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Human Biochemistry Research Unit
National Health Laboratory Service
School of Pathology
University of the Witwatersrand
Johannesburg
South Africa
E-mail: alexander.walker{at}nhls.ac.za
Dear Sir:
The editorial by Jenkins et al (1), "Too much sugar, too much carbohydrate, or just too much?," comments on the study by Gross et al (2), in which the adverse effects of the high consumption of refined-carbohydrate foods on the incidence of diabetes were examined. Jenkins et al considered that the seriousness of the present situation should evoke "a wake-up call for radical lifestyle reassessment." The crucial question concerning this issue is who is listening, let alone acting, with regard to the application of recommended health-improvement measures? A recent editorial in the Lancet, "The catastrophic failures of public health," stressed that "people are getting fatter and less physically active, and are therefore more prone to killer chronic illnesses such as cardiovascular disease, stroke, cancer, and diabetes" (3).
Understandably, attempts to secure health improvements should begin with the young. In this respect, and revealing the magnitude of the task, a recent School Nutrition Dietary Assessment Study in the United States examined the prevailing desirable dietary recommendations, which includes advice to reduce the average meat serving from 2 to 1.5 ounces (43 g); to eliminate milk-based desserts and high-fat meats, cheeses, nuts, nut butters, and desserts; and to reduce sharply the amount of fat added during food preparation. Disappointingly, it was found that only 1% of school lunches complied with these recommendations (4).
It is almost inevitable that changes in epidemiologic ill-health situations will continue. However, it must be appreciated that there will always be subpopulations who are more favored healthwise because of their particular daily habits and practices. For example, it is reported that vegetarians have a lower mortality rate from ischemic heart disease, cerebral vascular disease, and all causes combined than do nonvegetarians (5).
Major epidemiologic changes of this nature are also occurring in developing populations. In recent decades, urban blacks have experienced slow but steady adverse changes in their patterns of noncommunicable diseases concomitant with elevations in socioeconomic status. In South Africa, it was recently reported that the prevalence of diabetes has reached a level far higher in the black than in the white population, namely 5.2% compared with 2.3% (6). Obesity is particularly high among urban black women in South Africa; 44% of this population in Cape Town is obese (7). As for the situation in other developing populations, who are becoming increasingly more Westernized, it is noteworthy that changes in diet, coupled with increasingly inactive lifestyles, have led to major epidemics of obesity in several Asian countries (8). According to the World Health Organization, cardiovascular disease will be the most common cause of death in developing populations by the year 2020 (9).
On the one hand, the health situations and outlooks described in both developed and urban developing populations are consistent with rising life expectancies. For example, women in Japan—followed closely by their French and Swiss peers—now have a 1 in 20 chance of living to the age of 100 y (10). Yet, on the other hand, far fewer improvements have been occurring in "healthy life expectancies" (11).
ACKNOWLEDGMENTS
Neither author had a conflict of interest to disclose.
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