Doctoral Dissertation Research: Levels and Social Determinants of Nutritional Outcomes

SES-1539804 Michael WhiteVaidya Yashas Brown University饮食、体力活动和营养结果的转变正在世界各地发生，并在不同的极端产生不良的营养结果。也就是说，营养不良和肥胖可能在特定的社会中共存。这篇论文的研究将收集身体测量和生物标志物数据，以调查营养光谱极端的结果是否共存，以及在哪些分析单位。具体地说，调查员将在更精细的空间尺度上研究营养和健康结果及其原因，并将这些个人结果与有助于健康的家庭和背景因素联系起来。该项目利用了20世纪90年代中期的现有纵向数据，以及跟踪人口和社会变化的持续实地调查。这个项目还将着眼于早年生活和其他对健康的影响。因此，将对前瞻性和回溯性数据进行分析，以确定可能影响当前营养结果的早期生活因素。关于营养转型的文献侧重于国家或区域一级的趋势。营养不足和营养过剩的双重负担是这一营养转型的一个特征。中低收入国家目前也正在经历空间和城市转型、粮食生产的变化、全球化和日益加剧的社会不平等，这些被认为是营养结果发生变化和与饮食有关的非传染性疾病增加的原因。这种转变的社会根源，而不一定是经济根源，使得营养过剩和相关的慢性非传染性疾病的“流行病”从高收入国家蔓延到通常被归类为发展中国家的国家。对于这种社会转型，公共卫生的解释往往是一种线性理论。这个项目采用了社会学的观点，它认识到推动这些转变的社会过程是不均匀的。它更关注社区和家庭内部的微观过程，这些过程可能会导致不同的后果，如极端的营养结果，现在被称为双重负担。这种双重负担现象使得营养不足和营养过剩可能代表着贫困的不同方面。早年营养不良的普遍程度很高且持续存在，但这并不能否定晚年出现营养过剩问题的可能性。正在研究的南亚地区的非传染性疾病相关负担上升的速度超过了全球的速度。本项目审查的双重营养状况负担对国家医疗保健政策、国际援助目标等有潜在影响。因此，这种双重负担的发现和决定因素是个人和社区共同关心的问题。这项研究建立在与尼泊尔现有研究网站--奇特万山谷家庭研究(CVFS)合作的基础上。

SES-1539804Michael WhiteVaidya Yashas Brown UniversityShifts in diets, physical activity and nutritional outcomes are taking place across the world and are producing poor nutritional outcomes at different extremes. That is, malnutrition and obesity might co-exist within a particular society. This dissertation research will collect body measurements and biomarker data to investigate whether outcomes on the extremes of nutritional spectrum co-exist together and at what units of analysis. Specifically, the investigator will study nutritional and health outcomes and their causes at finer spatial scales and link these individual outcomes to household and background factors that contribute to health. The project takes advantage of existing longitudinal data from the mid-1990s, and ongoing fieldwork that tracks demographic and social changes. This project will also looks at early-life and other influences on health. Thus, prospective and retrospective data will be analyzed to determine early-life factors that might affect current nutritional outcomes. The literature on the nutrition transition has focused on trends at the country or region-level. The dual burden of undernutrition and over nutrition is one feature of this nutritional transition. Lower and Middle Income (LMICs) countries are now also experiencing spatial and urban transformations, changes in food production, globalization and increasing social inequalities that are pinpointed as factors responsible for shifts in nutritional outcomes and towards increased diet-related Non-communicable Diseases (NCDs). The social, and not necessarily economic, roots of this shift has allowed "epidemics" of over nutrition and related chronic NCDs to extend beyond high-income countries to those usually classified as developing countries. The public-health- interpretation often presents a linear theory of this societal transformation. This project takes a sociologically informed view, which recognizes that the social processes driving these shifts are unevenly distributed. It focuses more on the micro processes within the community and household that might result in heterogeneous consequences like extreme nutritional outcomes, now referred to as the dual burden. This dual burden phenomenon allows a possibility where undernutrition and over nutrition might represent different facets of deprivation. The high and continued prevalence of undernutrition at early ages does not negate the possibility of later-life problems of over nutrition. The related burden of NCDs for South Asia, the region being studied, has risen at a rate exceeding global rates. The dual nutritional status burden examined in this project has a potential impact on national healthcare policy, international aid objectives and more. Thus, the detection and determinants of such a dual burden is a concern for both individuals and communities. The study builds on collaboration with an existing research site in Nepal, the Chitwan Valley Family Study (CVFS).