Is There Sufficient Local Evidence to Inform Biofortification Policies Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overview and general recommendation:

This manuscript successfully draws attention to local evidence for improving biofortification against micronutrient deficiencies. Its language is written well, and the paper structure fits the rules of International Journal of Environmental Research and Public Health. The purpose and objective are clearly stated. Its introduction and conclusion are adequate and concise. For the development and support of this manuscript, major topics or ideas received enough interest and explanation. Besides, references and resource materials are adequate. For grammar and mechanics, punctuation, and spelling are decent and have no significant problems. Nevertheless, some comments and concerns still need to be explained below.

 

• Major comments

1. In the abstract, the information is sufficient. This is a timely and important perspective that addresses a genuine gap in the biofortification literature. The core argument, that research output is misaligned with nutritional burden, is compelling and well-supported by bibliometric evidence.

 

a. The title and abstract blend two distinct issues: (a) whether there is sufficient global evidence for biofortification's efficacy, and (b) whether there is sufficient locally-generated evidence to inform national policies. These require different types of evidence. Is the argument that biofortification lacks evidence in general, or that it lacks context-specific evidence? Can efficacy data from one region inform policy elsewhere, or must each country generate its own evidence base? What types of local evidence are actually needed, such as agronomic trials, efficacy studies, implementation research, and cost-effectiveness analyses? It is suggested that the central thesis be sharpened. If the argument is about implementation barriers due to a lack of local research capacity, frame it explicitly as a research equity and translational science issue rather than questioning biofortification's evidence base itself.

b. The abstract asserts that "effective implementation requires a body of locally relevant studies," but doesn't explain why. What aspects of biofortification are context-dependent, such as crop varieties, soil conditions, dietary patterns, and bioavailability? When can evidence transfer across contexts vs. when is local validation essential? Besides, how does the lack of local research create specific barriers to policy adoption or program design?

 

2. The introduction establishes relevance and attempts to justify the study, but it suffers from unclear argumentation, conceptual confusion, and gaps in logical flow. The core research question is important, but the framing conflates different types of evidence needs and lacks precision in defining what "sufficient" means.
   
   a. It combines several distinct evidence types without recognizing the differences. In lines 41-43, it suggests countries need "local body of studies when they plan and budget". Lines 59-61 ask about "sufficient scientific evidence and knowledge structures". And in lines 53-54, it refers to "scientific evidence on biofortification and nutritional deficiencies". Does biofortification efficacy research need to be locally generated, or can it be imported from similar contexts? Did this study measure research production capacity or research availability? The question implies each country needs its own evidence base, but this isn't justified. It is recommended to clarify (a) whether global evidence on biofortification is sufficient, (b) whether high-burden countries have the research infrastructure to generate/adapt evidence, or (c) whether policymakers in high-burden countries have access to relevant evidence.
   
   b. In lines 53-58, the paragraph states that previous work hasn't "systematically quantified" this relationship. Please explain why quantifying publication counts by country is the right approach and how publication volume relates to "knowledge structures" or policy capacity. It is required to be more precise about the research gap by describing the limitations of bibliometric approaches upfront and interpreting why this particular analysis matters for policy or practice.
   
   c. The research question has multiple problems in lines 59-63. "Do the countries facing the greatest micronutrient burdens also have sufficient scientific evidence and knowledge structures to effectively guide decision-making?". First of all, "sufficient" is undefined and likely context-dependent. "Knowledge structures" is vague. Does this mean institutions, expertise, or publications? Besides, the question assumes evidence must be country-specific. Finally, "effectively guide decision-making" implies an outcome you're not measuring.

 

3. The methods section describes a straightforward bibliometric approach, but it has significant methodological limitations, unclear decisions, and research gaps in transparency. The choice of indicators, search strategy, and analytical approach all need better justification.
   
   a.There is a mismatch between biofortification research and selected indicators in lines 81-84. This study compared biofortification publications with Iodized salt coverage (not a biofortification intervention), zinc deficiency, and childhood anemia. Iodized salt is food fortification, not biofortification. So why include it? Also, anemia has many causes beyond micronutrient deficiency, such as infections and hemoglobinopathies. Only zinc deficiency directly relates to biofortification crops like zinc wheat or rice. The revision could justify why iodized salt coverage is relevant to biofortification research, or replace it with vitamin A deficiency, iron deficiency, or a composite micronutrient deficiency index. Also, explain why you selected these three specific indicators, and illustrate that anemia is a poor proxy for micronutrient deficiency burden.
   
   b. In lines 78-80, "a country-level publication count was compiled, assigning one count to a country each time it appeared in a paper". Does this mean the author's affiliation country or the study location country? If a paper has 10 co-authors from 5 countries, does each country get 1 count? (This is what "each time it appeared" suggests, but it's non-standard) What about papers with no clear geographic focus, like lab studies and reviews? How were multi-country field studies handled? For example, an article published by Japanese researchers about biofortification trials in Kenya could be counted for Japan only, Kenya only, or neither. This dramatically affects your conclusions about where evidence is being generated vs. where it's being applied. Besides, standard bibliometric practice uses fractional counting or distinguishes the corresponding or first author's country. It is required to clearly state whether this study is measuring research production (author affiliations) or research location (where studies were conducted) by providing examples of how multi-country papers were handled. It could be analyzed separately, including the author affiliation and the study location. It is also necessary to describe why this study did not use fractional counting.
   
   c. In lines 86-88, specific thresholds are mentioned: Iodized salt <70% and <50%, Zinc >25% and >35%, and no threshold is mentioned for anemia. There is no justification for why these cut-points were chosen. Why different approaches for different indicators? What about countries just above or below thresholds? There is no sensitivity analysis with different thresholds either. It is recommended that continuous measures, in addition to categorical measures, be used to provide a rationale for thresholds, such as WHO benchmarks and policy targets. Correlation analyses might be used rather than just categorical comparisons.

 

4. Sections 3 and 4 are substantially comprehensive and well-presented. The data are logically organized and mostly support the claims. However, several critical issues affect the interpretation and claims.

a. In lines 113-125, this entire paragraph compares biofortification research with iodized salt coverage, but the core problem is that iodized salt is not biofortification, and it's industrial food fortification. In lines 122-124, "basic country-level studies" on "enforcing iodization standards" and "retail-level testing" are suggested. But they are NOT biofortification research. Also, lines 175-177 mention "basic studies on retail-level testing, enforcement audits, and distribution practices" for iodized salt. This is not biofortification research at all. It is suggested to (a) remove the iodized salt analysis entirely, or (b) explicitly reframe your manuscript as being about micronutrient interventions broadly (not just biofortification), or (c) replace it with vitamin A deficiency, iron deficiency, or folate deficiency data that actually relate to biofortification crops. This is not a minor issue. It fundamentally confuses what this manuscript is about.

b. In lines 100-101, "1308 country-linked authorships" but still no clear explanation of what "country-linked" means. Are these the author's affiliations or study locations? How are multi-country papers counted? Besides, in lines 107-111, India (242), USA (130), Pakistan (89) are reported as top countries, but are these papers by researchers in these countries or about these countries? For example, if the USA's 130 articles are mostly HarvestPlus studies conducted in Africa/Asia, that's very different from if they're lab studies in the USA. It is required to state explicitly: "Countries were attributed based on authors' institutional affiliations" (or whatever method this study used) and provide a sensitivity analysis separating the author's countries from the study location. This approach may misattribute research conducted in high-burden countries by international teams.

c. Statistical analysis is inadequate because the results present only descriptive statistics. There are medians and percentiles missing, arbitrary threshold comparisons, no formal correlation tests and no regression analyses. In lines 113-125, 126-136, 162-170, each paragraph uses the same pattern to describe a threshold, report median=0, and give percentages. However, is the relationship between burden and publications statistically significant? Could this be explained by GDP, population size, or research infrastructure? It is suggested that correlation analyses, maybe Spearman's rho Correlation, be performed between deficiency indicators and publication counts, and multiple regressions be performed controlling for GDP per capita, population, and region. The study may test whether the relationship holds across different time periods to provide effect sizes, not just descriptive patterns.

d. In lines 118-121, 131-133, and 165-167, the study lists countries with 0 publications and a high burden. However, are there counter-examples (high burden, high publications)? Are there high-income countries with low publications (would be expected)? What about countries with a moderate burden? Do they show the expected pattern? The problem is that electively highlighting extreme cases can overstate the pattern. It could be revised by presenting the full distribution, perhaps as a scatterplot, and reporting exceptions that don't fit the pattern. This study may use systematic criteria for which examples to highlight rather than selecting the most dramatic.

e. In lines 97-99, 6% annual growth is reported, which is substantial. However, there is no discussion of whether this growth is proportionally benefiting high-burden countries, and there is no analysis of whether the geographic distribution is improving over time. Also, there is no comparison to growth rates in other global health fields. It is suggested to analyze whether recent publications, such as the last 5 years, show better geographic equity and test whether the research gap is widening or narrowing by interpreting what 20.6% growth means for closing the evidence gap.

 

5. The conclusion uses strong moral language and makes sweeping recommendations, but it significantly overreaches beyond what the data can support. It mixes absence of publications with absence of evidence, ignores major methodological limitations, and oversimplifies both the problem and potential solutions. The rhetorical tone risks undermining the scientific credibility of the study.

 

a. There is an unjustified leap from data to moral claims. In lines 206-209, "absence of evidence...profound inequity...moral imperative". The logical gap is between what you measured (number of publications in Scopus by author affiliation country) and what you conclude (moral imperative to change global research priorities). The missing links are (a) the study hasn't shown that lack of publications equals lack of evidence, such as grey literature, government reports, and international studies may exist. (b) The study hasn't demonstrated that local publications are necessary for policy adoption compared to using regional and global evidence. (c) The study did not establish that the publication gap causes harm, which is the key requirement for an equity argument. (d) The study has not proven that current approaches are unjust rather than pragmatic.

b. The moral language requires stronger evidence because stating something as a "moral imperative" or "profound inequity" makes ethical claims that need ethical analysis, not just bibliometric data. The study needs to show that people are harmed by current arrangements, or that alternatives are feasible, or that someone has obligations to act differently. However, the results showed a correlation, which means that a low burden is not equal to low publications. It is not causation or moral responsibility.

 

6. Figure 1B co-authorship map may not actually show what the study claims if the method was simply country counting.

 

2.2 Minor comments

1. Reference [1] is overused in lines 39-43, which cite reference [1] three times for distinct claims. Either these need separate citations, or the single reference should be more carefully placed.
2. In Line 39, "worldwide challenge on global health". This is redundant.
3. In Line 44, "hidden hunger". It is recommended to consider defining or using "micronutrient deficiencies" consistently.
4. In Line 57, "territorial health and nutrition needs". The term "territorial" is unusual here. It may be revised to "country-specific" or "context-specific".
5. In lines 86-87, "results were reported as frequencies and percentages". But this belongs in Results, not Methods. Also, the study does not describe what statistical comparisons or tests were used.
6. In Line 69, "controlled vocabulary" is an odd phrasing for MeSH terms
7. In Line 80, "co-authorship networks" is mentioned, then immediately dismissed. And in Line 89, "co-authorship data were enriched" was mentioned. It is confusing since the method mentioned that this study didn't analyze co-authorship networks.
8. In lines 110-112, "In practical terms, most countries begin with very limited evidence". It is awkward phrasing that "begin" implies a temporal starting point.
9. In Line 206, "absence of evidence". It is actually the absence of publications.
10. In Line 207, "profound inequity". Does it compare to what baseline? What would equity look like?
11. In Line 209, "research agendas genuinely reflect". Whose agendas? Set by whom?
12. In Line 211, "aligning discovery with action". It is poetic but unclear.

Author Response

Answer to reviewers

Manuscript ijerph-3946419

Is There Sufficient Local Evidence to Inform Biofortification Policies Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health

 

We are grateful with the Editor and Reviewers for the expert reading of the manuscript. We have found the comments appropriate and helpful. They have permitted us to improve the manuscript. Appropriate changes were made and highlighted in the revised manuscript according to suggestions. Following are the responses to the comments.

 

Reviewer#1:

Major comments

 

The title and abstract blend two distinct issues: (a) whether there is sufficient global evidence for biofortification's efficacy, and (b) whether there is sufficient locally-generated evidence to inform national policies. These require different types of evidence. Is the argument that biofortification lacks evidence in general, or that it lacks context-specific evidence? Can efficacy data from one region inform policy elsewhere, or must each country generate its own evidence base? What types of local evidence are actually needed, such as agronomic trials, efficacy studies, implementation research, and cost-effectiveness analyses? It is suggested that the central thesis be sharpened. If the argument is about implementation barriers due to a lack of local research capacity, frame it explicitly as a research equity and translational science issue rather than questioning biofortification's evidence base itself.

 

r/ We fully agree that global evidence supporting the biological and nutritional efficacy of biofortification is already well established. Our study does not aim to question the efficacy of biofortification itself. Instead, the core purpose of this work is to examine whether countries with the highest micronutrient burdens generate the locally relevant evidence needed to contextualize and guide national policy implementation. We appreciate the reviewer’s suggestion to sharpen this distinction and to frame the issue more explicitly as one of research equity and translational capacity.

 

In response, we have implemented the following revisions:

 

-Title: The title has been refined to clearly reflect the focus on locally generated evidence for policy decision-making, avoiding any ambiguity regarding biofortification’s established efficacy: “Is There Sufficient Local Evidence to Inform Biofortification Policies Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health”

 

-Abstract: A concise clarifying sentence was added to explicitly indicate that the study evaluates the availability of country-level research necessary to inform policy, rather than the biological efficacy of biofortification.

 

We believe these revisions substantially improve the conceptual clarity of the manuscript and fully address the reviewer’s concern.

 

The abstract asserts that "effective implementation requires a body of locally relevant studies," but doesn't explain why. What aspects of biofortification are context-dependent, such as crop varieties, soil conditions, dietary patterns, and bioavailability? When can evidence transfer across contexts vs. when is local validation essential? Besides, how does the lack of local research create specific barriers to policy adoption or program design?

 

r/ We agree that the abstract should briefly justify why locally generated evidence is necessary for the implementation of biofortification. The effectiveness, adoption, and policy relevance of biofortified crops depend on multiple context-specific factors, including local crop varieties, soil micronutrient composition, agricultural practices, dietary patterns, cultural acceptability, and micronutrient bioavailability. These elements can vary substantially across settings, which limits the direct transferability of evidence from one region to another and makes local validation essential for national policy design.

 

To address the reviewer’s comment, we added a concise sentence to the abstract explicitly stating why local evidence is required and which context-dependent factors influence implementation. This clarification strengthens the abstract and aligns it with the conceptual rationale presented in the manuscript.

 

It combines several distinct evidence types without recognizing the differences. In lines 41-43, it suggests countries need "local body of studies when they plan and budget". Lines 59-61 ask about "sufficient scientific evidence and knowledge structures". And in lines 53-54, it refers to "scientific evidence on biofortification and nutritional deficiencies". Does biofortification efficacy research need to be locally generated, or can it be imported from similar contexts? Did this study measure research production capacity or research availability? The question implies each country needs its own evidence base, but this isn't justified. It is recommended to clarify (a) whether global evidence on biofortification is sufficient, (b) whether high-burden countries have the research infrastructure to generate/adapt evidence, or (c) whether policymakers in high-burden countries have access to relevant evidence.

 

r/ We agree that the introduction originally combined different types of evidence without clearly distinguishing between global efficacy research, context-specific implementation evidence, and broader research capacity considerations. Our analysis does not argue that every country must generate its own efficacy data; the global evidence base for the biological and nutritional effectiveness of biofortification is already strong. Rather, the purpose of this work is to examine the availability of locally relevant evidence needed to adapt, operationalize, and implement biofortification strategies within national contexts.

 

To address this, we added a new paragraph in the introduction that:

(a) distinguishes global efficacy from local implementation evidence,

(b) clarifies that our study measures research availability, not research capacity or access, and

(c) explains why context-specific studies are often needed for policy design.

 

These revisions clarify the conceptual boundaries of the study and respond directly to the reviewer’s concerns.

 

In lines 53-58, the paragraph states that previous work hasn't "systematically quantified" this relationship. Please explain why quantifying publication counts by country is the right approach and how publication volume relates to "knowledge structures" or policy capacity. It is required to be more precise about the research gap by describing the limitations of bibliometric approaches upfront and interpreting why this particular analysis matters for policy or practice.

r/ We agree that the introduction needed a clearer justification for why publication counts by country are an appropriate indicator for assessing territorial evidence gaps and how this relates to knowledge structures and policy capacity. Our intention is not to equate publication volume with research quality, research infrastructure, or policymaker engagement. Rather, bibliometric output offers a transparent and standardized proxy for the minimum level of locally generated evidence available to inform national discussions on biofortification. This method has been widely used to identify geographic disparities in scientific production and to highlight contexts where evidence for policy adaptation may be limited.

 

To address the reviewer’s suggestion, we added a new paragraph in the introduction clarifying:

 

(a) why bibliometric quantification is relevant to understanding evidence availability;

(b) how publication volume relates, although imperfectly, to local knowledge structures; and

(c) the limitations of this approach and its policy relevance.

 

This addition strengthens the conceptual foundation of the study and aligns the introduction more closely with the aims and scope of the analysis.

 

The research question has multiple problems in lines 59-63. "Do the countries facing the greatest micronutrient burdens also have sufficient scientific evidence and knowledge structures to effectively guide decision-making?". First of all, "sufficient" is undefined and likely context-dependent. "Knowledge structures" is vague. Does this mean institutions, expertise, or publications? Besides, the question assumes evidence must be country-specific. Finally, "effectively guide decision-making" implies an outcome you're not measuring.

 

r/ We agree that the original research question contained terms that were imprecise (“sufficient”), overly broad (“knowledge structures”), or implied constructs that our study does not measure (“effectively guide decision-making”). Our analysis does not evaluate institutional capacity, policy effectiveness, or whether each country needs its own evidence base. Rather, it quantifies the availability of locally linked, peer-reviewed research relative to nutritional burden indicators.

 

To address this concern, we fully reformulated the research question in the introduction to avoid vague terminology and to align it directly with what the study measures. The revised framing now focuses on the availability and geographic distribution of published research on biofortification and micronutrient deficiencies and how these patterns relate to global indicators of need. This modification improves conceptual precision and avoids suggesting outcomes beyond the scope of the analysis.

 

There is a mismatch between biofortification research and selected indicators in lines 81-84. This study compared biofortification publications with Iodized salt coverage (not a biofortification intervention), zinc deficiency, and childhood anemia. Iodized salt is food fortification, not biofortification. So why include it? Also, anemia has many causes beyond micronutrient deficiency, such as infections and hemoglobinopathies. Only zinc deficiency directly relates to biofortification crops like zinc wheat or rice. The revision could justify why iodized salt coverage is relevant to biofortification research, or replace it with vitamin A deficiency, iron deficiency, or a composite micronutrient deficiency index. Also, explain why you selected these three specific indicators, and illustrate that anemia is a poor proxy for micronutrient deficiency burden.

 

r/ We agree that the indicators used in our comparison represent different dimensions of micronutrient status, and that their relationship to biofortification varies. Our intention was not to imply a direct causal link between any specific indicator and biofortification outcomes. Instead, these indicators were chosen because they are internationally standardized metrics of nutritional vulnerability, widely used by WHO, UNICEF, the World Bank, and UN agencies to characterize population-level micronutrient deprivation and food security (see references 8 to 10 in the manuscript).

 

Iodized salt coverage, although reflecting a fortification rather than a biofortification intervention, is a long-standing global benchmark for national micronutrient programs and provides insight into a country’s implementation environment for nutritional policies. Zinc deficiency is directly relevant to biofortifiable crops such as zinc rice and wheat. Childhood anemia, while multifactorial, remains a core global indicator of micronutrient deprivation and dietary insufficiency, and is used to prioritize countries for nutrition interventions.

 

Our objective was not to evaluate biological suitability but to contextualize the availability of locally generated research within widely recognized indicators of nutritional need. This approach allows us to identify geographic misalignments between scientific production and the populations most likely to benefit from strengthened biofortification strategies. To clarify this rationale, we added a detailed explanation in the Methods sections.

 

In lines 78-80, "a country-level publication count was compiled, assigning one count to a country each time it appeared in a paper". Does this mean the author's affiliation country or the study location country? If a paper has 10 co-authors from 5 countries, does each country get 1 count? (This is what "each time it appeared" suggests, but it's non-standard) What about papers with no clear geographic focus, like lab studies and reviews? How were multi-country field studies handled? For example, an article published by Japanese researchers about biofortification trials in Kenya could be counted for Japan only, Kenya only, or neither. This dramatically affects your conclusions about where evidence is being generated vs. where it's being applied. Besides, standard bibliometric practice uses fractional counting or distinguishes the corresponding or first author's country. It is required to clearly state whether this study is measuring research production (author affiliations) or research location (where studies were conducted) by providing examples of how multi-country papers were handled. It could be analyzed separately, including the author affiliation and the study location. It is also necessary to describe why this study did not use fractional counting.

 

r/ Thank you for this detailed methodological observation. We appreciate the importance of distinguishing between research production (author affiliation) and research location (where the empirical studies were conducted). Our analysis relied on author affiliation data as indexed in Scopus, assigning one count to each country appearing in the affiliation metadata of a publication. This whole-counting approach is commonly used in territorial evidence mapping and is appropriate for our objective, which is to assess whether countries with high micronutrient burdens have a minimum presence in the peer-reviewed knowledge base.

 

Under this method, if a paper lists authors from five countries, each country receives one count. When a study is conducted in a country but lacks local institutional participation, for example, a biofortification trial conducted in Kenya by researchers affiliated exclusively with Japanese institutions, the publication is attributed to Japan. This avoids overestimating the availability of locally generated evidence in settings without domestic research involvement.

 

Fractional counting was not used because the purpose of this study was not to measure proportional contribution, but rather to determine whether any locally linked evidence exists that could inform territorial discussions on biofortification. As requested, we clarified this procedure in the Methods section, including the rationale, an explicit statement about the limitations, and the distinction between research location and affiliation-based attribution.

 

In lines 86-88, specific thresholds are mentioned: Iodized salt <70% and <50%, Zinc >25% and >35%, and no threshold is mentioned for anemia. There is no justification for why these cut-points were chosen. Why different approaches for different indicators? What about countries just above or below thresholds? There is no sensitivity analysis with different thresholds either. It is recommended that continuous measures, in addition to categorical measures, be used to provide a rationale for thresholds, such as WHO benchmarks and policy targets. Correlation analyses might be used rather than just categorical comparisons.

 

r/ We agree that threshold selection requires clear justification. In this case, however, the study did not define any of the cut-points used. Each indicator (iodized salt coverage, zinc deficiency, and childhood anemia) is reported by its respective global health source using standardized, normative thresholds established by WHO, UNICEF, the Global Burden of Disease, and related international agencies. For example, iodized salt coverage <70% and <50% reflect WHO/UNICEF classifications of “off-track” and “severely off-track” progress; zinc deficiency >25% and >35% correspond to WHO/GBD categories of moderate and high inadequacy; and anemia prevalence >40% is the WHO criterion for a severe public health problem. Because these thresholds originate from official public health monitoring systems and are intended for categorical interpretation, we reproduced them exactly as reported.

 

For this reason, sensitivity analyses using alternative thresholds were not applicable, and treating these indicators as continuous variables would have departed from the standardized global reporting frameworks on which the data are based. Our objective was descriptive: to compare territorial evidence availability with internationally recognized benchmarks of micronutrient vulnerability, not to test correlations or infer causal relationships. This rationale has been fully clarified in the Methods section.

 

In lines 113-125, this entire paragraph compares biofortification research with iodized salt coverage, but the core problem is that iodized salt is not biofortification, and it's industrial food fortification. In lines 122-124, "basic country-level studies" on "enforcing iodization standards" and "retail-level testing" are suggested. But they are NOT biofortification research. Also, lines 175-177 mention "basic studies on retail-level testing, enforcement audits, and distribution practices" for iodized salt. This is not biofortification research at all. It is suggested to (a) remove the iodized salt analysis entirely, or (b) explicitly reframe your manuscript as being about micronutrient interventions broadly (not just biofortification), or (c) replace it with vitamin A deficiency, iron deficiency, or folate deficiency data that actually relate to biofortification crops. This is not a minor issue. It fundamentally confuses what this manuscript is about.

 

r/ We fully agree that iodized salt is a food fortification strategy and that childhood anemia has multiple etiologies. Importantly, our analysis does not treat these indicators as the biological targets of biofortification, nor does it imply intervention-specific relationships. Rather, these indicators were selected because they are internationally standardized, high-quality proxies of micronutrient vulnerability and nutritional inequity, widely used by WHO, UNICEF, FAO, and the World Bank for global monitoring.

 

Our objective was not to infer causal links between biofortification and these indicators, but to examine whether countries with the greatest nutritional burdens, characterized using the most consistently available global metrics, also demonstrate minimal availability of locally linked, peer-reviewed research that could support discussions around micronutrient interventions, including biofortification. At present, indicators such as vitamin A deficiency or iron deficiency lack the same global completeness and consistency across countries, making them unsuitable for a comparative territorial analysis of this scale.

 

We have revised the introduction and methods to explicitly state that the chosen indicators are used as proxies of nutritional need, not as intervention-specific endpoints, and that the analysis aims to illustrate geographic misalignment between scientific output and globally recognized vulnerability metrics.

 

In lines 100-101, "1308 country-linked authorships" but still no clear explanation of what "country-linked" means. Are these the author's affiliations or study locations? How are multi-country papers counted? Besides, in lines 107-111, India (242), USA (130), Pakistan (89) are reported as top countries, but are these papers by researchers in these countries or about these countries? For example, if the USA's 130 articles are mostly HarvestPlus studies conducted in Africa/Asia, that's very different from if they're lab studies in the USA. It is required to state explicitly: "Countries were attributed based on authors' institutional affiliations" (or whatever method this study used) and provide a sensitivity analysis separating the author's countries from the study location. This approach may misattribute research conducted in high-burden countries by international teams.

 

r/ As requested, we now explicitly clarify that all country-level publication counts are based on authors’ institutional affiliations, not on the geographic locations where the studies were conducted. Countries were attributed based on affiliation data indexed in Scopus, following a whole-counting approach. For example, the publication counts reported for India (242), the United States (130), and Pakistan (89) reflect the number of publications in which authors affiliated with institutions in these countries appear, regardless of where the empirical work occurred.

 

We also clarify that Scopus does not reliably capture study locations, and inferring them indirectly would introduce substantial misclassification. Therefore, we did not conduct a sensitivity analysis comparing author-affiliation countries with study-location countries, as such data are not systematically available. This methodological choice, and its implications, are now explicitly stated in the Methods section. Importantly, this approach aligns with our objective: to evaluate locally linked research participation, rather than global research activity conducted in high-burden countries without domestic involvement.

 

Statistical analysis is inadequate because the results present only descriptive statistics. There are medians and percentiles missing, arbitrary threshold comparisons, no formal correlation tests and no regression analyses. In lines 113-125, 126-136, 162-170, each paragraph uses the same pattern to describe a threshold, report median=0, and give percentages. However, is the relationship between burden and publications statistically significant? Could this be explained by GDP, population size, or research infrastructure? It is suggested that correlation analyses, maybe Spearman's rho Correlation, be performed between deficiency indicators and publication counts, and multiple regressions be performed controlling for GDP per capita, population, and region. The study may test whether the relationship holds across different time periods to provide effect sizes, not just descriptive patterns.

 

r/ We fully agree that correlation analyses, multivariable regression models, and sensitivity analyses can provide valuable explanatory insights in studies aiming to identify determinants of research productivity or to quantify statistical associations between burden and publication output. However, this was not the conceptual aim of the present study.

 

Our objective was to conduct a global, descriptive evidence-mapping exercise that characterizes the territorial availability of peer-reviewed research on micronutrient deficiency mitigation strategies, with emphasis on biofortification, and to compare these patterns with internationally recognized indicators of nutritional vulnerability. This design aligns with established methods in scientometrics landscape analyses and evidence-gap mapping, where the primary goal is to document geographic misalignment, not to model causal or statistical relationships.

 

Introducing regression-based or correlational modeling would require redefining the research question, expanding the dataset, and incorporating additional covariates such as GDP, population size, research infrastructure indices, and temporal interactions. Such an approach represents a distinct analytical framework and a different type of study. While valuable, it lies beyond the scope of this descriptive, exploratory analysis. We have clarified this rationale in the “4. Interpreting the gaps: lessons for food security and health policy” section and noted that inferential modeling represents an important opportunity for future research.

 

In lines 118-121, 131-133, and 165-167, the study lists countries with 0 publications and a high burden. However, are there counter-examples (high burden, high publications)? Are there high-income countries with low publications (would be expected)? What about countries with a moderate burden? Do they show the expected pattern? The problem is that electively highlighting extreme cases can overstate the pattern. It could be revised by presenting the full distribution, perhaps as a scatterplot, and reporting exceptions that don't fit the pattern. This study may use systematic criteria for which examples to highlight rather than selecting the most dramatic.

 

r/ We agree that selectively highlighting extreme cases may unintentionally overemphasize specific patterns if not clearly contextualized. In our results, countries with zero publications and high nutritional burden were presented solely as illustrative examples that met systematic criteria: (a) falling below internationally recognized thresholds, (b) presenting high burden according to each indicator, and (c) appearing in the lowest percentile of publication counts. These examples were not used as the basis for analytical inference; instead, the interpretation relies on the entire distribution of publication counts, which is summarized through medians, percentiles, and frequency patterns.

 

The purpose of this study is descriptive evidence mapping rather than inferential modeling, and therefore we did not perform correlation analyses or generate scatterplots. We have clarified in the Methods and Discussion that the examples serve only to contextualize broader patterns, not to establish statistical relationships. We also acknowledge that future research could incorporate visualization techniques or multivariable modeling to further explore exceptions and determinants of publication output.

 

In lines 97-99, 6% annual growth is reported, which is substantial. However, there is no discussion of whether this growth is proportionally benefiting high-burden countries, and there is no analysis of whether the geographic distribution is improving over time. Also, there is no comparison to growth rates in other global health fields. It is suggested to analyze whether recent publications, such as the last 5 years, show better geographic equity and test whether the research gap is widening or narrowing by interpreting what 20.6% growth means for closing the evidence gap.

 

r/ We agree that reporting an annual growth rate raises important questions about whether this expansion has benefited high-burden countries or improved geographic equity. However, the temporal analysis in our study was included for contextual purposes only and was not intended to evaluate convergence or divergence in research distribution over time. Addressing whether publication growth is proportionally benefiting high-burden countries would require a different analytical framework involving longitudinal disaggregation, additional structural covariates (e.g., research infrastructure, financing, population size), and formal modeling of equity trends.

 

Because the aim of this study is descriptive evidence mapping rather than explanatory or inferential trend analysis, we did not conduct these temporal comparisons. Instead, we focused on characterizing the current geographic distribution of the evidence base in relation to globally recognized micronutrient vulnerability indicators. We have clarified this scope in the Discussion and note that examining whether the evidence gap is widening or narrowing represents an important avenue for future research.

 

The conclusion uses strong moral language and makes sweeping recommendations, but it significantly overreaches beyond what the data can support. It mixes absence of publications with absence of evidence, ignores major methodological limitations, and oversimplifies both the problem and potential solutions. The rhetorical tone risks undermining the scientific credibility of the study.

 

r/ We agree that the original conclusion used language that could be interpreted as normative or overly prescriptive, and that some statements extended beyond what can be directly supported by a descriptive bibliometric analysis. In response, we revised the conclusion to adopt a more neutral, evidence-based tone. The revised version now: (a) distinguishes between absence of publications and absence of evidence, (b) avoids moral or rhetorical language, (c) refrains from making prescriptive recommendations, and (d) situates the findings within the methodological limitations of the study. The updated conclusion focuses on the descriptive insights generated by the analysis and highlights opportunities for future research without overstating the implications of the current dataset.

 

There is an unjustified leap from data to moral claims. In lines 206-209, "absence of evidence...profound inequity...moral imperative". The logical gap is between what you measured (number of publications in Scopus by author affiliation country) and what you conclude (moral imperative to change global research priorities). The missing links are (a) the study hasn't shown that lack of publications equals lack of evidence, such as grey literature, government reports, and international studies may exist. (b) The study hasn't demonstrated that local publications are necessary for policy adoption compared to using regional and global evidence. (c) The study did not establish that the publication gap causes harm, which is the key requirement for an equity argument. (d) The study has not proven that current approaches are unjust rather than pragmatic.

 

r/ We fully agree that the original phrasing in the Discussion and Conclusion implied moral and normative claims that were not directly supported by the descriptive nature of the analysis. In response to this feedback, we have removed all language referring to “profound inequity,” “moral imperatives,” and similar expressions. The revised manuscript no longer makes ethical claims or prescriptive statements about global research priorities.

 

We also explicitly acknowledge that:

 

-An absence of publications in Scopus does not imply an absence of locally generated evidence, such as grey literature, government reports, or studies conducted by international teams;

-The study does not evaluate whether local publications are necessary for policy adoption or whether global evidence may be sufficient;

-The analysis does not assess harm or injustice; and

-The study does not determine whether current research patterns reflect inequitable practices or pragmatic constraints.

 

The revised Discussion and Conclusion now adopt a neutral, evidence-focused tone and frame the findings strictly as a descriptive mapping of publication patterns in indexed literature, highlighting underrepresentation rather than inequity. We also clarify that any policy implications or ethical considerations fall outside the scope of this analysis and should be addressed in future research.

 

The moral language requires stronger evidence because stating something as a "moral imperative" or "profound inequity" makes ethical claims that need ethical analysis, not just bibliometric data. The study needs to show that people are harmed by current arrangements, or that alternatives are feasible, or that someone has obligations to act differently. However, the results showed a correlation, which means that a low burden is not equal to low publications. It is not causation or moral responsibility.

 

r/ We fully agree that the original phrasing in the Discussion and Conclusion implied moral and normative claims that were not directly supported by the descriptive nature of the analysis. In response to this feedback, we have removed all language referring to “profound inequity,” “moral imperatives,” and similar expressions. The revised manuscript no longer makes ethical claims or prescriptive statements about global research priorities.

 

We also explicitly acknowledge that:

 

-An absence of publications in Scopus does not imply an absence of locally generated evidence, such as grey literature, government reports, or studies conducted by international teams;

-The study does not evaluate whether local publications are necessary for policy adoption or whether global evidence may be sufficient;

-The analysis does not assess harm or injustice; and

-The study does not determine whether current research patterns reflect inequitable practices or pragmatic constraints.

 

The revised Discussion and Conclusion now adopt a neutral, evidence-focused tone and frame the findings strictly as a descriptive mapping of publication patterns in indexed literature, highlighting underrepresentation rather than inequity. We also clarify that any policy implications or ethical considerations fall outside the scope of this analysis and should be addressed in future research.

 

Figure 1B co-authorship map may not actually show what the study claims if the method was simply country counting.

 

r/ Figures 1B, 1C, and 1D were modified to avoid confusion and clarify that we were referring to authorship frequencies by country.

 

Minor comments

 

Reference [1] is overused in lines 39-43, which cite reference [1] three times for distinct claims. Either these need separate citations, or the single reference should be more carefully placed.

 

r/ We appreciate the reviewer’s observation regarding the repeated use of reference [1] in this section. In this case, the statements in lines 39-43 intentionally refer to the same source because reference [1] is a comprehensive global report synthesizing evidence on the burden, drivers, and policy implications of micronutrient deficiencies. The claims cited in this paragraph (impact on health and development, interaction with structural determinants, and implications for policy planning) are all explicitly addressed within different sections of this single report. For this reason, a repeated citation of the same reference is appropriate and avoids fragmenting a coherent line of evidence. Nonetheless, we ensured that the placement of each citation clearly corresponds to the specific claim it supports.

 

In Line 39, "worldwide challenge on global health". This is redundant.

 

r/ Corrected.

 

In Line 44, "hidden hunger". It is recommended to consider defining or using "micronutrient deficiencies" consistently.

 

r/ Corrected.

 

In Line 57, "territorial health and nutrition needs". The term "territorial" is unusual here. It may be revised to "country-specific" or "context-specific".

 

r/ Corrected.

 

In lines 86-87, "results were reported as frequencies and percentages". But this belongs in Results, not Methods. Also, the study does not describe what statistical comparisons or tests were used.

 

r/ Corrected. As we have clarified in the text, statistical tests were not used, since the scope of the idea, objective, and statistical analysis is descriptive, not inferential.

 

In Line 69, "controlled vocabulary" is an odd phrasing for MeSH terms.

 

r/ Corrected.

 

In Line 80, "co-authorship networks" is mentioned, then immediately dismissed. And in Line 89, "co-authorship data were enriched" was mentioned. It is confusing since the method mentioned that this study didn't analyze co-authorship networks.

 

r/ Corrected in all cases.

 

In lines 110-112, "In practical terms, most countries begin with very limited evidence". It is awkward phrasing that "begin" implies a temporal starting point.

 

r/ We thank the reviewer for noting the imprecise temporal implication in the phrase “most countries begin with very limited evidence.” Our intention was not to describe a chronological starting point but rather the structural reality that many countries have persistently limited access to locally generated or context-relevant evidence. We have revised the sentence to: “In practical terms, most countries have access to only a minimal body of context-relevant evidence,” which more accurately conveys the intended meaning.

 

In Line 206, "absence of evidence". It is actually the absence of publications.

 

r/ Corrected.

 

In Line 207, "profound inequity". Does it compare to what baseline? What would equity look like?

 

r/ This term has been removed.

 

In Line 209, "research agendas genuinely reflect". Whose agendas? Set by whom?

 

r/ This sentence has been removed.

 

In Line 211, "aligning discovery with action". It is poetic but unclear.

 

r/ This sentence has been removed.

Reviewer 2 Report

Comments and Suggestions for Authors

Regarding the manuscript "Is There Sufficient Local Evidence to Advance Biofortification 2
Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health", The topic is scientifically sound and well written, however  I have few suggestion to improve the article.

1. Introduction : please define the process of biofortification.
2. Please improve introduction section by adding previous studies on biofortification to reduce malnutrition. 
3. Methodology: only 1 database i.e. Scopus is not enough to generate the relevant studies. at least 2 databases Scopus or may be PubMed should be selected to retrieve the data. Also, I am wondering about the search term which are too basics for in depth analysis of the topic.

Author Response

Answer to reviewers

Manuscript ijerph-3946419

Is There Sufficient Local Evidence to Inform Biofortification Policies Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health

 

We are grateful with the Editor and Reviewers for the expert reading of the manuscript. We have found the comments appropriate and helpful. They have permitted us to improve the manuscript. Appropriate changes were made and highlighted in the revised manuscript according to suggestions. Following are the responses to the comments.

 

Reviewer#2:

 

Regarding the manuscript "Is There Sufficient Local Evidence to Advance Biofortification to Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health", The topic is scientifically sound and well written, however  I have few suggestion to improve the article.

 

Introduction : please define the process of biofortification.

 

r/ We thank the reviewer for this important suggestion. Although the introduction provided contextual information on the role and relevance of biofortification, we agree that an explicit definition of the process strengthens conceptual clarity. We have therefore added the following sentence at the beginning of the biofortification paragraph: “Biofortification is the process of increasing the micronutrient content of staple crops through conventional plant breeding, agronomic practices, or modern biotechnological approaches, with the goal of improving the nutritional quality of foods at the point of production.” This revision ensures that readers are provided with a clear and formal definition before discussing its applications and implications.

 

Please improve introduction section by adding previous studies on biofortification to reduce malnutrition.

 

r/ We agree that strengthening the introduction with evidence from previous efficacy and effectiveness studies provides important context for readers. In response, we have added a concise summary of seminal trials demonstrating the nutritional impact of biofortified staple crops. Specifically, we cite large-scale effectiveness studies showing that consumption of vitamin A-rich orange-fleshed sweet potato improved vitamin A intakes and status among children and women in Uganda and Mozambique. We also reference a recent cluster-randomized effectiveness trial demonstrating that zinc-biofortified wheat flour improved zinc and iron status among adolescent girls in rural Pakistan. In addition, we incorporated evidence syntheses from a recent systematic review summarizing the role of biofortification in reducing vitamin A, iron, and zinc deficiencies. These additions now situate the study within the established literature and clarify the existing evidence supporting the role of biofortification in addressing micronutrient malnutrition.

 

Methodology: only 1 database i.e. Scopus is not enough to generate the relevant studies. at least 2 databases Scopus or may be PubMed should be selected to retrieve the data. Also, I am wondering about the search term which are too basics for in depth analysis of the topic.

 

r/ We thank the reviewer for this thoughtful comment regarding database selection and search strategy. Our primary objective was not to conduct an exhaustive systematic review of all intervention studies on biofortification, but to perform a global, territorial evidence-mapping exercise based on indexed, peer-reviewed publications.

 

This analysis used Scopus as the sole data source because it offers broad multidisciplinary coverage across agricultural sciences, nutrition, and health, and provides detailed affiliation metadata required for territorial mapping. Comparative evaluations of literature databases have shown that Scopus indexes a wider range of journals than PubMed, particularly outside core clinical medicine, and often retrieves a higher number of documents for publication-based analyses (DOI: 10.1096/fj.07-9492LSF; DOI: 10.3791/58494). Nevertheless, relying on a single database may omit studies indexed exclusively elsewhere; this potential under-coverage is acknowledged as a limitation of our study.

 

While no single database is fully comprehensive, Scopus is widely used as a primary data source in scientometrics studies of global research output.

 

Regarding the search terms, we have expanded the Methods section to report the full search string used in Scopus. The strategy was developed iteratively and combined biofortification-related terms with descriptors of micronutrient deficiencies and malnutrition in the title, abstract, and keywords (TITLE-ABS-KEY). The search was designed to maximize sensitivity for biofortification and micronutrient deficiency research while maintaining conceptual focus. We believe that, together with the explicit reporting of the search strategy, this approach provides sufficient transparency and reproducibility for the scope of this descriptive scientometrics study.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors declare that they conducted an analysis of 776 eligible articles. A systematic search of the Scopus database, selected for its largest database of peer-reviewed scientific literature, was conducted. The analysis was conducted on September 18, 2025 (one day?!). However, the authors' research does not answer the question posed in the title: " Is There Sufficient Local Evidence to Advance Biofortification Against Micronutrient Deficiencies?" and does not address the topic of "Global Concern for Food Security and Human Health". The analysis is cursory and focuses only on keywords contained in the publications. Such a superficial analysis cannot be used to draw conclusions regarding the global population, food security issues, and micronutrient deficiencies. While the issue in the title is very important and deserves thorough investigation, the manuscript does not contain sufficient content to be considered a valuable contribution to science. Furthermore, there is a lack of information about the existing literature on this topic, the citations are inappropriate, and too many self-citations were found. The bibliography list is very short (23 publications), even though, according to the authors, nearly 800 peer-reviewed publications were analyzed. Due to the above, the manuscript is not suitable for publication.

Author Response

Answer to reviewers

Manuscript ijerph-3946419

Is There Sufficient Local Evidence to Inform Biofortification Policies Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health

 

We are grateful with the Editor and Reviewers for the expert reading of the manuscript. We have found the comments appropriate and helpful. They have permitted us to improve the manuscript. Appropriate changes were made and highlighted in the revised manuscript according to suggestions. Following are the responses to the comments.

 

Reviewer#3:

 The authors declare that they conducted an analysis of 776 eligible articles. A systematic search of the Scopus database, selected for its largest database of peer-reviewed scientific literature, was conducted. The analysis was conducted on September 18, 2025 (one day?!). However, the authors' research does not answer the question posed in the title: " Is There Sufficient Local Evidence to Advance Biofortification Against Micronutrient Deficiencies?" and does not address the topic of "Global Concern for Food Security and Human Health". The analysis is cursory and focuses only on keywords contained in the publications. Such a superficial analysis cannot be used to draw conclusions regarding the global population, food security issues, and micronutrient deficiencies. While the issue in the title is very important and deserves thorough investigation, the manuscript does not contain sufficient content to be considered a valuable contribution to science. Furthermore, there is a lack of information about the existing literature on this topic, the citations are inappropriate, and too many self-citations were found. The bibliography list is very short (23 publications), even though, according to the authors, nearly 800 peer-reviewed publications were analyzed. Due to the above, the manuscript is not suitable for publication.

 

r/ We appreciate the reviewer’s careful reading of our manuscript and the opportunity to clarify the scope, methodological intent, and scientific contribution of this work. Several of the concerns raised appear to stem from a misunderstanding of the study design. This manuscript does not attempt to evaluate the efficacy of biofortification nor to perform a systematic review of all intervention studies; rather, it presents a territorial evidence-mapping exercise, a widely used scientometrics approach for identifying geographic imbalances in research production relative to global needs.

 

Our aim is explicitly descriptive: to examine whether countries experiencing the highest micronutrient burdens are proportionally represented in the indexed scientific literature on biofortification and micronutrient deficiencies. This question requires an approach fundamentally different from clinical or public health effectiveness reviews. It does not rely on analyzing the content of 776 publications in depth, but on mapping their distribution across countries, institutions, and regions using affiliation metadata. This approach is standard in global science-mapping research and is appropriate for addressing structural questions about research availability and visibility, rather than intervention outcomes.

 

Regarding the reviewer’s concern that the analysis was “superficial,” we respectfully note that keyword metadata, country-level publication counts, and bibliographic patterns are the primary data sources for context-specific scientometrics studies. These methods are not only accepted but widely applied in high-impact bibliometric analyses seeking to uncover research inequities, capacity gaps, and global misalignments between disease burdens and scientific production. Our conclusions are therefore intentionally circumscribed: we do not make inferences about population-level nutrition impact or food security outcomes; we strictly identify the geographic underrepresentation of high-burden countries in the indexed literature, a finding that is empirically supported by our dataset and aligns with broader discussions on research equity and global health priorities.

 

The reviewer also raises concerns about the number and nature of citations. We acknowledge this and have expanded the introduction to include multiple high-quality studies on biofortification efficacy and effectiveness, ensuring that the manuscript is properly situated within the existing scientific literature. We have also reviewed all citations to ensure that they are relevant, balanced, and appropriate for the scope of a scientometrics perspective.

 

Finally, we would like to emphasize that the value of this manuscript lies not in the application of complex inferential statistics, but in providing a novel, quantitative visualization of evidence gaps that are rarely examined despite their implications for global nutrition policy, research prioritization, and equity. By demonstrating a mismatch between global micronutrient burdens and the geographic distribution of biofortification research, this work contributes new insights that can inform international funding strategies, capacity-building initiatives, and the design of context-relevant agricultural and nutrition programs.

 

We believe that, with the revisions implemented, the manuscript makes a meaningful and original contribution to understanding how research landscapes align, or fail to align, with areas of greatest global need. We thank the reviewer for the opportunity to clarify these points.

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors. Thank you for your detailed explanation. I understood the content and message of the manuscript, but I still think that your manuscript is not suitable for publication due to its low scientific and substantive value. 

Author Response

Answer to reviewers

Manuscript ijerph-3946419

Is There Sufficient Local Evidence to Inform Biofortification Policies Against Micronutrient Deficiencies? A Global Concern for Food Security and Human Health

We are grateful with the Editor and Reviewers for the expert reading of the manuscript. We have found the comments appropriate and helpful. They have permitted us to improve the manuscript. Appropriate changes were made and highlighted in the revised manuscript according to suggestions. Following are the responses to the comments.

Reviewer#3:

Dear Authors. Thank you for your detailed explanation. I understood the content and message of the manuscript, but I still think that your manuscript is not suitable for publication due to its low scientific and substantive value.

r/ We sincerely thank you for taking the time to reassess our manuscript and for sharing your perspective. We appreciate your careful reading and acknowledge your opinion regarding the perceived scientific and substantive value of the work.

However, we would respectfully like to clarify the nature of the contribution and the evaluative framework under which this manuscript should be assessed.

This article is intentionally designed as a Perspective focused on epistemological and meta-scientific analysis, rather than on hypothesis testing, causal inference, or methodological innovation in the conventional statistical sense. Its primary scientific contribution lies in the systematic identification and territorial mapping of evidence gaps, a recognized and increasingly important domain within global health, food security, and evidence-based policy research.

Specifically, the manuscript addresses a well-documented but insufficiently operationalized problem: the misalignment between global nutritional burden and the availability of locally linked, peer-reviewed evidence to inform policy implementation. Using transparent bibliometric mapping and internationally standardized indicators, we demonstrate that countries with the highest micronutrient burdens frequently have little or no country-linked scientific literature in this field. This is not a trivial descriptive finding; rather, it highlights a structural vulnerability in evidence-informed decision-making that is directly relevant to public health, nutrition governance, and global development agendas.

Importantly, the value of this work does not rest on statistical sophistication, but on its epistemological framing:

1. It distinguishes clearly between global efficacy evidence and context-specific implementation evidence, a distinction that is often blurred in nutrition policy discussions.

2. It operationalizes evidence availability as a territorial concept, aligned with principles from implementation science, research equity, and meta-research.

3. It provides a reproducible and policy-relevant framework that can be extended, refined, or applied to other intervention domains.

Within the scope of IJERPH, which explicitly welcomes Perspectives that advance conceptual understanding, policy relevance, and population-level health insights, we believe this manuscript offers a substantive contribution by reframing how evidence gaps are identified and interpreted in global food security and micronutrient policy.

We fully respect that reasonable differences in judgment may exist regarding what constitutes scientific value. Nevertheless, we kindly note that an assessment of “low scientific and substantive value” would ideally be supported by specific methodological, conceptual, or interpretative critiques, which would allow authors and editors alike to engage constructively with the concern.

To make this point even clearer, we added a paragraph explicitly discussing the epistemological implications and knowledge gaps prior to the conclusion of the manuscript.

We hope this clarification helps situate the manuscript’s contribution more clearly within its intended epistemological and scientific context, and we remain open to further specific feedback that could strengthen its clarity or relevance.

 With sincere thanks for your time and consideration.