Biological Mechanisms

The Nutrition Innovation Lab will be exploring several important potential contributors to child stunting including water quality, aflatoxins, gut microbiota and environmental enteropathy, and animal source protein

Overview & ActivitiesRelated Publications

Some of the key elements largely missing from past consideration of agriculture to nutrition pathway analysis relates to biological mechanisms, as opposed to cultural or economic mechanisms. In collaboration with other Innovation labs, the Nutrition Innovation Lab will be exploring several important potential contributors to child stunting:

  • Water Quality
  • Aflatoxins
  • Gut Microbiota and Environmental Enteropathy
  • Animal Source Protein in the Asian Diet

There are two potential approaches to examining the aflatoxins issue in the first phase of the Nutrition Innovation Lab’s research. The first is an assessment of the PoSHAN Study sites of the extent of aflatoxin contamination levels using validated field tools. The second, a collaboration with AusAID, UNICEF and the University of Jakarta, is a nationally representative assessment of aflatoxin levels in the blood of mothers and children in Timor Leste, and associated nutritional status markers and indices of household food security. A study is planned in collaboration with Virginia Tech University on the potential for pathogens shared in the gut microbiota of humans and animals as determinants of nutrition outcomes. The objective of the research is to generate data on the human and livestock microbiome from distinct ecological regions of Nepal both in the rainy and dry seasons, and to measure link of the zoonotic disease burden to nutrition outcomes. The potential for collaboration with AquaFish and WorldFish is being explored to consider the role of aquatic protein sources in Asian diets and nutrition. The development of pond-based aquaculture in tandem with horticulture promotion and behavior change communication is being considered in certain parts of Nepal, as well as in Bangladesh and Cambodia. Theme3-Illustration

Browse through related publications here, or search through all of our publications.

Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Authors: Elizabeth Widen; Claire Biribawa; Daniel Acidri; Winifred Achoko; Harriet Achola; Jeffrey Griffiths; Sera Young January 2017
A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, mid upper arm circumference, triceps skin fold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time.
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Climatic conditions and child height: Sex-specific vulnerability and the protective effects of sanitation and food markets in Nepal

Authors: Prajula Mulmi; William A. Masters December 2016
Abstract Environmental conditions in early life are known to have impacts on later health outcomes, but causal mechanisms and potential remedies have been difficult to discern. This paper uses the Nepal Demographic and Health Surveys of 2006 and 2011, combined with earlier NASA satellite observations of variation in the Normalized Difference Vegetation Index (NDVI) at each child’s location and time of birth to identify the trimesters of gestation and periods of infancy when climate variation is linked to attained height later in life. We find...
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PoSHAN Community Studies: Panel 3 Report

Authors: Nutrition Innovation Lab November 2016
The goal of PoSHAN Community Studies is to understand the factors that link agriculture to nutrition. This involves researching the determinants of household food security, dietary intake, and nutritional status of children under 5 years of age and their mothers in relation to changes in agriculture and exposure to agricultural and microeconomic extension, as well as nutrition and health programs in Nepal. This descriptive report summarizes the main findings of the third panel survey.
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Nutrition Innovation Lab Annual Report- Year 6

Authors: Nutrition Innovation Lab November 2016
The following are the annual reports of the Feed the Future Innovation Lab for Nutrition for the fiscal year 2016 starting October 2015 through September 2016 (“Y6”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins...
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PoSHAN Community Studies: Panel 2 Report

Authors: Nutrition Innovation Lab October 2016
The goal of PoSHAN Community Studies is to understand the factors that link agriculture to nutrition. This involves researching the determinants of household food security, dietary intake, and nutritional status of children under 5 years of age and their mothers in relation to changes in agriculture and exposure to agricultural and microeconomic extension, as well as nutrition and health programs in Nepal. This descriptive report summarizes the main findings of the second panel survey conducted between May – July 2014.
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Relationship of Stunting and Overweight in Egyptian children under five years of age: Trends and associated risk factors.

Authors: Shibani Ghosh; Grace Namirembe; Marwa Moaz; Ashish Pokharel; Elizabeth Marino-Costello; Jeffrey Griffiths; Patrick Webb September 2016
Egypt’s emerging economy faces a dual burden wherein there is coexistence of under and over nutrition, either in the same population, community, household or same individual. The dual burden of disease can be extremely variable in its manifestation. It can, for example, be manifested as stunted children who are concurrently obese, or as stunted children who may not be currently obese but who are at risk of early onset chronic diseases. Secondary Analysis provided by the Nutrition Innovation Lab.  
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The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Authors: Barnabas Natamba; Jane Achan; Rebecca Stoltzfus; Sera Young August 2016
Abstract Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied...
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Protein Quality in the First Thousand Days of Life

Authors: Shibani Ghosh May 2016
The aim of this article is to provide an overview of the role of protein quality within the first 1000 days of life. The article outlines the importance of protein quality in pregnancy and early growth and examines the potential of high-quality protein in prevention of stunting and treatment of severe and moderate acute malnutrition. The article also provides a summary of the recent changes in protein quality evaluation and the development of a new index, the Digestibility Corrected Amino Acid Score, examining the opportunities...
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Cross-sectional but not Longitudinal Measures of Food Insecurity are Associated with the Rate of Weight Gain during Pregnancy in Northern Uganda

Authors: Barnabas Natamba; Francoise Vermeylen; Elizabeth Widen; Shibani Ghosh; Patsy Brannon; Sera Young April 2016
Food insecurity (FI) during pregnancy may lead to adverse health outcomes for affected women. However, little is known on whether such effects are due to short-term within person changes (longitudinal effects) in FI or long-term between person differences (cross-sectional effects) in this exposure. Therefore, the aim of this study was to assess whether differences in cross-sectional measures of FI between women (defined as the mean prenatal IFIAS score) and/or longitudinal changes in FI within women
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Progression of antepartum depression differs by level of perceived social support and food insecurity

Authors: Barnabas Natamba; Francoise Vermeylen; Rebecca Joyce Stoltzfus; Jeffrey Griffiths April 2016
Antepartum depression (AD) is a risk factor for adverse pregnancy outcomes and may be worsened by food insecurity (FI) and lack of social support (SS). We studied the progression of AD from mid gestation to term and examined whether such progression differed by measures of SS and longitudinal measures of FI
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Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV-Infected Pregnant Women and Reduced Linear Growth of HIV-Exposed Infants

Authors: Barnabas Natamba; Jeffrey Griffiths April 2016
Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda.
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HIV-Infected Pregnant and Lactating Women have Higher Serum Aflatoxin levels than HIV–Uninfected Women and Aflatoxin Levels are Higher during Early Postpartum than during Pregnancy among HIV-Infected Women

Authors: Barnabas Natamba; Shibani Ghosh; Jeffrey Griffiths April 2016
Aflatoxins are carcinogenic and may affect linear growth. Prior cross-sectional data from Ghana have shown that aflatoxin levels are ~ 20% higher among HIV-infected than HIV-uninfected post-partum women. It is not known if HIV-infected pregnant women have elevated serum aflatoxin levels during pregnancy, or if aflatoxin levels change during the perinatal period. We therefore studied these relationships among a cohort of 246 women recruited in Gulu, Uganda, and followed through pregnancy and early infant life. All HIV-positive women received HIV antiretroviral therapy for free from...
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HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

Authors: Barnabas Natamba; Jeffrey Griffiths; Patsy Brannon; Saurabh Mehta April 2016
Adequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub-Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth.
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High levels of food insecurity were observed among HIV, TB, and HIV/TB co-infected outpatients in northern Uganda

Authors: Mia Monique Blakstad; Barnabas Natamba April 2016
Food insecurity among individuals living with HIV is well-recognized globally. Since comorbidity with TB is common, particularly in sub-Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.
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District Presentations: Effectiveness of Integrated Agriculture, Health Livelihood and Nutrition Interventions to Improve Maternal and Child Nutrition and Health in Rural Uganda: A Birth Cohort Study.

Authors: Bernard Bashaasha; Florence Kinyata April 2016
These presentations were made in various Ugandan Districts, covering data gathered during the Uganda Birth Cohort Study specific to each of those districts. The presentations were delivered in April of 2016 by Drs. Bernard Bashaasha and Florence Kinyata. Click on the district name to see its specific presentation. Agweng Aduku Agoro Apac Atanga Atyakc Ayer Buganagri Buyanja Bwizi Kebisoni Nyamweru Parombo Kibiito Rugyeyo Ruhija
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Got Baby Food? Understanding the Market for Packaged Complementary Foods in Developing Countries

Authors: William Masters February 2016
This presentation was delivered by Dr. William Masters on Feb. 3, 2016 as a Friedman School Seminar, Tufts University.
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Global dietary quality, undernutrition and non-communicable disease: a longitudinal modelling study

Authors: Rosemary Green; Jennifer Sutherland; Alan D Dangour; Bhavani Shankar; Patrick Webb January 2016
The objective is to determine the relationship between global dietary energy availability and dietary quality, and nutrition-related health outcomes.
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Head Growth of undernourished children in rural Nepal: Association with demographics, health, and diet

Authors: Laurie Miller; Neena Joshi; Beatrice Rodgers; Jeffrey Griffiths; Shubh Mahato; Padma Singh; Patrick Webb January 2016
Background: Brain development in early childhood is a key determinant of later cognition, social achievement and educational success. Head circumference (HC) measurements are a simple method to assess brain growth, yet reports of these measurements are uncommon in nutritional surveys of undernourished children. To cite this article: Laurie C. Miller, Neena Joshi, Mahendra Lohani, Rupa Singh, Nisha Bhatta, Beatrice Rogers, Jeffrey K. Griffiths, Shibani Ghosh, Shubh Mahato, Padma Singh & Patrick Webb (2016): Head growth of undernourished children in rural Nepal: Association with demographics, health...
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The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal

Authors: R.K. Chandyo; Sigrun Henjum; P. Shrestha; L. Locks; Wafie Fawzi; Tor Strand December 2015
Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal.
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Nutrition Innovation Lab Annual Reports- Year 5

Authors: Nutrition Innovation Lab December 2015
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2015 starting October 2014 through September 2015 (“Y5”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the...
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UNICEF: Timor-Leste Food and Nutrtion Survey 2013- Final Report

Authors: Nutrition Innovation Lab October 2015
UNICEF Report: The data collection for this survey was carried out between May and September 2013 among children aged 0-59 months and their non-pregnant mothers (aged 14 – 60 years). The survey assessed the risk factors for undernutrition based on Conceptual Framework of Malnutrition (UNICEF, 1990) which is being used for nutrition programming worldwide for the past 25 years. The prevalence of micronutrient deficiencies (vitamin A, iron, zinc, and iodine deficiency), and the iodine content of household iodised salt and aflatoxin exposure among children (aged 6 – 59...
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Community Connector: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This presentation was made to the Ugandan Community Connector and is an update on the Birth Cohort Study in Uganda on Oct. 20, 2015.
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Africa Day: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This poster presentation was featured at the Africa Day for Food and Nutrition Security in Kampala Uganda on Oct. 28-30, 2015.
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The Global Pattern of Malnutrition: From undernutrition to obesity and diet-related disease

Authors: William Masters October 2015
This presentation was delivered Oct. 14, 2015 for the BIFAD event at the World Food Prize Borlaug Dialogue by Dr. William Masters.
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Agricultural Diversity and Child Stunting in Nepal

Authors: Gerald Shively; Celeste Sununtnasuk September 2015
This article investigates empirical connections between agriculture and child nutrition in Nepal. We augment the standard approach to explaining child nutrition outcomes by including information about household level agricultural production characteristics, including indicators of agricultural diversity. Data from the 2010/2011 Nepal Living Standards Survey (NLSS) are used in a series of regression models to explain stunting outcomes and variation in height-for-age Z-scores among 1,769 children 0–59 months of age. Results highlight the relative importance of overall agricultural yields, specific crop groups, and the consumption of own-production as factors correlated...
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Understanding Agriculture to Nutrition Linkages: A Rapidly Moving Agenda

Authors: Nutrition Innovation Lab September 2015
Presentations from Sept 30th, 2015 in Washington DC on research findings from the first 5 years of our research in Asia and Africa. These are the compiled slides from 8 separate presentations from: Patrick Webb, Patrick, Gerald Shively, Keith West, Shibani Ghosh, Nassul Kabunga, Robin Shrestha, Bernard Bashaasha, and Jeffrey Griffiths. To view the presentations, click on the presentation below to see the recording. Understanding Agriculture to Nutrition Linkages: A Rapidly Moving Agenda Maura Mack  Opening Statements Patrick Webb  Mapping Nutrition Innovation Lab Research: How does it all...
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Risk Factors for Anemia in Non-pregnant Women across the Agroecological Zones of Nepal

Authors: Swetha Manohar; Raman Shrestha; Ruchita Rajbhandary; Devendra Gauchan ; Ramesh Adhikari; Shibani Ghosh; Patrick Webb; Keith P.W. West Jr August 2015
Abstract- Objectives: Describe the prevalence of anemia in Nepali non-pregnant women of reproductive age by agroecological zone and potential risk factors.
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Obesity and Stunting in Egypt, and The Roles of Water, Sanitation, and Mycotoxins

Authors: Jeffrey Griffiths August 2015
Presentation given by Dr. Jeff Griffiths for USAID Egypt in Cairo, Aug. 4, 2015
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Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries

Authors: David Pelletier; Barnabas Natamba; Dia Sanou; Jackson Tumwine August 2015
Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda.
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Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Authors: Shalean Collins; Barnabas Natamba; Angela Arbach; Elizabeth Widen; Pooja Desai; Hijab Khan; Jeffrey Griffiths; Sera Young July 2015
Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal-infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low-income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.
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Social support modifies the bidirectional linkages between food insercutiy and prenatal depresseive symptoms while domestic violence alters the unidirectional impact of food insecurity on prenatal depressive symptoms

Authors: Barnabas Natamba June 2015
This presentation by Barnabas Natamba examines and draws links between food security/ nutrition and social support/ mental health/ HIV status.
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Maternal Food Insecurity is Associated with Loss of Fat, but not Lean Mass during Lactation among Ugandans of Mixed-HIV Status

Authors: E. Widen; B. Natamba; S. Ghosh; J. Griffiths April 2015
HIV-infected women lose more weight during lactation than HIV-uninfected women. Whether this loss is fat-mass (FM) or fat-free mass (FFM) is unknown, but important, as lean mass loss accelerates HIV progression.
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UNICEF: Timor-Leste Food and Nutrtion Survey 2013- Summary of Key Findings and Recommendations

Authors: Nutrition Innovation Lab April 2015
UNICEF Report: The data collection for this survey was carried out between May and September 2013 among children aged 0-59 months and their non-pregnant mothers (aged 14 – 60 years). The survey assessed the risk factors for undernutrition based on Conceptual Framework of Malnutrition (UNICEF, 1990) which is being used for nutrition programming worldwide for the past 25 years. The prevalence of micronutrient deficiencies (vitamin A, iron, zinc, and iodine deficiency), and the iodine content of household iodised salt and aflatoxin exposure among children (aged 6 – 59...
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Update on the Nutrition Innovation Lab Approach

Authors: Jeffrey Griffiths April 2015
Presentation given by Dr. Jeff Griffiths for USAID Malawi, April 15, 2015
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Maternal HIV Infection, but not Food Insecurity, Predicts the Pattern of Weight Gain in Pregnant Women Attending Antenatal Services in Northern Uganda

Authors: Barnabas Natamba; Elizabeth Widen; Patsy Brannon; Sautabh Mehta April 2015
In Sub-Saharan Africa, the differential impact of maternal HIV infection and/or food insecurity on the pattern of weight gain among pregnant women is unknown. To fill this gap, data on 402 pregnant women (33% HIV+ & participating in antiretroviral treatment) enrolled in a perinatal cohort study at Gulu Regional Referral Hospital in northern Uganda were analyzed.
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Social Support Modifies Bidirectional Linkages Between Food Insecurity and Prenatal Depressive Symptoms while Domestic Violence Alters the Unidirectional Impact of Food Insecurity on Prenatal Depressive Symptoms

Authors: Barnabas Natamba; Shibani Ghosh; Sera Young April 2015
To inform perinatal nutrition and mental health interventions, we used a cohort study to: 1) examine the directionality of relationships between maternal food insecurity (MFI) and prenatal depressive symptoms (PDS); and 2) see if social support (SS) or domestic violence (DV) modify this relationship. We enrolled 403 Ugandan pregnant women (33% HIV+ on antiretrovirals)) in mid-gestation and assessed them monthly through delivery for MFI (IFIAS) and the PDS (CES-D) using validated scales.
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Maternal HIV infection, but not food insercutity access score, predicts the rate of weight change in pregnant women attending antenatal services in northern Uganda

Authors: Barnabas Natamba April 2015
This poster examines seasonal food security/ insecurity, MUAC measurements, and HIV status in Uganda.
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Connecting the dots between human malaria, livestock, and under-nutrition: An unexpected pathway

Authors: Jeffrey Griffiths; Nassul Kabunga March 2015
Presentation given by Drs. Jeff Griffiths and Nassul Kabunga for USAID in Washington DC, March 15, 2015
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Household Malaria and Livestock: Linking Health, Nutrition & Agriculture

Authors: Nassul Kabunga; Jeffery Griffiths February 2015
Presentation on the benefits of Improved Dairy Cows.
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Dietary quality, undernutrition and disease: global patterns and trends over three decades

Authors: Rosemary Green; Jenny Sutherland; Alan Dangour; Bhavani Shankar; Patrick Webb February 2015
Recent studies have found evidence of an increasing polarization between healthy and unhealthy diets, with many high income countries having diets that are becoming more healthy, while in lower income countries diets are becoming more unhealthy. However, little is known about how the changing availability of different kinds of foods at a national level may be related to both undernutrition and NCDs.
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Malaria predicts maternal and child anemia in Uganda and is modulated by altitude and prior IRS

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths for USAID in Kampala, Uganda, Feb. 10, 2015
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Why Food is Not Enough-Boston University

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths at Boston University, February 27, 2015
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Low dietary diversity and micronutrient adequacy among lactating women in a peri-urban area of Nepal

Authors: Sigrun Henjum; Liv Elin Torheim; Andrew L Thorne-Lyman January 2015
The main objectives were to assess the adequacy of the micronutrient intakes of lactating women in a peri-urban area in Nepal and to describe the relationships between micronutrient intake adequacy, dietary diversity and sociodemographic variables. Breast-feeding is one of the most important factors that can influence child health in low- and middle-income countries. During lactation, women have increased requirements for energy and micronutrients. An inadequate maternal intake of certain nutrients during this period may have consequences for both the mother’s health and nutritional status, as well as those of the breast-fed...
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Why Food is Not Enough-BBNC

Authors: Jeffrey Griffiths January 2015
Presentation given by Dr. Jeff Griffiths at the Boston to Bangalore Nutrition Collaboration event, January 2015
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The 3rd Annual Scientific Symposium: Agriculture, Food Systems, and Nutrition: Connecting the Evidence To Action

Authors: Nutrition Innovation Lab December 2014
Briefing from the 3rd Annual Scientific Symposium The Nutrition Innovation Lab’s partner, Johns Hopkins University, in collaboration with the Institute of Medicine and the Nepal Agriculture Research Council, hosted its 3rd annual Scientific Symposium in Kathmandu, Nepal on November 18-20, 2014. The question driving this symposium was simple: how can agriculture improve household food security and nutrition outcomes? Yet the work of understanding the agriculture to nutrition pathway is complex. Building sustainable systems that promote food security, nutrition, and health in Nepal requires the utilization of high-quality, empirical evidence. The...
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Chapter 7: Childhood Threats to Adult Cognition in Sub- Saharan Africa: Malaria, Anemia, Stunting, Enteric Enteropathy, and the Microbiome of Malnutrition

Authors: Jeffrey Griffiths; Joyce Kikafunda December 2014
Many common childhood conditions are associated with cognitive deficits. While some causes of impaired cognition, such as lead exposure, are well understood, other common conditions in countries such as Uganda – malnutrition, anemia and malaria – are not sufficiently recognized. In this chapter we discuss stunting and its root causes of undernutrition, a lack of sanitation and its relationship to environmental enteropathy and the intestinal microbiome. We also review information about iron-deficiency anemia and malaria, and their neurological and cognitive consequences. We believe that cognitive declines later in life,...
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2014 Scientific Symposium Presentations

Authors: Nutrition Innovation Lab December 2014
AGRICULTURE, FOOD SYSTEMS AND, NUTRITION: CONNECTING THE EVIDENCE FOR ACTION CO-Hosted by Johns Hopkins Bloomberg School of Public Health, Department of Community Medicine and Public Health– Institute of Medicine & the Nepal Agricultural Research Council.   Day 1 Oral Presentations Alan Dangour Time to move from Agriculture to Action in Agriculture and Health Akriti Singh Maternal Access to Information: Can Bhanchhin Aama Influence Child Diets? Chandra Thapa Bridging the Gap: Food Security Response Analysis and Planning Based on the Nepal Food Security Monitoring System (NEKSAP)...
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Cover Image: Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young November 2014
In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th....
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Linking Antenatal and Postnatal Care, maternal health knowledge, and behavior among women in the PoSHAN Community Studies

Authors: Jamie Dorsey November 2014
The 2014 Annual Scientific Symposium in Katmandu Nepal, Jamie Dorsey’s poster presentation entitled, “Linking Antenatal and Postnatal Care, maternal health knowledge, and behavior among women in the PoSHAN Community Studies”.
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“Eat your Fruits and Vegetables and Don’t Get Malaria”: Linkages between Agriculture, Nutrition, and Health in Uganda

Authors: Jeffrey Griffiths November 2014
Presentation given by Dr. Jeff Griffiths for the Center for Global Public Health Event at Tufts University, Nov. 20, 2014
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“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

Authors: SL Young; F Luwedde; B. Okia; P Natureeba; L. Johnson; C. Michel; M. Robine; E. Charlebois; D. Havlir November 2014
We evaluated the acceptability and use of macronutrient supplementation among HIV-infected pregnant Ugandan women receiving antiretroviral therapy in a clinical study (NCT 00993031). We first conducted formative research among 56 pregnant and lactating women to select a supplement regimen. Acceptability and use of the supplementation regimen (35 sachets of lipid-based nutrient supplements (LNS) and 4 or 6 kg of instant soy porridge for the household provided monthly) were evaluated among 87 pregnant women. Organoleptic assessments of LNS were favorable. Participants reported consuming LNS a mean...
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Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

Authors: Sera Young; Flavia Luwedde; Paul Natureeba; Jane Achan ; Veronica Ades; Beth Osterbauer; Edwin Charlebois; Moses Kamya; Diane Havlir; Deborah Cohan November 2014
Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial...
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Nutrition Innovation Laboratory:Nepal Research and Capacity-Building Activities

Authors: Maura Mack November 2014
This presentation was given by Maura Mack as an update to USAID in Nepal on the nature of the Nutrition Innovation Lab’s work and progress in Nepal, November, 2014.
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Nutrition Innovation Lab Annual Reports- Year 4

Authors: Nutrition Innovation Lab October 2014
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2014 starting October 2013 through September 2014 (“Y4”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the...
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Determinants of Stunting and Severe Stunting among under-fives: Evidence from the 2011 Nepal Demographic and Health Survey

Authors: Rina Tiwari; Lynne M Ausman; Kingsley Emwinyore Agho September 2014
Stunting remains a major public health concern in Nepal as it increases the risk of illness, irreversible body damage and mortality in children. Public health planners can reshape and redesign new interventions to reduce stunting and severe stunting among children aged less than 5 years in this country by examining their determinants. Hence, this study identifies factors associated with stunting and severe stunting among children aged less than five years in Nepal.
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Cover Image:Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Authors: Barnabas K. Natamba; Angela Arbach; Hillary Kilama; Jane Achah; Jeffrey Griffiths; Sera Young August 2014
Food security occurs “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework. FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infected with HIV, women and children. Women’s responsibilities in managing family...
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Henjum et al 2014

Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake

Authors: Sigrun Henjum; Mari Manger; Eli Skeie; Manjeswori Ulak; Andrew L. Thorne-Lyman; Ram Chandyo; Prakash S. Shrestha; Lindsey Locks; Rune J. Ulvik; Wafaie W. Fawzi; Tor A. Strand July 2014
The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70% of the women were found...
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Factors Associated with Dietary Diversity Among Women of Reproductive Age (15-49 yrs) in Agago District

Authors: Ray Oroma June 2014
Despite the internationally accepted recommendation that eating a diversity of foods leads to a healthy diet, and is associated with positive health outcomes such as reduced mortality, little information exists on what factors influence dietary diversity among women of reproductive age in Agago district.  The objective of this study is to determine dietary diversity among women of reproductive age (15-49 years) in Agago district.
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Can Smallholder Fruit and Vegetable Production Systems Improve Household Food Security and Nutritional Status of Women?

Authors: Nassul Kabunga; Shibani Ghosh; Jeffrey Griffiths April 2014
This paper aims to empirically infer potential causal linkages between fruit and vegetable (F&V) production, individual F&V intake, household food security, and anemia levels for individual women caregivers of childbearing age. Using a unique and rich data set recently collected from rural smallholder Ugandan households, we show that the use of a qualitative tool to measure household food insecurity is robust and applicable in other contexts. We also show, using robust econometric methods, that women living in F&V-producer households have a significantly higher intake of...
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Maternal food insecurity, anemia, and social support are independently associated with prenatal depression among HIV-positive and -negative women attending antenatal services in northern Uganda

Authors: Barnabas Natamba; Thomas Oyok; Sophie Mou; Shibani Ghosh; Rebecca Stoltzfus; Jeffrey Griffiths; Sera Young April 2014
Limited data exist on prenatal depression in in high HIV burden resource-poor settings. Population: 403 pregnant clinic attendees at Gulu Hospital, Uganda. HIV (+) women were oversampled in a ratio of 1 HIV (+): 2 HIV
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Cover Image: Research in Asia: Approach, Methods and Protocols

Research Briefing #14: Research in Asia: Approach, methods, And Protocols

Authors: Patrick Webb; Shibani Ghosh; Eileen Kennedy; K. West; Rolf Klemm; D. Sapkota; Swetha Manohar; Jeffrey K. Griffiths March 2014
At the 19th International Congress on Nutrition in Bangkok (in 2009), the United Nations’ Standing Committee on Nutrition concluded that “there is an urgent need to provide evidence- based information on food-based strategies and systems in order to make a case for their promotion. A series of scientific articles on food security interventions for nutrition should therefore be published to complement the public health interventions promoted by the Lancet Series [of 2008]. Sustainable food security approaches to nutrition require systemic, multidisciplinary and inter-sectoral approaches taking...
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Nutrition Innovation Labs Overview and Opportunities for Collaboration

Authors: Patrick Webb February 2014
Given as a webinar for USAID in February 2014, this presentation details the work and mission of the Nutrition Innovation Lab, why our work is important, and possibilities for collaboration with other Innovation Labs.
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Uganda Baseline Report: Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households.

Authors: Nutrition Innovation Lab October 2013
This report provides baseline and nationally representative data regarding nutritional and health issues in Uganda, particularly in terms of maternal and child health. Areas of assessment include livestock, malaria, aflatoxin exposure, water access, sanitation, and dietary information
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2013 Scientific Symposium Presentations

Authors: Nutrition Innovation Lab September 2013
AGRICULTURE, FOOD SYSTEMS AND, NUTRITION: CONNECTING THE EVIDENCE FOR ACTION CO-Hosted by Johns Hopkins Bloomberg School of Public Health, Department of Community Medicine and Public Health– Institute of Medicine & the Nepal Agricultural Research Council.  Akoto Osei  Impact of Homestead Food Production on Nutritional Status of Children and Women in Baitadi District, Nepal Ram K Chandyo  Socio economic status, food security and anemia among mothers in Bhaktapur, Nepal Shibani Ghosh  PoSHAN Process Research: Understanding Processes that Support Nutrition Program Impacts John Groopman Prevalence of aflatoxin...
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2nd Annual Scientific Symposium Proceedings, August 13-14, 2013

Authors: Raman Shrestha; Swetha Manohar; Rolf Klemm August 2013
The Nutrition Innovation Lab‘s 2nd Annual Scientific Symposium held in Kathmandu, Nepal on August 13-14, 2013 under the theme “Science and Policy for Health, Agriculture and Economic Growth” facilitated the sharing of new research findings along the agriculture to nutrition pathway.
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Nutrition Innovation Lab Annual Reports- Year 2

Authors: Nutrition Innovation Lab October 2012
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2012 starting October 2011 through September 2012 (“Y2”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Research Brief #6: Aflatoxin

Authors: Gerald Shively August 2012
This brief explains the sources of aflatoxin, its importance in nutrition-related research, and its effects on humans, animals, and economics
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Nutrition Innovation Lab Annual Reports- Year 1

Authors: Nutrition Innovation Lab October 2011
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2011 starting October 2010 through September 2011 (“Y1”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Association between household food insecurity and infant growth in rural Bangladesh

Authors: Muzi Na; Sucheta Mehra; Rolf Klemm; Parul Christian April 2011
Food insecurity is a global concern, yet its association with child growth is not fully understood. This study in rural Bangladesh explored associations between household food insecurity, using standardized questions, and infant growth. We asked a published 10-item, 6-mo household food insecurity questionnaire at 6 and 12 mo postpartum to 6,333 mothers participating in an antenatal micronutrient supplementation trial.
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