Academic journal article Bulletin of the World Health Organization

Nutritional Aspects of Changes in Disease Patterns in the Western Pacific Region

Academic journal article Bulletin of the World Health Organization

Nutritional Aspects of Changes in Disease Patterns in the Western Pacific Region

Article excerpt


In populations that have progressed socio-economically there is nearly always a shift from diseases of undernutrition and microbial contamination of food, which affected mostly the health of infants and young children, to diseases of excessive food consumption, affecting mainly the adult population and a growing number of children. At a WHO technical meeting on changing lifestyles and health, held in Japan in 1991, it was noted that demographic and socioeconomic changes have led to a situation where the number of deaths from lifestyle diseases are now greater in the developing countries than in the developed world.(a) According to the World health statistics annual 1984, 16 developing countries in the WHO Western Pacific Region reported, for the first time, more deaths from noncommunicable diseases than from infectious and parasitic diseases (1).

The lifestyle-related illnesses include noncommunicable diseases (NCD) such as heart disease, hypertension, many forms of cancer, obesity, diabetes and osteoporosis, as well as sexually transmitted diseases, acquired immunodeficiency syndrome (AIDS), and traffic accidents. This paper focuses on the nutrition-related chronic diseases in countries of the WHO Western Pacific Region and on the behavioural factors, such as diet and physical activity, that influence them.

Risk factors for cardiovascular disease and cancer

Dietary fat According to present knowledge the most important single dietary component responsible for atheroma in human beings is fat (2). An analysis of trends in 27 countries in the consumption of animal and vegetable fats, between 1961 and 1985, and in mortality from ischaemic or coronary heart disease (CHD) in men, between 1972 and 1984, shows that in most nations a marked decline in CHD mortality was related to a decrease in animal fat consumption and, to a lesser extent, an increase in that of vegetable fats. Countries with an increase in CHD mortality showed a rise in animal and total fat consumption (2).

Cholesterol plays an important role in the genesis of atherosclerotic diseases. as indicated by the fact that no population with a mean total cholesterol (TC) level <190mg/dl has been reported to have a significant CHD burden. In contrast, all populations with a mean TC value >220mg/dl have substantial CHD rates (3). A meta-analysis of the randomized controlled trials of cholesterol reduction suggests that a 10% fall in total cholesterol corresponds, on average, to a reduction of about 25% in CHD incidence (4).

Saturated fatty acids with 12-16 carbon atoms have been found consistently to raise the serum level of low-density lipoprotein cholesterol. The role of different unsaturated fatty acids (UFA) in the prevention of CHD remains unclear, because the diets of populations with a high UFA intake are also generally characterized by a low intake of saturated fatty acids (5).

Other dietary components such as fibre have an effect on serum cholesterol in experimental studies and are correlated with cholesterol levels in intercountry comparisons. The dietary factors that affect serum cholesterol in a similar way tend to cluster together in many diets. This makes it difficult to assess quantitatively the effects of the individual factors on the atherosclerotic process. However, in general, population subgroups consuming diets rich in plant foods have lower CHD rates than the general population (5).

Epidemiological studies consistently suggest that blood pressure is lower among vegetarians than non-vegetarians, which is independent of age, weight and pulse rate. Although it is not easy to determine the precise cause of these findings, the studies indicate that some component of animal products, possibly protein or fat, may influence blood pressure in well-nourished populations (5).

Obesity. The public health importance of obesity in relation to cardiovascular diseases has been discounted by epidemiologists because in multivariate analysis its predictive effect is found to depend on blood pressure and cholesterol levels (4). …

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