Changing diets and a call to action

Diets are changing, and a recently published study in The Lancet Global Health journal describes how. Moving beyond measures of food availability and industry-derived reports on food imports and exports, the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group provides us with a first of its kind systematic dietary assessment to characterize global dietary patterns using 325 surveys encompassing 187 countries covering almost 4.5 billion adults.

Aside from providing an excellent picture of diets worldwide, what I particularly liked about the study was the authors’ move beyond more traditional analyses to looking foods and nutrients in healthy and unhealthy patterns, separately. Healthy items were: Whole grains, fruits, fruit juices, vegetables, fish, nuts/seeds, beans/legumes, milk, fiber, polyunsaturated fat, seafood omega-3, plant omega-3 and calcium. Unhealthy items were: sugar-sweetened beverages, unprocessed red meats, processed meats, salturated fat, trans-fat, cholesterol and sodium. Both sets of items were derived from scientifically established relationships between food/nutrient and health.

This approach resulted in both good and (mostly) bad news:

“Compared with low-income countries, high-income countries had higher healthy dietary pattern scores, but substantially lower unhealthy dietary pattern scores. Consumption of healthier foods and nutrients has modestly increased during the past two decades; however, consumption of unhealthy foods and nutrients has increased to a greater extent. Improvements in healthier foods were seen in high-income and middle income countries; by contrast, no improvements were seen in the poorest regions.”

The significance of these findings are that, as the authors point out, “although caloric deficits and disease burdens other than those of NCDs must not be overlooked in some low-income countries, the trends in dietary patterns we note show the urgent need to focus on improvement of diet quality among poor populations worldwide. Left unaddressed, undernutrition and deficiency diseases will be rapidly eclipsed in these populations by obesity and [non-communicable diseases, as is already occurring in India, China, and other middle-income nations.”

And this, for me, is the main takeaway of this article – the need to start moving quickly to address the growing burden of malnutrition in low and middle income countries. Yet – the task at hand is not an easy one. Governments with already low resources to address food and nutrition problems will need to devise a two pronged approach to promote and encourage the consumption of healthy foods, while at the same time devising policies that diminish the consumption of unhealthy items. It is in this second task that the difficulties lie, as they may go against market investments and interests that promote the consumption of the calorie dense, ultra-processed foods driving the widening of waistlines worldwide. These efforts need to move beyond medical, reductionist and individual-centered approaches to nutrition problems, and start encompassing the wider context in which food choices are made, including businesses, agriculture, and development policies, to name a few. It also calls for encompassing the influence of global and transnational policies, and how these affect food access and availability, food preferences and ultimately food consumption worldwide.

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Original article: Fumiaki Imamura, Renata Micha, Shahab Khatibzadeh, Saman Fahimi, Peilin Shi, John Powles, Dariush Mozaffarian. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. The Lancet Global Health, 2015; 3 (3): e132 DOI: 10.1016/S2214-109X(14)70381-X

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