Asian Decadal Nutrition Evaluation, Reflection and Benchmarking : Galvanizing Efforts for Future (ACTIVATOR )

By guest contributors Sangeetha Shyam, Priyadarshini S, Muhammad Daniel Azlan, Jessica Rigutto & Carl Lachat

Asia home to 55 % of the global population,  had the highest increase in GDP in 2023 and is projected to have the most promising growth in 2024 and 2025. This level of economic advancement is bound to be accompanied by sociodemographic shifts, including a change in people’s lifestyle and dietary habits. Some of these changes are  for the better: with improvements in food availability, more individuals will be able to access sufficient calories. Yet, the risk of caloric overconsumption, i.e. that in excess of what is used in an increasingly sedentary lifestyle, has also increased. Still, a sizable portion of Asia’s inhabitants remain unable to afford healthy food. This means that Asian countries must tackle both overnutrition and undernutrition in public health – and in varying proportions, often within the same country. This complexity of managing both ends of the malnutrition spectrum makes investment in nutrition research and practice both important and urgent. However intelligent investments are almost impossible to achieve without taking stock of the current state of play. In the first week of June 2024, the ACTIVATOR (Asian Decadal Nutrition Evaluation, Reflection and Benchmarking : Galvanizing Efforts for Future) team came together for the first time in an overall effort to foster home-brewn nutrition research, to provide evidence for food and nutrition policies in the years to come on the continent.

Need for local nutrition research

Evidence generation in nutrition research predominantly occurs in high-income countries outside Asia.  Therefore first, we need to understand why local nutrition research in Asia is particularly necessary. There are several reasons:

Asian diets are unique, and highly diverse between and within countries across the region, adding a layer of complexity to any nutrition research initiative.

Asian phenotypes are different, for example, to Caucasian phenotypes, thus responses to dietary intervention may not follow findings in published literature. A typical point in case is that the Thin on the Outside and Fat on the Inside (TOFI) phenomenon is particularly widespread in Asia, which has led to altering the Asian criteria for defining excessive adiposity or body fatness.

Asian food environments are also diverse and different from the formalized sector of the West.

Taking these points into account, one can’t help but question the adequacy of Western-centric evidence to address Asia’s nutritional challenges.

Concerns with the existing nutrition research scene in Asia

At a time when there is concern on the credibility of nutrition evidence globally, Asia brings its unique set of problems.  Several meta-analyses and systematic reviews that inform global dietary recommendations routinely exclude Asian studies because of their smaller sample size, lack of robust methodology, or adoption of study designs that do not support causal inference. Anecdotally, the lacuna in Asian evidence is often attributed to the insufficient public investment in nutrition research.  

While public-private partnerships are important to improving the food and nutrition security of this region, another primary concern is that a large part of the research in the region is industry-driven, which may prioritize commercial-driven research directions.  Industry-funded research often tends to be applied in nature, confirming hypotheses generated elsewhere and in support of product marketing. Generation of local evidence for preventive strategies using local products or resources are nearer to public interest/benefit but do not often invite industry attention. With climate change likely to have an enormous impact on agriculture, livelihood and food security in Asia, it is unclear if sustainable nutrition receives sufficient focus in academic research and discussion.

Over the past decade the number of publications from Asia have increased. However, it is unclear if these increased scientific output has supported policy making.  Several national, regional and international collaborations have built capacity and funded important Asian nutrition research. However, the power dynamics of these collaborations have been understudied. Arguably, powers lies with established researchers or institutions hindering exploration of alternative ideas. The need to recognize good mentoring practices and incentivize mentoring is also often felt by Asian researchers.

Moving forward sustainably and inclusively

To move forward from intention to action requires a team of active researchers with shared goals. The CORE Team of ACTIVATOR has identified a team of active and consenting researchers at different career stages from ten Asian countries (Bangladesh, China, India, Indonesia, Malaysia, Nepal, Pakistan, Singapore, Sri Lanka and Thailand) that account for the majority of the publication output from the region.

With the ACTIVATOR team in place, Phase I of the project will map existing nutrition evidence in prespecified key nutrition areas. The goal for this phase is to have a transparent evaluation of what has transpired, an honest discussion of successes, failures and gaps.  A systematic review protocol will be published to ensure transparency and as a venue to receive feedback from experts.  Findings of the review will be disseminated in an open access format for review, public consultation and policy debate.

During Phase II, we will hold focus groups and workshops with a wider group of nutrition researchers through involving nutrition societies in Asia, with the aim to facilitate an inclusive discussion on facilitators and barriers to impactful Asian nutrition research and to build agency and advocacy. The workshop will facilitate an intergenerational brainstorming on the way forward, involving several countries and researchers at various levels in their careers aiding natural mentor-mentee linkages. The workshop is expected to outline a road map for future nutrition research of, by and for the stakeholders of Asian nutrition research.

Finally, to move from intention to action, the outcomes of the workshop will be published as a white paper and disseminated through webinars with an aim to reach all stakeholders: academia, professional bodies, industry and policymakers.

Through ACTIVATOR, we aim to consciously be inclusive and sustainable throughout the project, adopting sustainable practices such as online meetings, and hybrid workshops to remove the geopolitical and economical barriers for Asian researchers. We believe that ACTIVATOR will spark honest debate and discussions that will advocate for good quality local research that provides optimal solutions to the region’s nutrition challenges. Through this blog post we aim to elicit interest and connect with interested researchers, academics and funders who share our aim of galvanizing nutrition research efforts in Asia. Get in touch with us using the links in the author bio section.  We look forward to inviting interested researchers join us in the workshop, brainstorming, dissemination and advocacy activities planned for Phases II and III of ACTIVATOR.

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