Why Nutrition Is Part of the Whole
This post is written by Clarissa Perkins, KDLT, and the Feed the Future Innovation Lab for Nutrition.
The public health community once dismissed the link between aflatoxin levels in a mother during pregnancy and birth outcomes.
But the Feed the Future Innovation Lab for Nutrition knew it was worth exploring. As a result, they not only proved the public health community wrong, but also illuminated the nuanced dangers of aflatoxin.
Led by Dr. Patrick Webb at Tufts University, the Nutrition Innovation Lab conducted the first longitudinal studies that followed women during pregnancy and determined whether the aflatoxin in their blood was linked to birth outcomes and stunting.
In Nepal and Uganda, they conducted large studies with 3,000 mother-infant pairs in which they followed the pairs for years, through pregnancy, birth and child growth. Controlling for wealth, education and a myriad of other things, they determined an independent link between aflatoxin in a mother’s blood during pregnancy and growth of the child.
Aside from being a carcinogen, aflatoxin, it became clear, represents a public health threat.
But the risks of aflatoxin are not straightforward. The negative effects are triggered by inflammation in the body. “Where we measure inflammation in the body,” Dr. Webb says, “the effects of the aflatoxin light up. If there’s no inflammation, it doesn’t.”
In Uganda, HIV, which causes inflammation, is strongly related to the negative effects of aflatoxin. But diarrheal disease, which can be caused by poor sanitation, dirty water, and lack of a proper sewage system, can also cause inflammation. “What people eat and the poor environment where they live is all related,” says Dr. Webb.
Reducing the risks of aflatoxin points to the need for multi-sectoral solutions: not only properly storing goods, but also cleaning up water, providing working sewage systems, and reducing HIV.
As a result of these studies, the Nutrition Innovation Lab has brought the health community together for a policy discussion across sectors, with trade experts, agriculture experts, WASH staff and more to help determine a multi-sectoral solution. A nutrition governance indicator to quantify the quality of governance in nutrition has also been designed.
But the Nutrition Innovation Lab’s success isn’t only related to aflatoxin. It also spans relationship building, research and program building.
For example, the Malawi government recognized that their nutrition capacity needed more rigor. The country had doctors and nurses, but no officially trained clinical dietitians. They called on the Nutrition Innovation Lab to create the country’s flagship nutrition and dietetics program.
Borrowing from programs in South Africa, Ghana, the US, Canada, and Europe, the Nutrition Innovation Lab developed a program of international standards. They blended the nutrition program into the University of Malawi’s College of Medicine and the College of Agriculture with both a dietitian and a doctor overseeing the program. Now, it is credited by the Malawi Medical Council.
As part of the program, they created a tool that helps dietitians examine what people are eating and make recommendations, which will be launched at the Ministry of Health this week. And, now Malawi has two cohorts of graduated, registered dietitians.
Going forward, Dr. Webb has a lot on his mind. He hopes to do more work on food safety. He’d like the lab to focus on showing how improving WASH, like adding focuses on water quality and quantity, improves nutrition.
He’d also like to explore how nutrition is tied to cognitive development: How nutrition in utero affects brain development and head circumference is poorly understood and poorly measured, he said.
The topics Dr. Webb wants to impact go on, from gut microbe to quality of breastmilk to consumer behaviors and more.
Nutrition, it is evident, is not a silo, and is, according to the Nutrition Innovation Lab results, part of a whole complex system which needs to be examined together.
Ten years ago, Dr. Webb says, USAID research funding was mostly focused on commodities, like peanuts and legumes. The creation of the Feed the Future Nutrition Innovation Lab, “was in a way, a recognition of focusing on people, not just commodities.” It was the start of a new wave of nutrition, one that saw nutrition as something that fits into the larger story of food security.
With the Nutrition Innovation Lab’s work today, it is even more clear how wide spreading nutrition is. It’s impacted by food safety, and the growth of dangerous aflatoxin in food; it’s tied to markets, which give people access to buy and sell nutrient-rich food. It’s tied to technology, which can help farmers safely store their food to prevent mold growth; it’s tied to maternal and child health and breastfeeding practices.
The Nutrition Innovation Lab’s work is a key part of clearly understanding how these items fit into a larger development story.
Over the last 10 years, over 2,000 students have been trained through Feed the Future Nutrition Innovation Lab in programs at partner universities in the U.S., in the student’s own country, and in tertiary countries. The research generated by the Feed the Future Innovation Lab for Nutrition over the past 10 years includes studies on resilience to climate, environmental shocks and price changes. They focus on "agriculture to nutrition" which encompasses the relationships between agricultural yields, rainfall, disease, child growth, diet quality, and diet affordability, as well as neglected biological factors such as mycotoxins and enteric enteropathy. Visit their publications page for more information on these projects.