Golden, ChristopherKelahan, Heather2026-03-0420252026-01-052026Kelahan, Heather. 2026. Connecting Dietary Intake, Health Outcomes, and Environmental Shocks in Southwestern Madagascar. Doctoral Dissertation, Harvard University Graduate School of Arts and Sciences.32402657https://dash.harvard.edu/handle/1/42731178Environmental and human health are increasingly understood as interrelated; yet more research is needed to understand how extreme weather events impact diet quality and individual health outcomes. There is also a need for context-specific research to understand how extreme weather events affect diet quality and health outcomes in areas with high levels of malnutrition and high vulnerability to climate change. Individuals living in southern Madagascar face extremely high levels of poverty and malnutrition driven by underlying social and ecological conditions, exacerbated by climate-change-related drought and food insecurity. Before interventions can improve nutritional well-being, there must be an understanding of dietary intake patterns in the region, how these patterns relate to human health outcomes, and their relationship to environmental events such as drought, cyclones, heavy winds, and floods. This study harnesses a longitudinal cohort of 1,702 individuals living in southwestern Madagascar, from 12 villages along the Bay of Ranobe, to analyze the role of environmental factors in shaping dietary patterns and diet quality and subsequent impacts on overweight and obesity-related health outcomes. In chapter one, we conducted a dietary pattern analysis to characterize dietary patterns in the diets of individuals living on or near the Bay of Ranobe, Madagascar, and examined the socio-economic characteristics and diet quality of individuals in each dietary pattern group. In chapter two, we analyzed the association between dietary pattern group membership and overweight- and obesity-related health outcomes, including overweight Body Mass Index, abdominal obesity, and hypertension. In chapter three, we evaluated the relationship between diet quality and the self-reported experience of environmental shocks, including droughts, cyclones, heavy winds, and floods and heavy rains. Together, these research results elucidate the mechanistic pathways linking environmental conditions to diet quality and subsequent health outcomes in southwestern Madagascar, thereby informing public health policy and targeted nutritional and planetary health interventionsapplication/pdfendietdietary patternsfood systemMadagascarnutrition transitionoverweightNutritionPublic healthSustainabilityThesis or Dissertation2026-03-040000-0003-4162-9668