ISSN: 2690-0777
Open Journal of Environmental Biology
Review Article       Open Access      Peer-Reviewed

21st Century challenges in animal production and food security, additional positive and negative impacts on human health and the environment

Marcelo Ghezzi*

Faculty of Veterinary Sciences, National University of the Center of the Province of Buenos Aires, University Campus, 7000, Tandil, Buenos Aires, Argentina
*Corresponding author: Marcelo Ghezzi, Faculty of Veterinary Sciences, National University of the Center of the Province of Buenos Aires, University Campus, 7000, Tandil, Buenos Aires, Argentina, Tel: +54-0249-4465186; E-mail: ghezzi@vet.unicen.edu.ar
Received: 19 September, 2022 | Accepted: 24 September, 2022 | Published: 26 September, 2022

Cite this as

Ghezzi M (2022) 21st Century challenges in animal production and food security, additional positive and negative impacts on human health and the environment. Open J Environ Biol 7(1): 021-025. DOI: 10.17352/ojeb.000030

Copyright

© 2022 Ghezzi M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Meat, milk and eggs are nutrient-rich products that could effectively boost nutrient-poor diets, either as part of the normal diet or if access is increased through enrichment with vitamins and minerals, among others. Scientific evidence on the role of livestock products in improving nutrition is limited, especially in low-and middle-income countries, during the first 1,000 days of a child's life. Beyond food production, the livestock sector has additional positive and negative impacts on human health, the environment, societies and economies that must be understood and managed..

Introduction

In the 21st century, the growth rate of the world population is at an annual average of 1.14%, estimating for the year 2022 to reach 8 billion inhabitants [1], of which about 784 million people (9.8%) will suffer from hunger [2]. After the COVID-19 pandemic, in 2021, there was hope in considering that the world would start to get better. However, problems related to food security and world hunger continued to increase even more in that year. About 3.1 billion people could not count on a healthy diet in 2020 due to rising costs [3]. This is reflected in inequalities between countries, sometimes exacerbated and with regional differences within them, whose origins are due to a pattern in the inequality of economic recovery and unrecovered income losses among those most affected by the pandemic of COVID-19 [2].

When considering food security, we must consider the following aspects, on the one hand, the availability and access to a sufficient quantity of food and, on the other hand, access to quality food. For this, it is important to assess their innocuousness, that is, that they are healthy and, when ingested, do not affect the health of the consumer, in addition, nutritional safety and access to sufficient nutritious food, must be considered. However, little attention has been paid to the specific role of livestock products such as meat, milk and eggs (and their derived products) in nutrition and their potential to help achieve nutrition security goals.

The media in high, middle and low-income countries play a fundamental role in the population's nutrition because the information provided to consumers often influences their lifestyle habits. In recent years, reports critical of the role of meat, in particular and livestock-derived foods (e.g., milk and eggs), in general, as part of diets have predominated. Its environmental perspective and suggested adverse health effects are overt arguments used to promote a shift to diets containing little or no animal foods. However, you should expect that, behind the intentional or unintentional communication, there may be more fundamentalist and unchanging concerns about the use of animals. Furthermore, the information may have effects beyond the context in which it was intended. The general bad reputation of the consumption of products of animal origin, which can be accepted in industrialized countries, tends to reduce the interest and investment in the advantages of consuming this type of food among the poor populations of low and middle-income countries that it desperately needs the high-value protein and micronutrients they contain [4]. There are environmental and sustainability concerns related to livestock production that require serious reflection with the evolution of farming systems and dietary patterns in various countries [5]. In many low- and middle-income countries, the livestock sector is a key contributor to national economies, accounting for between 15% and 80% of agricultural domestic product, providing a potential pathway out of poverty and essential livelihood for millions of people [6]. In those countries where there are high volumes of livestock production but there are also important problems of malnutrition, an important lost opportunity is constituted, failing to obtain food products derived from livestock that can optimize the nutrition of the most vulnerable [7].

Also, the double subjugation of malnutrition should be considered, characterized by the coexistence of malnutrition together with overweight and obesity, sometimes added to non-communicable diseases related to diet, affecting people throughout their lives. , households and populations [8]. This has great consequences on human health, nutritional problems affect more than 50% of the world's population, 1 in 10 people suffer from malnutrition while 4/10 are overweight and, among the latter, one will suffer from obesity. This also indicates that eating habits cause imbalances between what is produced and what is consumed (WHO, 2016).

On the other hand, considering our legal order - and in that of most countries in the world-, animals have had and, in many cases, still have the category of "things", with or without owners and in the latter case, susceptible to appropriation. As sentient beings owned by other individuals, their condition is comparable to that of human slaves under the socio-economic system of slavery. Recently some countries have begun to change their legislation considering animals as sentient beings. But there are different philosophical positions that condition the professional practice of the Veterinarian and generate ethical and moral concerns about the life of animals that frequently produce conflicts and often distrust in the producers, the people in charge of the animals and ultimately, in the intervention with animals. This article will summarize the current state of knowledge on the challenges of the 21st century related to animal production and food safety, highlighting the characteristics of possible additional positive and negative impacts on human health and the environment.

The challenge of controversial philosophical conditioning

One of the current challenges is the need to provide people who eat food of animal origin, such as meat, milk and eggs, among others, with scientific and ethical arguments that allow them to defend their food autonomy in the context of moral conflict that has emerged in societies around the consumption of products and by - products of animal origin. In addition, it is necessary to reflect on the criticism, even attacks, made on consumers of these foods by activists, ovolactovegetarians, or vegetarians with eating habits that emphasize ethical and moral respect for animals. These people refuse to eat meat and animal products, but sometimes show disrespect for those who do. In recent decades, veganism and vegetarianism have reached a peak in some Western societies where it is often considered a healthy option for humans that, at the same time, favors animal and environmental welfare. While such diets can provide numerous benefits, they can also pose health risks by not providing the necessary dietary balance and supplements. Several researchers also agree that they are not appropriate for pregnant women, children, or carnivorous or omnivorous pets. Dietary regimens that lack animal protein often lead to the conclusion that these dietary changes, by themselves, do not reduce animal suffering or pollution generated by the meat, dairy, and poultry industries [9].

Food safety

The United Nations Organization (UN) in Resolution No. 73/250 mentions that "there is no food availability without food security"; and provides advice to help the entire production chain to ensure the supply of food in quantity and quality. To guarantee these principles, they encourage countries and government decision-making bodies, both agencies and institutions, as well as companies and society as a whole, to manage the appropriate measures to maintain the living conditions of the citizens. Governments, producers, and consumers must cooperate and be jointly responsible for food safety (WHO, 2020). The quality of food of animal origin must be considered throughout its supply chain, from the field to the consumer's table, to ensure that they are safe and do not harm health. Any event that affects food security can have detrimental consequences for public health, trade and the economy. Likewise, the Pan American Health Organization [10] highlights that food safety has an effective impact, favoring marketing, facilitating the creation of jobs, and reducing poverty. Furthermore, the pillars of the food chain, which in the COVID-19 context became evident when considering modern production systems are animal welfare, food safety and environmental protection.

Environmental challenges

The environment inevitably influences nutrition, as well as the quantity and quality of food produced. Environmental characteristics determine the type, availability and nutritional composition of foods, define eating habits and have cultural repercussions regarding food choices. When raising the relationship between food and the environment, is immediately linked to the negative impact of food production on the latter. Indeed, environmental pollution is currently a major problem that requires specific actions [11]. Agriculture and livestock occupy 50% of the land surface and employ a third of the world's working people [12-14]. The expansion of agricultural production towards territories not originally suitable [12,14] and sites of considerable biodiversity [12], as well as changes in the intensity of this production, has led to excessive use of non-renewable resources [12,13]. On the other hand, the intensification of animal production has absorbed part of this agricultural production and accentuated the pollution derived from these activities [15], causing a significant environmental impact [12,16]. In parallel, the increase in the world population estimated for the year 2050 [17] suggests an increase in food production by 60% [16] if the models of production and consumption of food continue. Current foods are characterized by diets based on ultra-processed foods, with excess fats and sugars, which require a large number of resources for their production. Additionally, a large part of the food produced is lost in the first steps of the production chain, while another part is used to feed livestock and/or to generate energy [18]. Likewise, a high percentage of the food produced (30%) is discarded [19] due, in part, to the high-quality requirements of consumers who prioritize physical characteristics (shape, color, size, etc.) among others) over nutritional requirements [20]. This not only has a negative economic impact but also has enormous effects on the environment.

Soil degradation, water, and air pollution affect the health of people, as well as plants and animals. The increase in global temperature influences the productive, and reproductive potential [21-23] and the immune system of animals in production decrease the gene expression of certain cytokines and their receptors [24-29], which could increase susceptibility to opportunistic infections. This has direct and indirect repercussions on the economy of the producers [30] and, potentially, on the safety of food derived from these animals.

Several factors, such as poverty, social inequity, environmental pollution, and inefficient use of resources, among others, are associated with the lack of access of some sectors of the world population to a healthy diet in terms of quantity and quality. Current scenarios demand a new paradigm for animal production, emphasizing the development of new production systems and techniques that consider the ethical principles of sustainable development and the commitment to promoting well-being. This implies the development of production strategies that guarantee the conservation of the natural environment, that is, the preservation of natural resources, without endangering healthy communities and, in turn, ensuring the profitability of producers and the vitality economy that contributes to consumer satisfaction. According to Paranhos da Costa [31], sustainability in animal production can only be achieved under the concept of ONE HEALTH/ONE WELFARE.

To achieve sustainable production systems, it is necessary to radically modify current systems, choosing those that optimize efficiency in food production and the use of natural resources, recycling and reuse. It is necessary to implement policies that promote and strengthen the production of native animals [32], re-educate consumers in sustainable consumption, varied diets, rich in vegetables, and moderate consumption of products of animal origin that guarantee the incorporation of the necessary daily nutrients [15,33], reducing the consumption of ultra-processed products.

Final conclusions

Current food production is destroying the environment on which current and future food production depend. Deforestation, soil degradation, loss of biodiversity and water pollution are some of their consequences. At the same time, environmental impacts are beginning to make food production more difficult and unpredictable in many regions of the world [34], while failing to ensure adequate and affordable nutrition for all [35-44]. Current consumption habits have the potential to exacerbate obesity/malnutrition problems and chronic diseases. It is necessary to adopt measures focused on both production and consumption and establish objectives based on the three pillars of sustainability: environment, economy, and society, which guarantee biodiversity, ecosystems, food and nutritional security, and healthy life for current and future generations. This will undoubtedly be one of the great challenges of the 21st century.

  1. UN. World population to reach 8 billion this year, as growth rate slows. 2022.https://news.un.org/en/story/2022/07/1122272
  2. FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World 2022. Repurposing food and agricultural policies to make healthy diets more affordable. Rome, FAO. 2022. https://doi.org/10.4060/cc0639en
  3. FAO. The State of Food Security and Nutrition in the World 2022. 2.3 Cost and affordability of a healthy diet: an update (fao.org). Rome, FAO. 2022. https://www.fao.org/3/cc0639en/online/sofi-2022/cost-affordability-healthy-diet.html
  4. Perry BD, Grace DC. How Growing Complexity of Consumer Choices and Drivers of Consumption Behaviour Affect Demand for Animal Source Foods. Ecohealth. 2015 Dec;12(4):703-12. doi: 10.1007/s10393-015-1091-7. Epub 2015 Dec 18. PMID: 26682899.
  5. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019 Feb 2;393(10170):447-492. doi: 10.1016/S0140-6736(18)31788-4. Epub 2019 Jan 16. Erratum in: Lancet. 2019 Feb 9;393(10171):530. Erratum in: Lancet. 2019 Jun 29;393(10191):2590. Erratum in: Lancet. 2020 Feb 1;395(10221):338. Erratum in: Lancet. 2020 Oct 3;396(10256):e56. PMID: 30660336.
  6. World Economic Forum. Meat: The Future series Options for the Livestock Sector in Developing and Emerging Economies to 2030 and Beyond. Geneva. Switzerland. www.weforum.org. Accessed June 2019.
  7. Alonso S, Dominguez-Salas P, Grace D. The role of livestock products for nutrition in the first 1,000 days of life. Anim Front. 2019 Sep 28;9(4):24-31. doi: 10.1093/af/vfz033. PMID: 32002271; PMCID: PMC6951902.
  8. Shrimpton R, Rokx C. The Double Burden of Malnutrition: A Review of Global Evidence. Health, Nutrition and Population Discussion Paper: World Bank, Washington, DC. © World Bank. 2012. https://openknowledge.worldbank.org/handle/10986/27417
  9. Mota-Rojas D, Whittaker AL, Thielo de la Vega L, Ghezzi M, Lezama K, Mora-Medina P, Domínguez A, Falcón I, Alonso-Spilsbury M. Veganism and animal welfare, scientific, ethical and philosophical arguments. Animals 2022: 12.
  10. PAHO. Día Mundial de la Inocuidad de los Alimentos 2021. Organización Panamericana de la Salud. https://www.paho.org/es/campanas/dia-mundial-inocuidad-alimentos2021#:~:text=El%20D%C3%ADa%20Mundial%20de%20la,la%20seguridad%20alimentaria%2C%20la%20salud
  11. Mariné FA., Vidal Carou MC. Influencia del medio ambiente en las relaciones entre la alimentación y la salud. Departamento de Nutrición y Bromatología, Universidad de Barcelona. 2000. https://estrucplan.com.ar/influencia-del-medio-ambiente-en-las-relaciones-entre-alimentacion-y-salud/
  12. Foley JA, Ramankutty N, Brauman KA, Cassidy ES, Gerber JS, Johnston M, Mueller ND, O'Connell C, Ray DK, West PC, Balzer C, Bennett EM, Carpenter SR, Hill J, Monfreda C, Polasky S, Rockström J, Sheehan J, Siebert S, Tilman D, Zaks DP. Solutions for a cultivated planet. Nature. 2011 Oct 12;478(7369):337-42. doi: 10.1038/nature10452. PMID: 21993620.
  13. Tilman D, Clark M. Global diets link environmental sustainability and human health. Nature. 2014 Nov 27;515(7528):518-22. doi: 10.1038/nature13959. Epub 2014 Nov 12. PMID: 25383533.
  14. Erb KH, Lauk C, Kastner T, Mayer A, Theurl MC, Haberl H. Exploring the biophysical option space for feeding the world without deforestation. Nat Commun. 2016 Apr 19;7:11382. doi: 10.1038/ncomms11382. PMID: 27092437; PMCID: PMC4838894.
  15. Springmann M, Godfray HCJ, Rayner M, Scarborough P. Análisis y valoración de los beneficios colaterales del cambio dietético para la salud y el cambio climático. Actas de la Academia Nacional de Ciencias de los Estados Unidos de América. 2016; 113:1–6.
  16. Cassidy ES, West PC, Gerber JS, Foley JA. Redefining agricultural yields: from tonnes to people nourished per hectare. Environmental Research Letters. 2013; 8:034015.
  17. Roberts L. 9 billion? Science. 2011 Jul 29;333(6042):540-3. doi: 10.1126/science.333.6042.540. PMID: 21798924.
  18. Shepon A, Eshel G, Noor E, Milo R. The opportunity cost of animal based diets exceeds all food losses. Proc Natl Acad Sci U S A. 2018 Apr 10;115(15):3804-3809. doi: 10.1073/pnas.1713820115. Epub 2018 Mar 26. PMID: 29581251; PMCID: PMC5899434. 
  19. Gustavsson J, Cederberg C, Sonesson U, van Otterdijk R, Meybeck A. Global food losses and food waste: Extent, causes, and prevention. Food and Agriculture Organization of the United Nations, Rome. 2011.
  20. Garibaldi LA. Andersson A, Fernández Ferrari C, Pérez-Méndez N. Seguridad alimentaria, medio ambiente y nuestros hábitos de consumo. Ecología Austral. 2018; 28:572-580 https://doi.org/10.25260/EA.18.28.3.0.768
  21. Mota-Rojas D, Habeeb AA, Ghezzi MD, Kanth Reddy PR, Napolitano F, Lendez PA, Cuibus A, Ceriani MC, Sarubbi J, Braghieri A, Martínez-Burnes J, Bertoni A, Gómez-Prado J, Orihuela A. Termorregulación del búfalo de agua: mecanismos neurobiológicos, cambios microcirculatorios y aplicaciones prácticas de la termografía infrarroja. En: El búfalo de agua en Latinoamérica. 3° Edición, BM Editores. Gorra. 2021a; 22:923-958.
  22. Mota-Rojas D, Habeeb AA, Napolitano F, Sarubbi J, Ghezzi MD, Ceriani MC, Cuibus A, Martínez-Burnes J, Braghieri A, Lendez PA, Cruz-Monterrosa R, Martínez GM, Rayas-Amor AA, José-Pérez N, Mora-Medina P, Barrios-García H, Kanth Reddy PR. Bienestar del búfalo de agua, bovino europeo y bovino índico: aspectos ambientales, fisiológicos y conductuales en respuesta a la sombra natural y artificial. En: El búfalo de agua en Latinoamérica. 3° Edición, BM Editores. Gorra. 2021b; 23: 960-1015.
  23. Dahl GE, Tao S, Laporta J. Heat Stress Impacts Immune Status in Cows Across the Life Cycle. Front Vet Sci. 2020 Mar 6;7:116. doi: 10.3389/fvets.2020.00116. PMID: 32211430; PMCID: PMC7067922.
  24. do Amaral BC, Connor EE, Tao S, Hayen J, Bubolz J, Dahl GE. Heat stress abatement during the dry period influences prolactin signaling in lymphocytes. Domest Anim Endocrinol. 2010 Jan;38(1):38-45. doi: 10.1016/j.domaniend.2009.07.005. Epub 2009 Aug 26. PMID: 19733997.
  25. Carroll JA, Burdick NC, Chase CC Jr, Coleman SW, Spiers DE. Influence of environmental temperature on the physiological, endocrine, and immune responses in livestock exposed to a provocative immune challenge. Domest Anim Endocrinol. 2012 Aug;43(2):146-53. doi: 10.1016/j.domaniend.2011.12.008. Epub 2012 Jan 23. PMID: 22425434.
  26. Sun Y, Liu J, Ye G, Gan F, Hamid M, Liao S, Huang K. Protective effects of zymosan on heat stress-induced immunosuppression and apoptosis in dairy cows and peripheral blood mononuclear cells. Cell Stress Chaperones. 2018 Sep;23(5):1069-1078. doi: 10.1007/s12192-018-0916-z. Epub 2018 Jun 2. PMID: 29860708; PMCID: PMC6111079.
  27. Tao S, Connor EE, Bubolz JW, Thompson IM, do Amaral BC, Hayen MJ, Dahl GE. Short communication: Effect of heat stress during the dry period on gene expression in mammary tissue and peripheral blood mononuclear cells. J Dairy Sci. 2013 Jan;96(1):378-83. doi: 10.3168/jds.2012-5811. Epub 2012 Nov 8. PMID: 23141830.
  28. Lendez PA, Nieto Farias MV, Martínez Cuesta L, Vater AA, Ghezzi MD, Mota-rojas D, Dolcini G, Ceriani C. Estrés por calor: su efecto sobre el estado inmunológico de las vacas lecheras. Rev Medica Vet. 2020; 101:7-13.
  29. Joo SS, Lee SJ, Park DS, Kim DH, Gu BH, Park YJ, Rim CY, Kim M, Kim ET. Changes in Blood Metabolites and Immune Cells in Holstein and Jersey Dairy Cows by Heat Stress. Animals (Basel). 2021 Mar 31;11(4):974. doi: 10.3390/ani11040974. PMID: 33807443; PMCID: PMC8065422.
  30. Quiñones G. (2018) Investment evaluation of a cooling and ventilation system for lactating cows in a dairy in the central east of the province of Córdoba.
  31. https://rdu.unc.edu.ar/bitstream/handle/11086/6762/Quin%CC%83ones%2C%20G.%20Evaluaci%C3%B3n%20de%20inversi%C3%B3n%20de%20un%20sistema%20de%20refrescado%20y%20ventilaci%C3%B3n%20para%20vacas%20en%20lactancia...pdf?sequence=1
  32. Paranhos Da Costa MJR. (2018) Animal welfare and sustainable systems for livestock production. Argentine Site of Animal Production. https://www.produccion-animal.com.ar/etologia_y_bienestar/bienestar_en_bovinos/104-sistemas_sosteniblesdocx.pdf
  33. CyTA Agency-Leloir Institute, 2016. Sustainable production of llamas and alpacas promoted in Argentina | Cyta Agency - Leloir Institute Foundation. CyTA Science and Technology News Agency (2016). https://www.agenciacyta.org.ar/2016/08/impulsan-en-argentina-la-produccion-sostenible-de-llamas-y-alpacas/.
  34. O'Keefe JH, DiNicolantonio JJ, Sigurdsson AF, Ros E. Evidence, Not Evangelism, for Dietary Recommendations. Mayo Clin Proc. 2018 Feb;93(2):138-144. doi: 10.1016/j.mayocp.2017.12.001. PMID: 29406200.
  35. Gerber PJ, Steinfeld H, Henderson B, Mottet A, Opio C, Dijkman J, Tempio G. Tackling climate change through livestock: a global assessment of emissions and mitigation opportunities. Food and Agriculture Organization of the United Nations (FAO). 2013; https://agris.fao.org/agris-search/search.do?recordID=XF2016016977
  36. FAO. The State of Food Insecurity in the World. 2015. https://www.fao.org/agrifood-economics/publications/detail/en/c/1476651/
  37. Tulchinsky TH. Correction to: micronutrient deficiency conditions: Global Health issues. Public Health Rev. 2017 Oct 31;38:25. doi: 10.1186/s40985-017-0071-6. Erratum for: doi: 10.1007/BF03391600. PMID: 29451564; PMCID: PMC5809998.
  38. Gonzalez Fisher C, Garnett T. Plates, pyramids and planets. Developments in national healthy and sustainable dietary guidelines: a state of play assessment. Food and Agriculture Organization of The United Nations and The Food Climate Research Network at The University of Oxford. 2016; 8-11. https://www.fao.org/3/i5640e/i5640e.pdf
  39. Kadokawa H, Sakatani M, Hansen PJ, Perspectivas sobre la mejora de la reproducción en el ganado bovino durante el estrés por calor en un Japón futuro. Anim Sci. J. 2012. https://doi.org/10.1111/j.1740-0929.2012.01011.x
  40. Kim ET, Joo SS, Kim DH, Gu BH, Park DS, Atikur RM, Son JK, Park BY, Kim SB, Hur TY, Kim M. Common and Differential Dynamics of the Function of Peripheral Blood Mononuclear Cells between Holstein and Jersey Cows in Heat-Stress Environment. Animals (Basel). 2020 Dec 24;11(1):19. doi: 10.3390/ani11010019. PMID: 33374309; PMCID: PMC7824059.
  41. Lendez PA, Martinez Cuesta L, Nieto Farias MV, Vater AA, Ghezzi MD, Mota-Rojas D, Dolcini GL, Ceriani MC. Alterations in TNF-α and its receptors expression in cows undergoing heat stress. Vet Immunol Immunopathol. 2021 May;235:110232. doi: 10.1016/j.vetimm.2021.110232. Epub 2021 Mar 19. PMID: 33799007.
  42. Mota-Rojas D, Habeeb AA, Napolitano F, Sarubbi J, Ghezzi MD, Ceriani MC, Cuibus A, Martínez-Burnes J, Braghieri A, Lendez PA, Cruz-Monterrosa R, Martínez GM, Rayas-Amor AA, José-Pérez N, Mora-Medina P, Barrios-García H, Kanth Reddy PR. Bienestar del búfalo de agua, bovino europeo y bovino índico: aspectos ambientales, fisiológicos y conductuales en respuesta a la sombra natural y artificial. En: El búfalo de agua en Latinoamérica. 3° Edición, BM Editores. Gorra. 2021b ;23: 960-1015.
  43. Organización Mundial de la Salud.. Informe de la comisión para acabar con la obesidad infantil. Organización Mundial de la Salud. 2016. https://apps.who.int/iris/handle/10665/206450
  44. Organización Mundial de la Salud (OMS). La inocuidad de los alimentos es asunto de todos. Organización Mundial de la Salud. 2020. https://www.who.int/es/ news-room/campaigns/world-food-safety-day/2020
  45. WHO. The double burden of malnutrition. Geneva, Switzerland. 2017. http://apps.who.int/iris/bitstream/handle/10665/255413/WHO-NMH-NHD-17.3-eng.pdf?ua=1
 

Help ?