IntroductionAs urbanization accelerates globally, towns and cities face increasing challenges in ensuring nutrition security for rapidly growing populations within complex and evolving local food systems. In low- and middle-income countries, urban food systems are often characterized by fragmented value chains, extensive geospatial flows of food, and a high degree of informality. These complexities are further exacerbated by climate change and infrastructural constraints, limiting the capacity of urban planners to effectively design nutrition-sensitive interventions. Despite this, there remains a lack of robust methodological tools to guide nutrition security planning in such contexts.MethodsThis paper presents the NutriShed Framework, a novel methodological approach developed through the NutriShed study in Ghana to map the origins, flows, and vulnerabilities of key micronutrients within urban food systems. The framework is illustrated through its application in two Ghanaian settings, Takoradi and Asesewa. Building on the foodsheds concept, the NutriShed Framework integrates dietary assessment, market system analysis, and geospatial techniques to track nutrient flows into, within, and out of urban areas. The approach is implemented through five stages: (i) identification of nutrient gaps among vulnerable population groups using dietary surveys; (ii) quantification of nutrient flows through assessments of markets, traders, and transport systems; (iii) spatial mapping of nutrient flows alongside food system infrastructure, climate risks, and production patterns; (iv) analysis of vulnerabilities in nutrient flows in relation to infrastructure and environmental factors; and (v) identification of nutrition-sensitive interventions using Geographic Information Systems to strengthen nutrient supply and food system resilience.ResultsThe detailed empirical findings generated from the application of the framework are reported in separate companion papers.ConclusionThe NutriShed Framework provides a systematic and scalable tool for understanding and addressing nutrition security within complex urban food systems. By integrating stakeholder engagement throughout the process, it offers practical pathways for informing policy, planning, and investment to enhance resilient and nutrition-sensitive urban food systems.

Understanding the barriers that women in rural, low-income settings face in acquiring nutrient-dense foods (NDFs) is fundamental to improving health. Most existing evidence comes from quantitative studies. However, complementary qualitative insights can deepen understanding of individuals' lived realities and inform contextually relevant strategies to address these barriers. We qualitatively examined how gender norms and other socioeconomic inequalities shape women's interactions with their market food environment for acquiring NDFs in rural Bihar, India's poorest and most undernourished state. We also considered men's experiences to understand gender differences in barriers. We sampled 12 villages across two districts (Bhojpur and Samastipur) and conducted 12 focus groups with women and 76 interviews with women and their spouses. A complementary survey was also conducted to contextualise our qualitative findings.The unaffordability of NDFs, caused by low income and high prices, was the main barrier to acquisition. This barrier was most pronounced for the poorest and was greatest during seasonal price spikes. Women faced unique affordability challenges due to their exclusion from markets, driven by restrictive gender norms that stigmatise their participation and view markets as unsafe spaces. Consequently, women relied on expensive local sources or travelled longer distances to more distant markets, diminishing food budgets. Affordability barriers for the poorest and lower-caste women were compounded by pay discrimination and gender norms that restricted women's livelihood opportunities. Our insights suggest that providing women with cash transfers, alongside the development of safer, more inclusive markets, could improve women's acquisition of NDFs and their nutritional health.

Healthy food choices are increasingly understood to be shaped by the everyday interactions between people and their environment. However, current efforts to monitor dynamic food environments in low- and middle-income countries are limited by a lack of globally applicable, context-specific measures that holistically capture diverse lived experiences within the same location. To address this, we utilise expert consultations and cognitive testing to develop the Multidimensional Food Environment Experience Questionnaire (MFEEQ) and corresponding Metric (MFEEM), constructed using the Alkire-Foster multidimensional framework, to quantify the favourability of local food environment experiences for the acquisition of healthy foods. The questionnaire was administered over two rounds to 1661 households in Hyderabad (India), East Lombok (Indonesia), and Kaffrine (Senegal), and evaluated for internal coherence, directional consistency and outcome sensitivity. The metric enables simultaneous comparison across eight food environment dimensions, spanning external and personal domains, multiple foods, seasons and geographical contexts (i.e., urban, peri-urban and rural settings). Results show that whilst dark-green leafy vegetables and chicken meat and organs are both socio-culturally desirable and convenient to acquire and prepare across all three study sites, common barriers relating to their lack of availability, affordability, hygiene, and limited promotional information persist. Food environment experiences are further found to be seasonally variable and spatially clustered, highlighting key opportunities for policymakers to target interventions towards specific times and locations. By operationalising a novel multidimensional metric, this study demonstrates the need to incorporate lived experiences into the measurement and monitoring of food environments to help create equitable food systems for all.

This study delves into the Knowledge, Attitudes, and Practices of vegetable handlers in Jashore Sadar, Bangladesh, specifically focusing on the crucial significance of food safety across the entire farm-to-fork process. Integrating quantitative and qualitative data provides a multifaceted depiction of this pivotal component within the food supply chain. Ten focus group discussions were conducted, and in total, 50 vegetable handlers were interviewed separately. In the survey, there were 17 questions on food safety knowledge, 16 on food safety attitudes, and 17 on food safety-related practices followed by vegetable handlers. We found that while approximately 60% of handlers had good knowledge about food safety, only about one-quarter of the interviewed vegetable handlers had good attitudes and practices toward food safety. The attitudes and practices of individuals involved in handling vegetables demonstrate a complex range of variations shaped by factors such as educational background, prior experience, and availability of food safety training. Concerns regarding the rising expenses linked to adherence to food safety regulations and a perceived lack of accountability among those involved were also noted. The interviewed wholesaler group reported that approximately BDT 100-150 (USD 0.91-1.371)/maund1 was incurred in maintaining proper safety practices, while the interviewed retailer group said costs would increase by BDT 20-40 (USD 0.18-0.36)/maund if they followed proper handling practices. It is important to note that vegetable handlers recognize the favorable economic consequences of implementing appropriate food safety measures. This study highlights the significance of implementing focused educational and policy interventions to address knowledge disparities and encourage the adoption of food safety procedures among individuals involved in handling vegetables.

As urbanization accelerates, towns and cities worldwide face the challenge of planning nutrition security for their growing populations, in the context of their local food systems. Urban food systems in low- and middle-income countries are often complex, with large geospatial spread in the flow of foods. This complexity is compounded by the frequently informal nature of the markets and value chains governing flows, and the changing climate. Urban planners could benefit from tools to plan their nutrition security in such settings, but there is little research on such methods and tools.Our study proposes a novel approach, NutriShed, to map the origins and flows of key micronutrients, and illustrates its application in two Ghanaian cities: Takoradi and Assesewa. Nutrished involves objectively identifying vulnerabilities within nutrient supply chains and food systems infrastructure as a means to unravel the flow of food into and through cities. The NutriShed approach is guided by a framework designed to track the spatial flows of essential nutrients into and out of the study communities, focusing on nutrient gaps, regional production deficits, and food system vulnerabilities. The NutriShed approach is structured in several stages: Stage I identifies nutrient gaps using dietary surveys of vulnerable population sub-groups. In stage II, quantifies nutrient flows by surveying food markets, traders, and food transport systems. Stage III utilizes geospatial tools to map nutrient flows and assess food system infrastructure and climate vulnerabilities. Stage IV examines nutrient flow vulnerabilities in relation to road density, climate risks, and infrastructure usage. Stage V identifies nutrition-sensitive interventions using GIS techniques to propose strategies for enhancing nutrient supply and bolstering food system resilience. Throughout the process, it is important to engage with relevant stakeholders to ensure participation and uptake of findings for planning and implementation.

This paper uses an optimisation model to quantify the necessary food consumption adjustments for Chinese diets to fulfil the requirements in the health-based Chinese Dietary Guidelines (CDG) or WHO dietary guidelines. We further aim to determine whether adopting these guidelines could lead to lower levels of greenhouse gas emissions (GHGE) while maintaining diet affordability. Modelling outcomes under the CDG and WHO scenarios differ significantly from nutritional, GHGE and diet affordability perspectives: relative to observed eating patterns, diets following the WHO guidelines are equally emissions intensive, while diets consistent with the CDG recommendations are less sustainable. Further optimisations imposing significant reductions in GHGE indicate important environmental and nutritional co-benefits can be achieved through the WHO guidelines, while maintaining diet affordability. In the WHO scenario, the maximum diet-related GHGE reduction policymakers could aim for is 30%, since above this threshold, recommended diets would deviate considerably from observed patterns. The CDG model with a 20% emissions reduction does not converge for 64% of the initial data set, casting doubt on the affordability and compatibility of the CDG with China's decarbonisation goal. We recommend that future versions of the CDG be reformulated to closer align with WHO advice and explicitly include environmental considerations.

BACKGROUND:Improving nutrition for all requires understanding how interventions influence nutrition inequalities within society. Intersectionality, which considers how multiple disadvantages intersect, may offer more precise insight into the equity of these interventions. OBJECTIVES:Using an intersectionality-informed approach and mediation with exposure-mediator interaction, we investigated how participation in nutrition-sensitive agriculture interventions tested in the UPAVAN trial affected inequalities in women's diets in Odisha, India. METHODS:We analyzed cross-sectional endline data from 3294 mothers of children aged 0-23 months in 111 UPAVAN intervention villages. We estimated dietary inequalities as excess relative risk of minimum dietary diversity (MDD-W) according to scheduled tribe (ST) identity (ST or non-ST), education (≥5, <5 y), or wealth (higher, lower) and comparing intersectional groups that combine ST/non-ST with education or wealth group. We used a 4-way decomposition to estimate whether these MDD-W inequalities were affected by social group differences in intervention participation rates (mediation only), participation benefits (interaction only), or both combined (mediated interaction). RESULTS:Intervention participation and MDD-W were greater among the more advantaged groups of non-ST, higher education, or higher wealth. Often, the more disadvantaged groups had greater participation benefits (interaction only), which narrowed MDD-W inequalities. However, intersectional groups with 2 disadvantaged characteristics (e.g., poorer ST) had smaller participation benefits than those with 1 disadvantaged characteristic (e.g., wealthier ST), which widened MDD-W inequalities. Differences in participation rates had negligible effects on MDD-W inequalities. Often, any marginal widening of MDD-W inequalities due to disadvantaged groups participating less (mediation only) was suppressed by their greater participation benefits (mediated interaction). CONCLUSIONS:To our knowledge, this is the first intersectionality-informed analysis of nutrition interventions. UPAVAN interventions mostly had equitable impacts, reducing several inequalities in maternal diet quality. We demonstrate how intersectionality-informed analyses can help identify inequities in nutrition interventions and inform the design of inclusive interventions that reach and benefit the most marginalized groups.

BACKGROUND:Inadequate access to affordable, safe, desirable and convenient nutrient-dense food is one of the underlying causes of child stunting. While targeted nutrition-sensitive interventions (eg, backyard 'nutri-gardens') may increase dietary diversity within farming households, such interventions have limited scalability across the wider food system where markets remain underdeveloped. This research aims to develop and assess market-based interventions for key nutrient-dense foods to help improve the diets of women and children in the first 1000 days of life. METHODS:Data collection uses four parallel approaches in each of the three study countries (India, Indonesia and Senegal). (1) A novel food environment tool will be developed to characterise the accessibility and affordability of nutrient-dense foods in the study countries. The tool will be validated through pretesting using cognitive interviewing and piloting in purposively sampled households, 10 (cognitive interviewing) and 30 (piloting) households in each country; (2) stakeholder interviews (eg, with producers, intermediaries and retailers) will be conducted to map out nutrition-sensitive entry points of key value chains (eg, animal-sourced foods), before hotspots of potential food safety hazards will be identified from food samples collected along the chains; (3) the Optifood and Agrifood tools will be used to identify foods that can address food system nutrient gaps and engage key stakeholders to prioritise market interventions to improve nutrition outcomes. Optifood and Agrifood parameters will be informed by publicly available data, plus interviews and focus groups with value chain stakeholders; (4) informed by the previous three approaches and a campaign of participatory 'group model building', a novel system dynamics model will evaluate the impact of alternative market-based solutions on the availability and affordability of nutrient-dense foods over time. ETHICS AND DISSEMINATION:The study has received ethical approval in the United Kingdom, Senegal, Indonesia and India. Dissemination comprises peer-reviewed journals, international disciplinary conferences and multistakeholder dissemination workshops.

Significant progress has been made in cereal production in Bangladesh due to an agricultural policy environment that prioritizes the productivity of staple crops over fruit and vegetables (F&V). However, many smallholder farmers remain poorly connected to markets, which may lead to a limited supply response of F&V that can reduce opportunities for sufficient intake in neglected, consumer-facing, smaller retail markets. To address this issue, aggregation schemes have been conceived that collect and transport F&Vs on behalf of multiple farmers. Given the volume of horticultural produce produced and the reliance on developed transport infrastructure, aggregation schemes tend to supply wholesale and urban markets rather than underdeveloped rural and isolated markets. To this end, we investigated how a particular aggregation intervention ('Loop') could potentially improve the distribution of F&V to smaller markets whilst improving farmer benefits. We used an innovative system dynamics modeling approach based on Loop`s aggregation services in Jashore, Bangladesh, and to identify the potential trade-offs between consumer outcomes in retail markets and farmer benefits. We find that combining aggregation with a quota at the smaller market, transport subsidy, and current price growth does not result in trade-offs between consumer purchases and farmers`benefits. However, combining aggregation with current price growth can increase demand without losing farmers`benefits. The findings emphasize that standalone and multiple market-oriented interventions generate broader win-win benefits to promote inclusive food systems.

Pesticide use in Bangladesh is disproportionately high in vegetable farming compared to other crops like cereals, pulses, and cash crops. This study delves into the knowledge, attitudes, and practices regarding pesticide use among vegetable farmers, focusing on the impact of a digital aggregation service implemented by Digital Green. Based on interviews with 120 vegetable farmers in the LOOP aggregation scheme and 120 non-LOOP vegetable farmers this study indicates that the farmers using the aggregation service have a moderately higher level of food safety knowledge. LOOP farmers scored higher in pesticide safety knowledge (67.83 %) compared to non-LOOP farmers (55 %). Regarding pesticide safety attitudes, LOOP farmers scored 17.39 %, while non-LOOP farmers 4.17 %, reflecting a generally poor attitude toward pesticide application. Regarding practices, 65.55 % of LOOP farmers adhered to scientifically sound methods, compared to 43.10 % of non-LOOP farmers. Although participation in the LOOP program significantly influenced farmers' pesticide-related knowledge, attitudes, and practices, this study still identifies the need for targeted interventions and training to improve food safety practices among both groups.

With the increasing likelihood of agricultural production failures under a warmer global climate, the importance of markets in providing access to nutrient-dense foods (NDFs) through trade is predicted to grow. However, regions with relatively poor access to markets and supporting infrastructures (e.g. roads and storage facilities) are potentially ill-equipped to deal with both short-term hydrometeorological hazards such as droughts and floods, and longer-term shifts in agricultural productivity. Despite the increasing focus upon markets within academic and policymaking circles, a regional-scale assessment of these potentially coexisting hotspots of vulnerability has not been conducted. We conduct a two-stage geospatial analysis integrating three publicly available datasets across the Indian states of Bihar, Chhattisgarh, Jharkhand, and Odisha. Combining the 2011 national census with the new PMGSY-GeoSadak database, we conduct nearest neighbour analysis to measure multidimensional market inaccessibility by: (i) distance from a settlement to its nearest village, town or city with a market, (ii) distance from a settlement to its nearest major road, and (iii) distance from a settlement to its subdistrict headquarters. We then correlate these measures with India’s only district-wise assessment of climate vulnerability to identify hotspots of market inaccessibility and climate hazards. We find that the three market access measures are spatially autocorrelated and positively interrelated at the settlement ( n = 129 555) and district ( n = 107) levels, meaning that settlements located further from their nearest market tend to experience poorer road connectivity and access to the subdistrict economic hub. Approximately 18.5-million people live in districts with relatively high climate vulnerability and relatively high and multidimensional market inaccessibility. Hotspots of coexisting vulnerabilities are also disproportionately populated by ‘Schedule Castes and Schedule Tribes’ (SC/ST) communities. The identification of coexisting hotspots has important implications for the development of equitable and resilient markets that bolster NDF access for climate vulnerable and nutritionally insecure populations.

Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to in fl uence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States ( n = 35) and India ( n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected ( n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed -method or interventional research was identi fi ed. Regression with interaction terms was the most prevalent method ( n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention -relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed -method research to identify speci fi c interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.

Poultry is one of the fastest-growing agricultural sectors in India and its demand is said to be rising. There is a perception that higher incomes, growing population, urbanisation, and increased productivity in the industry have influenced Indian poultry consumption. However, consumer surveys have shown that the average poultry consumption in India has remained low. With this in mind, the paper analysed household determinants of chicken and egg consumption within the Indian population, using two rounds of National Sample Survey data (1993-1994 and 2011-2012). By conducting a spatiotemporal analysis of household consumption and expenditure survey and by using truncated Double Hurdle and Unconditional Quantile regressions (UQR) models, this study explored socio-economic and food system determinants of chicken and egg consumption in India. Key results highlight that while consumption has increased marginally over twenty years, supply-side determinants, such as price and poultry production concentration, influenced heterogenous consumption patterns in India. We also find evidence that historically marginalised groups consumed more chicken and eggs in comparison to non-marginalised groups and preliminary evidence suggests how household gender dynamics influence different consumption patterns. Adequate consumption of poultry is important to improve nutrient-deficient diets of vulnerable groups in India. Our findings on demand side determinants of poultry products are crucial to support consumer tailored actions to improve nutritional outcomes along with the Indian poultry sector policy planning.

Objectives Sales of ultraprocessed foods (UPFs) and beverages are rising in low-income and middle-income countries. Such foods are often linked with weight gain, obesity, type 2 diabetes and hypertension—diseases that are on the rise in India. This paper analysed patterns in purchases of processed and UPF by urban Indian households. Setting Panel data from Kantar —Worldpanel Division, India for 2013 and 2016. Participants 58 878 urban Indian households. Methods We used K-mean partition clustering and multivariate regression to analyse patterns in processed food (PF) and UPF purchase for urban India. Results Three-quarters of urban Indian households purchased over ten PF groups. Mean per person annual PF purchase was 150 kg. UPF purchase was low at 6.4 kg in 2016 but had grown by 6% since 2013. Cluster analysis identified three patterns of consumption, characterised by low (54% of the households in 2016), medium (36%) and high (10%) PF purchase quantities. High cluster households purchased over three times as much PFs and UPF as the low cluster households. Notably, salt purchases were persistently high across clusters in both years (>3.3 kg), while sweet snack and ready-to-eat food purchases grew consistently in all clusters between 2013 and 2016. A positive and significant association was found between household purchases of UPF and their socioeconomic status as well as ownership of durables, such as refrigerator, colour television and washing machine (all p<0.001). Spatial characteristics including size of town (p<0.05) in which the household is located were also positively associated with the purchase of UPF. Conclusion Results suggest the need for tailored regional and city level interventions to curb the low but growing purchase of UPF. New data on obesity and rise of non-communicable diseases, the results are concerning given the links between lifestyle changes and the speed of urbanisation in Indian cities.

PurposeAgricultural aggregation schemes provide numerous farmer-facing benefits, including reduced transportation costs and improved access to higher-demand urban markets. However, whether aggregation schemes also have positive food security dimensions for consumers dependent on peri-urban and local markets in developing country contexts is currently unknown. This paper aims to narrow this knowledge gap by exploring the actors, governance structures and physical infrastructures of the horticultural value chain of Bihar, India, to identify barriers to using aggregation to improve the distribution of fruits and vegetables to more local market environments.Design/methodology/approachThis study uses mixed methods. Quantitative analysis of market transaction data explores the development of aggregation supply pathways over space and time. In turn, semi-structured interviews with value chain actors uncover the interactions and decision-making processes with implications for equitable fruit and vegetable delivery.FindingsWhilst aggregation successfully generates multiple producer-facing benefits, the supply pathways tend to cluster around urban export-oriented hubs, owing to the presence of high-capacity traders, large consumer bases and traditional power dynamics. Various barriers across the wider enabling environment must be overcome to unlock the potential for aggregation to increase local fruit and vegetable delivery, including informal governance structures, cold storage gaps and underdeveloped transport infrastructures.Originality/valueTo the best of the authors’ knowledge, this study is the first critical analysis of horticultural aggregation through a consumer-sensitive lens. The policy-relevant lessons are pertinent to the equitable and sustainable development of horticultural systems both in Bihar and in similar low- and middle-income settings.

Global broiler production and consumption levels continue to rise. South Africa’s broiler system is dominated by commercial production and formal retail trade, with competition from cheap imports. Local broiler policies have narrow, production-driven, short-term aims for industry growth and national food security. However, these have unintended consequences that undermine the system’s future sustainability. Using a food systems approach, this study developed a qualitative system dynamics model of the South African commercial broiler system and used it to engage stakeholders in policy discussions within the boundaries of health, nutrition, and environmental sustainability. A problem statement and key system elements were drawn from a previously published qualitative study and were validated by 15 stakeholders via an online questionnaire. From this, a seed model was developed, expanded into a larger model, and shared in a modular format with stakeholders in virtual meetings, on an individual or institutional basis, for feedback and validation, and for discussion of areas for policy consideration. Refinements were incorporated into the modules, policy considerations were summarised, and crosscutting issues were identified. The model demonstrated the system’s complexity, interlinkages, feedbacks, reinforcing and balancing loops, and behaviour archetypes. The modular presentation format created a suitable platform for stakeholder engagement. Current policies focus on local commercial production, formal markets, and affordability without cognisance of the broader system represented by the model. Inequality pervades throughout the system. Commercial producers, linked to large supermarkets and fast-food chains, dominate the system, presenting barriers to entry. Affordability is unintentionally traded off against non-communicable disease risks through brining of most frozen products, and ultra-processing of fast-food items. Foodborne disease control is critical, given the proportion of vulnerable individuals, and greater coherence of food safety policy is urgently needed. The environmental footprint of broilers, whilst less than that of ruminants, deserves closer scrutiny based on its dependence on intensive cereal production for feed. This study’s food systems approach provides a system-wide perspective and a foundation for policymakers to develop more integrated and transformative policies.