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8/13/2019 Sample Master's Capstone Project
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Students Name
Student Number
Course Number
Professors Name
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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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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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NUTRITION AND DISEASE: A CASE STUDY 2
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 AND DISEASE: A CASE STUDY 3
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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NUTRITION AND DISEASE: A CASE STUDY 4
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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NUTRITION AND DISEASE: A CASE STUDY 20
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_population8/13/2019 Sample Master's Capstone Project
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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
Dietary FatConsumption(g/person/day) -2000-02
Dietary FatConsumption(g/person/day) -2005-07
58 72 82 90
Source: chartsbin.com
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.
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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
Dietary FatConsumption(g/person/day) -1995-97
Dietary FatConsumption(g/person/day) -2000-02
Dietary FatConsumption(g/person/day) -2005-07
32 29 31 34
Source: chartsbin.com
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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