Let food be thy medicine: linking local food and health systems to address the full spectrum of malnutrition in low-income and middle-income countries

Jaacks LM, Bellows AL. BMJ Glob Health 2017;2:e000564. doi:10.1136/bmjgh-2017-000564 Hippocrates (fifth century BCE), the father of medicine and namesake of the Oath many medical students swear by to this day, was among the first to recognise the centrality of diet in disease prevention and treatment. In that Oath, the statement, ‘I will apply dietetic measures for the benefit of the sick according to my ability and judgement’, comes before statements about drugs and surgery. Unfortunately, the importance of diet and nutrition in medicine is lost in most discussions of health system reform today, especially in low-income and middle-income countries (LMICs). Moreover, few food system researchers and policymakers consider the myriad opportunities for improving health through forging partnerships between local food, agriculture and health systems. In this commentary, we highlight the potential for healthcare institutions to improve access to and adoption of healthy diets beyond providing nutrition counselling in order to address the full spectrum of malnutrition in LMICs (figure 1) and provide examples of how this framework could be implemented in LMICs. We adopt the United Nations’ definitions of a food system as ‘all activities related to the production, distribution and consumption of food’, and of a health system as ‘the people, institutions and resources, arranged together in accordance with established policies, to improve the health of the population they serve’. 2 Considering the great success of extending the reach of antenatal clinics in LMICs—over 80% of women in 38 LMICs studied had at least one visit during pregnancy—and the anticipated increase in healthcare utilisation in LMICs as a result of expansion of universal health coverage, healthcare institutions as an intervention setting have the potential to have a substantial impact. In many LMICs struggling to address the full spectrum of malnutrition, from undernutrition to obesity and nutrition-related non-communicable diseases, the underlying problem is not one of caloric insufficiency, but rather one of poor diet quality. For example, in Guatemala, 50% of reproductive-aged women are overweight or obese and 48% of children under five are stunted (an indicator of chronic undernutrition). Prospective epidemiological studies have demonstrated a positive relationship between consumption of red meat, processed foods and sugar-sweetened beverages and risk of obesity in adults, whereas consumption of fruits, vegetables, nuts and legumes is associated with a decreased risk of obesity. On the other end of the malnutrition spectrum, randomised controlled trials of nutrition counselling to mothers delivered by trained healthcare providers that focuses on improving healthy complementary feeding Let food be thy medicine: linking local food and health systems to address the full spectrum of malnutrition in lowincome and middle-income countries