Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, Ontario, Canada.
Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
World Rev Nutr Diet. 2020;121:21-30. doi: 10.1159/000507499. Epub 2020 Oct 6.
Over the past decade, public health advocates and policymakers have grappled with the increasing issue of the double burden of malnutrition. Building on the Sustainable Development Goals and the United Nations Decade of Action on Nutrition, strengthening food systems is paramount to addressing hidden hunger, otherwise known as micronutrient deficiencies, and the provision of healthy, sufficient quality and quantity, affordable, safe, and culturally acceptable food. Using the UNICEF Innocenti Framework on Food Systems for Children and Adolescents as guidance, this review identifies four evidence-based food system strategies to drive improvements in micronutrient deficiencies in low- and middle-income countries in the context of school-aged children and adolescents: agriculture, food supply chains, food environments, and social behavioral change communication. With multiple players and drivers in the picture, strong and reliable oversight from national and local governments is required, through accountability, regulation, and sustained commitment to creating policies and proper infrastructure to support healthy food consumption and limit access to unhealthy food items. Moreover, given the complexity of hidden hunger, a holistic systems approach with a "right to food" lens is required to begin addressing and improving the diets and nutrition of children and adolescents. This involves synergistic and collaborative actions from all actors within the food system, as well as interactions with systems that have the ability to deliver nutrition interventions at scale. These systems include health, water and sanitation, education, and social protection. Only through partnerships and collaboration between all drivers, determinants, and key components of the food system, including its interactions with other global systems, will we be able to appropriately address hidden hunger in school-aged children and adolescents.
在过去的十年中，公共卫生倡导者和政策制定者一直在努力应对营养双重负担日益严重的问题。在可持续发展目标和联合国营养行动十年的基础上，加强粮食系统对于解决隐性饥饿（又称微量营养素缺乏症）以及提供健康、充足、优质、经济实惠、安全和文化上可接受的食物至关重要。本综述以儿童基金会儿童和青少年粮食系统框架为指导，确定了四项基于证据的粮食系统战略，以改善中低收入国家学龄儿童和青少年的微量营养素缺乏状况：农业、粮食供应链、粮食环境和社会行为改变沟通。鉴于有多个参与者和驱动因素，国家和地方政府需要进行强有力和可靠的监督，通过问责制、监管和持续承诺制定政策和适当的基础设施，以支持健康食物消费并限制不健康食物的获取。此外，鉴于隐性饥饿的复杂性，需要从“食物权”的角度采用整体系统方法来开始解决和改善儿童和青少年的饮食和营养。这涉及到粮食系统内所有行为体的协同和协作行动，以及与有能力大规模实施营养干预措施的系统的互动。这些系统包括卫生、水和环境卫生、教育和社会保护。只有通过粮食系统的所有驱动因素、决定因素和关键组成部分之间的伙伴关系和合作，包括其与其他全球系统的相互作用，我们才能妥善解决学龄儿童和青少年的隐性饥饿问题。
