Doctoral Dissertation Research: Levels and Social Determinants of Nutritional Outcomes

SES-1539804迈克尔·怀特·瓦伊迪亚·亚沙斯·布朗大学饮食、体育活动和营养结果的变化正在世界各地发生，并在不同的极端情况下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社会中共存。本论文的研究将收集身体测量和生物标志物数据，以调查营养谱的极端结果是否共存，以及在什么单位的分析。 具体而言，研究人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，并将这些个体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1990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工作。该项目还将研究早期生活和其他对健康的影响。因此，将分析前瞻性和回顾性数据，以确定可能影响当前营养结果的早期因素。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种营养转型的一个特点。中低收入国家现在也正在经历空间和城市转型、粮食生产变化、全球化和社会不平等加剧，这些都被认为是造成营养结果变化和与饮食有关的非传染性疾病增加的因素。这一转变的社会根源，而不一定是经济根源，使营养过剩和相关慢性非传染性疾病的“流行病”从高收入国家蔓延到通常被列为发展中国家的国家。公共卫生的解释往往提出了这种社会转型的线性理论。该项目采取了社会学的观点，认识到推动这些变化的社会进程分布不均。它更侧重于社区和家庭内部的微观过程，这些过程可能导致极端营养结果等异质性后果，现在被称为双重负担。这一双重负担现象使人们有可能认为，营养不足和营养过剩可能是贫困的不同方面。幼年营养不良的高比例和持续存在并不排除日后出现营养过剩问题的可能性。研究中的南亚区域的非传染性疾病相关负担的增长速度超过了全球增长速度。本项目中研究的双重营养状况负担对国家卫生保健政策、国际援助目标等具有潜在影响。因此，这种双重负担的发现和决定因素是个人和社区都关切的问题。 这项研究建立在与尼泊尔现有研究网站奇旺谷家庭研究（CVFS）的合作基础上。

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).