Sample Master's Capstone Project

8/13/2019 Sample Master's Capstone Project

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Students Name

Student Number

Course Number

Professors Name

Due Date

School Name

Food and Nutrition: A Case Study


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NUTRITION AND DISEASE: A CASE STUDY ii

Abstract

Nutrition is a topic that impacts everyone. And what we think we know about proper nutrition is

often contradicted by new research that disproves previously held beliefs about what foods are good

for us and what foods are not. Therefore, gaining insight into how nutrition impacts our health, and

how specific nutritional deficiencies and poor eating habits can create chronic illness, is vital. Thus

this Capstone project analyzed the relationship between nutrition and disease. In the context of

controversy dietary choices and how those choices influence human health, this research sought to

augment current research by identifying gaps and contradictions within the discipline, and analyzing

how real-world practitioners in the field specifically define the relationship between food consumption

and the presence of disease or lack thereof.

In the qualitative tradition and bounded by the case study method, this study examined nutrition

and health in three countries: China, Peru, and Tanzania. Data from document analyses and

interviews reveal that poor eating habits and the consumption of processed foods in particular,

negatively impact human health on a relatively consistent and broad scale.

This study confirmed the reality that there is a giant paradox in food and nutrition. The

countries in the present study suffered from chronic diseases caused by the simultaneous problem of

malnutrition and over-nutrition. Moreover, the findings of this Capstone Project also support the

notion that the role of proper nutrition in achieving and maintaining a healthy life integral and highly

interrelated.


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NUTRITION AND DISEASE: A CASE STUDY iii

Table of Contents

Abstract iiTable of Contents iii

List of Figures vList of Tables viI. Introduction to the Project

A. Introduction 1B. Background 1C. Problem Statement 2D. Professional Significance 2E. Overview of Methodology 3F. Limitations of the Study 4H. Definition of Terms 4I. Conclusion 5

II. Review of LiteratureA. Introduction 6B. Diet, Nutrition and the Prevention of Chronic Disease: WHO 6C. Functional Foods: Institute of Food Technology 7D. Bioactive Compounds in Foods: American Journal of Medicine 8E. The China Study 9F. Conclusion 10

III. MethodologyA. Introduction 12B. Research Questions 12C. Research Perspective 12

D. Research Method 13a. Interviews 14b. Document Analysis 15c. Data Analysis 15d. Plausibility 16

IV. Results of the StudyA. Introduction 17B. Select Global Trends in Food and Nutrition 17C. Case I: China 20

a. Brief Country Context 20b. Nutrition and Health Trends 20

c. Interviews 22D. Case II: Peru 23

a. Brief Country Context 23b. Nutrition and Health Trends 23c. Interviews 26

E. Case III: Tanzania 28a. Brief Country Context 28b. Nutrition and Health Trends 28


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NUTRITION AND DISEASE: A CASE STUDY iv

c. Interviews 31V. Summary and Discussion

A. Chapter Aims 33B. Introduction 33C. Restatement of the Problem 34

D. Explanation of the Project 35E. Review of Methodology 35F. Summary of Results 36

a. Sub-question 1 36b. Sub-question 2 36c. Sub-question 3 37

G. Relationship of Research to the Field 38H. Discussion: Significance of Findings 39I. Conclusion 40

VI. References 41


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NUTRITION AND DISEASE: A CASE STUDY v

List of Figures

Number Page

Figure 1: Daily fat intake per gram per capita per day. 20

Figure 2: Child anthropometry in Tanzania. 29


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NUTRITION AND DISEASE: A CASE STUDY vi

List of Tables

Number Page

Table 1: Fat intake recommendations 18

Table 2: Chinese fat consumption per gram per day per capita 21

Table 3: Peruvian, Argentinian, Brazilian, and Chilean fat consumption 24

per gram per day per capita

Table 4: Comparative GDP for select South American Countries 25

Table 5: Tanzanian fat consumption per gram per day per capita 30


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NUTRITION AND DISEASE: A CASE STUDY 1

Introduction to the Project

Introduction

The aim of this Capstone project is to determine and analyze the relationship between nutrition

and disease. There is significant controversy and debate about what constitutes the ideal human

diet. The impact of poor dietary choicesincluding the consumption of processed foods and those

altered via human interventionare thought to play a leading role in a persons susceptibility to

disease and poor health.

This report is an evaluation and analysis of the most current research in the field of nutrition. An

ancillary intent is to examine the casual relationship between diet and the manifestation of disease.

Special considerations will be taken to address knowledge gaps in this field. There is broad corpus o

research on this topic, yet a much of the research is contradictory. Moreover, there is a lack o

consensus among professionals in the field. Last, this research seeks to substantiate claims that by

removing certain nutritional elements from ones diet may improve their health and subsequent

longevity.

Background

Nutrition is a topic that impacts everyone. Weve all grown up with intake patterns based on

culture and geography. According to the World Health Organization (WHO), there is an increasing

risk and prevalence of chronic disease present in populations of developing countries, specifically in

men (WHO, 2002). These chronic conditions, including heart disease, cancer and diabetes are

shown to have a strong correlation with nutrition (WHO, 2002). And according to the Who, a persons

diet actually defines their health status (2002). Poor eating habits in conjunction with other

environmental factors such as pollution and addition create conditions where disease can thrive.


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However, what exactly constitutes poor eating habits? What foods and nutrient deficiencies are

directly associated with chronic disease? Surprisingly, research in the field of nutrition produces

conflicting results. It is the purpose of this report to explore the evidence and discover how nutrition

specifically impacts health and contributes to chronic disease.

Problem Statement

According to the World Health Organization, chronic illness is on the rise (WHO, 2002). Thus,

this Capstone Projects principal question is this: In what way does nutrition contribute to the onset

and presence of chronic illness? Sub-questions, detailed in Chapter 3 will address how specific

nutrient combinations, overconsumption, and ethnicity may negatively impact health.

Other topics that will be explored through a review of literature and in interviews and document

analysis will explore the controversies and contradictions in nutrition research, and best practices for

achieving and maintaining health. Other issues of interest are (a) how processed foods, chemical

additives and man-made food interventions impact the nutritional value of foods impact the body, and

(b) how foodstuffs such as meat and dairy influence health.

Professional Significance

The significance of these questions is undeniable for their exploration has a potential for

impacting every single human being on the planet. We all desire to enjoy long, healthy, and happy

lives; and nutrition is a major factor that contributes to ones ability to achieve those aims. We live in

a world where food is manufactured and processed, created and packaged as products to entice and

influence consumers to make a purchase; and to continually support a given organization. The

amount of nutritional education we are provided in the United States is, at best, limited. And what we

think we know about nutrition is often contradicted by new research that disproves previously held

beliefs about what foods are good for us and what foods are not. Therefore, gaining insight into how


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nutrition impacts our health, and how specific nutritional deficiencies and poor eating habits can

create chronic illness, is vital. We can all benefit from having an awareness of how certain foods

affect our physiology: what foods to avoid and what foods to enjoy. Last, a selfish aim of this

research is for my own education, health, and well-being. Unselfishly, however, the knowledge that I

glean from this project will help me to inform others about proper nutrition and the importance of a

healthy diet.

Overview of Methodology

To address the questions that I have presented for my project, I will primarily rely on leading

research derived from case studies. A large portion of my project will detail correlations between

nutritional components and the presence of disease; therefore, in the review of literature, I will look to

quantitative, qualitative and statistical data to provide the foundation of those relationships. Certain

organizations and institutions such as the World Health Organization and the Centers for Disease

Control and Prevention will provide invaluable information in that regard. Secondly, I wish to highlight

the contradictions that exist between researchers and what they suggest are healthful eating habits;

therefore, I will need to look through a variety of independently published journals that are not

influenced by organizations and corporations who have a vested interest in selling some type of

product. By that measure, I will hope to find information that is verified and consistent between

various researchers and professionals.

Following a review of literature, the case study method in the qualitative research tradition,

detailed in Chapter 3, will be employed to answer the research questions. The qualitative method is

valuable for this study to the extent that it does not strip meaning from context. I will acquire accurate

information from practitioners in the field.


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Limitations of the Study

The primary boundary or limitation that is present in my project is in having the ability to verify and

validate the information I discover and to find nutritional specifications that contribute to health

universally. This is incredibly difficult because each person is a unique individual with a different

physiology and biological make-up. Another second limitation is the ability to trust and verify the

information discovered. Corporations and organizations that have a vested interest in selling

products (food) are known to finance research studies in which they know that the outcomes of such

endeavors will not harm their sales. Therefore, it is critical that I acquire factual, unadulterated

information from the field. The finial limitation of this study is the reality that nutrition is not the only

factor that contributes to disease. As discussed above, other variables such as environment,

pollution, life choices (smoking, drinking, etc) significantly impact human health. I hope that the

following definition of terms is as helpful to the reader as it was to me in beginning to frame the

problem of how diet and nutrition impacts health.

Definition of Terms

- Nutrientsnecessary elements contained within food that impact our bodies in a variety of

ways, contributing to overall functionality, operability and health.

- CarbohydratesMacronutrient characterized as being the element which provides us with

energy; sugars, breads, fruits, vegetables, etc.

- FatMacronutrient necessary for health. Both healthy and non-healthy fats exist and

overconsumption of fats can lead to weight gain and poor health.

- ProteinMacronutrient necessary for health. Utilized in building muscle and performing a

variety of tasks in our body. Protein is essential for healing and rebuilding damaged tissue.


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- Chronic IllnessAny of a variety of diseases having a lasting and detrimental impact on

human health, re-occurring or persistent illness. Examples of chronic illness as related to this

project include heart disease, diabetes, cancer.

- Vegetarianone who does not ingest flesh of animals but may consume dairy products, eggs,

etc.

- Veganone who does not ingest any product associated with animals including meat, dairy,

eggs, animal fats and oils and so on.

- Processed FoodsFood that has been altered by man.

- GMOGenetically Modified Organism, plants and animals that have been modified at the

genetic level to produce or create some sort of desired outcome.

Conclusion

The topic I have chosen will undoubtedly present me with a variety of challenges. Nutrition is a

topic that relates to us all and impacts every person on this planet. Finding an ideal diet that which

would promote healthfulness, longevity and prevent/ward off disease is something we can all hope to

discover. Doing so is complicated by the fact that we all have unique biological characteristics and

physiologies. What works for one person might not work for others; and there are a multitude of

variables that will impact health beyond nutrtition. However, it is possible to determine the effect of

certain elements on our cells and to discover how nutrition or lack of nutrition contributes to disease.


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Review of Literature

Introduction

The role of nutrition in achieving health is integral and highly interrelated. The topic is becoming

more and more relevant in todays society as Westernized cultures characterized by a large

percentage of high and middle class individuals are experiencing greater instances of chronic illness

and nutritionally related diseases (WHO, 2003). On that premise, various researchers and groups

within the scientific community have embarked on a journey to determine which dietary factors

promote disease and which promote health (WHO, 2003). In that quest, the specific nutrient

combinations and intake recommendations have been explored, argued and validated; however,

research in this field often contradicts itself and discovering a dietary course of action that promotes

health universally has yet to be revealed. It is in all peoples interest to pursue and discover

information that when applied can have a positive impact on their health and well-being. In making

such an effort one must ask themselves to what degree does the role of nutrition play in decreasing

our chances of experiencing disease and physical degradation. The following report serves as a

literature review examining some of the research having already been performed in relation to this

topic.

Diet, Nutrition and the Prevention of Chronic Disease: World Health Organization

In 2002, a meeting involving members of the World Health Organization (WHO) and the Food and

Agriculture Organization (FAO) met to discuss research and findings in relation to nutrition and the

prevention of chronic disease (WHO, 2003). The purpose of the consultation was to prepare and

present recommendations for public use in regards to appropriate nutritional choices and pursued

lifestyles (WHO, 2003). The report and interest in the field was triggered by the organizations

recognition of rising chronic illnesses being experienced both in the United States and worldwide


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(WHO, 2013). The commission has come to recognize that specific nutritional considerations have a

significant correlation to health conditions (WHO, 2003). The commission also recognizes that diet

and nutrition are not the only factors which contribute to ones health but a multitude of variables

interact with one another producing either health or illness (WHO, 2003).

The report recognizes that rapid changes in diets and lifestyles that have occurred with

industrialization, urbanization and economic development and market globalization, have accelerated

over the past decade (WHO, 2003). These factors arehaving a major impact on the health of the

population due to food availability, inappropriate dietary changes, decreased physical activity, and an

increase in lifestyle choices that have a negative impact on health such as smoking tobacco and

drinking alcohol (WHO, 2003). In addition, trends involving increased consumption of foods high in

fat, saturated fat, which have undergone high degrees of processing and have been injected with

chemical additives as well as low consumption of healthy carbohydrates have been shown to have a

negative impact on health (WHO, 2003). The World Health Organization report serves to provide a

historical background on these topics, to provide information regarding the current state of health

globally and essentially to provide recommendations and nutritional targets for humans to follow in

achieving optimal health (WHO, 2003).

Functional Foods: Institute of Food Technologists

The publication released by the Institute of Food Technologists is meant to serve as a guidelines

for the way specific foods impact our health both negatively and positively. The publication begins by

recognizing an age old tenet spoken by Hippocrates, the father of medicine almost 2,500 years ago,

Let food be thy medicine and medicine be thy food (Hasler, 1998). This publication had been partly

instigated by growing interest on the part of consumers regarding the role of nutrition and its impact


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on their health (Hasler, 1998). The first topic explored by Hasler is the definition and explanation of

what is a functional food. One initial discovery explored by Hasler is the overwhelming evidence

pointing to the benefits derive from consuming plant based foods (Hasler, 1998). Hasler then goes

on to pinpoint specific plant based foods and explain their benefit, characteristics and impact on the

human body (Hasler, 1998).

After an in-depth look at plant foods, their nutritional profiles and their positive or negative effects

on health; Hasler approaches the topic of animal based foods including fish, dairy products, beef and

chicken (Hasler, 1998). One aspect of animal foods that is explored in detail are the safety issues

surrounding their consumption and the risks taken when we consume these products (Hasler, 1998).

Finally, Hasler concludes that mounting evidence supports the observation that functional foods

containing physiologically active components, either from plant or animal sources, may enhance

health (Hasler, 1998). Though this evidence supports the claim that processed, unnatural,

manipulated foods may not provide the same healthful benefits as their natural counterparts; dietary

patterns, lifestyle choices and overall intake levels play a major supporting role in the experience of

health or disease (Hasler, 1998).

Bioactive Compounds in Foods: American Journal of Medicine

The American Journal of Medicine published an article in which they explore the role of bioactive

compounds in foods and their role in the prevention of cardiovascular disease and cancer (Etherton

et al 2002). Their research indicates that bioactive compounds are naturally present in foods in small

quantities (Etherton, 2002). These compounds have been demonstrated to provide protective effects

especially in relation to plant based foods (Etherton et al., 2002). The compounds explored include

Phenolic compounds and their subcategory, flavonoids (Etherton et al., 2002). The study begins from


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a general discussion of the effects of these compounds to a specific look at various anti-oxidants

which are Phenolic compounds (Etherton et al, 2002). The conversation moves into the exploration

of specific compounds such as Lycopene, Hydroxytyrosol, Resveratrol, Carotenoids, and

organolsulfur compounds as well as isothiocyanates found in root vegetables and cruciferous

vegetables respectively (Etherton et al., 2002).

The study reveals what has been discovered in relation to these compounds. Namely, these

compounds have various positive impacts such as anti-inflammatory properties and the ability to

protect against and ward off cancer cells and cancer initiation (Etherton et al. 2002). In conclusion,

this study validates the position regarding the impact of nutrition on health and provides specific

scientific evidence for how and why this is the case.

The China Study

Colin Campells China Study is one of the most exhaustive explorations of nutrition in modern

times. This source initially reveals the history of Campbell, a Cornell University graduate and

explains how he became involved and interested in nutrition. Through arduous research spanning at

least half of a century, Campbell has come to shocking conclusions regarding health, societal

preconceptions and dietary recommendations. His study reveals the relationship of various macro-

nutrients, carbohydrates, fats and protein and their relationship to human health when ingested or

consumed at varying levels. What Campbell has discovered is that protein, specifically animal

protein, when consumed at excessive levels actually instigates cancer initiation (Campbell, 2005).

What follows is that upon decreasing protein levels, cancer initiation had actually come to a halt and

cancer had disappeared from the organism (Campbell, 2005).


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foods. In any case, the relationship between nutrition and disease cannot be denied and has been

discovered to have a significant impact on ones health.


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Methodology

Introduction

As mentioned in the preceding chapters, this research seeks to investigate the relationship

between nutrition and disease. The purpose of this chapter is twofold. First, it will augment the

foregoing discussion by identifying the studys principal and ancillary research questions. Next it will

detail the proposed methodology. Specifically, these sections will identify: 1) the research

perspective; 2) the research type; and 3) how the research will be conducted.

Research Questions

This Capstone Projects principal research question is: How does nutrition differentially impact

an individuals susceptibility to disease? This question subsumes three related sub-questions:

1) Does an individuals intake of specific nutrient combinations significantly impact an

individuals health?

2) Why does overconsumption of fats (which is identified as unhealthy by a broad corpus of

literature) negatively impact the health of individuals of particular racial or ethnic backgrounds

differently or more significantly?

3) How significant is impact of nutrition on chronic illness.

Research Perspective

Chapter 1 details the challenges associated with determining the impact of nutrition on health.

To briefly reiterate, myriad environmental and genetic factors impact healthnot to mention age.

Thus it is extraordinarily difficult to isolate what specific nutrients contribute to health or lack thereof.

Given this limitation this research will employ the qualitative method. This method was selected

based upon several factors and this important caveat: the grounding assumption of quantitative

research is that reality can be depicted objectively as static abstractions corresponding to real life.


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Moreover, the method is impersonal and value-free (Brower, et al., 2000). This was identified as

neither desirable nor realistic in terms of cost and time.

Other names for the qualitative approach include action research (Denzin and Lincoln, 2005),

interpretive analysis (Yanow, 2000) and naturalistic research (Lincoln and Guba, 1985)to name a

few. These names lend a hint to why the qualitative method was selected for this study. Revealing

correlations between nutrition and health requires an understanding of human experiences with food.

Beyond sleep, there is little else that impacts the human condition than nutrition. The qualitative

method was identified as ideal because its basis for conclusions is evidence from naturally occurring,

everyday experiences (Brower et al., 2000).

Moreover, nutrition is often based on local customs, mores, traditions, values and agricultural

factors. Thus the meaning of nutrition will likely vary from continent to continent; country to country;

state to state; and municipality to municipality. Yanow (2000) illustrates this point in her suggestion

that local customs and traditions help to define communities of meaning. This is particularly

germane to this research given the vast disparities in (mal)nutrition and health across the globe.

Moreover, as this study seeks to examine discrepancies of the definition of healthy eating from

country to country, it is paramount that local meaning-making is understood, exploited, and explained.

Last, the qualitative tradition identifies the inextricable link between meaning and context

(Mishler, 1979). The epistemological assumption of this study, therefore, is that impact of nutrition on

human health cannot be stripped of context.

Research Method

This research proposes to employ the case-study approach in the spirit of Yin (1994; 2013),

Merriam (1998) and Stake (1994; 2006). The case study is an attractive method because it helps to

address how and why questions (Yin, 1994). Further, the case serves a bounding function (Stake,


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2008). It enables the researcher to establish data collections parameters and clarify the scope of the

study. The definition of a case study illustrates this reality succinctly: An intensive analysis of an

individual unit (as a person or community) stressing developmental fac tors in relation to environment

(Merriam-Webster 2009).

Several studies on nutrition and health have benefited from the case study approach. Yang,

Chen, and Feng, for example, employed the method to explore how biofortification in the soil-plant

system in China improved micronutrient nutrition (2007). Similarly, Babu (2000) examined nutrition

interventions in Malawi through the case study lens. These examples were selected randomly.

There exist literally hundreds of case studies that either relate to food, nutrition, health, and/or a

combination of the three. They are identified here to lend legitimacy and validity to this effort. The

next sections identify what proposed research tools the case study will contain. They are: interviews

and secondary research (document analysis).

Interviews

This research proposes to conduct interviews in with government officials, ministers of health,

and physicians on four continents: Africa (Tanzania), Asia (China), and South America (Peru). Also,

individuals from the World Health Organization will be identified as useful to this study and then

interviewed. Please note: If a particular interviewee identifies another individual knowledgeable about

the subject of nutrition and health and valuable to this study, additional interviews will be conducted.

Cost and time limitations require that the majority of the interviews be executed via telephone.

One week prior to an interview, the responded will be furnished with an electronic copy of the

interview protocol. This protocol will be uniform across continents. During each interview notes will

be taken. They will be transcribed as soon as possible afterwards using software that transforms

spoken words directly into text. This approach will preserve richness and detail without imposing


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either the costs of tape transcriptions or the tedium of manual entry. To improve reliability this study

will promise no attribution. Electronic versions of these documents will be entered into an electronic

qualitative analysis tool, discussed later.

Document Analysis

Prior to the interviews, extensive research on demographics, nutrition and health will be

obtained via the World Health Organization (WHO), United Nations Development Programme

(UNDP), Centers for Disease Control (CDC), and Central Intelligence Agency Country Factbook,

among other documentary sources. It is assumed that part6icipants will identify other rich sources of

data to augment the pre-interview research work.

Each of the documents will be catalogued and scanned electronically so that they too can

become part of the study database. They will be coded and bundled into sub-topics. One benefit of

the qualitative tradition is that hypotheses are emergent. Thus patterns in the data lead to categories,

which lead to codes, which, in turn, lead to the development theoretical propositions.

The document analysis will be painstaking to the extent that every documentfrom fliers to white

paperswill be annotated and re-annotated to ensure that no data points are overlooked.

Data Analysis

All text, including interviews and electronic documents, will be imported into a software

program for development, support, and management of qualitative data analysis: the NUD*IST

program (Non-numerical, unobstructed, indexing sorting and theorizing software). The program also

permits the importation of external documents. This program affords a researcher: limitless coding

categories and subcategories; the use of separate document and indexing categories and sub-

categories; comprehensive hypermedia-like browsing tools for both document and indexing

databases support; support and exploitation of hierarchical indexing systems; and Mechanisms for


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creating new indexing categories out of existing ones, relating them to the data documents, and using

them for further analyses (Richards and Richards, 1991).

Following the coding schema, preliminary reports will be drafted. Officials from each country

(case) will read drafts to ensure accuracy, reliability and internal validity.

Plausibility

This research will strive to present readers with a plausible account of health and nutrition. To

that end, it will employ the qualitative assessment guidelines promulgated by Brower et al. (2000).

Authenticity, therefore, will be a principal aspiration of this research. Therefore, accounts will be rich,

thick and descriptive, portraying the natives views of the world. The final product will help to

legitimate the research methods, establish a connection with the reader, create unique impressions

about the subject matter, recognize an examine competing views, and to stimulate readers to

reexamine taken-for-granted assumptions in their own world views (p. 291).


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Results of the Study

Introduction

The purpose of this chapter is to present the results of the case study on food and nutrition.

As noted in Chapter III, the data are bound by country-level case studies of China, Peru, and the

Republic of Tanzania. The chapter is organized as follows. A brief discussion of global trends in

nutrition and health contextualizes the country case studies. Each of the following sections is

organized about the case. Four sections comprise each case: 1) brief country context; 2) nutrition

and health trends; and 3) interviews.

Select global trends in food and nutrition

A recent study of economic and food availability data for 19621994 revealed a significant shift

in the structure of the global diet. Drewnowski and Popkin (2009) found a cleavage in the classic

relationship between incomes and fat intakes, where the global availability of cheap vegetable oils

and fats has greatly increased fat consumption among low-income nations. And ironically, where

economic development has led to improved food security and better health, adverse health effects of

the nutrition transition include growing rates of childhood obesity.

More troublesome, however, is the fact that obesity has reached pandemic proportions. Termed

globesity by the WHO(2013), there are several factors contributing to the problem. Pompkin, Adair

and Ng (2012) identify three: 1) an increased reliance upon processed foods; 2) greater away-from-

home food consumption; and (3) the increased use of edible oils and sugar-sweetened beverages.

And these causes are not isolated in a certain socioeconomic levels or geographic areas.

The National Heart Foundation of Australia (NHFA) underscores another problematic global

reality relative to increased fat consumption. In an exhaustive review of the relationship between


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dietary fat and obesity, NHFA identified linkages between an increased intake of saturated fat and

increased risk of coronary heart disease (CHD) (National Heart Foundation of Australia, 2003).

Another disturbing trend identified by the World Health Organization (WHO) is that the

increase in dietary fat supply worldwide exceeds the increase in dietary protein supply. Globally, the

average supply of fat has increased by 20 g per capita per day since 1967-1969. This increase in

availability has been most pronounced in the Americas, East Asia, and the European Community

(World Health Organization, 2013). Protein should account for 10% to 20% of the calories consumed

each day. Essential to the structure of red blood cells protein: aids in the proper functioning of

antibodies to resist infection; regulates enzymes and hormones, for growth; and repairs body tissue

(Nutristrategy.com). While fat does help to maintain body temperature and protect tissues and organs

overconsumption poses significant health risks (Brooks and Osborn, 2012; Bocarsly, Powell and

Avena, 2010; De Meester, Zibadi and Watson, 2010; Menaa, Menaa, Menaa, and Trton, 2012; Tan,

2011).

Given the health threats associated with overconsumption of fats, many nations have

developed guidelines for daily fat intake. These guidelines are useful to this study to the extent that

they aid in contextualizing Figure 1. Table 1 illustrates recommendations on fat limits promulgated by

the U.S. Department of Agriculture (USDA) (USDA Food and Nutrition Center, 2013).

Table 1.Fat intake recommendations

Age Group Total Fat Limits

Children ages 2 to 3 30% to 40% of total caloriesChildren and adolescents ages 4 to 18 25% to 35% of total calories

Adults, ages 19 and older 20% to 35% of total calories

Based upon a 2,000 calorie diet per day, it is thus recommended that an adult consume 600

calories at the 30 percent level. Two empirical examples help to clarify what this means to an


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average person on an average day. The first is one serving of Oreos, a quintessentially American

sweet treat, which contains 100 fat calories and 11 grams of fat. That is 16.7 percent of the

recommended daily fat limit. The second is a frozen Celeste cheese pizza for 1 (a single serving).

The pizza contains 130 fat calories and 14 grams of fat, representing 21.6 of the daily limit. These

figures may be indicative of why daily fat intake in the United States is so high. Developed by the

WHO, figure 1 shows daily fat intake in grams per day the United States and across the globe.

Juxtaposing the upper bounds of these statistics with the two real-world food examples above

shows a surprising reality. On average, Americans consume the equivalent of 11.7 frozen Celeste

cheese pizzas and 14.9 servings of Oreos. Please note that the selected foods are not considered

healthy. They are processed; but they do highlight the reality that overconsumption is a considerable

public health problem.

Applying the USDA fat limits to Figure 1 reveals that appropriate fat intake per capita per day falls

somewhere within the two lighter hues of orange: 61 to 73 and 73 to 87, respectively.

Yet even with this data, researchers lament that no recommendations for fat intake or general

advice for improvements can be given worldwide. Specifically, Elmadfa and Kornsteiner (2009) note

that given different dietary patterns, only regionally specific recommendations can be made about

what would be necessary to modify and improve fat quantity and quality of the diet.

This contextual backdrop sets the stage for the next four sections: individual country case

studies. Each section begins with a brief socioeconomic and health context. Embedded in each case

are the results document and interview analyses.


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Figure 1. Daily fat intake per gram per capita per day.

Source: chartsbin.com

Case I. China

Brief country context

China is the world'smost populous country,witha population of over 1.35 billion.Covering

approximately 9.6 million square kilometers, it is the world'ssecond-largest country by land area

(Listofcountriesoftheworld.com). Chinas economic reformswhich began in earnest in 1978

transformed the republics economy into the world'sfastest-growing.As of 2013, it is the world's

second-largest economy by bothnominal total GDP andpurchasing power parity (PPP),and is also

the world'slargest exporter andimporter of goods (White, 2013).

Nutrition and health trends

Zhai, et al (2009) in an exhaustive study based on massive longitudinal datasets found:
http://en.wikipedia.org/wiki/List_of_countries_by_populationhttp://en.wikipedia.org/wiki/Demographics_of_Chinahttp://en.wikipedia.org/wiki/List_of_countries_and_outlying_territories_by_land_areahttp://en.wikipedia.org/wiki/List_of_countries_by_real_GDP_growth_ratehttp://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)http://en.wikipedia.org/wiki/List_of_countries_by_exportshttp://en.wikipedia.org/wiki/List_of_countries_by_importshttp://en.wikipedia.org/wiki/List_of_countries_by_importshttp://en.wikipedia.org/wiki/List_of_countries_by_exportshttp://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)http://en.wikipedia.org/wiki/List_of_countries_by_real_GDP_growth_ratehttp://en.wikipedia.org/wiki/List_of_countries_and_outlying_territories_by_land_areahttp://en.wikipedia.org/wiki/Demographics_of_Chinahttp://en.wikipedia.org/wiki/List_of_countries_by_population


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China is undergoing a remarkable, but undesirable, rapid transition towards a stage ofnutrition transition characterized by high rates of diet-related non-communicablediseases in a very short time. It is facing simultaneous challenges of under- and over-nutrition. On the one hand, the government's efforts in the past decades to reduceunder-nutrition have been very successful and the prevalence of stunted and

underweight children has decreased significantly. On the other hand, the prevalence ofoverweight and obesity and the morbidity associated with non-communicable diseaseshave increased significantly in the past 20 years.

Stated earlier, the correlation between overconsumption of fats and the prevalence of disease

is uncontroversial. Table 2 illustrates a significant increase in the per day per capita fat consumption.

Reported in the next section, interview data suggest that overconsumption of fats is a major concern

for Chinese health officials.

Table 2.Chinese fat consumption per gram per day per capita

China Dietary FatConsumption(g/person/day) -1990-92

Dietary FatConsumption(g/person/day) -1995-97



58 72 82 90


There is no statistical evidence to support the idea that the introduction of Western-style food

correlates with steep increases in Chinese fat consumption since 1992. However, fast food has

gained considerable popularity in China over the last few decades. Chains like Kentucky Fried

Chicken, McDonald's, Pizza Hut and Burger King consider children their target customers. As a

result, they have become extraordinarily popular with young people (li, 2012).

In one effort to combat obesity, the Chinese Ministry of Health instituted food labeling

guidelines in 2011 (Badlissi 2011). Yet there are no serious efforts to promote the labeling or educate

the public (Li, 2012).


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It should be noted that the Chinese Ministry of Health has no official online documentation on

food and nutrition or any reporting on their efforts to combat obesity.

Interviews

Four respondents were interviewed over the phone for this study. Two interviewees were from

the office of the Chinese Health Minister, Li Bin. Dr. Bin has occupied the post since March, 2013.

When asked about specific nutrient combinations and their impact on human health both respondents

referenced fat and protein intake, and lamented that over the past 2 decades daily fat consumption

has outpaced protein consumption. Thirty-nine percent of all Chinese are now overweight, reported

a senior official. Another reported, The Western food influence is shameful. For example, In

Shanghai, our most westernized city, obesity among children has jumped 24 percent in only ten

years. This is unacceptable. We have to thank open markets for this problem.

Two physicians also participated in the study. When asked about whether or not fat

consumption impacted one racial or ethnic group differently, one physician stated, Food consumption

in China is influenced by regional, ethnic, cultural, income and agricultural production differences. Our

vast territory of China covers a range of different soil types, climatic variations and agro-ecological

zones that influence the agricultural production and indirectly dietary patterns. Think about it, he

said, we have 14,000km of coastline. Populations living in these areas are significantly healthier

when it comes to nutrition. More fish; more rice; less Burger King.

A second physician observed something very different, We have proof that the epidemic of

obesity is localized to certain areasand please do not say that I said epidemic; but in terms of

whether or not overconsumption of fats impacts one ethnic group more than the next, and I have read

no solid evidence. The localized problem of obesity is more of an urban issue. For example, in


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President Ollanta Humala, however, has made nutrition a key priority for his administration.

He has signed into law legislation to promote healthy eating and curb the advertising of junk food

(Peruvian Times, 2013) and in 2011 at his behest, the Ministry of Health approved the "Estrategia

Sanitaria Nacional de Alimentacin y Nutricin Saludable" (National Health Strategy for Healthy

Feeding and Nutrition), which for the first time included overweight and obesity among its priorities;

stunting was previously included. Although the strategy mentions the reduction of overweight and

obesity prevalence among children and adults as one of its goals for 2021, to date there are no

specific actions associated with it. Therefore, it is unclear what type of obesity prevention efforts will

take place. However, the President also ordered the establishment of the Ministry of Development

and Social Inclusion. The mission of this agency is to provide a significant boost to the countrys

approach to nutrition governance. Specifically, it has two main functions: 1) address childhood

malnutrition, and 2) to combat obesity. There are no data to support whether or not the strategy

document or the Ministry of Development and Social Inclusion have impacted obesity rates in Peru.

Table 3 illustrates trends in per day per capita fat consumption. This table also includes data

from border countries. The data from Brazil, Chile, and Ecuador suggest that while Perus obesity

rate because of fat intake is a concern, the Peruvian fat intake trend is somewhat of an anomaly

when compared to neighboring South American nations.


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These data show, admittedly unscientificallythat beyond Poterico et al.s 2012 findings on the

correlation between socioeconomic status and obesitythat GDP rates may also be an indicator of

the prevalence of obesity. The interviews reported below suggest that officials are concerned about a

paradoxical problem for the nation: undernourishment and obesity.

Interviews

Like the China interviews, two government officials and two physicians were interviewed for

the Peruvian case study. The first interview was conducted via telephone with a member of President

Humalas staff. When asked about the Peruvian food consumptionand how trends in that

consumption impact an individuals help, this aide suggested that poor nutrient combinations are

significantly impacting public health. He stated:

The public health system in Peru faces the same challenges as many other developingnationsmisinformation, poverty, and under-nutrition are chronic issues in the population.

Aside from these, the country is also seeing a slow, but steady growth in overweight and

obesity rates, accompanied by an increase in the incidence of chronic, non-communicablediseases, and a shift in dietary patterns toward the consumption of less healthy food items.

When probed about less healthy food items, the respondent indicated that imports of processed food

have significantly impacted obesity rates and thus public health. He also suggested that indigenous

foods such as fish derived from a massive fishing industry, for whatever reason, have lost popularity

while items like Kraft Macaroni and Cheese have steadily gained popularity. He stated: I dont

understand it; we have some of the most delectable fish in the world. But we do not advertise that to

our people. Fish do not come in fancy, colorful boxes. Macaroni and cheese does.

The second government interviewee, a relatively low-level bureaucrat from the Peruvian

Ministry spoke to the question of fat consumption and its differential impacts on different ethnic


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populations. He said, Peru is one of the most ethnically diverse nations in South America, if not the

world. We have five major ethnic groups: Mestizos, Amerindians, Europeans, Afro-Peruvians, and

Asians. He went on to state: seemingly, our statistics indicate that Amerindians who suffer from

obesity suffer from higher rates of diabetes, cardiovascular disease and other chronic, life-threatening

illnesses. And this is highly problematic to the extent that Amerindians constitute about 30 percent of

the Peruvian population.

The third participant is a physician from the largest hospital in Lima. When asked about

nutrient combination intakes relative to an individuals health, he stated: You must understand that in

certain sectors of Peru, it is not a combination of certain nutrient intakes that most greatly impacts

Peruvian health. It is a lack of nutrient intakes period. He specified the plight of children in two

areas of Peru: the high Andes and the Amazon. He reported, these regions are among the most

malnourished in the world: up to half of them suffer from chronic malnutrition and many are anemic

and Vitamin A deficient. He then linked the nutrient discussion to the question of obesity and chronic

illness, stating, Here, you see, our population suffers from two nutritional maladies that are

simultaneously problematic and ironic: we are an over- and under-nourished country.

The last interviewee was a high-ranking physician with the Ministry of Health who was extraordinarily

fluent in health statistics and nutrition demographics. Half of our population lives below the poverty

line; so many Peruvians have insufficient access to food and are deficient in numerous

micronutrients. Over one-third of child deaths are the cause of malnutrition in Peru, he stated. Then

he described his dual role as a doctor and as an official in the Ministry of Health. As a physician, I

am concerned with the prevention of chronic illness and death, of course. But as a ministerial official,

I must also focus on the economic and social impacts of improper nutrition at all levels of the

spectrum. He stated cogently the economic burdens of ill-nourishment:


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The economic costs of undernutrition and overweight include direct costs such as theincreased burden on the health care system, and indirect costs of lost productivity. Asoverweight and obesity increase, the Latin America is poised to lose $8 billion dollars tochronic disease. This is unacceptable.

Case III: Tanzania

Brief Country Context

Tanzania is one of the poorest countries in the world. Its population of 48,261,942 ranks 47 th

globally (Central Intelligence Agency, 2013b). The nations primarily agrarian economy

accounts for 75% of both exports and employment. The countrys life expectancy is relatively low at

61 years. Only 33 other nations fare worse in this area. Estimates for this country explicitly take into

account the effects of excess mortality due toAIDS;this can result in lower life expectancy, higher

infant mortality, higher death rates, lower population growth rates, and changes in the distribution of

population by age and sex than would otherwise be expected (Central Intelligence Agency, 2013).

Before a discussion of health and nutrition trends it important to note that Tanzania is one of the most

malnourished nations of the world. Illness and death rates from malnutrition, especially in children,

are staggering.

Health and nutrition trends

Tanzanias rate of malnutrition warrants a discussion before other elements of nutrition

contained in the sub-research questions are addressed. Figure 2 depicts rates of child

anthropometry in Tanzania from 1999 to 2010. Anthropometry is the study of weights and proportions

of the human body.
http://en.wikipedia.org/wiki/AIDShttp://en.wikipedia.org/wiki/AIDS


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Figure 2. Child anthropometry in Tanzania.

Source: World Health Organization Nutrition Landscape Information System

Comparative to other world nations, the rates of children under 5 who are underweight or stunted are

staggering. Peru, also a relatively poor nation helps to establish a point of reference, especially in

terms of children under five who are underweight. Over the same ten year period, the percentage of

Perus children living underweight never eclipsed 5.2%. In China over the same period the

percentage of underweight children under 5 did not exceed 5.1 percent.

Shayo and Mugusi (2011) contend that obesity is on the rise worldwide, not sparing developing

countries. Tanzania is no different. I n the first survey study of its kind conducted to identify and

understand obesity rates in Tanzania, Shayo and Mugusi (2011) found that in Tanzania, like China


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and Peru, both demographic and socio-economic factors play parts in obesity causation. However,

this study did not take into account fat consumption and its correlation with obesity. Instead, the

authors focused on increasing age, marriage and cohabitation, high SES, female sex and less

vigorous physical activities.

Like his Peruvian counterpart, President, H.E. Dr. Jakaya Mrisho Kikwete of Tanzania has made

advancing nutrition a capstone priority of his administration. At his direction, the country has

established a High-Level Steering Committee for Nutrition, convened by the Prime Ministers office.

The committee involves representatives from key ministries, development partners, UN agencies, civil

society, faith-based organizations, academia and business. This committee has enabled the country

to finalized its National Nutrition Strategy. The group is now working to complete a corresponding

implementation plan.

It should be noted that the lions share of emphasis in Tanzania insofar as nutrition has been on

malnutrition. Fat intake in the country has remained relatively constant. Table 5 illustrates fat

consumption per day per capita.

Table 5. Tanzanian fat consumption per gram per day per capita

Tanzania Dietary FatConsumption(g/person/day) -1990-92




32 29 31 34


Notice that the fat consumption has remained relatively constant. Interviewees attribute this to the

fact that the economy is agrarian. Beyond aid shipments, Tanzania has not had an influx of Western-

style food chains or significant imports of processed, high-fat foods.


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Interviews

The first respondent serves on the High-Level Steering Committee for Nutrition. After she

listened to the questions posed, she asked if she may speak somewhat off topic. This is what she

said:

In many countries there is a concern about obesity and what costs that it imposes ona given state or region. Here, obesity is near the bottom of our nutritional concerns.In the United States, there is much talk about national security. In Tanzania, ournational security is not weapons or soldiers but food. Long ago we developed adefinition of food security. Allow me to share it with you. Food security is defined bythe availability and accessibility of food at all times to all people especially childrenand other groups which are easily affected by lack of adequate food supply forexample, small children, pregnant and lactating women, the sick and the elderly.

After providing this definition, the minister explained that obesity, like malnutrition is often pronounced

in certain geographic regions. The foothills of Mount Kilimanjaro are places where malnutrition is

rampant. In Dodoma, our capital, obesity is more of a concern. It is estimated that nearly twenty-five

percent of the adult female population is obese. The more money people have, the more they eat.

A second participant was an official from the United Nations development Programme stationed

in Zanzibar. He responded to the question of nutrient combinations and the presence or absence of

illness by lamenting, I wish we had the problem of nutrient combinations. We do not have enough

nutrients to combine. When asked about overconsumption of fats and whether or not

overconsumption impacts certain racial or ethnic groups more, he responded, Here we are 99%

African. I would say that too much fat in a diet affects most Tanzanians similarly, but those urban city

dwellers tend to be far more sedentary, so overconsumption affects them much, much more.

The two final respondents, both physicians in a Dodoma hospital, echoed the initial sentiments of

the other interviewees. They were steadfast in their conviction that nutrition was a significant factor in

the manifestation of chronic illness. One physician quipped, Listen, nutrition impacts everything.


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Nutrition involves vitamin intake, the proper proteinfat balance. It impacts the regulation of so many

organs and systems. The kidneys, the liver: what has a greater impact on these organs than

nutrients, then food? The second physician said that he has witnessed an incredible spike in

diabetes cases over the last decade. [As an aside, I appreciate the candor of Tanzanians]. You

know who comes to see me complaining that I test them for diabetes because their toes are numb?

fat people. I tell my younger patients to simply not eat too much. Is it that hard not be gluttonous? Of

course there is a correlation between nutrition and chronic disease. I see it every day.


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amounts instigates cancer initiation. And astonishingly, he was able to turn-on and -off cancer

initiation simply by altering the animal protein amounts delivered to his test subjects. In short,

Campbell (2005) identified the undeniable relationship between dietary components and the

development of disease conditions.

To address the studys principal and secondary research questions, a methodology was

developed that was thorough yet realistic. While a broad survey with a large population (N) would

have been ideal, its administration and statistical analysis proved unrealistic given time and financial

constraints. Thus the qualitative case-study approach utilizing interviews and document analysis

was selected as the method. This is discussed further below.

The data were reported, bound by country-level case studies. China, Peru, and the Republic

of Tanzania were the study countries. The data reporting section began with a brief discussion of

global trends in nutrition and health. This was meant to contextualize the country case studies.

Then, each case was reported and data were organized in a consistent fashion: 1) country context;

2) nutrition and health trends; and 3) interviews.

Restatement of the Problem

Globally, the presence of chronic illness is on the rise (World Health Organization, 2002). This

report aimed to understand that reality in further depth. Thus the primary research question was: In

what way does nutrition contribute to the onset and presence of chronic illness? The sub-questions

are as follows: 1) Does an individuals intake of specific nutrient combinations significantly impact an

individuals health? 2) Why does overconsumption of fats (which is identified as unhealthy by a broad

corpus of literature) negatively impact the health of individuals of particular racial or ethnic


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backgrounds differently or more significantly? 3) How significant is impact of nutrition on chronic

illness.

Explanation of the Project

Review of Methodology

The qualitative perspective was the lens through which data were collected and analyzed for

this project. The rationale for approaching the study from this perspective was the reality that

nutrition is often based on local customs, mores, traditions, values and agricultural factors; that the

meaning of nutrition was likely to vary from continent to continent, et cetera.

The case study served as the binding mechanism for the data. That is, each country

represented an individual case. Interviews, document analysis and the collection of country-specific

data were compartmentalized by country. The case was useful in establishing data collection

parameters and containing the scope of the study.

Interviews and document analysis were the means of acquiring data for this research.

Interviews were conducted with government health officials and physicians. Each of the interviews

was conducted via telephone, guided by an interview protocol.

The second source of data was documents. These documents were mined from the World

Health Organization (WHO), the United Nations Development Programme (UNDP), the Centers for

Disease Control (CDC), and the Central Intelligence Agency Country Factbook.

To organize the data, all text, including interviews and electronic documents, were imported a

software program for development, support, and management of qualitative data analysis. Called

NUD*IST, (Non-numerical, unobstructed, indexing sorting and theorizing software), the program

affords a researcher limitless coding categories and subcategories, distinguishable document and


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One respondent lamented about the lack of research on the efficacy of a low-fat diet on

disease risk. He suggested that if the research were available and the facts publicized, this might

inspire a shift in thinking and thus a shift away from high fat processed foods.

The unintentional finding of this research described above is worth mention because it

substantiates the negative and significant impact of poor nutrition on chronic illness: healthcare costs

as a result of chronic disease caused by under-nutrition and obesity will cost $8 billion over the next

decade. And to reiterate the sentiments of one physician detailed in Chapter IV: Listen, nutrition

impacts everything. Nutrition involves vitamin intake, the proper proteinfat balance. It impacts the

regulation of so many organs and systems. The kidneys, the liver: what has a greater impact on

these organs than nutrients; then food?

Given the data collected pursuant to the sub questions, this research has found that fat as an

element of nutritioncontributes to the following chronic illnesses: cancer, cardiovascular disease,

diabetes, and obesity. One interesting finding from a physician was his description of the heart

relative to the mass of the body. It nicely sums up the findings of this study.

The adult hearts size is fixed. When ones body mass grows due to overeating orpartaking in a high-fat, high carbohydrate diet, the heart does not grow correspondinglylarger; it simply must work harder. So the more weight one gains, the more strain onthe heart. The more strain on the heart, the more likely a heart attack.

Relationship of Research to the Field

Perhaps not surprisingly, this research confirmed a broad body of research which suggests

that nutrition is related to the presence of chronic disease. In particular, it qualitatively supports the

findings of Campbell (2005) in the China Study.The physician respondents unequivocally stated that

poor nutritional choices lead to cancer and other chronic diseases. This study also found, however,

that malnutrition and under-nutrition may have equally or more significant impacts on chronic disease

and public health.


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This study confirmed the reality that there is a giant paradox in food and nutrition. The

countries in the present study suffered from chronic diseases caused by the simultaneous problem of

malnutrition and over-nutrition.

The findings of this Capstone Project also support the notion that the role of nutrition in

achieving health is integral and highly interrelated. The specific assertion by the World Health

Organization (WHO, 2003) that the Western-influenced regions comprised of upper and middle

income experience significantly higher instances of obesity and thus chronic illness and nutritionally

related diseases. And respondents in this study confirm a specific assertion by the WHO (2003)

discussed in Chapter II: rapid changes in diets and lifestyles that have occurred with industrialization,

urbanization and economic development and market globalization, have accelerated over the past

decade.

Discussion: Significance of Findings

The goal of this Capstone Project was similar to all other research endeavors: to demonstrate

cause and effect relationships. A key limitation of this study is that it is low on external validity. That

is, findings are not generalizable to the population at large. There we no surveys, no random sample.

However, the selected countries were chosen at random. And the interview protocol assured that all

participants were interviewed consistently and without systematic error or researcher bias. The

researcher kept his values and opinions in abeyance.

This research adds to the body of knowledge in food and nutrition as it relates to chronic illness in

the following terms: it confirms that free-market economies, geography and socioeconomic status

negatively impact an individuals predisposition to chronic disease.

This study is also significant to the extent that the combination of participants and the

combination of regions has not previously been studied. The linkages between nutrition and the


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onset of chronic disease in China, Peru, and Tanzania may provide a useful starting point for other

research. The novel presentation of demographic informational may also be of use for further

investigation.

Conclusion

The goal of this research was to understand how nutrition contributes to the onset and

presence of chronic illness. The case study evidence shows that malnutrition and overconsumption

of fats significantly impact the onset and presence of chronic illness. Moreover, the country case

studies, interview data, and documentary analysis show that overconsumption of fats, in particular, is

a leading cause of health maladies in three nations. It also shows that a fat diet does not

discriminate. That is, there is no one racial or ethnic group (with the exception of one population in

Peru) that suffers more grievously than another; however, upper and middle income city dwellers are

the most at-risk populations for chronic disease resulting from poor nutrition.


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