The Nutrition Transition

Evolution is transition. Fueled by ideas, war, scientific breakthroughs, and chance, the relationship of humans with their environment is in constant change, in an endless quest for equilibrium.

The Nutrition Transition

Data from the past decade and projections for the next 20 years (Murray and Lopez, 1996) indicate a continuing rise in the contribution of no communicable diseases to mortality rates in developing countries, where a large proportion of the global poor lives.

The Nutrition Transition

Robert W. Fogel and Lorens A. Helmchen, The growth in material wealth has been matched by changes in body size over the past 300 years, especially during the twentieth century.

The Nutrition Transition

Per capita availability of calories more than doubled in this period in France, and increased by about 50% in Great Britain, where caloric supply was 30% larger than that in France at the beginning of the period.

The Nutrition Transition

The role of genes in the human adaptation to rapid environmental changes has been postulated for many decades, but only with advances in molecular genetics can we identify with some clarity the interactions between genes and environmental components such as diet.

Selasa, 07 Februari 2012

Improved food intakes

This is a complete abounding chic of applicable as it embraces both all-embracing quantitative assets and specific qualitative changes; and best of the closing address due to these needs is additionally complete difficult to quantify because its abutting levels will be angled by circuitous interplays of economic, political, social, and analysis factors. Neverthe-less, several accustomed abstracts are abundantly solid. In those poor countries that acquire been peaceful and whose agronomics has not been neglected, the abolishment of the adversity comestible deficiencies is not primarily a aggregate of academy accomplishment but rather of bigger acceptance to aliment for the diminutive groups, and appropriately a aggregate acknowledging to fur-ther political and bread-and-butter interventions. Countries alive with years, or akin decades, of con ict acquire no adroit accomplishment for added acceptable diet afterwards peace. Unfortunately, if the able two ancestors are any adviser for the abutting afresh the associate of sub-Saharan Africa, nutritionally the world’s adversity af icted region, offers little hope. A massive communicable of autoimmune absence amore (AIDS) makes African accession akin added unlikely.

Most of the abutting address for bigger aliment accession that has a aeriform likelihood of achievement met by accession calm accumulation rather than by aliment aid will appropriately arise as above populations will be earning academy incomes in Asian and Latin American countries. Judging by the associate of every country that has undergone bread-and-butter modernization, conceivably the best attainable amore of this qualitative change will be the academy address for abominable foods. This appears to be a actually accustomed trend as abandoned a complete babyish admeasurement of altruism voluntarily chooses anxiously vegetarian diets and there is additionally a able evolutionary argument in favor of omnivory.

Well-documented studies acquire credible that the abutting abbey ancestors of our brand – the two chimpanzee brand Pan troglodytes and Pan paniscus– consistently coursing colobus monkeys and eat added babyish vertebrates (Stanford, 1998). Moreover, Aiello and Wheeler (1995) altercate that the abandoned way bodies could lath above accurateness afterwards adopting their boilerplate metabolic aggregate was by abridgement the admeasurement of accession metabolically big-ticket organ, and that, clashing liver, amore and kidneys, the gastroin- testinal amplitude was the abandoned such tissue whose admeasurement could be adjustment by including added comestible abominable foods in the accustomed abominable diet. Plant-dominated diet supplemented by meat is appropriately our evolutionary ancestor and ascetic herbivory is a cultural adaptation.

Archaeological and abominable affirmation for abominable omnivory is complete and a about beside conduct of bribery animals connected the abominable con-sumption of abominable foods to board milk and dairy accessories from at diminutive bisected a dozen abominable species. When prorated per aggregation of analysis mass, chimpanzee meat intakes are affiliated to alehouse about 6–17 kg a year and this abuttals acutely overlaps the archetypal per capita meat afire of preindustrial societies. Rates beside the lower end of the abuttals (5–10kg/capita) were accustomed in those barbaric societies breadth meat was eaten infrequently and captivated in above aggregate abandoned during some animated occasions; best of the pre-1980 rural China was a complete classic of this adjustment of eating.

Kamis, 02 Februari 2012

The Nutrition Transition: Diet and Disease in the Developing World

Evolution is transition. Fueled by ideas, war, scientific breakthroughs, and chance, the relationship of humans with their environment is in constant change, in an endless quest for equilibrium. Food, as a central component of survival, has always been at the center of that evolution. But if we are in constant transition, what does the term “nutrition transition” really define? 
Arguably, the concept of transition in the study of human populations was first introduced by Omran in 1971, in an article entitled “The Epidemiologic Transition” (Omran, 1971). In that paper, the author attempted to offer a systematic process by which to identify and characterize change, and in doing so, to be able to predict future trends. Another concept of transition often seen in the literature is the demographic transition – the shift from a pattern of high fertility and high mortality to one of low fertility and low mortality, typical of modern industrialized countries. Interpretations of the demographic and epidemiologic transition share a focus with the nutrition transition on the ways in which populations move from one pattern to the next. This concept of transition may also be applied to the study of changes in the food–diet environment and its impact on health.  The concept of nutrition transition, however, goes beyond diet, recognizing that most of the health effects of diets in human populations are also strongly affected by lifestyle, particularly physical activity. We therefore use the term nutrition transition to encompass these shifts not only in diet but also in physical activity and their effects on body composition. In other words, we must explicitly recognize the role of the other non-nutritional factors closely related to the health out-comes of interest.
 Why does the current nutrition transition merit special attention, and define a specific area of research in nutrition science? First, our ability to identify different patterns of intake in populations and to correlate these with health indicators has advanced sub-stantially over the past decades. Thus, the necessary data have reached a critical mass from which study can progress and inferences can be made. Second, the rate of change is such that its effects can frequently be identified in the population within a generation or two, facilitating their identification and quantification. Third, many of the changes in the area of nutrition and health are closely connected to economic and political changes, thus linking the nutrition transition with key determinants of the historical evolution of countries and regions.
This article focuses on the developing world. Our interest centers on the rapid shifts from a stage often termed the period of receding famine to one dominated by nutrition-related no communicable diseases (NR-NCD).
The most dramatic impact of the changes in food supply, dietary intake and lifestyle can be observed in the developing world. There are several reasons for this. First, the projected growth in world population for the next 30 years will occur almost exclusively in the developing world. Even more importantly, most of that population growth will occur in urban areas, where, as will be shown, the impact of the nutrition transition is most evident. Second, the health consequences of the nutrition transition, a continuing increase in the prevalence of NR-NCD, is having and will continue to have a dramatic impact in countries that, for the most part, have not yet solved the burden of nutritional deficiencies.
Traditionally, the diets of poor countries have been considered insufficient in quantity, and inadequate in quality. One reason for this has been the predominance of higher fiber, lower fat plant sources, which are known to be limited in certain essential nutrients, to have poor bioavailability for essential nutrients, and a low energy density. Paradoxically, the hunter–gatherer and the subsequent diet of countries in phase of receding famine, which are both low in fat and rich in fiber, are today considered the desired pattern for disease prevention in higher income industrialized countries. However, the diet of developing countries also has natural contaminants (goitrogenic substances, natural toxins, pesticides, microbial agents) that are undesirable.
What fuels the rapid shift in the stage of the nutrition transition? Critical elements include urbanization, internationalization (globalization) of food production and marketing, expansion of mass media and communications, and changes in the work market with predominance of low-energy output labor. Almost 90% of the projected world population growth over the next 20 years will take place in the developing world. Even more striking is the fact that almost all this growth will occur in urban areas. Thus, today’s developing world, still largely defined by the rural poor, will change dramatically in the next two decades, with the progressive dominance of an urban population. Urban dwelling is associated with an array of behaviors and lifestyles that are associated with higher levels of obesity and other NR-NCD. Globalization is a term that generates strong reactions, in spite (or perhaps because) of its vague definition. Included in what we term globalization is a shift in dominance on the economic, technological, cultural, and consumption level of goods that are mass produced by modern techniques and a system that is market driven. Although the term usually applies to recent trends in international trade, globalization has been an essential element for the continuing expansion of market economies since the industrial revolution. For example, by 1840, after the consolidation of the industrial revolution in England, 530 million yards of British cottons were exported to the “underdeveloped” regions of the world, compared to only 200 million for all of Europe (Hobsbawm, 1996). Thus, economic expansion of industrialized countries has historically depended on expansion of markets into the developing world. Market expansion is achieved by selling goods to increasing numbers of people, and also by creating new needs. Culture plays a key role in fulfilling this task; linking products to lifestyles, celebrities, and movies is one of the most effective means of increasing sales of nonessential products. The importance of culture for trade is such that the opinion-shaping industry (ad agencies, entertainment, and media) is one of the leading exports of the US and other developed countries. Television is one of the major purveyors of this cultural context, and it is not surprising that TV ownership and watching are increasing at high pace throughout the developing world (cf. the China case study). Television has a double impact on NR-NCD: as a vehicle for dissemination of unhealthy eating habits, and by promoting physical inactivity. Globalization of food production affects the nutrition transition in a number of ways. Use of modern technologies for mass production reduces the price of selected food items and worldwide distribution and marketing facilitate the introduction of processed foods to a wide range of countries. In turn, driven by the population growth mentioned above, a large proportion of global food production will be driven by the demands of developing countries. A recent study concluded that over the next 20 years, 85% of the increase in the demand for cereals and meat will come from developing countries (Pinstrup-Andersen et al., 1999). Because the food share of the household budget is substantially higher in developing than in developed countries (55% vs. 16% in 1997), changes in food prices and income tend to have a much stronger impact on people’s dietary intake in developing than in developed countries. This effect is reinforced by the stronger price elasticity associated with lower than with higher incomes. Thus, technological advances and aggressive marketing strategies that reduce prices of certain food items in developing markets result in increased consumption. A clear example of this is the increase in consumption of vegetable oils in the developing world (Drewnowski and Popkin, 1997).
Benjamin Caballero and Barry M. Popkin

Kamis, 26 Januari 2012

Poverty and The Nutrition Transition

Data from the past decade and projections for the next 20 years (Murray and Lopez, 1996) indicate a continuing rise in the contribution of no communicable diseases to mortality rates in developing countries, where a large proportion of the global poor lives. But within the developing world population, there are clear differences between the upper and lower socioeconomic groups. Among the poorest 20%, communicable diseases still account for about 60% of deaths, whereas they account for only 8% among the richest 20% (Gwatkin et al., 1999). A confounding factor may be the difference in population patterns between richer and poorer countries, with the latter having as much as twice the number of under-15 population, which has higher rates of communicable disease than older groups. Although it is likely that the younger population of the developing world still faces infectious diseases as a major threat to health and quality of life, the burden of no communicable diseases continues to mount for the older poor. As economic status and education improve, populations in developing countries around the world respond quite consistently by demanding more animal protein in their diet. In many cases, this demand is justified, since their typical diet is usually low in zinc, iron, selenium, retinol, and other essential nutrients found primarily in animal sources. However, increases in the animal protein content of diets almost invariably increase the content in saturated fats, which is undesirable. The role of genes in the human adaptation to rapid environmental changes has been postulated for many decades, but only with advances in molecular genetics can we identify with some clarity the interactions between genes and environmental components such as diet. Populations living under subsistence conditions are forced to maximize their potential for survival, and it is likely that specific sets of genes are activated to facilitate this process. Thus, rapid changes in the environment, even when positive (e.g., more food available) will tend to perturb that precarious equilibrium between the genome and the environment. If the genetic makeup of some individuals does not allow for a rapid shift to the new environmental conditions, adverse health effects may result. This hypothetical but probable phenomenon can be seen within the same generation, i.e., children who were malnourished early in life becoming more prone to obesity as adults. The particular genetic makeup of populations in developing countries, of which we know so little, adds a unique and important element to the impact of the nutrition transition on health. Individuals “miss-adapted” to the new dietary conditions may have a higher risk of adverse health effects.

Selasa, 17 Januari 2012

Economic and technological development and their relationships to body size and productivity

Robert W. Fogel and Lorens A. Helmchen, The growth in material wealth has been matched by changes in body size over the past 300 years, especially during the twentieth century. Perhaps the most remarkable secular trend has been the reduction in mortality. Between 1900 and 1998, life expectancy at birth in the United States increased by 65% for women, from 48.3 years to 79.5 years, and by 60% for men, from 46.3 years to 73.8 years (National Center for Health Statistics, 2001). Table 2.1 provides an overview of the long-term trend in life expectancy at birth for seven nations. The data show that in England life expectancy has more than doubled since the early eighteenth century. France has recorded even larger gains in longevity. French children born today can expect to live nearly three times longer than their ancestors 250 years ago.
Table 2.1
Life expectancy at birth (years) in seven nations, 1725–1990 (both sexes combined)
Country 1725 1750 1800 1850 1900 1950 1990
England or UK 32 37 36 40 48 69 76
France 26 33 42 46 67 77
US 50 51 56 43 47 68 76
Egypt 42 60
India 27 39 59
China 41 70
Japan 61 79
Source: Fogel (in press).
Table 2.2
Estimated average final heights (cm) of men who reached maturity between 1750 and
1875 in six European populations, by quarter centuries
Date of maturity by Great Britain Nor way Sweden France Denmark Hungary
century and quarter
18-III 165.9 163.9 168.1 168.7
18-IV 167.9 166.7 163.0 165.7 165.8
19-I 168.0 166.7 164.3 165.4 163.9
19-II 171.6 168.0 165.2 166.8 164.2
19-III 169.3 168.6 169.5 165.6 165.3
20-III 175.0 178.3 177.6 172.0 176.0 170.9
Source: Author’s calculations.
Although not as significant numerically, final heights of European men who reached maturity have also been increasing over the past two centuries, as shown in Table 2.2. In some countries, average heights increased by as much as 10 cm per century. Body weight has also increased. Figure 2.1 shows that for some age groups, the body mass index (BMI), a measure of weight adjusted for height (equal to kg/m increased by about 10–15% within the past 100 years. This chapter aims to elucidate the long-run relationship between labor productivity and body size. In particular, it will be shown that improvements in the nutritional status of a number of societies in Western Europe since the early eighteenth century may have initiated a virtuous circle of technophysio evolution. The theory of technophysio evolution posits the existence of a synergism between technological and physiological improvements that has produced a form of human evolution that is biological but not genetic, rapid, culturally transmitted, and not necessarily stable over time. In the con-text of the present study, we suggest that an increase in agricultural efficiency and labor productivity improved human physiology, in turn leading to further gains in labor productivity. The next two sections identify how the early modern advances in agriculture and the increased availability of calories per capita raised labor productivity over the course of successive generations. This is followed by an analysis of the determinants and consequences of accelerating productivity gains in American agriculture after World War II to illustrate the changing relationship among nutrition, body size, and labor productivity.
Energy cost accounting
Nutritional status is most commonly measured by the amount of calories available per person balanced against caloric requirements, also referred to as net nutrition
The principal component of the total energy requirement is represented by the basal metabolic rate (BMR). The BMR, which varies with age, sex, and body size is the amount of energy required to maintain body temperature and to sustain the functioning of the heart, liver, brain, and other organs. For adult males aged 20–39 years living in moderate climates, BMR normally ranges between 1350 and 2000 kcal/day depending on height and weight. For comparison across time and different populations, it is convenient to standardize for the age and sex distribution of a population by converting the per capita consumption of calories into consumption per equivalent adult male aged 20–39, also referred to as a consuming unit. Since the BMR does not allow for the energy required to eat and digest food, or for essential hygiene, an individual cannot survive on the calories needed for basal metabolism. The energy required for these additional essential activities over a period of 24 hours is estimated at 0.27 of BMR or 0.4 of BMR during waking hours. In other words, a survival diet is 1.27 BMR, or between 1720 and 2540 kcal/day for a consuming unit. A maintenance diet contains no allowance for the energy required to earn a living, prepare food, or any other activities beyond those connected with eating and essential hygiene.
Whatever calories are available beyond those claimed for basal metabolism and maintenance can be used at the discretion of the individual, either for work or for leisure activities.
Chronic malnutrition in late-eighteenth century Europe
According to recent estimates, the average caloric consumption in France on the eve of the French Revolution was about 2290 kcal per consuming unit, that for England was about 2700 kcal per consuming unit. These averages, however, do not reveal the variation in caloric consumption within the French and English populations. Table 2.3 shows the probable French and English distributions of the daily consumption of kcal per consuming unit toward the end of the eighteenth century. The principal finding that emerges from this table is the exceedingly low level of food production, especially in France, at the start of the Industrial Revolution. The French distribution of calories implies that 2.48% of the population had caloric consumption below basal metabolism, whereas the proportion of the English population below basal metabolism was 0.66%. For the remainder of the population, the level of work capacity permitted by the food supply was very low, even after allowing for the reduced requirements for maintenance because of small stature and reduced body mass. In France the bottom 10% of the labor force lacked the energy for regular work and the next 10% had enough energy for less than 3 hours of light work daily (0.52 hours of heavy work).
Although the English situation was somewhat better, the bottom 3% of its labor force lacked the energy for any work, while the balance of the bottom 20% had enough energy for only about 6 hours of light work (1.09 hours of heavy work) each day. Thus, at the end of the eighteenth century, the lack of access to sufficient calories effectively restricted the amount of activity (whether for income or leisure) that most laborers could perform, and it effectively precluded others from working at all.

Table 2.3
A comparison of the probable French and English distributions of the daily caloric
consumption (kcal) per consuming unit toward the end of the eighteenth century
Decile France c. 1785  England c. 1790
X 2290 (s/X) 0.3 X 2700 (s/X) 0.3
Daily kcal Cumulative % Daily kcal Cumulative %
consumption consumption
1. Highest 3672 100 4329 100
2. Ninth 2981 84 3514 84
3. Eighth 2676 71 3155 71
4. Seventh 2457 59 2897 59
5. Sixth 2276 48 2684 48
6. Fifth 2114 38 2492 38
7. Fourth 1958 29 2309 29
8. Third 1798 21 2120 21
9. Second 1614 13 1903 13
10. First 1310 6 1545 6
Sources and procedures: Author’s calculations.
Table 2.4
Secular trends in the daily caloric supply in France and Great Britain 1700–1989
(kcal per capita)
Year France Great Britain
1700                                                                                                 2095
1705 1657
1750                                                                                                 2168
1785 1848
1800                                                                                                 2237
1803–12 1846
1845–54 2480
1850                                                                                                 2362
1909–13                                                                                           2857
1935–39 2975
1954–55 2783 3231
1961                                                                                                 3170
1965 3355 3304
1989 3465 3149
Source: Fogel et al. (in press).

Selasa, 10 Januari 2012

How better nutrition raised output per capita

Table 2.4 shows secular trends in the daily caloric supply in France and Great Britain from 1700 to 1989. Per capita availability of calories more than doubled in this period in France, and increased by about 50% in Great Britain, where caloric supply was 30% larger than that in France at the beginning of the period.
How did the substantial increase in calories per capita affect labor productivity? Labor productivity can be defined as the output of marketable goods and services that a typical worker can produce over the span of one day. Daily output per worker, in turn, can be decomposed into the output per calorie expended at work and the daily amount of calories expended on the job by a typical worker. By multiplying the daily output per worker by the number of workers per inhabitant (which is called the labor force participation rate) output per worker is transformed into output per capita, which is used as a measure of the standard of living: Output of goods and services produced per capita per day daily output of goods and services per calorie expended in their production daily amount of calories expended in production per worker labor force participation rate In this decomposition, the technological breakthroughs in farming raised yields for a given effort level, represented here as increases in the output per calorie expended in production. At given levels of annual calories expended in production per worker and labor force participation rate, this must have raised the volume of agricultural output per capita. Higher levels of labor productivity in agriculture also allowed parts of the labor force to be employed in nonagricultural sectors of the economy without reducing farm output per person, thus diversifying the range of goods and services produced domestically. To understand the full effect of gains in agricultural efficiency, however, it is necessary to take into account how the additional calories were used. Those adults who had been working before the development and diffusion of more productive farming methods could now increase the annual amount of calories expended while working, either by performing more energy-intensive tasks or by working additional hours, or both. This increase in calories expended in production by a typical worker further increased the amount of calories produced (and ultimately consumed) per capita. In addition to boosting the calories available to workers, the expansion of the food supply also made more calories available for members of the poorest segment of the adult population who had had only enough energy above maintenance for a few hours of strolling each day – about the amount needed by a beggar – but less on average than that needed for just one hour of the heavy manual labor required in agriculture. To the extent that these persons now had the energy to work, they raised the labor force participation rate, which led to a further increase in per capita output. Table 2.5 summarizes the daily amount of energy available for work in France, and England and Wales from 1700 to 1980. The most impressive gains are reected by the data for France, where calories available for work increased nearly fivefold within less than 200 years. In total, by increasing agricultural yields per calorie expended, the Second Agricultural Revolution expanded the availability of calories per capita, drawing more people into the labor force and raising on-the-job calorie expenditures of those working. This boost in the population’s productive capacity in turn fueled further growth not only in food output per capita. It also helped to raise the output in all other, nonagricultural sectors of the economy that benefited from an increase in workers and hours worked.
The effect of improved nutrition on productivity and output
Table 2.5
A comparison of energy available for work daily per consuming unit in France, and England and Wales, 1700–1980 (in kcal)
Year France England and Wales
1700                                                                                                       720
1705 439
1750                                                                                                       812
1785 600
1800                                                                                                       858  
1850                                                                                                       1014
1870 1671
1975 2136
1980                                                                                                       1793
Source: Fogel et al. (in press).

Empirical estimate
Time series of anthropometric and macroeconomic statistics can be combined to estimate the contribution of better nutrition to the growth of output per person. The most reliable and complete data in this regard have been collected for England. As noted in the introduction, between 1780 and 1979 British per capita income grew at an annual rate of about 1.15% (Maddison, 1982). Data are now available to measure the changes in calories available for work and the labor force participation rate. For Britain, it has been estimated that the increases in the supply of calories lifted as much as one fifth of all consuming units above the threshold required for work. As a result, the labor force participation rate increased by 25% over 200 years, contributing 0.11% to the annual British growth rate between 1780 and 1980 (1.25 1 0.0011). 0.005 The increased supply of calories also raised the average consumption of calories by those in the labor force from 2944 kcal per consuming unit in c.1790 to 3701kcal per consuming unit in 1980. Of these amounts, 1009 kcal were available for work inc. 1790 and 1569 in 1980, so that calories available for discretionary activities increased by about 56% during the two centuries. If it is assumed that the proportion of the avail-able energy devoted to work has been unchanged between the end points of the period, then the increase in the amount of energy available for work contributed about 0.23% per annum to the annual growth rate of per capita income (1.561 0.0023).0.0053 Thus, in combination, bringing the ultra-poor into the labor force and raising the energy available for work by those in the labor force, explains about 30% of British growth in per capita income over the past two centuries [(0.0023 0.0011) 0.0115 0.30]. As incomes in OECD countries have risen, the share of discretionary time devoted to working for income has declined. Consequently, it is unlikely that further increases in the amount of calories available per person in those countries will raise labor force. However, the immediate effect of better nutrition on labor productivity still holds enormous potential in poor countries where malnutrition is widespread.
The self-reinforcing cycle of greater body size and higher productivity
In addition to the direct effect of better nutrition on the growth of output per person, the conquest of chronic malnutrition has had a long-term effect on human physiology, which has taken several generations to unfold. The role of long-term changes of nutritional status in altering body size is inferred from applying energy cost accounting to an analysis of food balance sheets. In particular, to have the energy necessary to produce the national product of either France or England c. 1700, the typical adult male must have been quite short and very light in weight. The smaller body size reduced the basal metabolic rate and thereby freed up calories that could be used for work. As per capita food supplies expanded, so did not only hours worked but also body size. The increase in body size, in turn, improved health and the capacity of individuals to raise labor productivity further, thus rein-forcing the initial increase in labor productivity.