Investing in early nutrition and food systems for human and planetary health

Diet-related poor health, climate change, environmental degradation, and growing social inequities require urgent global, aligned, systemic action. In 2021, COVID-19, climate change, and conflict are some of the biggest drivers of food insecurity,¹ and recovery from COVID-19 impact creates an opportunity to change trajectories to ensure optimal human and planetary health for today's children. Healthy diets are not only compatible with environmental objectives, but also necessary for attaining global climate² and biodiversity³ goals. Actioned commitments to achieve healthy and sustainable diets for children can advance multiple global goals: human health, reduced social inequalities, and climate and environmental stability.

In 2020, globally, 22% of children younger than 5 years were stunted, 7% were affected by wasting, and 6% had overweight or obesity, primarily driven by compromised food and nutrient intakes.⁴ Strengthening global action towards food systems that support healthy child and adolescent growth and development can be achieved by improving the nutritional quality of their food environments and dietary practices. A transition to diverse, culturally appropriate healthy dietary patterns is key to preventing further degradation of environmental capital (biodiversity, ecosystems, and climate) and is crucial for current and future human health. Major global investments are urgently needed, with children at the heart of the action.

Transforming food systems must start with children's first foods. Breastfeeding provides infants with all energy and nutritional needs for their first months, with zero environmental impact or food waste. Effective strategies that start during pregnancy and continue throughout lactation are needed to support exclusive breastfeeding up to 6 months, continued up to 2 years with age and stage appropriate complementary foods. Government policies must be resourced to support appropriate parental leave duration to facilitate exclusive breastfeeding, workplace breastfeeding policies, and access to trained breastfeeding specialists, health workers, and peer counsellors.

Reducing production and over-consumption of ultra-processed foods and increasing consumption of minimally processed foods will concurrently improve diet quality and reduce environmental footprints through reduced resources used to manufacture, package, and distribute ultra-processed foods. Ultra-processed foods are made mostly or entirely from compounds extracted or derived from whole foods, combined with additives to enhance taste or sensory qualities and extend shelf life.⁵ They are typically high in added fat, sugars, and salt, with low nutrient density. With relentless marketing of ultra-processed foods, it is unsurprising that they contribute 30–50% of total energy intake in some high-income country populations,⁵ with sales increasing rapidly in middle-income countries, including in Latin America⁶ and Asia.⁷ Ultra-processed food consumption is associated with higher body fat in children.⁸ Higher ultra-processed food intakes are associated with an increased risk of overweight or obesity at the population level,⁹ all-cause mortality in adults, and asthma and cardiometabolic risk factors among children. The tracking of dietary patterns from childhood to adulthood highlights the importance of limiting ultra-processed foods and consuming appropriate amounts of nutrient-dense foods including fruits and vegetables, from early life.

Increasing consumption of diverse, minimally processed plant foods, complemented with appropriate amounts of animal-sourced foods, has important human and planetary health benefits and could meet cultural preferences; furthermore, such foods can be produced in a variety of climatic zones. Systematic interventions and policies that create healthy, sustainable, and diverse food systems are needed. These include improving the availability and affordability of minimally processed foods with low food miles; pricing policies (eg, subsidising unprocessed or minimally processed plant foods while taxing ultra-processed foods¹⁰); increasing the protection of children from harmful, aggressive food marketing by strengthening regulatory measures; and removing ultra-processed food sponsorship from children's sport. People's choices are constrained by the environment in which they live, calling for effective approaches to address food systems.

Food-based dietary guidelines (FBDGs) should incorporate environmental considerations and characterise sustainable healthy dietary patterns that meet the needs of the population, including children, in a culturally appropriate way. Sustainable, healthy dietary recommendations promote balanced consumption of plant-based and animal-sourced foods. Successfully attaining healthy diets for all would reduce food-based greenhouse gas emissions by 30% compared with current intakes.² In considering environmental impacts in addition to health, the Netherlands' FBDGs recommend a lower intake of animal-sourced foods, predicted to result in reductions of 28–46% in greenhouse gas emissions.¹¹ By contrast, in many developing countries in sub-Saharan Africa and south Asia, animal-sourced foods are minimally consumed, despite the fact that they provide important sources of vitamins and minerals, especially for children. In the absence of alternative nutrient-dense foods, increasing animal-sourced food consumption in these chronically undernourished, vulnerable populations would benefit health. Emphasis should be on appropriate consumption of animal-sourced foods, acknowledging widely varying health and environmental impacts of animal-sourced foods.¹² Focusing further attention on how and where foods are produced and reducing food waste have important environmental impacts and merit mention in FBDGs. Although further defining optimal child dietary patterns in FBDGs is an important step, globally, child dietary intakes are far from meeting recommendations. Population dietary behaviour change warrants major global investment.

We have a collective global responsibility to act immediately to ensure that every child has access to adequate, appropriate nutrition. This includes a safe, equitable food system that optimises diet-related health for current and future child populations, and assures climate and environmental security into their adult lives. This will require the international community to work cooperatively, through responsible and transparent partnerships, including declaring conflicts of interests. In 2021, the UN Food Systems Summit (UNFSS) met in New York, USA, in September; the Biodiversity COP15 summit meets in Kunming, China, in October; and the Climate COP26 summit meets in Glasgow, Scotland, in November. The UNFSS and COP summits bring together world leaders, negotiators, governments, businesses, and citizens to drive action. World leaders should commit to major global investments to achieve healthy, sustainable diets as a key measure to synergistically address human and environmental health, which is lower than the cost of inaction. In so doing, every child would have a chance to reach their full potential within planetary boundaries.

© 2021 SasinParaksa/iStock

We declare no competing interests.