Nutrition and the Sweep of History

Looking back in history, one can see that a major shift is taking place in the impact on humanity of the main factors—poor diet and ill health—that have traditionally accounted for most malnutrition. Over the centuries the human species survived hand-to-mouth on whatever it could manage to hunt, gather, harvest, or hoard. The diet which fuelled most of human evolution was low in fat and very low in sugar but high in fiber and other complex carbohydrates.

In the overall context of human development, it is only recently that people in high-income countries could stop worrying about the threat of occasional hunger and increasingly indulge in preferred foods owing to radical improvements in methods of food production, processing, storage, and distribution. Only in recent decades, as people benefited from greater control of infectious disease and better access to safe food, have research findings confirmed the well-founded suspicion that dietary preferences may influence the onset of several major chronic diseases, including coronary heart disease, stroke, various cancers, diabetes mellitus, gastrointestinal disorders, and various bone and joint diseases. Although many dietary factors have been investigated, those most frequently linked to such diseases figure prominently in a pattern of eating typified by the high consumption of energy-dense foods of animal origin and of foods processed or prepared with added fat, sugar, and salt.

As a result, grade 2 overweight, which warrants close attention, is relatively common in industrialized and many developing countries—up to 20% of Europeans and of Whites in the US 60 years of age are affected. The figure increases to 40% for women in eastern European and Mediterranean countries and Black women in the USA. Even higher prevalences are observed among American Indians, Hispanic Americans, and Pacific islanders. While the prevalence of grade 2 overweight is much lower in some African and Asian countries—the range is about 3% to 17%—in South America and the Caribbean it is close to that in many European countries, about 25%. WHO estimates that major noncommunicable diseases (NCDs) are responsible for at least 40% of all deaths in developing countries and 75% in industrialized countries, where cardiovascular diseases are the first cause of mortality and cancer is the third. By the year 2020, NCDs will account for about three-quarters of all deaths in the developing world.

Meanwhile, over 800 million people still cannot meet basic needs for energy and protein, more than 2000 million people are deficient in essential micro-nutrients, and an estimated 174 million children under 5 years of age in developing countries are malnourished, as indicated by low weight for age, while 230 million are stunted. Malnutrition results in poor physical and cognitive development as well as lower resistance to illness. Nearly half of the estimated 11 million deaths occurring annually among children under 5—or about 49% of young child mortality in developing countries—are associated with malnutrition.

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