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    • Lo and colleagues also add to the evidence that

    2019-07-01

    Lo and colleagues also add to the evidence that MDA might need to be widened beyond school-aged children (5–14 years). Different frequencies of treatment are known to be needed for communities with different intensities of infection, but less appreciated is that different age groups need to be treated for different circumstances, particularly with the aim to stop transmission of infections. Lo and colleagues\' results suggest that widening coverage to additional age groups could be highly cost effective in terms of disability-adjusted life-years averted, motivating wider treatment programmes for effect rather than purely for the aim of local elimination.
    Inadequate dietary zinc contributes to stunting in young children, which WHO identifies as “one of the most significant impediments to human development”. Stunting\'s long-term effects include “diminished cognitive and physical development, reduced productive capacity and poor health, and an increased risk of degenerative diseases such as diabetes”. In , Samuel Myers and colleagues estimate that 138 million additional people will be at risk of zinc deficiency in 2050 on the assumption that elevated atmospheric carbon dioxide (CO) concentrations lower the zinc content of key food crops. The paper postulates that the biggest increases in zinc deficiency will occur in regions where the contribution of staple crops to the diet is highest—south Asia and sub-Saharan Africa; these regions currently have the world\'s highest prevalence of stunting. Myers and colleagues point out that, whereas wealthier people will be responsible for most of the projected increases in CO emissions, people with lower incomes will bear the brunt of the resulting zinc deficiency, making this cox pathway an issue of social justice. The study makes an important contribution to our knowledge of the effects of climate change on human nutrition. However, we do find that certain aspects are problematic. First, Myers and colleagues indicate that there is evidence that elevated CO concentrations will also mean reduced iron and protein content in key food crops. The paper\'s single-nutrient focus and policy recommendations are not in keeping with current best practice. The 2014 Rome Declaration on Nutrition, endorsed at the Second International Conference on Nutrition, summarises this ethos, calling for a holistic approach to “the elimination of malnutrition in all its forms”, with “nutrition policies [that] promote a diversified, balanced, and healthy diet at all stages of life”. Second, despite the paper\'s emphasis on social justice, its policy recommendations (zinc supplementation, fortification of staple foods, application of zinc-containing fertilisers to food crops, biofortification of staple crops, and cross-breeding of staples with varieties with less nutritional sensitivity to rising CO levels) are all top-down in nature. A rights-based approach to addressing the effect of climate change on food security and nutrition would also focus on empowering poor farmers and food consumers to improve their own nutrition and make informed choices about combatting malnutrition. It would include community-based promotion of good nutrition, balanced diets, and healthy practices. Third, Myers and colleagues assert that “Anticipating how the global diet is likely to change over the coming decades is difficult.” However, several studies have examined various scenarios of future food consumption, and the paper\'s failure to engage with this literature is a noticeable shortcoming. Related to this oversight, the paper bases its conclusions on a dietary model that remains unchanged with respect to calories and composition, an assumption Myers and colleagues acknowledge as being simplistic, and despite the above-mentioned studies, which indicate that future dietary composition is likely to involve a reduction in staples and increases in vegetable oils and animal-sourced foods which are expected to increase zinc intake. Furthermore, the paper does not take population growth or urbanisation into consideration, despite the considerable evidence that these factors will have a considerable bearing on the composition and quality of diets, including the adequacy of zinc and other micronutrient intakes. Additionally, the paper suggests in passing that economic growth might improve the quality of diets, but does not explore this point adequately.