Expert Speak Health Express
Published on Aug 07, 2019
There is significant research to support the fact that diet and lifestyle have impact on reducing risk for chronic disease.
The Kigali Global Dialogue: A Discussion About Health and Non-Communicable Diseases in Developing Countries

Africa and other countries in the developing world are currently challenged by the double-burden of under nutrition and communicable diseases, along with over nutrition and non-communicable diseases caused by changes in lifestyle.

In 2016, The World Health Organization (WHO) identified the top ten global causes of death. Six of these causes were lifestyle-related and included the following: ischemic heart disease, stroke and chronic obstructive pulmonary disease followed closely by Alzheimer’s disease and certain cancers and diabetes. The International Diabetes Federation (IDF) projects that by 2040, sub-Sahara Africa will have 34.2 million people with diabetes (almost 3 times more than 2015 estimates of 14.2 million) while South East Asia will experience almost a doubling of diabetes rates by 2040 (140.2 million in 2015 to 78.3 million). This will not only add a significant burden to health care costs, but also to the people living with this chronic disease. People with diabetes are 2-3 times more likely to have cardiovascular disease, and the prevalence of end stage renal disease is up to 10 times higher in people with diabetes. The IDF estimates that every 30 seconds a lower limb or part of a lower limb, is lost to amputation somewhere in the world because of diabetes.

Today rapid increase in the rate of obesity and overweight cases are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels.

Many countries throughout the world are undergoing a nutritional transition which has been triggered by a population rapidly migrating into cities. This pattern changes dietary habits and decreases levels of physical activity. The effects of these changes have been recognized in the early 1990s, especially in low- and middle-income populations, but they did not become evident until hypertension, diabetes and obesity started to dominate the globe. Today rapid increase in the rate of obesity and overweight cases are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels.

The introduction of processed foods combined with economic growth have caused global obesity rates to increase. The Global Health Observatory of WHO estimates that in 2016, more than 1.9 billion adults were overweight (39% of the global population). The upward shift in obesity is associated with an increased consumption of highly refined and processed foods, an increased consumption of salt, sugar and fat, a decreased consumption of plant-based foods and less physical activity.  A recent study examined trends in the per capita volume of “unhealthy commodities” (soft drinks and processed foods that are high in salt, fat and sugar, along with the consumption of tobacco and alcohol). It showed that based on the average rates of growth between 1997 and 2011, and projected trends between 2011 and 2016, the growth of snacks, soft drinks and processed foods is fastest in low and middle income countries, with little or no growth expected in higher income countries in the next five years. The authors note that additional research is needed to address the rise in consumption of unhealthy commodities and their consequences.

The Global Burden of Disease tracked trends between 1990– 2017, and examined 15 dietary factors. A poor diet was responsible for more deaths than any other risk factor in the world (1 in 5 deaths). The leading causes of death included a high intake of sodium and a low intake of plant-based foods including whole grains, fruits, nuts, seeds, legumes and vegetables.

A 190-country study published this year assessing diet quality concluded that an improvement in dietary quality from the current global diet to the reference healthy diet could prevent 11 million premature deaths, or 24% of total deaths in 2017.

A poor diet was responsible for more deaths than any other risk factor in the world (1 in 5 deaths).

The Current Scenario:

In 2010, 1.65 million CVD deaths worldwide— or 1 out of every 10 CVD deaths— were attributed to salt consumption. The WHO recommendation is that salt should be limited to 5gram per day. Salt reduction has been described by the WHO as one of the best ways to improve public health, and an efficient and cost-effective way to decrease the burden of elevated blood pressure and cardiovascular diseases. In 2013, the WHO aimed to reduce average salt intake by 30% in the mean population; this goal is to be realized by 2025.

In 2014, 75 countries had national sodium reduction strategies, including food reformulation, front of package labelling, consumer education, and initiatives in public institutions. For many countries, these strategies are voluntary or restricted to a limited number of food products. South Africa is the first country to adopt a mandatory legislation for the reduction of sodium levels across a wide range of processed foods.

In 2010, the WHO began The Global Hearts Initiative. It developed  three population-based strategies to reduce cardiovascular disease. These include: salt reduction, improvement of access to preventative care for cardiovascular disease, and tobacco cessation. One of the most important activities for controlling risk factors are related to the Tobacco Free Initiative. Situation analyses are being conducted in Botswana, Kenya, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe. Health education programs targeting school youngsters are also underway in these countries.

In conclusion, there is significant research to support the impact diet and lifestyle has on reducing risk for chronic disease.  All countries around the world have room for improvement with dietary intake. Diet quality (and quantity) does matter. Access to nutrient rich foods can be a challenge, but research supports healthy diets can improve health and life.

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Katherine D. McManus

Katherine D. McManus

Katherine D. McManus is Director Department of Nutrition and Director of the Dietetic Internship at Brigham &amp: Womens Hospital Harvard Medical School. Katherine also serves ...

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