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

Food security and healthy eating: Views from El Salvador

Food security is “a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life”. The term was first coined in the 1970s, alongside global food crises, when hunger and malnutrition were front and center in the food and nutrition agenda internationally. As defined by the Food and Agriculture Organization of the United Nations, this concept encompasses dimensions of availability, access and the biological utilization of food, for an “active and healthy life”. It seeks to include the quantitative aspects of food (“sufficient” food) along with the quality aspects (“safe and nutritious” food), with the latter being a relatively recent addition to the concept.

Things have changed since the 1970s. Under- and over-nutrition coexist within many countries in the Global South, and in many cases within communities and households. Yet, while the food security concept has evolved, interventions, more often than not, still seek to provide “sufficient” food, which may not always be “safe and nutritious”.

The evolution of nutrition concerns alongside the changes in conceptualizations of food security motivated my research in El Salvador, and, in specific, a piece recently published in Perpectivas de Nutricion Humana. In the article, published in Spanish, I addressed the question, “Is healthy eating part of food security?” This question was discussed with individuals living in resource-poor communities in El Salvador, and the answer, not surprisingly, was not simple. Some research collaborators argued that as long as you had something to eat, even if it was only tortillas y frijoles, you were food secure, while others argued that this was not the case, as seen in these quotes below,

Comer saludable sí es tener seguridad alimentaria, no lo contrario. Si tiene el recurso económico, pero no tiene el conocimiento, va a comprar cualquier cosa para llenar el estómago
[To eat healthy is to have food security, but not the contrary. If you have the economic resource, but not the knowledge, you will buy anything to fill your stomach]

No todo lo que tenemos de seguridad alimentaria es nutritivo, pero sí lo básico tiene que estar en el hogar para la seguridad alimentaria. Más tarde, compramos otras cosas, que son el complemento para la alimentación nutricional
[Not everything that we have for food security is nutritious, but the basics have to be in the home to attain food security. Later, we buy other things, which are complementary for nutritious eating]

While nutrition knowledge and economic access are essential for families to eat healthfully, this expected rational behavior is confounded when foods considered healthy are also associated with states of food deprivation, and foods seen as unhealthy and even dangerous, are associated with increased purchasing power and a higher socioeconomic status.

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This juxtaposition of health values against pleasure, convenience and social status needs to be acknowledged and address in policy and programming implementation. There is still a long road to tackle what seems to be the unsolvable issue of persisting hunger and food insecurity in the global south, we must not turn a blind eye to the growing and perhaps more difficult issue of “over-nutrition”.

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Related post: “Some thoughts on eating healthy