Complementary Food Supplements Fill Energy and Protein Gaps among Children with Dietary Inadequacy in a Complementary Feeding Trial in Rural Bangladesh.

Background: Few studies have evaluated the dietary impact of complementary food supplements (CFSs) designed to deliver macro- and micronutrients to children at risk for undernutrition. In a randomized controlled trial in rural Bangladesh, we previously reported that CFSs increased children's micronutrient adequacy.

Objectives: To longitudinally characterize energy and macronutrient intakes and inadequacies and evaluate the extent to which CFSs fill intake gaps.

The cost-effectiveness of a cash-based transfer, specialised nutritious food, and social and behaviour change communication intervention package to prevent undernutrition among children 6-23 months in Pakistan: A cluster randomised controlled trial.

Background: There is mixed evidence on the cost-effectiveness of cash transfers, along with food supplements and behaviour change communication interventions in improving child nutrition outcomes. To add to existing literature, we examined the cost-effectiveness of medium-quantity lipid-based nutrient supplement (LNS) and social and behaviour change communication (SBCC) messaging, separately and combined, compared to an existing unconditional cash transfers (UCT) programme in children 6-23 months of age in the district Rahim Yar Khan, Pakistan.

Methods: This was a four-arm, community-based cluster randomised controlled trial.

Delivery platforms for reaching adolescents with nutrition interventions in low- and middle-income countries.

Adolescents in low- and middle-income countries (LMICs) are a vulnerable population given increased nutritional needs as puberty approaches. School-based nutrition programs exist in some settings, but the comprehensive provision of nutrition services requires knowledge of the mechanisms to reach out-of-school adolescents. A comprehensive scoping review was performed using formal and informal search strategies to landscape all potential delivery platforms with nutrition services to reach adolescents.

Measuring food access using least-cost diets: Results for global monitoring and targeting of interventions to improve food security, nutrition and health.

Benchmark diets using the most affordable locally available items to meet health and nutrition needs have long been used to guide food choice and nutrition assistance. This paper describes the result of recent innovations scaling up the use of such least-cost diets by UN agencies, the World Bank, and national governments for a different purpose, which is monitoring food environments and targeting systemic interventions to improve a population's access to sufficient food for an active and healthy life. Measuring food access using least-cost diets allows a clearer understanding of where poor diets are caused by unavailability or high prices for even the lowest-cost healthy foods, insufficient income or other resources to acquire those foods, or the use of other foods instead due to reasons such as time use and meal preparation costs, or cultural factors such as taste and aspirations.

High Non-affordability of Diets and Malnutrition in Africa's Drylands: Systems Analysis to Guide Action.

Background: Africa's drylands have unique food environments and persistently high rates of wasting and stunting. This article documents findings and experiences from Fill the Nutrient Gap (FNG) processes conducted in 7 Sub-Saharan African countries that include drylands.

Objective: This study advocates for a comprehensive consideration of the specific food environments of drylands using a novel analytical framework and shares findings and best practices for improving food and nutrition security in these contexts.

Effectiveness of nutritional supplementation during the first 1000-days of life to reduce child undernutrition: A cluster randomized controlled trial in Pakistan.

Background: Childhood stunting can start in the womb and continue for two years. Therefore, the first 1000 days of life between a woman's pregnancy and her child's 2nd birthday offer a unique window of opportunity to build healthier and more prosperous futures. Therefore, we aimed to assess the effectiveness of nutritional supplementation during the first 1000-days to reduce the prevalence of stunting in children at 24 months of age.

Design, development, and local production of lipid-based nutritional supplements to enhance the complementary feeding diet: A model for collaboration for a feeding trial in Bangladesh.

: Lipid-based nutrient supplements (LNS) are effective for treating childhood wasting and for preventing stunting, wasting, and anemia, but large-scale production and programmatic use are a barrier. Locally-developed and produced LNS may be more affordable and reduce logistical procurement and importation hurdles, while promoting private sector engagement and partnership. : In northwestern Bangladesh, we conducted a community-based trial of complementary food supplementation to test its efficacy to reduce childhood stunting.

Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors.

Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low- and middle-income country case studies and used thematic analysis to understand the data.

Acceptability of 11 fortified balanced energy-protein supplements for pregnant women in Nepal.

Evidence suggests that multiple micronutrient and balanced energy protein (BEP) supplementation during pregnancy can decrease the risk of stillbirth and small-for-gestational-age births and increase birth weight. We conducted a mixed-methods formative research study to identify the most acceptable among a range of 11 candidates fortified BEP supplements for use in pregnancy and lactation in a rural district in Nepal. Forty pregnant women aged 15-40 years participated in a test meal tasting of 11 different sweet and savoury candidate BEP supplements.

Compliance with and acceptability of two fortified balanced energy protein supplements among pregnant women in rural Nepal.

Some evidence suggests that balanced energy protein (BEP) supplements taken during pregnancy and lactation can have positive effects on birth outcomes such as small-for-gestational age and birthweight, but more evidence is needed on the long-term use and acceptability of such supplements. We conducted a mixed-methods formative research study to assess and compare compliance with and acceptability of two BEP supplements, a lipid-based peanut paste and a biscuit, to identify BEP supplements for subsequent inclusion in an efficacy trial. We conducted an 8-week feeding trial of daily supplementation among two groups of 40 pregnant women each in rural Nepal.

Effectiveness of unconditional cash transfers combined with lipid-based nutrient supplement and/or behavior change communication to prevent stunting among children in Pakistan: a cluster randomized controlled trial.

Background: In Pakistan, the prevalence of stunting among children younger than 5 y has remained above WHO critical thresholds (≥30%) over the past 2 decades.

Objectives: We hypothesized that an unconditional cash transfer (UCT) combined with lipid-based nutrient supplement (LNS) and/or social and behavior change communication (SBCC) will prevent stunting among children 6-23 mo of age.

Methods: This was a 4-arm, community-based cluster randomized controlled trial conducted in the district of Rahim Yar Khan, Pakistan.

Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia.

Background: To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals.

Objectives: We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously.

Methods: We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data.

COVID-19 pandemic leads to greater depth of unaffordability of healthy and nutrient-adequate diets in low- and middle-income countries.

Unaffordability of healthy diets affected 3 billion people before the COVID-19 pandemic, 2.5 billion of whom lived in 63 low- and middle-income countries. In these 63 countries, income losses due to the pandemic have markedly worsened the affordability gap.

Home consumption of two fortified balanced energy protein supplements by pregnant women in Burkina Faso.

Balanced energy protein (BEP) supplementation for pregnant and lactating women in low- and middle-income countries is a promising strategy to improve birth outcomes and child growth. The objective of this study was to assess and compare the acceptability of new formulations of two fortified BEP supplements, a lipid-based peanut paste and a vanilla biscuit, among 80 pregnant women in rural Burkina Faso, prior to an efficacy trial. A 10-week individually randomized cross-over study was designed, in which women received a weekly supply of each supplement for 4 weeks, and a daily choice between the supplements in the last 2 weeks.

Sociocultural Influences on Food Choices and Implications for Sustainable Healthy Diets.

Background: The global policy discourse on sustainability and health has called for dietary transformations that require diverse, concerted actions from governments and institutions. In this article, we highlight the need to examine sociocultural influences on food practices as precursors to food policy decisions.

Discussion: Sociocultural food practices relate to ideas and materials that give rise to food choices and food patterns of a group.

Shaping Physical, Economic, and Policy Components of the Food Environment to Create Sustainable Healthy Diets.

Background: Sustainable healthy diets are those dietary patterns that promote all dimensions of individuals' health and well-being; have low environmental pressure and impact; are accessible, affordable, safe, and equitable; and are culturally acceptable. The food environment, defined as the interface between the wider food system and consumer's food acquisition and consumption, is critical for ensuring equitable access to foods that are healthy, safe, affordable, and appealing.

Discussion: Current food environments are creating inequities, and sustainable healthy foods are generally more accessible for those of higher socioeconomic status.

Specialized Nutritious Food Combined With Cash Transfers and Social and Behavior Change Communication to Prevent Stunting Among Children Aged 6 to 23 Months in Pakistan: Protocol for a Cluster Randomized Controlled Trial.

Background: In Pakistan, the prevalence of stunting in children younger than 5 years has remained above global critical levels over the past two decades, with the stunting rate being 40.2% in 2018. Children living in rural areas and in the poorest households suffer the most from stunting across the country-43.

Effect of lipid-based nutrient supplement-Medium quantity on reduction of stunting in children 6-23 months of age in Sindh, Pakistan: A cluster randomized controlled trial.

Background: Chronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan.

Objective: The primary objective of this study was to test the hypothesis that the provision of lipid-based nutrient supplement-medium-quantity (LNS-MQ) known as Wawamum will result in a 10% reduction in risk of being stunted at the age of 24 months in the intervention group compared with the control group.

Acceptability of 12 fortified balanced energy protein supplements - Insights from Burkina Faso.

Poor maternal nutrition contributes to poor birth outcomes, including low birth weight and small for gestational age births. Fortified balanced energy protein (BEP) supplements may be beneficial, although evidence is limited. This mixed method study, conducted among pregnant women in Burkina Faso, is part of a larger clinical trial that seeks to understand the impact of fortified BEP supplements on pregnancy outcomes and child growth.