General comments
The structure of the V0 report is fully adequate due to the four chapters and subentries. So is the Conceptual framework and the five Definitions and extended concepts. The Introduction (page 9) quite precisely outlines the present frame of the report.
Specific comments
1 APPROACH AND CONCEPTUAL FRAMEWORK
1.1: Definitions 1, 2 (sustainable) and 3 (F. environments) are sequentially necessary, but reading one after the other one perhaps gets the impression of redundancy.
1.2: FS Typologies are very important because of the different food environments. To whom will this be addressed?
2 THE BURDEN
Due to my medical background and nutritional path I’ll concentrate on the triple burden of the adequate approach given to the malnutrition term.
2.1 When considering Undernutrition I would only like to make two comments. The first is related to the evaluation of anthropometric measurements, maybe it would be worth suggesting a proved general standard, such as the one by Cole or CDC, WHO because of its design would be the third option. The second is that when considering stunting (and obese stunted children), the easy calculated target height should be attempted in order to evaluate more precisely the causes of height reduction.
2.2 Overweight & Obesity. It is ok for adults. Because of the firm tracking from childhood to adulthood and the poor therapeutic results in all ages, the pediatric approach should be particularly stressed, as the World Heart Federation has signaled since 2004. This, furthermore due to the presence already in children of obesity comorbidities (1)
2.3 Micronutrient Malnutrition, causes and consequences. Perhaps it would be worth adding a 2.3.4 entry for zinc
2.3.4. Other important micronutrients. For further versions I would consider the importance of essential amino acids (EAA), because in LMIC the amount of protein intake is less worrisome nowadays, but the quality does matter. The deficiency in lysine and tryptophan (2, 3) have clinical consequences that should be avoided. Deficiency of all EAA is also associated with stunting (4).
4 GARNERING QUALITY DIETS FROM SUSTAINABLE FOOD SYSTEMS
4.1.2. Food value chains and Food environments affect nutrition and diets. Figure 27 (page 68) depicts precisely the value chain for nutrients. In this context one option for dry LMIC will be to get complete proteins from plants. Mixing flours (5, 6) of chickpeas and sorghum (~20/80%) could be an issue until transformed seeds could be available.
REFERENCES
- Moya M. Lysine genetically enriched cereals for improving nutrition in children under 5 years in low- and middle-income countries. J Nutr Health Food Eng 5(2): 00164. DOI: 10.15406/jnhfe.2016.05.00164.
- Moya M. Fatty Liver Disease among Other Comorbidities Requiring Early Diagnosis in Pediatric Obesity. Obes Control Ther 2013; 1(1), 02. http://symbiosisonlinepublishing.com/obesity-control-therapies02.pdf.
- Moya M. Low tryptophan chronic intake present consequences. BAOJ Pediatrics 2016 (In press)
- Semba RD. Trehan I, Gonzalez-Freire M, Kraemer K, Moaddel R, Ordiz M. Perspective: The potential role of essential amino acids and the mechanistic target of rapamycin complex (mTORC1) pathway in the pathogenesis of child stunting. Adv Nutr 2016; 7(5) 853-65.
- El-Adawy TA. Nutritional composition and antinutritional factors of chickpeas (Cicer Arietinum L) undergoing different cooking methods and germination. Plant Foods Hum Nutr 2002; 57(1): 83-97
- Suri DJ. Tano-Debrah K, Ghosh SA. Optimization of the nutrient content and protein quality of cereal-legume blends for use as complementary foods in Ghana. Food Nutr Bull 2014; 35(3): 372-81
Manuel Moya