School Name

Food and Nutrition: A Case Study

Students Name Student Number Course Number

Professors Name
Due Date

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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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Table of Contents

Abstract Table of Contents List of Figures List of Tables I. Introduction to the Project A. Introduction B. Background C. Problem Statement D. Professional Significance E. Overview of Methodology F. Limitations of the Study H. Definition of Terms I. Conclusion II. Review of Literature A. Introduction B. Diet, Nutrition and the Prevention of Chronic Disease: WHO C. Functional Foods: Institute of Food Technology D. Bioactive Compounds in Foods: American Journal of Medicine E. The China Study F. Conclusion III. Methodology A. Introduction B. Research Questions C. Research Perspective D. Research Method a. Interviews b. Document Analysis c. Data Analysis d. Plausibility IV. Results of the Study A. Introduction B. Select Global Trends in Food and Nutrition C. Case I: China a. Brief Country Context b. Nutrition and Health Trends c. Interviews D. Case II: Peru a. Brief Country Context b. Nutrition and Health Trends c. Interviews E. Case III: Tanzania a. Brief Country Context b. Nutrition and Health Trends

ii iii v vi 1 1 2 2 3 4 4 5 6 6 7 8 9 10 12 12 12 13 14 15 15 16 17 17 20 20 20 22 23 23 23 26 28 28 28

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c. Interviews V. Summary and Discussion A. Chapter Aims B. Introduction C. Restatement of the Problem D. Explanation of the Project E. Review of Methodology F. Summary of Results a. Sub-question 1 b. Sub-question 2 c. Sub-question 3 G. Relationship of Research to the Field H. Discussion: Significance of Findings I. Conclusion VI. References

31 33 33 34 35 35 36 36 36 37 38 39 40 41

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List of Figures Number Page

Figure 1: Figure 2:

Daily fat intake per gram per capita per day. Child anthropometry in Tanzania.

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List of Tables

Number

Page

Table 1: Table 2: Table 3:

Fat intake recommendations Chinese fat consumption per gram per day per capita Peruvian, Argentinian, Brazilian, and Chilean fat consumption per gram per day per capita

18 21 24

Table 4: Table 5:

Comparative GDP for select South American Countries Tanzanian fat consumption per gram per day per capita

25 30

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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 of research on this topic, yet a much of the research is contradictory. Moreover, there is a lack of 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 Nutrients necessary elements contained within food that impact our bodies in a variety of ways, contributing to overall functionality, operability and health. Carbohydrates Macronutrient characterized as being the element which provides us with energy; sugars, breads, fruits, vegetables, etc. Fat Macronutrient necessary for health. Both healthy and non-healthy fats exist and overconsumption of fats can lead to weight gain and poor health. Protein Macronutrient 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.

NUTRITION AND DISEASE: A CASE STUDY

Chronic Illness Any 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.

Vegetarian one who does not ingest flesh of animals but may consume dairy products, eggs, etc.

Vegan one who does not ingest any product associated with animals including meat, dairy, eggs, animal fats and oils and so on.

Processed Foods Food that has been altered by man. GMO Genetically 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 are having 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 macronutrients, 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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What Campbell had revealed was his ability to turn on and off cancer initiation simply by the amount of animal protein delivered to his test subjects (Campbell, 2005). In addition, the China Study finds its name based on the immense study undertaken which followed the dietary habits of millions of people residing in China (Campbell, 2005). The study carefully examined, disease statistics, mortality rates, dietary habits, economic conditions and a host of other factors the Chinese population had experienced during the almost 30 year study (Campbell, 2005). Correlations made based on the information from this study indicated a significant relationship between diet and disease, namely the types of diseases experienced in the consumption of various diets (Campbell, 2005). Campbell reveals that those residing in rural parts of China with little access to animal protein and diets consisting mostly of plant based foods displayed the least amount of diseases such as cancer, heart disease, diabetes, high blood pressure etc (Campbell, 2005). The rural conditions instead produced higher instances of bacterial, viral and sanitary related diseases (Campbell, 2005). On the other hand, more prominent areas marked by higher consumption of meat and animal products experienced high levels of cancer, heart disease and what Campbell called diseases of affluence because of their relationship with income levels and social status (Campbell, 2005). In conclusion, what Campbell has discovered is the undeniable relationship between dietary components and the development of disease conditions. Conclusion Based on the various but limited sources thus far analyzed, it can be determined that the human conditions of either health or disease are highly related with nutrition and the various nutritional components one consumes in their lifetime. Overwhelming evidence has so far pointed to a consensus maintaining the overall benefit of consuming diets high in plant based foods. On the other hand, there is a significant risk associated with diets high in fat, animal products and processed

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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 factors 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 document from 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 subcategories; 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 1962 1994 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-fromhome 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 Children ages 2 to 3 Children and adolescents ages 4 to 18 Adults, ages 19 and older Total Fat Limits 30% to 40% of total calories 25% to 35% of total calories 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's most populous country, with a population of over 1.35 billion. Covering approximately 9.6 million square kilometers, it is the world's second-largest country by land area (Listofcountriesoftheworld.com). Chinas economic reformswhich began in earnest in 1978 transformed the republics economy into the world's fastest-growing. As of 2013, it is the world's second-largest economy by both nominal total GDP and purchasing power parity (PPP), and is also the world's largest exporter and importer of goods (White, 2013). Nutrition and health trends Zhai, et al (2009) in an exhaustive study based on massive longitudinal datasets found:

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China is undergoing a remarkable, but undesirable, rapid transition towards a stage of nutrition transition characterized by high rates of diet-related non-communicable diseases in a very short time. It is facing simultaneous challenges of under- and overnutrition. On the one hand, the government's efforts in the past decades to reduce under-nutrition have been very successful and the prevalence of stunted and underweight children has decreased significantly. On the other hand, the prevalence of overweight and obesity and the morbidity associated with non-communicable diseases have 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 Fat Consumption (g/person/day) 1990-92 58

Dietary Fat Consumption (g/person/day) 1995-97 72

Dietary Fat Consumption (g/person/day) 2000-02 82

Dietary Fat Consumption (g/person/day) 2005-07 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 c onsumption 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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Shangai, Tianjin and especially Beijing, overweight and correlated diseases are becoming a public health problem. In fact, in Beijing almost half of the adult population is overweight. The physician went on to emphasize the following: We are hearing a lot in the Western media about fat people in China, that we are starting to look like Americans with pot-bellies. But people should know that we have made improvements in nutrition. We have increased the availability of potable water, better food distribution system throughout the country, lowered morbidity and improved of health facilities.

Case II: Peru Brief Country Context Slightly smaller than the state of Alaska, Peru ranks 20th in total land area compared with other nations of the world. Perus population of 30,135,875 ranks 40th globally and 4th in South America (worldpopulationreview.com/). Its colonial history makes Peru a very ethnically diverse nation. Seventy-seven percent of the population resides in urban areas (Central Intelligence Agency, 2013). Economically, the World Bank classifies Peru as an upper middle-class nation (The World Bank, 2013). Health and nutrition trends Poterico, et al (2012) found that obesity poses a considerable health burden in Peru, where its prevalence has grown from 9.4% in 1996 (22), to 14.1 % in 2008. Given this fact, the Peruvian government has embarked upon a nutrition transition. Before 2011, there were no concerted efforts by the Peruvian government to educate the population on obesity or to prevent its prevalence. In fact, the Ministry of Health had focused its resources mainly on surveillance and control of infectious diseases and had not developed the health infrastructure needed to deal with the increase in obesity and associated chronic diseases. (Chaparro and Estrada, 2013)

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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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Table 3. Peruvian, Argentinian, Brazilian, and Chilean fat consumption per gram per day per capita Dietary Fat Consumption (g/person/day) 1990-92 43 106 80 67 Dietary Fat Consumption (g/person/day) 1995-97 47 113 83 79 Dietary Fat Consumption (g/person/day) 2000-02 45 115 100 84 Dietary Fat Consumption (g/person/day) 2005-07 41 118 105 90

Peru Argentina Brazil Chile

Source: chartsbin.com

Unlike China, Peru has not experienced an influx of fast food chains. Moreover, Peru is significantly poorer than China and its neighboring nations. In addition to the findings of Poterico, et al (2012) (reported above) that obesity is a concern in Peru, that research also found a correlation between socio-economic status and obesity: The higher the socioeconomic status, the higher the obesity rate. This may explain why Perus daily fat consumption trends differently than its South American neighbors. Table 4 shows a 2013 gross domestic product (GDP) comparison data from the World Bank.

Table 4. Comparative GDP for select South American Countries

Rank World Rank 1 7 2 28 5 6 43 50

Country 2,090,314 Brazil Argentina 369,992

Chile Peru

GDP (millions of US$)

203,299 153,802

Source: The World Bank

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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 consumption and 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 developing nationsmisinformation, 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-communicable diseases, 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 dive rse 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 li ves 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 the increased burden on the health care system, and indirect costs of lost productivity. As overweight and obesity increase, the Latin America is poised to lose $8 billion dollars to chronic 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 to AIDS; 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 nutritio n 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 Fat Consumption (g/person/day) 1990-92 32 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 Westernstyle food chains or significant imports of processed, high-fat foods. Dietary Fat Consumption (g/person/day) 1995-97 29 Dietary Fat Consumption (g/person/day) 2000-02 31 Dietary Fat Consumption (g/person/day) 2005-07 34

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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 on a 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, our national security is not weapons or soldiers but food. Long ago we developed a definition of food security. Allow me to share it with you. Food security is defined by the availability and accessibility of food at all times to all people especially children and other groups which are easily affected by lack of adequate food supply for example, 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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Summary and Discussion Chapter Aims Purposed to illustrate this projects contribution to the methodological and food and nutrition disciplines, this chapter includes: 1) a restatement of the problem and explanation of the project; 2) a review of the methodology; 3) a summary of results; 4) a discussion of how this project relates to research in the methodological and food and nutrition disciplines; 5) a description of the projects significance and its contribution to the disciplines; and 6) the conclusion. Preceding these sections is the introduction below. Introduction The topic for this Capstone project is to determine and analyze the relationship between nutrition and disease. The composition of the ideal human diet is the subject of considerable

controversy. Moreover, the topic is gaining relevancy in todays society as Westernized cultures characterized by large percentages of upper and middle class individuals who experience chronic illness and diseases relative to nutrition (WHO, 2003). The impact of processed foods and foods that are altered through human intervention may impact a persons susceptibility to chronic illness and poor health. Thus the intention of this research was to examine the casual relationship between diet and the presence of disease. Myriad studies exist on this topic but information conflicts. For example, a World Health Organization (WHO) study found that diet and nutrition are not the sole factors contributing chronic illness and disease; a multitude of variables interact with one another producing either health or illness (WHO, 2003). Another study conducted by Campbell (2005) followed the dietary habits of millions of people residing in China. The research explored the relationship between macro-nutrients, carbohydrates, fats and protein and human health. He found specifically that animal protein consumed in excessive

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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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indexing categories and sub-categories, advanced searching capabilities, indexing systems, and tools for developing novel indexing categories from existing ones. Summary of Results This section reports results of the study. The framework for the discussion is the sub-questions. Sub question 1: Does an individuals intake of specific nutrient combinations significantly impact an individuals health? It is clear that the intake of specific nutrient combinations, specifically the overconsumption of fats and proteins negatively and significantly impacts an individuals health. Overwhelmingly, participants voiced concerns about fat consumption. They were particularly alarmed by the degree to which fat consumption has outpaced protein consumption. Moreover, data from two of the study countries suggest that the spike in processed food consumption has dramatically impacted populations, especially young people. In one city, for example, obesity among children jumped 24 percent in a decade. The data also show that processed foods in the form of fast foods have had an obvious negative impact on human health. This study also unintentionally revealed that the negative impacts of nutrient-deficient, high fat food intake on an individuals health is uncontroversial to the extent that the costs of treating chronic illness is rising exponentially. In Latin America, for example, healthcare costs as a result of chronic disease caused by under-nutrition and obesity will cost $8 billion over the next decade.

Sub question 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? The primary finding related to this question is that the overconsumption of fats does not necessarily impact one racial or ethnic group per say. Instead, a major finding of this study is that a combination of regional, ethnic, cultural, income and agricultural production differences create the

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health impact. Urban areas in particular tend to suffer greater rates of obesity. Respondents indicated that the urban areas were more likely to be populated by middle- and upper-income residents. Also, the availability of Western-influenced, processed, and fast foods was considerably higher in cities. One physician stated, The more money people have, the more they eat.

There was one exception to this general rule: The Amerindian people of Peru who suffer from obesity as a result of overconsumption of fat suffer from higher rates of diabetes, cardiovascular disease and other chronic, life-threatening illnesses.

The finding pursuant to this question is that geography and economics play a much more significant role in negatively impacting and individuals health than ethnicity, relative to the overconsumption of fats.

Sub question 3: How significant is impact of nutrition on chronic illness. All of the physicians interviewed for this study were unfaltering in their conviction that nutrition was a significant factor in the manifestation of chronic illness. The respondents also indicated that a sedentary lifestyle and the aging population are concomitant risk factors for non-communicable diseases. Poor nutrition (mal- or under-nutrition or overconsumption of fats) poses an increasing challenge to public health. And beyond the finding that fat intake is a major cause of obesity; hypertension, diabetes, and gallbladder disease. Two physicians specifically suggested that greater dietary fat intake correlates to higher mortality due to various cancers. This confirms Campbells (2005) findings that intake levels directly correlate to cancer.

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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 protein fat 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 or partaking in a high-fat, high carbohydrate diet, the heart does not grow correspondingly larger; it simply must work harder. So the more weight one gains, the more strain on the 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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