Dietary animal source food across the lifespan in LMIC
Introduction
Globally, an estimated 11% of people are undernourished, and 30% have micronutrient deficiencies (Roser and Ritchie, 2019). Poor nutrition is associated with poverty; both conditions are especially acute in low- and middle-income countries (LMIC). Despite historical increases in global food production and availability, LMIC have not comparably benefited from these improvements (Speedy, 2003). Although the individuals most vulnerable to poor nutrition and its sequelae are infants, young children, and women of child-bearing age, poor nutritional status also affects adolescents, adult men and women, and the elderly, as it is related to multiple health problems, increased susceptibility to infections, and increased mortality (Table 1). Poor nutrition in children is associated with impaired growth, development (cognitive and other domains), and school performance; in adults, with reduced work capacity and income; and in women, with poor reproductive outcomes. Thus, poor nutrition is an individual, household, and community problem; a less healthy and productive population exacts a significant societal cost.
Animal source foods (ASF; meat, offal, fish, eggs, milk, and other dairy products) are important sources of high-quality calories, providing energy along with essential amino acids and micronutrients. Micronutrients, essential components of the human diet, are required for full growth, physical and mental health, cognitive function, metabolism, immunity, and overall well-being across ages (Table 2). Nutrients are typically more concentrated and bioavailable in ASF than in foods of plant origin (FPO; see Fig. 1), critically important for children, whose gastric capacity is significantly limited.
Signs of nutrient deficiency differ at different ages, but periods of rapid growth and physical change are the most vulnerable. Consequently, a significant amount of research has investigated ASF consumption and various health and nutrition outcomes of children under 5 (CU5), with relatively little research investigating ASF at older ages, despite important age-related demands for the principal ASF-derived nutrients (Table 2).
Given discussion about the negative environmental effects of livestock production, the cost/benefit of ASF production and consumption globally has fostered debate (Adesogan et al., 2020; Capper, 2013; de Vries et al., 2010; Moumen et al., 2016; Salmon et al., 2020; Steinfeld and Wassenaar, 2007). Recognition of the important contribution of dietary ASF to health and well-being and barriers constraining consumption among individuals in LMIC is largely missing. For them, diets tend to be cereal-based, with low levels of diversity (see Fig. 2) (Sans and Combris, 2015). Fortification and supplementation - alternatives in HIC rendering ASF optional without comparable nutritional risk - are not widely available in LMIC (Mkambula et al., 2020). Inclusion of even small amounts of ASF in these diets provides much-needed, concentrated and bioavailable energy, high-quality protein, and multiple micronutrients. Focusing on LMIC, this narrative review aims to examine the contributions of dietary ASF to human health and well-being across the lifespan and barriers to their consumption.
Section snippets
Contributions of ASF
This section is presented by life stage. We review what is known about typical LMIC dietary patterns, including ASF, and the relationship between ASF intake and health and functional outcomes.
Barriers to ASF consumption in LMIC
Generally, consumption of ASF increases with age, household wealth, and urban (vs rural) residence, (Kupka et al., 2020; White et al., 2017), but important variations exist at individual, household, and community levels (Pachón et al., 2007; Perry and Grace, 2015). Individual factors may include age, gender, education level, and nutrition-related knowledge. At the household level, ASF consumption may be influenced by household composition, religious or cultural beliefs, and decision-making
Discussion
Dietary ASF play an important role in health and well-being in LMIC. The nutritional profiles of ASF fill specific needs, created by the complex biological demands and social determinants of health at each phase across the lifespan. This reality complicates dominant western narratives, which position ASF as detrimental to human and environmental health (Bonnet et al., 2020; Godfray et al., 2018). Importantly, in a 2019 Lancet systematic analysis of evidence from 195 countries, the greatest
Limitations
Measuring ASF consumption is not standardized nor consistent across the field of nutrition research, making it challenging to compare results and limiting the conclusions made regarding the association between ASF consumption and health outcomes. Furthermore, this paper is focused on the impact of ASF in LMIC, limiting the available data. We included important references from outside LMIC only when nothing else was available, where findings should be less affected by context, or when
Conclusion
This narrative review presents the contributions of dietary ASF to health outcomes across the lifespan. Barriers to ASF consumption in LMIC exist at the individual, household, and community level and vary across contexts, limiting consumption most severely among women and children. Given the nutritional potential of ASF, older children, adolescents, adult men and women, and elders would all benefit from research on ASF and health outcomes at their life stage. Better, more standardized measures
Funding
Support for this research was provided by Heifer International and the United States Agency for International Development (USAID) Bureau for Food Security under Agreement AID-OAA-L-15-00003 as part of Feed the Future Innovation Lab for Livestock Systems (University of Florida, Gainesville).
Authors’ contributions
SM and LM contributed to the study conception and design. Material preparation, data collection, and analysis were performed by SM, KM, and LM. The first draft of the manuscript was written by SM and LM, and all authors commented on and further developed subsequent versions of the manuscript. KM developed tables. All authors read and approved the final manuscript.
Declaration of competing interest
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Laurie Miller reports financial support was provided by Heifer International. Sarah McKune reports financial support was provided by United States Agency for International Development (USAID) Bureau for Food Security under Agreement AID-OAA-L-15-00003 as part of Feed the Future Innovation Lab for Livestock Systems.
Acknowledgements
Support for this research was provided by Heifer International and the generous support of the American people through the United States Agency for International Development (USAID) Bureau for Food Security under the Feed the Future initiative. This publication is supported as a part of the Feed the Future Innovation Lab for Livestock Systems (Agreement # AID-OAA-L-15-00003) and the Feed the Future Innovation Lab for Nutrition (Agreement # AID-OAA-L-10-00006). The contents are the
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