El Niño Southern Oscillation (ENSO) is a naturally occurring atmospheric phenomenon that leads to inter-annual shifts in precipitation, temperature, and river discharge in Peru. More recently, there is evidence to suggest that ENSO is evolving in response to Global Climate Change. Very little research has been conducted on how ENSO affects food prices, dietary intake, and overall nutritional security. The major objectives of this thesis are to explore the relationship of ENSO and: (1) river discharge, (2) food prices, (3) frequency of meal patterns, (4) amount of food consumed, (5) Dietary Diversity (DD), (6) macronutrient and micronutrient intake, and (7) nutrient adequacy among children 9-36 months of age in the Peruvian Amazon. Data on monthly ENSO indices were extracted from National Oceanic and Atmospheric Administration (1969 to 2015). Daily river data was retrieved from the Sedaloreto water treatment plant (1969 to 2015) in Iquitos, Peru. Data on weekly food prices were obtained from Peruvian Ministry of Agriculture and Irrigation (2008 to 2015). Data on monthly dietary intake were obtained from The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development birth cohort study in Iquitos, Peru (2010 to 2014). Using regression models, Multivariate ENSO index (MEI) was identified as the best fit for associations with river discharge levels, in comparison to other ENSO indices. In addition, severe categories of MEI were also strongly associated with river flows. Using time series regression, ENSO severity, river level and seasonality were associated with local food prices, particularly yucca, eggs and sugar. Results from longitudinal poisson, negative binomial, and regression models show that under moderate El Niño & La Niña, and strong La Niña, there were reduction in the number of meals with fish, grains, plantain, dairy, sugar and rice. In strong La Niña, reduction of rice and grains were 18-20%, and interestingly, there is a higher intake of plantains by 99% suggesting possible substitutions. The practice of consuming gifted foods is higher during moderate El Niño and weak La Niña and is higher among girls compared to boys.Despite seasonal availability, DD remained consistent, however under La Niña conditions, girl’s DD score is reduced significantly compared to boys. Energy intake was significantly lower under moderate El Niño and significantly higher during weak La Niña. Girls consumed 89-112 less calories than boys even after adjusting for weight and other covariates, particularly under moderate La Niña. Further, gender differences were found in animal source protein intake, iron, zinc, calcium intake under various ENSO conditions. Overall, there was high prevalence of inadequacy for vitamin A (among the non-breastfed group), calcium, iron, folate, and zinc. Nutrient Adequacy Ratios of calcium, iron, and zinc were negatively associated with weak, and strong La Niña. This is the first study to show ENSO associations with local ecological factors, regional food prices and dietary intake in the same setting and time frame.These findings illustrate that ENSO, a large scale atmospheric phenomenon, is linked with individual-level dietary intake. The findings also highlight the gender differences in dietary intake observed under various ENSO conditions. Further studies are needed to explore how dietary patterns in other ENSO-affected regions (South East Asia, Southern China, Zimbabwe, Ethiopia) are altered. Peruvian national nutritional programs should strongly consider using ENSO indices as a factor in determining the distribution of additional food and cash subsidies to the most vulnerable households, and especially, to such households with girls.
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Effects of El Niño Southern Oscillation on Food Prices, Dietary and Nutrient Intake among children: Case Study in Iquitos, Peru
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