Doctoral Dissertation Research: Levels and Social Determinants of Nutritional Outcomes

Brown University, Providence RI

Investigators

Abstract

SES-1539804 Michael White Vaidya Yashas Brown University Shifts 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).