Let food be thy medicine: linking local food and health systems to address the full spectrum of malnutrition in low-income and middle-income countries

• Published in: BMJ global health 2017-11, Vol.2 (4), p.e000564-e000564
• Main Authors: Jaacks, Lindsay M, Bellows, Alexandra L
• Format: Article
• Language: English
• Subjects: Agriculture; Bans; Beverages; Childrens health; Counseling; Diet; Disease prevention; Eggs; Employees; Food; Fruits; Global health; Health care policy; Hospitals; Infectious diseases; Legumes; Low income groups; Malnutrition; Maternal & child health; Nutrition; Nuts; Obesity; Overweight; Patients; Smoking; Urban farming; Vegetables
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2017-000564

Unfortunately, the importance of diet and nutrition in medicine is lost in most discussions of health system reform today, especially in low-income and middle-income countries (LMICs). [...]few food system researchers and policymakers consider the myriad opportunities for improving health through forging partnerships between local food, agriculture and health systems. In many LMICs struggling to address the full spectrum of malnutrition, from undernutrition to obesity and nutrition-related non-communicable diseases, the underlying problem is not one of caloric insufficiency, but rather one of poor diet quality.4 For example, in Guatemala, 50% of reproductive-aged women are overweight or obese and 48% of children under five are stunted (an indicator of chronic undernutrition).5 Prospective epidemiological studies have demonstrated a positive relationship between consumption of red meat, processed foods and sugar-sweetened beverages and risk of obesity in adults, whereas consumption of fruits, vegetables, nuts and legumes is associated with a decreased risk of obesity.6 On the other end of the malnutrition spectrum, randomised controlled trials of nutrition counselling to mothers delivered by trained healthcare providers that focuses on improving healthy complementary feeding practices have been shown to result in a 29% reduction in stunting.7 Results from a randomised trial, published this year, found that the prevalence of stunting among Ecuadorian children (ages 6–9 months) who received one egg per day for 6 months was reduced by 47% compared with controls.8 Few studies have explicitly evaluated both ends of the malnutrition spectrum. Taking the farm-to-hospital movement a step further, Boston Medical Center recently opened a 650 m2 rooftop garden that is expected to produce 3175 kg of food this summer, which will feed into hospital cafeterias, patient meals and an on-site patient food pantry.16 While few evaluations of farm-to-hospital programmes have been conducted to date, a recent study found that US communities with healthcare institution-affiliated gardens had lower levels of obesity compared with the general US population (27% vs 34%) despite a similar demographic profile,17 indicating that such programmes are a promising approach to promoting health. [...]the primary goal of the Food and Agriculture Organisation’s Purchase from Africans for Africa programme in Ethiopia, Malawi, Mozambique, Niger and Senegal is to promote food and nutrition securit