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Understanding dietary patterns is vital to reducing the number of people experiencing hunger (about 795 million), micronutrient deficiencies (2 billion), and overweight or obesity (2.1 billion). We characterize global trends in dietary quality by estimating micronutrient density of the food supply, prevalence of inadequate intake of 14 micronutrients, and average prevalence of inadequate intake of these micronutrients for all countries between 1961 and 2011. Over this 50-year period, the estimated prevalence of inadequate intakes of micronutrients has declined in all regions due to increased total production of food and/or micronutrient density. This decline has been particularly strong in East and Southeast Asia and weaker in South Asia and sub-Saharan Africa. Sub-Saharan Africa is the only region where dietary micronutrient density has declined over this 50-year period. At the global level, micronutrients with the lowest levels of adequate estimated intake are calcium, iron, vitamin A, and zinc, but there are strong differences between countries and regions. Fortification has reduced the estimated prevalence of inadequate micronutrient intakes in all low-income regions, except South Asia. The food supply in many countries is still far below energy requirements, which suggests a need to increase the availability and accessibility of nutritious foods. Countries where the food energy supply is adequate show a very large variation in dietary quality, and in many of these countries people would benefit from more diverse diets with a greater proportion of micronutrient-dense foods. Dietary quality can be improved through fortification, biofortification, and agricultural diversification, as well as efforts to improve access to and use of micronutrient-dense foods and nutritional knowledge. Reducing poverty and increasing education, especially of women, are integral to sustainably addressing malnutrition.

Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.

Global diets are inadequate in micronutrients, leading to deficiencies and related diseases. Addressing these micronutrient shortfalls requires increasing the nutrient density of the global food supply. Inferring micronutrient supply based on food balance sheet data is widespread practice in nutrition modelling, whereas designing food‐based interventions is usually done using dietary data. Here, we provide an online interactive tool for investigating the micronutrient density of food balance sheet items, to help identify appropriate food supply interventions to increase the availability of micronutrient‐dense foods globally. While the tool can be used for up to 28 food components (including macronutrients), we demonstrate its use by ranking food balance sheet items based on their combined content of 17 micronutrients per 100 g or per 100 kcal. High ranking foods varied between the mass and energy lists, but included offals, seeds, nuts, seafood, and non‐starchy vegetables. The tool can be used by nutrition researchers to identify foods with the potential for supplying the specific combinations of micronutrients needed by at‐risk populations.

To reorient food systems to ensure they deliver healthy diets that protect against multiple forms of malnutrition and diet-related disease and safeguard the environment, ecosystems, and natural resources, there is a need for better governance and accountability. However, decision-makers are often in the dark on how to navigate their food systems to achieve these multiple outcomes. Even where there is sufficient data to describe various elements, drivers, and outcomes of food systems, there is a lack of tools to assess how food systems are performing. This paper presents a diagnostic methodology for 39 indicators representing food supply, food environments, nutrition outcomes, and environmental outcomes that offer cutoffs to assess performance of national food systems. For each indicator, thresholds are presented for unlikely, potential, or likely challenge areas. This information can be used to generate actions and decisions on where and how to intervene in food systems to improve human and planetary health. A global assessment and two country case studies—Greece and Tanzania—illustrate how the diagnostics could spur decision options available to countries.

A growing literature in Life Cycle Assessment seeks to better inform consumers, food policymakers, food supply chain actors, and other relevant stakeholders about how individual foods contribute to sustainable diets. One major challenge involves accurately capturing potential trade-offs between nutritional provision and environmental impacts associated with food production. In response, food system sustainability literature has turned increasingly to nutritional Life Cycle Assessment, which assesses the environmental footprints of different foods while accounting for nutritional value. Here we provide examples that show how environmental footprints based on a priority micronutrient-focused functional unit can provide nutritionally meaningful insights about the complexities involved in sustainable food systems. We reinforce the idea that there are limitations in using single-value nutrition-environment scores to inform food guidance, as they do not adequately capture the complex multi-dimensionality and variation involved in healthy and sustainable food systems. In our discussion we highlight the need for future agri-food sustainability assessments to pay attention to regional nutritional and environmental variation within and between commodities, and to better interpret trade-offs involved in food substitutions.

Complementary feeding among children aged 6–23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange‐fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal‐source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. Vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange‐fleshed fruits and vegetables, avocado and small dried fish, while calcium, animal‐source protein, zinc and iron are less affordable with more provincial variation (depending in large part on small dried fish availability). Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions. Key messages Small dried fish, liver, milk, dark green leafy vegetables, beans and eggs are the most affordable food sources of nutrients lacking during the complementary feeding period in Kenya. Unaffordability prevents adequate consumption of iron and zinc among young children. Fortification and supplementation may be needed. Availability of small dried fish—which is lowest in Central, Eastern, North Eastern and parts of Rift Valley and Coast provinces—is a key determinant of calcium, animal‐source protein and zinc affordability. Gaps in vitamin A, vitamin B12 and folate consumption among young children are likely rooted in other causes, such as inconsistent availability or demand‐side barriers.

Complementary feeding practices are greatly influenced by local contexts. Therefore, national home‐grown evidence, policies and guidelines are critical to improving infant and young children's diets. This Special Issue has provided a comprehensive, evidence‐based analysis of the situation, gaps and context‐specific opportunities for improving young children's diets in Kenya. The primary research findings of the Special Issue supported the identification of a set of recommendations articulated across the four systems (food, health, water, sanitation and hygiene [WASH] and social protection) to improve food availability and accessibility in Kenya at the national and subnational levels. It is anticipated that the decentralised government functions seen in Kenya provide a strong opportunity to develop and mainstream context‐specific recommendations into action. This Special Issue recommends adopting a multi‐sectoral systems approach, including a shared vision, joint planning, implementation and monitoring, towards improving young children's diets with a focus on service delivery as well as scaled‐up community social behaviour change interventions. In particular, the approach should entail advocacy for policy revisions for service delivery that support complementary feeding and development of costed implementation strategies in support of the same, across four critical systems—food, health, WASH and social protection, along with, the strengthening of national coordination, monitoring and accountability structures as per the Kenya Nutrition Action Plan. Finally, the development of a legal framework for enhanced accountability from all relevant sectors towards sustainable, nutritious, safe and affordable children's diets. These recommendations provide a clear direction in addressing the complementary feeding challenges, which the primary research of this Special Issue has presented. Key messages Dietary patterns are varied across regions more so sub‐regions within the same country. Therefore, home‐grown and localized evidence is crucial for developing national complementary feeding guidelines. Food market forces, especially availability, and supply, are crucial aspects of food environments. Improving trade policies and tariffs infrastructure should become part of efforts to enhance complementary feeding diets of young children. Social‐behavior‐change focused on addressing socio‐cultural norms and skills for nutritionally optimal food utilization is needed to improve complementary feeding diets. This special issue shades light on the use of a multi‐sectoral systems approach in addressing the drivers of poor complementary feeding diets.

Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal‐source foods could be improved. Ethnographic data were analyzed to identify socio‐cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user‐friendly and low‐cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal‐source foods. Furthermore, it emphasizes the need for a multi‐sectoral approach in enacting policies and programmes that address these barriers. Key messages In most low‐income countries, including Kenya, just over a quarter of the young children receive a nutritionally adequate diet during the complementary feeding period, 6–23 months. Some global investments have been made to promote breastfeeding. However, efforts to improve the complementary feeding diet for young children still lag behind. The drivers for the persistent nutritionally poor quality of complementary feeding diets lie in broader contextual issues in these three key areas: Food environment, which includes a milieu of climatic, economic factors; Services in WASH, Social Protection, Education, which shape a conducive environment; and Socio‐norms on feeding practices.

In Kenya 26% of children under age 5 experience stunted growth, 4% are wasted and 11% are underweight. In pregnant women, the prevalence of iron deficiency is 36% and iron‐deficiency anaemia prevalence is 26%. Previous studies have identified affordability as a key barrier to the intake of nutrients, particularly from animal‐source foods (ASFs). Thus, this study analyzes to what extent the affordability of ASF in Kenya can be improved. It focuses on four ASFs: eggs, milk, chicken and beef. Using a computable general equilibrium model, three policy simulations were undertaken to establish the impact of potential changes on nutritious ASF availability and affordability: a 20% increase in total factor productivity (TFP) for the four products; a 20% TFP increase plus a 25% reduction in trade and transportation margins; and a 20% TFP increase for ASF and maize (a key input in animal feed). Simulations suggest increasing the productivity of the four ASF products would increase their availability and lower consumer prices (up to 17% lower). Household consumption of the four commodities would increase, resulting in improved household dietary diversity. Rural households would gain more compared with urban households. Poor households (the lowest 40%) would register larger welfare (Equivalent Variation) gains than other households in both urban and rural areas. The richest 20% of the population would neither lose nor gain following the policy changes. Reducing transportation costs and trade margins and increasing maize productivity could further reduce the price of ASFs through lower production costs and increased consumption. Key messages Affordability is a key barrier to the consumption of nutritious animal‐source foods (ASFs) in Kenya. We undertook simulations to understand how policy changes would impact ASF affordability and availability. Increasing the supply of ASFs could yield lower prices for these foods. The impact on prices could be magnified if supply increases were accompanied by reduced trade and transportation margins. Intake of ASFs and dietary diversity could increase if prices were lowered.