Using crop genetics to understand the importance of dietary resistant starches for maintaining healthy glucose homeostasis

Lead Research Organisation: Quadram Institute Bioscience
Department Name: Food Innovation and Health

Abstract

Type 2 diabetes is a major and increasing problem worldwide and is particularly prevalent among the aging population. Over 2.5 million individuals in the UK are affected, costing the NHS around £10 billion per year (almost 10% of its budget). The risk of diabetes is thought to increase with age because of poor control of blood glucose levels. This in turn is due to a progressive decline in the capacity of cells in the pancreas (beta-cells) to secrete insulin, the hormone that controls glucose levels. The decline in beta-cell function can be accelerated by a poor diet and lifestyle, thus increasing the risk of developing type 2 diabetes.
There is much evidence that diets rich in a type of carbohydrate called resistant starch have a positive impact on controlling of blood glucose levels, and hence reduce susceptibility to type 2 diabetes. Resistant starch, as the name suggests, is not completely digested in upper parts of the digestive tract, and so is fermented by bacteria in the colon. The products of fermentation, known as short-chain fatty acids, are thought to improve beta-cell function and thus insulin secretion. There are a variety of fruits and vegetables that contain various amounts of resistant starch, but UK diets are generally low in resistant starch. Thus there is great potential to reduce the incidence of type 2 diabetes in the long term by promoting the widespread consumption of resistant starch. However, very little is known about why particular types of starch are resistant to digestion and whether resistant starches from different food sources differ in their capacity to improve beta-cell function. Plugging these gaps in our knowledge will help the development of strategies to increase the amount of resistant consumed in the UK diet, thus helping to reduce the rates of onset of type 2 diabetes.

Our aim is to study systematically which features of starch structure are important in making it resistant to digestion and in allowing it to improve beta cell function. As well as studying resistant starch itself, we will study the influence of the type of food in which the starch is contained, and the way in which the food is cooked prior to consumption. Our study will focus on peas, as they are a range of naturally occurring variants or mutants known to contain different types of resistant starch. These seeds, and starch extracted from them, will be digested in an artificial gut, allowing us to assess which features of the starch and the food are important for maximum fermentation in the colon. In parallel, selected types of peas will be fed to human volunteers to determine the digestibility of the starch in vivo, together with a full spectrum of short and medium term physiological responses relevant to beta-cell function and control of blood glucose levels to be monitored.

We will also study the best way to process/prepare the peas, as some resistant starch can behave differently, so that they can be used in a wide range of foods.

This project will provide new insights into the relationship between resistant starch and susceptibility to type 2 diabetes. Importantly it will also inform crop breeders about which genes in crop plants are associated with types of starch that provide the best protection against type 2 diabetes. This will immediately allow the directed breeding of peas that provide maximal protection against this disease. It will also increase the flexibility of peas by investigating the use of pea flour in commonly consumed foods.

Technical Summary

Our aim is to develop a systematic basis for increasing the intake of resistant starch in the diet in order to protect the function of insulin-secreting pancreatic beta-cells and improve blood glucose homeostasis in an ageing population. Age related declines in beta-cell function and glucose homeostasis increase susceptibility to type 2 diabetes, the incidence of which has doubled in the UK since 1996. We and others have shown that carbohydrates such as resistant starch that escape digestion in the small intestine lead to improved insulin sensitivity and first phase insulin response. We propose that short chain fatty acids liberated by colonic carbohydrate fermentation causes receptor-mediated improvements in beta-cell function. In this project we will define which starches and food matrices are most effective in protecting beta-cell function and discover the basis of this protection. The results will underpin development of a roadmap for increasing the most effective types of resistant starch in the diet via a concerted approach involving crop breeding and food processing.
Our project utilises a suite of genetically-defined natural mutants of peas, representing two types of resistant starch in a variety of genetic backgrounds. Experiments with static and dynamic digestion models will examine starch digestibility and colonic fermentability in raw and processed materials and purified starch. Selected samples will be physically characterised to establish which starch/matrix features determine digestibility and fermentability, which will be confirmed in human studies. In parallel we will carry out human trials on selected peas to assess effectiveness in beta-cell protection. Volunteers aged 55 - 65 will be used to assess physiological functions related to susceptibility to diabetes including measures of insulin release, gut hormones, colonic microbiota and the microbiota activity.

Planned Impact

This project addresses one of UKs major diet-related health challenges. It has huge potential for long term impact on a wide range of stakeholders from consumers to policy makers. In addition to the academic beneficiaries listed, the outputs of the research will impact on the following stakeholder groups:-

Food Industry: The outputs from this project will enable the food industry to develop a new generation of foods targeted at reducing the incidence of type 2 diabetes through improved delivery of functional carbohydrates to the colon. Further research will allow the generic design principles to be incorporated into a wide range of food and beverages. Results from the project will inform efforts to ensure that new resistant-starch foods have consumer acceptability comparable to currently-available foods, making it more convenient for consumers to adopt healthier options. Food with high nutritional impact is a growing sector of the food industry and robust scientific evidence of positive health benefits arising from this and future projects will support health claims and further growth and give the UK food industry a competitive advantage.
Consumers: Individual consumers will have new knowledge regarding the health benefits of certain foods, together with a wider choice of manufactured foods with specific, proven health benefits. Care must be taken with the health communication aspects as consumption of these foods may only be effective as part of a healthy balanced diet. In the long term, the benefits of reducing the prevalence of diabetes will impact on lifelong health and wellbeing of individuals and improve the quality of life into old age.
Pharmaceutical Industry: The generic principles involved in this research are expected to stimulate further research to improve the targeted delivery of carbohydrates, polymers and other therapeutic and health promoting compounds to the colon.
National Health Service and Government: The number of individuals diagnosed with type 2 diabetes in the UK has roughly doubled since 1996 to about 2.6 million, with over 70% of cases being over the age of 55. Older diabetes patients often develop complications including heart disease, stroke, blindness, kidney disease and amputations leading to disability and premature mortality. The direct cost to the NHS and other health care providers for treating type 2 diabetes and related conditions is around £10 billion per year (approx. 10% of the NHS budget). The total cost of diabetes to the nation including direct care, loss of working days due to sickness and loss of productivity is estimated to be £23.7 billion. Any reduction in the prevalence of diabetes would have a huge impact through fewer hospital admissions, fewer surgical interventions and fewer prescriptions, hence lower health costs. The basic knowledge generated from this project and further research targeted at foods which would naturally deliver fermentable starch to the colon, will also help Government agencies to develop dietary advice for individuals at risk from developing diabetes in later life.

To maximise impact, we will assemble an Advisory Panel composed of various stakeholders including academics, beneficiaries, end users and industry (see Pathways to Impact). The panel will meet three times during the project to review progress and advise on future directions, application and exploitation. In addition, two further open meetings will be held at the end of the project to consult with a broader group of stakeholders.
 
Description Have just completed the in vitro digestions, and has shown some interesting effects of processing. Cooking at high water activity appears to increase the amount of resistant starch. Also, digesting the starch can also influence the crystallisation of the starch. Microscopical and physical analysis showed that the crystallinity of the cooked rr pea actually increased but that of the wild type did not. Thus a combination of starch granule structure and processing can be used to control the resistant starch content. By understanding the mechanisms underpinning these observations, we can develop strategies to optimise the health impact of peas and pea-derived ingredients.

The matrix of the pea was also found to change with the different variants, affecting cell wall properties, which could also affect digestibility and fermentability of the product.
Key differences in digestibility were found between the pea flour and whole peas, and the effect of processing was also different depending on the water activity.
After digestion, chunks of pea material were still visible and light microscopy showed that they did not change in size (approx. 2 mm), although they appear more translucent towards the end of digestion, especially material from RR peas. This would suggest that much of the starch is still trapped inside the cells of the pea tissue. Further measurements using the dynamic gastric model are currently investigating the role of mixing and gastric emptying on the particle size of the 'chunks' and the composition of the digesta emptied from the stomach in order to interpret the in vivo studies.
Following a standardised in vitro chewing step, the different properties of the tissues led to the rr pea being more difficult to break up, and thus formed larger chunks and less free starch was release, resulting in a slower digestion of starch.
Novel approaches to combine process with genotype to optimise the amount of fermentable starch delivered to the colon are being investigated to develop cases for future funding applications.
The results of the project are currently being written up for publication.
Update 2020 - The manuscript is currently under review with Nature Food. We obtained further impact / translation funding from BBSRC, and workshops were organised with companies, including several SMEs to develop ideas for food products which are being taken forward into the development of a super follow on fund application in 2020.
Update 2021 - The manuscript was published in Nature Food (Petropoulou et al (2020)), the super follow on fund application was submitted in October 2020, (awaiting outcome). A further BBSRC response mode application is also currently being prepared based upon some preliminary data generated by this project on the behaviour of soluble fibre during digestion.
Exploitation Route The project is contributing to a new programme of research undertaken jointly at IFR and the John Innes Centre to determine similar effects in wheat, which is likely to have greater future potential due to the amount of wheat consumed compared to pea.
The results concerning the matrix structure and nutrient availability is being utilised through GCRF-based research projects funded by BBSRC and MRC.
Update 2020 - Following the food hack workshop, an opportunity has arisen through one of the participants to grow up and multiply larger amounts of wrinkled peas with local farmers for further translational research. This will provide sufficient material to run longer / larger studies should the follow on fund be successful. This will benefit our collaborations with the food production and manufacturing industry, and ultimately on the health of the consumer with the development of new, tasty, healthier food ingredients and products.
Sectors Agriculture, Food and Drink,Healthcare,Manufacturing, including Industrial Biotechology

URL https://www.imperialhackspace.com/whats-on/food-hack/
 
Description We have been working closely with a stakeholder group to develop commercially viable strategies to progress the research. We gained valuable feedback from the project from a number of industrial stakeholders and we are currently using this information to develop further collaborative funding to understand the role of food structure and processing on health outcomes in real food products. Update 2020 - The findings were used to help obtain impact acceleration funding from BBSRC to organise workshops, which have had significant impact on a number of food companies to help them develop ideas for new, healthier food products. This will feed into the development of a super follow on fund grant later in 2020. Update 2021 - Following discussions with partners, a patent application was submitted. The Super Follow on Fund application was submitted in October 2020. Following publication of the paper (Petrolopoulou et al (2020)), several companies have approached us about the development of healthier food ingredients based on our research.
First Year Of Impact 2019
Sector Agriculture, Food and Drink,Manufacturing, including Industrial Biotechology
Impact Types Societal,Economic

 
Description ILSI panel on short chain fatty acids
Geographic Reach Europe 
Policy Influence Type Participation in a advisory committee
 
Description Diet and Health Seeding Award
Amount £100,000 (GBP)
Funding ID BBSRC/DH/SA/2019/3 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 09/2019 
End 02/2020
 
Description The biosynthetic control of amylose fine structure and its implications for nutrition
Amount £160,908 (GBP)
Organisation John Innes Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2020 
End 11/2022
 
Description STFC Food network 2.0 
Organisation Science and Technologies Facilities Council (STFC)
Country United Kingdom 
Sector Public 
PI Contribution I am a member of the advisory board for the UKRI/STFC Food Network 2.0 grant. My role on this project is to provide oversight for the development of projects using STFC facilties for applications in Food Science
Collaborator Contribution The other partners on the award are directly involved in selecting projects to fund, organising meetings and disbersing funds.
Impact Several successful projects have been funded as a result of the STFC 2.0 network, see the attached URL for full details
Start Year 2019
 
Description STFC Food network 2.0 
Organisation University of Manchester
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a member of the advisory board for the UKRI/STFC Food Network 2.0 grant. My role on this project is to provide oversight for the development of projects using STFC facilties for applications in Food Science
Collaborator Contribution The other partners on the award are directly involved in selecting projects to fund, organising meetings and disbersing funds.
Impact Several successful projects have been funded as a result of the STFC 2.0 network, see the attached URL for full details
Start Year 2019
 
Description STFC Food network 2.0 
Organisation University of Sheffield
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a member of the advisory board for the UKRI/STFC Food Network 2.0 grant. My role on this project is to provide oversight for the development of projects using STFC facilties for applications in Food Science
Collaborator Contribution The other partners on the award are directly involved in selecting projects to fund, organising meetings and disbersing funds.
Impact Several successful projects have been funded as a result of the STFC 2.0 network, see the attached URL for full details
Start Year 2019
 
Title Foodstuffs having improved digestion properties 
Description Methods to increase the resistant starch content of peas through combined genomics and processing 
IP Reference GB2014104.0 
Protection Patent application published
Year Protection Granted 2020
Licensed No
Impact The discovery has led to several industrial interactions to further develop the discovery in terms of aiding the development of new food ingredients. This has led to a UKRI super follow on fund application to accelerate exploitation, and specific confidential discussions with individual companies to potentially license the IP towards ingredient development.
 
Description 'Pulse Research Update' at John Innes Centre - PGRO & press visit 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Media (as a channel to the public)
Results and Impact 'Pulse Research Update' at John Innes Centre - PGRO & press visit
Year(s) Of Engagement Activity 2018
 
Description 2016 Celebration of Peas, Beans and Legumes at The Cut Science Cafe in Halesworth, Suffolk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact The Science Café is a series of regular meetings held at The Cut in Halesworth, Suffolk to explore and discuss the latest ideas in Science and Technology in an informal atmosphere. Talk was given by Claire Domoney and Mike Ambrose, titled '2016 Celebration of Peas, Beans and Legumes' with debate/discussion after.
Year(s) Of Engagement Activity 2016
 
Description BRIT Pact symposium of Arthritus 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was a formal information giving lecture with a question and answer session
Year(s) Of Engagement Activity 2017
 
Description CRESTAR project meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Workshop on pea genetics to develop a way forward
Year(s) Of Engagement Activity 2018
 
Description Celebrating 50 years of John Innes research in Norwich at The Cut Science Cafe in Halesworth, Suffolk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Celebrating 50 years of John Innes research in Norwich at The Cut Science Cafe in Halesworth, Suffolk
Year(s) Of Engagement Activity 2018
 
Description DRINC update meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Report back to the DRINC panel on progress of the project on pease
Year(s) Of Engagement Activity 2017
 
Description Exhibition at the Norfolk Farming Conference 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Exhibition at the Norfolk Farming Conference 2017, JIC Conference Centre, Norwich, Norfolk, UK
Year(s) Of Engagement Activity 2017
 
Description Exhibition at the Norwich Science Festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Pea TimeVine display at the Norwich Science Festival. Part of the '50 years of John Innes Centre Research in Norwich' display at the Norwich Forum.
Year(s) Of Engagement Activity 2017
 
Description FENS conference Dublon 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Spoke to an audance of over 100 one food and the gut covering aspects from many of my awards
Year(s) Of Engagement Activity 2019
URL http://www.fens2019.org/
 
Description Food digestion meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 400 scientist attended a two day meeting. I present the impact of fermentable carbohydrate on appetite regulation. Good audience feed back
Year(s) Of Engagement Activity 2017
 
Description Food hackathon 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact 50 small to medium size enterprises will take part in a Hackaton aimed at finding a way forward and translation around legume foods and health
Year(s) Of Engagement Activity 2019,2020
URL https://www.imperial.ac.uk/events/95859/food-hack-2020-translating-nutritional-research-into-product...
 
Description Imperial Science Festival - dissemination to general public 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact We had a two stands disseminating information in out work on dietary fibre and dietary assessment
Year(s) Of Engagement Activity 2017
URL http://www.imperial.ac.uk/festival/about/festival-2017/
 
Description Institute Open Day - Breeders Day 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Tour of JIC caged pea plot area at Breeders' Day 2016.
Year(s) Of Engagement Activity 2017
 
Description Institute Open Day - JIC Open Day 2017 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact JIC Open Day 2017: Pea TimeVine and displays based around the research from the Domoney Lab
Year(s) Of Engagement Activity 2017
URL https://storify.com/JIC_Comms/open-day-2017
 
Description LEGATO-EUROLEGUME International Conference - Advances in grain legume cultivation and use 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Attendance at LEGATO-EUROLEGUME International Conference - Advances in grain legume cultivation and use
Year(s) Of Engagement Activity 2017
 
Description Pea genetics and glycaemic control 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact This day was aimed at engaging the industrial partners in the project and getting views on a way forward
Year(s) Of Engagement Activity 2018
 
Description Presentaion to Cambridge metabolic group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact 50 post doctoral scientist attended the workshop on short chain fatty acids. The talk raised a number of questions and suggestion
Year(s) Of Engagement Activity 2018
 
Description Presentation to JIC Governing Council: 'Translating Genetic Research In Species Pisum: from MfN to Breeders and Beyond' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Supporters
Results and Impact Presentation to JIC Governing Council: 'Translating Genetic Research In Species Pisum: from MfN to Breeders and Beyond'
Year(s) Of Engagement Activity 2017
 
Description Presentation to Norwich Research Park Diet and Health Tea Club 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Presentation of the food structure research to the Norwich Research Park Diet and Health Tea Club. This group is formed of researchers and clinicians from the Norwich Research Park, to disseminate and communicate developments in diet and health research and to foster collaborations.
Year(s) Of Engagement Activity 2016
 
Description Press article - The Pulse Magazine - The Official Journal of the PGRO 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other audiences
Results and Impact The Pulse Magazine - The Official Journal of the PGRO. The John Innes Centre celebrates 50 Years in Norwich in 2017
Year(s) Of Engagement Activity 2017
 
Description Public lecture to local members of the University of the Third Age 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Public lecture organised for members of the University of the third age held at Quadram Institute, Norwich to disseminate and inform of the research activities and outputs of the Institute in the area of food structure and health.
Year(s) Of Engagement Activity 2017
 
Description Public lecture to the North Norfolk National Trust Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact A public lecture to the North Norfolk National Trust society to communicate some of the research activities of the Institute as part of our outreach activities.
Year(s) Of Engagement Activity 2016
 
Description Radio broadcast - BBC Radio Norfolk 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Radio broadcast on BBC Radio Norfolk. JIC Open Day 2017: 'The application of genetic research in pea at JIC to the development of novel foods' - hosted by Thordis Fridriksson
Year(s) Of Engagement Activity 2017
 
Description Rank Prize conference - Designing Food Structure to Control Digestion and Improve Health Impacts 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact 60 young scientist attended a week long workshop to understand the role of food structure. The aim was to develop interest in this area
Year(s) Of Engagement Activity 2019
URL http://www.rankprize.org/index.php/symposia
 
Description TV Broadcast - BBC Look East 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact TV broadcast on BBC Look East - JIC Open Day 2017: 'The application of genetic research in pea at JIC to its many uses in food and agriculture'
Year(s) Of Engagement Activity 2017
 
Description Transatlantic Sessions on Conservation and Organic Agriculture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact PPP: Potential and Power of Pea presentation at Transatlantic Sessions on Conservation and Organic Agriculture
Year(s) Of Engagement Activity 2018
 
Description UN International Year of Pulses at The Cut Science Cafe as part of the Norwich Science Festival 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact The Norwich Festival is held annually as a celebration of the ground breaking scientific research associated with the city. Talk was given by Claire Domoney, entitled 'UN International Year of Pulses', as part of the Norwich Festival's series of The Cut Science Cafe talks.
Year(s) Of Engagement Activity 2016
 
Description Using crop genetics to understand the importance of dietary resistant starches for maintaining healthy glucose homeostasis (CRESTAR) Industrial Stakeholder Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Using crop genetics to understand the importance of dietary resistant starches for maintaining healthy glucose homeostasis (CRESTAR) Industrial Stakeholder Meeting
Year(s) Of Engagement Activity 2017
 
Description Visit to Norway to talk to opinion makes about Nutrition 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Talk to 15 Norwegian opinion leaders about the role of Nutrition in the prevention of non communicable disease highlighting my research
Year(s) Of Engagement Activity 2019
 
Description Workshop at DAVOS 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact 120 people attended a science update at DAVOS. My talk was on the double hit of Malnutritiion
Year(s) Of Engagement Activity 2018
URL https://www.weforum.org/events/world-economic-forum-annual-meeting-2018