de Medicna

      Pediatric Dept. University Miguel Hernández

      Ctra Valencia s/n. 03550 S Juan. Alicante. Spain

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Sir, Dear Madam,

      Here are the my comments on the revised Draft for the second International Conference on Nutrition

      General comment: The four sections, Introduction; Multiple threats; a vision; Commitment, clearly encompass the present problems related to nutrition for any specific or general audience.

      Specific comments for the development actions:

      Point 6. Over/underweights coexists in many countries and even in the same household with a growing trend. When taking into account how difficult obesity prevention has resulted in countries of high income economy, then clear nutritional information to avoid extra energetic intake should be planned and given to low income economy countries.

      Point 9. This point should maybe reworded to make it clearer.

      Point 12.c. Food and agriculture. Taking into account that cereals, grains and flour are an important nutritional base and also assuming that genetically it is possible to increase essential amino acids in these (i.e. corn), an effort should be made to increase lysine content in sorghum flour.

      Point 12 f. To limit processed foods is a primordial governmental aim in the lower income countries.

      Point 13.b.  Reshape cattle. Goat’s milk is nutritionally acceptable and goats are more resilient than cows.

      Should you require additional information, please let me know.

      Yours faithfully

      Manuel Moya

      Catedrático E Pediatría/E Professor and Head

      Chair of Technical Adviser Group on Nutrition.  International Pediatric Association(IPA)

      Chief Editor of IPA Newsletter

      International Pediatric Association Foundation, Board of Directors

      Vice President European Pediatric Association

      Academician of the Real Academia de Medicina

      Pediatric Dept. Universidad Miguel Hernández

      Campus de San Juan. Ctra Valencia s/n

      03550 S Juan. Alicante Spain 

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Sir, Dear Madam,

      Down please find my unfinished comment on the Zero Draft.

      1. Background and rationale. I would suggest reorganizing the point  that will make up the final text. The concept should come first (1,4,5,6). The definition should name the key characteristics . Next frequency (2,3) and then evaluation(7,8,9). Pont 10 in may opinion has already been considered. Finally actions (11,12,13). I’m not sure if the important 8 points included in 12 are in the appropriate place.
      2. Objective, purpose scope, alignment and audience. All the five entries are ok for me.
      3. Principles for action.

      Introduction should probably  be focused on them avoiding repetition of important concepts already mentioned. The concept of resilience should probably require a more      conventional definition so adding the different uses of this concept by organizations.

      1. Principles for action. I reviewed thoroughly the  4 first principles and read all of them.

      Question 1. Ten principles, they are adequate. In my opinion principles should carry a clear and concise message, then I’d propose to reconsider if redundancies are present and if the they are perhaps too long, For no full experienced persons with this scientific ideas and language perhaps the text is sometimes not clear enough.

      Question 4. CFS A4A document is appropriate both in vision and mission but perhaps a rewording will improve its quality.

      This afternoon I’m leaving for abroad, so I feel sorry for not completing my comments as the Zero draft merits.

      Yours faithfully    

      Manuel Moya

      Catedrático E Pediatría/E Professor and Head

      Chair of Technical Adviser Group on Nutrition.  International Pediatric Association(IPA)

      Chief Editor of IPA Newsletter

      International Pediatric Association Foundation, Board of Directors

      Vice President European Pediatric Association

      Academician of the Real Academia de Medicina

    • Manuel Moya

      International Pediatric Association. TAG on Nutrition
      Испания

      Dear Sir or Dear Madam,

      Here are my opinions and responses to the four questions. Really is to  the 3rd question where pediatric nutrition could be more related and has a scientific base. If any additional information may be of interest, please do not hesitate contacting me.

      1st Q. 

      R: The main drivers are heavily influenced by politicians' will. Education and decreasing corrupts chain's impunity can be achieved by applying the constitution directives at all administrative levels. The obstacles are the chronicity of the situation, the current level of welfare, subsidies, lack of health efficacy over the whole country and food insecurity. 

      2nd Q.

      R: The scenarios for Malawi represent quite accurately the present situation. The actions should be timed and priorized in order to gain efficacy. Perhaps the judicial branch should be the first to clean up (2nd and 4th scenarios).

      3rd Q.

      R: On behalf of the International Pediatric Association and as Chair of its Technical Advisory Group on Nutrition, I consider food security paramount and by extension the influence exerted over it by climate change. In order to improve the nutritional status of children in Malawi, the crops of sorghum grain should be preserved or even promoted. The reasonable content of protein (not in lysine) of these crops and their resilience to climate threats would justify this action. Another point that should be taken into account is to maintain or even increase the goat herds. By mixing the sorghum flour and the goat's milk (~3 L/day/animal)  the DRIs requirements for lysine will be met. If nutrition improves so do infectious diseases issues. More technical data can be provided if necessary.

      Furthermore IPA has contacts with the Malawi Pediatric Association and also with the Mzuzu University (HIRS center) so a plan for health providers education, as it is currently in place in some other countries of Sub-Saharan Africa, could be considered

      4th Q

      R:  First step: if agriculture will continue to be the main basis for economy, transparency in its management and pertinent directions should be a priority, followed by transparency in politics and Education quality and development. Once these steps are ongoing the adaptation to climate change and health improvement should become easier

      Manuel Moya

      E Professor and Head

      Chair of Technical Adviser Group on Nutrition.  International Pediatric Association(IPA)

      Chief Editor of IPA Newsletter

      International Pediatric Association Foundation, Board of Directors

      Vice President European Pediatric Association

      Academician of the Real Academia de Medicina