Econutrition and utilization of food-based approaches

for nutritional health

Tanya L. Blasbalg, Bram Wispelwey, and Richard J. Deckelbaum

Abstract Introduction

Background. Macronutrient and micronutrient defi- Food is the primary source of nutrients needed to
ciencies continue to have a detrimental impact in lower- sustain life, promote health and normal growth and
income countries, with significant costs in morbidity, development, and assure human productivity. For the
mortality, and productivity. Food is the primary source of world’s poorest people, who often live the closest to
the nutrients needed to sustain life, and it is the essential agricultural lands, this source is frequently inadequate
component that links nutrition, agriculture, and ecology to supply all nutritional needs. This paradox—that
in the econutrition framework. those who have the potential to grow the most food
Objective. To present evidence and analysis of food- are the most in need—has prompted the development
based approaches for improving nutritional and health of econutrition.
outcomes in lower-income countries. Econutrition integrates environmental health and
Methods. Review of existing literature. human health, with a particular focus on the interac-
Results and conclusions. The benefits of food-based tions among the fields of agriculture, ecology, and
approaches may include nutritional improvement, food human nutrition. Figure 1 [1] illustrates how adverse
security, cost-effectiveness, sustainability, and human interactions among health, agriculture, and environ-
productivity. Food-based approaches require additional ment are critical contributors to poverty in developing
inputs, including nutrition education, gender considera- areas. The vicious cycles that lead to loss of nutrients,
tions, and agricultural planning. Although some forms soil erosion, and decreasing biodiversity link into
of malnutrition can be addressed via supplements, food- environmental degradation and result in decreased
based approaches are optimal to achieve sustainable food production. Lack of food is associated with
solutions to multiple nutrient deficiencies.

Loss of nutrients and biodiversity

Key words: Development, econutrition, food-based Increased soil erosion
approach, food fortification, hidden hunger, lower-
income countries, micronutrient deficiency, nutrition, Agriculture Environmental
supplements, sustainability Poor management degradation

Richard J. Deckelbaum is affiliated with, and Tanya L. Blas-

balg and Bram Wispelwey were formerly affiliated with, the
Institute of Human Nutrition, Columbia University College
of Physicians and Surgeons, New York, New York. Decreased Declining
Please direct queries to the corresponding author: Richard labor productivity food productivity
J. Deckelbaum, Institute of Human Nutrition, Columbia Uni-
versity College of Physicians and Surgeons, 630 West 168th Malnutrition, illness
Street, PH 1512, New York, NY, 10032, USA; e-mail: rjd20@
columbia.edu. FIG. 1. Interrelationships among malnutrition, agricultural
Financial support for this paper came from the Institute
of Human Nutrition. None of the authors have any conflicts mismanagement, and environmental degradation, dem-
of interest. Tanya Blasbalg drafted the manuscript, Bram onstrating the necessity of utilizing econutrition-based
Wispelwey contributed research and writing, and Richard solutions. An interdisciplinary approach is critical for the
Deckelbaum wrote the initial outline and reviewed and edited implementation of successful interventions. Reprinted with
all drafts of this paper. permission from Deckelbaum et al. [1]

S4 Food and Nutrition Bulletin, vol. 32, no. 1 (supplement) © 2011, The United Nations University.
Econutrition and utilization of food-based approaches S5

malnutrition, illness, and especially with declining adequate calorie consumption and a diverse intake of
labor productivity, which exacerbates poor agricultural micronutrient-rich products. This choice inevitably
management. alleviates acute hunger, but it also exacerbates micro-
From an econutrition perspective, undernutrition nutrient deficiencies and their costs in mental and
is best solved through local, ecologically sustainable, physical growth.
biodiverse agriculture. Although such an approach These micronutrient deficiencies remain endemic
is sound in theory, evidence is scarce due to the chal- in many developing countries. Almost one-third of
lenges of assessing the multiple input variables required children in lower-income countries suffer from some
for a comprehensive program. However, critical pieces level of vitamin A deficiency [10]. In Mozambique, the
of the econutrition model can be evaluated independ- prevalence of vitamin A deficiency is as high as 71%
ently to understand each sector’s contribution to the in children 6 to 59 months of age [11]. Iron deficiency
whole. Each chapter in this Supplement of the Food is recognized as the most common deficiency in the
and Nutrition Bulletin deals with a critical link in the world: one-half of pregnant women are anemic, along
econutrition model: agrodiversity, biofortification of with one-third of school-age children [10]. Iodine
crops, enhancing the bioavailability of critical nutrients, deficiency remains a problem in 54 countries, affecting
ecological agriculture, and the socioeconomic/behav- an estimated 2 billion people worldwide [12, 13]. Zinc
ioral aspects of nutrition decisions. The goal of this deficiency is responsible for over 450,000 deaths a year
chapter is to assess whether one key aspect of the eco- [14]. In total, over 40% of the world’s population suffer
nutrition model is viable: can food-based approaches from micronutrient deficiencies [15].
provide adequate nutrients to the undernourished in In The Fifth Report on the World Nutrition Situation,
lower-income settings? the United Nations Standing Committee on Nutri-
tion acknowledges not only that nutrition is essential
for improving hunger and poverty measures, but
The costs of undernutrition that it “is also an instrument to achieve other MDGs
[Millennium Development Goals], especially those
With the improved seed technologies of the Green relating to improvements in primary education enroll-
Revolution, agricultural and food-based approaches to ment and attainment, gender equity, child mortality,
malnutrition since the 1960s have focused on provid- maternal health, and an ability to combat disease” [2].
ing sufficient calories to populations in the developing The systemic impact of nutrition is due to the role of
world through the increased production of staple crops. nutrients in the physical processes that preserve health
Food consumption on a global basis increased from and ensure proper growth and development, with long-
2,280 kcal/person/day in the early 1960s to 2,800 kcal/ lasting effects on immunity, cognition, and behavior.
person/day in 2003 [2]. The proportion of undernour- Adequate nutrition is necessary to reduce the spread
ished people in developing countries decreased from of contagious diseases. Vitamin A plays such a critical
37% in 1969–71 to 17% in 2002–04 [2]. In all areas role in immunity that eliminating its deficiency has
of the world except Africa, the rates of underweight, been predicted to reduce the global burden of disease
stunting, and wasting among children under 5 years among children by 16%][16]. Zinc deficiency contrib-
of age decreased between 1990 and 2005 [2]. Indeed, utes to increased death from pneumonia, malaria, and
a calories-focused approach to dealing with hunger diarrheal disease [14]. Iodine-deficiency disorders—
has achieved a great deal of success in poor countries, including goiter, hypothyroidism, and cretinism—may
and an excess of available calories in urban areas is result in miscarriage, stillbirth, stunted growth, and
associated with a new set of health threats related to brain damage [12, 17]. Deficiencies in calories, essen-
obesity [3–6]. tial amino acids, essential fatty acids, iron, iodine, and
The success of the Green Revolution, however, is zinc have been shown to limit IQ, influence mood and
not without unintended consequences for those with behavior, and reduce worker productivity [1, 10, 12,
the lowest incomes. Whereas agricultural policy has 17–26]. Adults who were fed a nutritious supplemen-
concentrated on macronutrient sufficiency, dietary tary food while growing up in a Guatemalan village
diversity has often decreased, resulting in decreased earn 46% more than their counterparts who were fed a
availability of micronutrients [7]. Cereal produc- less nutritious food [27]. Even in the absence of severe
tion in South Asia has quadrupled since 1970, yet signs of clinical deficiencies, such as goiter and night-
micronutrient-rich pulse production has declined blindness, the “hidden hunger” of chronic malnutrition
by 20% [8]. The relative prices of vegetables, fruits, leads to compromised growth, cognitive development,
and meats have increased during the same period immune function, reproductive performance, and work
that staple prices have fallen, allowing for a situation productivity [28].
where achieving a diverse and adequate diet becomes In aggregate, these productivity losses influence
increasingly difficult for many people worldwide [9]. national economies. Whereas the prevalence of severe
As a result, the poor are often forced to choose between intellectual disability (IQ under 55) is from 2 to 5 per
S6 T. L. Blasbalg et al.

1,000 in high-income countries, it is from 5 to 22 per absorbable, as the presence of other food constituents
1,000 in lower-income countries, due in large part to often increases the availability of nutrients in ways
malnutrition [21]. The World Bank found that anemia that are not fully understood [32]. Supplementation
in women will result in agricultural productivity losses with high doses of isolated nutrients can mask or
in Sierra Leone reaching nearly $100 million over the even precipitate deficiencies in other nutrients [32].
course of 5 years [16]. In 1990, 46 million years of For instance, folic acid supplementation can improve
productive, disability-free life were lost, the result of vitamin B12 anemia while vitamin B12 dementia from
lost social productivity caused by four types of malnu- preexisting deficiency goes untreated and can even
trition: stunting and disorders related to iodine, iron, cause vitamin B12 deficiency by diverting cobalamin
and vitamin A deficiency [29]. In some developing from the central nervous system to the hematopoietic
countries, 3% of gross domestic product (GDP) every system. Food provides a number of health-promoting
year is lost through productivity losses resulting from constituents, many of which have actions that are not
stunting and from deficiencies in iodine and iron [29]. yet fully defined and are therefore difficult to add in
Overall, the insidious cycle of malnutrition results in supplementation or fortification approaches [30]. A
increased neonatal and infant mortality, decreased food-based approach reduces the risks of nutrient tox-
mental and behavioral performance for those who icity (particularly in the case of vitamin A, vitamin D,
survive past 5 years, and increased risk of adult chronic and iron) and diminishes adverse interactions that are
diseases, thereby entrenching productivity losses introduced by supplementation and food fortification
for local communities and national economies [30]. [30]. Diets can be tailored to meet individual needs
Although morbidity and mortality rates are dropping by varying portion size, rather than supplement dose,
in the developing world, there are still significant as long as access within the household is equitable. A
nutritional barriers preventing these countries from diverse diet is more palatable, often making it easier to
achieving their full potentials. meet energy needs as well as nutrient needs, and food
preservation techniques can be used to make food
readily available throughout the year. Proper use of
The rationale for food-based approaches local foods may be met with greater receptivity than
pills, drops, and Sprinkles. By focusing on food groups
Focus on food rather than single nutrients, sufficiency in several
micronutrients and macronutrients can be met at once.
There are several methods for dealing with micronu- Food-based dietary guidelines that are based on local
trient deficiency in low-income settings, divided into foods and scientific rationale already exist in many
the broad categories of nutrient supplementation and countries but are generally underutilized [30].
food-based approaches. The latter encompasses food
fortification, food supplementation, and agricultural Focus on agriculture
empowerment (especially through home gardens),
whereas the former includes supplementation of single Agrodiversity is a key component of an econutrition
nutrients using pills, sprays, and Sprinkles. approach to malnutrition. A biodiverse agricultural
Single-nutrient supplementation was developed system should provide a nutritionally diverse diet to the
at a time when nutrition was a reductionist science local community as long as there are no economic or
whose parts were considered in isolation. But today, social factors impeding consumption of the food that
just as ecology, physiology, and economics are viewed is grown. In the short run, it is advisable to integrate
as systems, nutrition is considered a complex of syner- supplementation, food fortification, and agricultural
gistic parts, with complexities that are far from being food-based approaches, given the instant impact but
completely understood. Although the full scope of sustainability problems of the first two and the time
the interactions between nutrients and various food lag during a transition to the third [35]. However, a
factors is not known, many studies of single-nutrient complete transition to local food independence for the
supplementation have proven inconclusive, and current poor should be a long-term goal.
research suggests that the benefits of proper nutrition Agriculture is an ideal target for intervention, for a
can only be seen with intact foods, when measuring variety of reasons. Nearly two-thirds of hungry people
overall diet quality [31, 32]. Furthermore, most micro- worldwide are farmers and pastoralists living in Asia
nutrient deficiencies can be resolved with relatively and Africa [36]. Therefore, agricultural interventions
small increases in the variety of food consumed [1], target those who need them those most, using the
as confirmed by studies showing that greater dietary tools that are most accessible to them. GDP growth
diversity is associated with improved growth and originating in agriculture is at least twice as effective
micronutrient status [1, 33, 34]. in reducing poverty as GDP growth originating out-
Nutrients from food are often superior to those side the sector [37]. A stable, local agriculture is less
from supplements. They can be more bioavailable and vulnerable to economic and political instability than is
Econutrition and utilization of food-based approaches S7

the infrastructure required to disperse nutrient supple- be a hub for education services focused on nutrition,
ments or food aid and oversee fortification programs women’s empowerment, and improving literacy, while
[38]. Evidence from a 10-country analysis suggests that teaching agricultural techniques.
dietary diversity is a useful indicator of food security Although household income generation is not often
[33]. The most severe forms of malnutrition often an intended outcome of agricultural interventions
result from inequitable food distribution policies or are designed to improve human nutritional status, it is a
the result of natural disasters or civil unrest [28]. South substantial benefit noted in multiple sub-Saharan Afri-
Africa, for example, produces enough food to feed the can studies that increases food-purchasing power for
entire nation, yet 35% of its people are food insecure program participants [46–50]. Often just months after
[39]. The macroeconomic and policy causes of malnu- the introduction of new crops designed to address one
trition can best be dealt with by providing local alterna- or multiple micronutrient intake levels, novel markets
tives to the larger system. Rather than perpetuating a appear spontaneously [47]. In a Mozambique interven-
dependency on foreign aid, agricultural interventions tion, the newly introduced orange-fleshed sweet potato
promote self-sufficiency and food security in develop- not only became a popular plant to grow and sell but
ing countries [40]. As for hunger in the event of natural soon became the least expensive source of vitamin A in
disasters or civil unrest, emergency food aid may be the local markets, which allowed nonintervention house-
only solution, but such programs would be enhanced holds to access the food cheaply as well [11].
by greater crop diversity in local markets.
Affordability
Economic growth is not enough
Although food-based nutrition programs often require
Some argue that improving GDP is sufficient to multiple inputs, especially when introducing animal
improve the nutritional status of a population [41]. husbandry projects, many successful agricultural
Although economic growth has been correlated with food-based approaches to improving nutrition have
increased productivity and reduced hunger on a been cost-effective, with multiple and far-reaching
national level, cross-country studies of developing outcomes. Although donors and governments have
countries have shown that economic growth alone, traditionally been drawn to faster results, returns on
without any hunger-reduction measures, can leave programs designed to improve nutrition have consist-
behind large vulnerable populations, particularly in ently outweighed their costs. Community-based crop
rural areas [10]. Approximately 70% of the poor in growth promotion has been estimated to be up to 100
developing countries live in rural areas and depend times as cost-effective as direct food supplementation
on agriculture for their livelihood [42]. These rural [16]. Nutrition education is also 14 to 69 times less
poor need not wait for their national economies to expensive than direct food supplementation, and it has
experience boons—indeed, many countries that have been shown to have excellent results in the absence of
successfully reduced hunger have done so without high any other form of intervention [10, 16, 38]. In China,
national growth rates [43]. preventing micronutrient deficiencies will be worth
anywhere from US$2.5 to US$5.0 billion annually
Targeted intervention, systemic effects in increased GDP [16]. In addition, it is difficult to
quantify all the indirect outcomes of community-based
Econutrition represents the evolution of nutrition food interventions, including empowerment of women,
toward a systems-model approach. The focus of eco- community ownership and self-determination, simul-
nutrition goes beyond food and nutrients to encompass taneous addressing of multiple nutrients, and potential
goals like healthy weight, normal growth and develop- for long-term sustainability with the improvement of
ment, disease prevention, productivity enhancement, agriculture and building of markets.
food security, community support, and, ultimately,
the development of impoverished nations. A key way
of achieving this is through agricultural food-based Recommendations for food-based
approaches. Improved nutrition is just one outcome approaches
of a well-designed agrodiversity program. An agrodi-
verse food system can be highly sustainable and well Although food-based approaches to micronutrient
protected from environmental fluctuations through deficiency are supported by sound theory [10, 51],
improved disease and pest resistance [44, 45]. Develop- not all such interventions have been successful. These
ing an ecologically sound agricultural system optimizes failures are often due to non-food-related causes of
reliance on national resources in the developing world malnutrition. For instance, adequate dietary intake
while also putting a halt to the vicious cycle of environ- is rendered irrelevant when parasites and diarrheal
mental deterioration that has consequences in numer- disease, which are intractable in the absence of clean
ous sectors of public welfare. Such programs can also drinking water, prevent absorption of nutrients. In a
S8 T. L. Blasbalg et al.

2002 review of all available agrodiversity–nutrition whether or not a household suffers deficiency can
projects, the Programme for Appropriate Technology depend not only on the food provider’s knowledge of
in Health Canada noted that the success of 40 different the type and quantity of food that should be eaten, but
agricultural interventions depended on the number of also on the combinations and cooking methods applied
different capital investments made in addition to the to a meal [54].
one designed to directly improve agrodiversity. The Iron poses a particular challenge to food-based
types of capital described by the group’s Sustainable interventions because it is difficult to achieve adequate
Livelihoods Framework included physical, natural, absorption of the nonheme iron found in plant foods.
financial, human, and social sectors [52]. In short, The low absorption rate of nonheme iron is further
a variety of areas must be simultaneously addressed compromised by inhibitors such as phytates, tan-
in order for the nutrients produced in a local food nins, and certain dietary fibers, which are common
economy to reach their intended recipients [52]. These in iron-rich foods [38]. Phytic acid intake levels can
considerations are discussed below and summarized be reduced by limiting the number of high-phytate
in table 1. foods consumed in a meal; by consuming iron and
zinc sources with vitamin C–rich foods, which counter
Dietary design the effects of phytate; and by subjecting high-phytate
foods to lactic acid fermentation or sprouting, which
Nutrient adequacy can most readily be attained by also counteracts phytic acid [34, 55, 56]. The same
including meat and animal products in the diet. Animal problem applies to zinc; although legumes contain
foods are a rich source of protein, essential fatty acids about 50% of the concentration of zinc that is found
(especially fish), highly absorbable heme iron, the in meat, only about 15% of this zinc can be absorbed
highly absorbable retinoid form of vitamin A, zinc, because of the high phytate content of these foods [57].
vitamin D, and vitamin B12 [53]. A well-designed agri- The viability of meeting vitamin A requirements with
cultural intervention includes an animal husbandry a vegetarian diet has been contested, particularly after
and/or aquaculture component that is unimpeded by it was found in the mid-1990s that the provitamin A
local taboos forbidding meat consumption. However, carotenoids found in vegetable-source foods are only
livestock require greater financial, land, and resource half as biologically active as previously suggested [10,
investment, and meat-eating is proscribed in certain 34]. Several recent feeding trials have shown either
communities, making it difficult to incorporate this significantly increased serum retinol concentrations
rich source of nutrients into most interventions [34]. or improved vitamin A status after feeding β-carotene-
In the absence of fish, meat, eggs, and dairy prod- rich foods to deficient subjects for short periods of
ucts, all nutritional needs can be met by cereals, leg- time [58–63]. This has been achieved by using highly
umes, and vegetables, but an education component nutrient-dense local foods and by consuming these
is important to such interventions. The availability of foods with some fat, which has been shown to increase
micronutrients from vegetarian sources can be greatly vitamin A absorption [10].
influenced by how the food is processed and consumed; In addition to home processing, agricultural
advancements involving both the oldest and the newest
TABLE 1. Strategies to coordinate nutrition, agriculture, and crops are expected to improve the nutritional value of
ecology vegetarian diets in the future. Recent studies on indig-
» View agriculture as a managed ecosystem, rather than a enous crops have revealed that many local vegetables
production factory can provide a nutrition windfall [64]. For instance,
» Agricultural policy to promote and support home gar- African leafy vegetables have been found to account for
dens, small livestock production, agroforestry, aquacul- a sizeable percentage of vitamin A consumption among
ture, and the like the rural poor [54], and these plants are also proving
» Train a variety of extension workers from different dis- to be high in antioxidants [9]. Ironically, although sub-
ciplines in nutrition promotion Saharan Africa suffers the greatest rates of hunger and
» Agriculture and health extension workers can reinforce malnutrition, it also has many exceptionally nutrient-
nutritional messages and help draw links among agri- dense native fruits and vegetables that are underutilized
culture, nutrition, and health [65]. Combining these highly nutrient-dense foods
» Farm school: education programs for both agricultural with the proper processing techniques would result in
techniques and food processing very high-quality diets. As the gap in scientific knowl-
» Education on the benefits of food combined with edge regarding these plants narrows, the opportunities
changes in food storage and agricultural techniques to to design interventions that provide the greatest benefit
increase household nutritional status by relying on the most local, and culturally empower-
» Education on the benefits of food combined with ing, resources continue to increase [9]. Furthermore,
changes in food storage and agricultural techniques to biofortified crops that are bred or engineered to contain
increase household nutritional status
fewer iron and zinc inhibitors (such as low-phytate
Econutrition and utilization of food-based approaches S9

corn) or high concentrations of provitamin A (such as purchased with the fishing income did not resolve the
Golden Rice) are poised to have a sizeable impact on participants’ nutritional insufficiencies [68, 69].
the health of the poor, as discussed in another chapter
in this Supplement [66]. Gender considerations
There remains one nutrient that cannot be supplied
through a combination of agriculture-based initiatives: Intrahousehold dynamics pose a substantial barrier
iodine. The amount of iodine in a food system is lim- to the effectiveness of agricultural food-based inter-
ited by the amount available in the soil, which cannot ventions. Women and girls in the developing world
be enhanced with fertilizer or ecological agricultural often receive smaller portions of nutrient-dense food,
techniques. Salt iodization has been found to be the and with less frequency, than their male counterparts,
only effective way to ensure adequacy for the world’s selectively increasing the risk of micronutrient defi-
populations [12, 13]. Other required nutrients for ciencies among women and their offspring [30, 70, 71].
health can be found in sufficient quantities in diverse Although it is not possible to regulate intrahousehold
vegetarian diets [34]. food delivery, gender considerations in food-based
interventions that increase women’s control over the
Year-round food security family’s food resources and decision-making have
been shown to improve nutritional outcomes for the
Food-based interventions have been criticized for their whole family [52]. In a follow-up to a home gardening
failure to provide year-round food security in the event intervention in Bangladesh, women who had been or
of seasonal shifts and unforeseen droughts and other were currently involved in the project were more likely
natural disasters. It is difficult to secure a constant food to have year-round gardens, greater vegetable intake,
supply when dealing with the small number of staples and more gardening income [72]. The influence of
typical of undiversified farms. Such systems are highly these women in household decision-making increased
susceptible to environmental conditions and have no in a “dose-dependent” manner based on how long
backup when a major crop fails. Home gardens and they had been involved in the project [72]. It has been
small land plots provide the ability to grow numerous posited that home gardening may be the only source
seasonal plants throughout an entire year. Enhanced of income for many poor women, playing a major role
preparation and storage techniques can further secure in self-sufficiency and empowerment [73]. A balance is
a year-round supply. needed to ensure that while women have more control
over household food and agriculture sources, they do
Education not compromise their young children’s well-being by
being frequently absent [30]. The few studies that have
Although the hurdles of proper dietary design and food measured the impact of home gardens on production,
processing may make food-based interventions more income, and women’s control over income have found
challenging, the inclusion of a strong nutrition educa- positive increases in each of these measures [38].
tion component will help to address them [38]. One
review observed that home garden programs had an Reaching the landless poor
impact only when paired with education and/or social
marketing campaigns [38], and others have found that Strictly agriculture-based interventions risk further
nutrition education alone may be sufficient to improve marginalizing society’s most underprivileged—the
nutrition [10, 67]. In this way, the landless poor can landless and the urban poor. Many interventions have
learn to make appropriate choices in local markets to addressed this concern by building communal plots.
meet their nutrition needs. Agricultural interventions Although requiring greater financial input, these
are still necessary, however, to improve the options communal lands serve multiple purposes; they can be
available in local markets, to ensure the independence experimental plots for testing new agricultural ideas,
and sustainability of farming communities, [39] and, training grounds for local farmers and home gardeners,
with education, to promote high-yield environmental and sources of food for the landless and the poorest of
farming techniques. the poor. In a Malawi project, some villages used com-
In addition, agricultural interventions that improve munal plots to distribute seeds and food to the most
financial capital, such as cash crop production, can food-insecure households in the community, a spon-
ultimately decrease micronutrient availability if too taneous development that had not been an intended
much food is sold rather than locally consumed and outcome [50]. In addition, greater availability of diverse
income is directed toward nonfood expenses. An foods on a household level provides more options in
intervention implementing fish ponds in Bangladesh local markets, allowing those who may not be involved
found that teaching a person to raise and catch a fish is in farming to have affordable, nutritionally adequate
not enough; one must learn to eat that fish rather than options. As reported above (“Targeted intervention,
selling it at the market. In this intervention, the food systemic effects”), in an intervention in Mozambique,
S10 T. L. Blasbalg et al.

orange-fleshed sweet potatoes not only became a popu- the principal impediment [9]. Some barriers to food-
lar plant to grow and sell, but soon became the least based approaches are summarized in table 2.
expensive source of vitamin A in local markets, which As the price of food continues to increase substan-
allowed nonintervention households to access the food tially, and coming years promise greater diversion of
cheaply [11]. It is through a focus on agriculture that land for the production of biofuels [79], the importance
dietary benefits can most effectively reach the broader of using local foods for achieving nutritional adequacy
community. is becoming increasingly recognized. In order to
In conclusion, any food-based intervention can improve the nutritional status of individuals and popu-
benefit from home gardening with a strong educa- lations, cultural, agricultural, economic, and social
tion and/or social marketing component, preferably conditions must be better integrated. An important
complemented by small-animal husbandry and/or consideration underlying agrodiversity interventions
fish ponds. A multidisciplinary approach will ensure is that since many nutrient deficiencies are concur-
that households have an adequate supply of micronu- rent and interrelated, solutions must be integrated as
trient-rich foods and have the knowledge to use them well. Careful consideration of the interrelationships
appropriately. Without an education component, those between nutrition and human health, agriculture and
participating in food-production programs may turn food production, environmental health, and economic
the products of their gardening and husbandry into development is of fundamental necessity for adequately
profits that may not be used to improve dietary diver- addressing the ecological and nutritional problem of
sity. It is important to make an impact on knowledge, the world’s poor. Vertical, narrow interventions have
attitude, and practices to motivate householders to keep often failed to acknowledge this reality, which may
high-value crops and animal products for themselves. in part be responsible for the very slow success of the
United Nations Millennium Development Goals. As
Per Pinstrup-Anderson, the Director General of the
Conclusions International Food Policy Research Institute, stated,
“Coordination between sectors is crucial. Multidiscipli-
The relationships between agricultural interventions nary teams must join together to design and implement
and improved nutritional outcomes have been dis- global strategies to attack the problem in a sustainable
cussed continually over the past three decades [74–76]. way” [80].
Although it seems logical that improved access to
a greater diversity of foods would increase nutrient TABLE 2. Potential barriers to food-based approaches
consumption, the efficacy, cost-effectiveness, and
» Food availability
long-term sustainability of such programs have been
» Access to diverse foods
difficult to prove. As more recent evidence is published,
however, the potential impact of food- and agriculture- » Cost
based approaches is being considered more and more » Sociocultural factors
favorably [10, 52]. Although there is a lack of data on » Difficulties in achieving adequate intakes of some
micronutrients (e.g., iodine, folate, iron)
the long-term efficacy of agrodiversity interventions,
there are large-scale projects in Bangladesh, Mozam- » Bioavailability of certain nutrients
bique, and elsewhere that have achieved great success » Requirements for safe food storage
[77, 78]. Although some would still argue that the lack » Food contamination with infectious agents and/or toxic
of scientific data on food-based approaches is hamper- compounds
ing project development [10], there are others who cite » Resistance to different textures and flavors
a dearth of political and organizational commitment as » Competition with new/introduced processed foods

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