Nutrition transition in 2 lowland Bolivian subsistence populations

Abstract

Background Traditional diets are often credited for the robust cardiometabolic health of subsistence populations. Yet, rural subsistence populations are undergoing nutrition transitions that have been linked to the increase in chronic noncommunicable diseases. Few studies have presented detailed dietary estimates in transitioning populations. Objectives We aimed to 1) characterize and compare dietary profiles of 2 neighboring subsistence populations in Bolivia who vary in market integration and 2) identify dietary factors contributing to low cardiovascular disease risk. Design We used a mixed longitudinal design to estimate nutrient intake via 24-h recall and dietary questionnaires among 1299 Tsimane (aged 30–91 y) and 229 Moseten (aged 30–84 y) men and women. We constructed population-level estimates of energy intake, dietary diversity, and nutrient shortfalls and analyzed dietary changes over time and space using multilevel models. Last, we compared Tsimane and Moseten dietary profiles with those of Americans (NHANES). Results The Tsimane diet was characterized by high energy (2422–2736 kcal/d), carbohydrate (376–423 g/d), and protein (119–139 g/d) intakes; low fat intake (40–46 g/d); and low dietary diversity relative to the average US diet. Most calories (64%) were derived from complex carbohydrates. Total energy and carbohydrate intake increased significantly during the 5-y study, particularly in villages near market towns. Tsimane consumption of food additives (lard, oil, sugar, salt) increased significantly [sugar (15.8 g ⋅ person−1 ⋅ d−1) and oil (4.9 mL ⋅ person−1 ⋅ d−1)] between 2010 and 2015. The more-acculturated Moseten consumed substantially more sugar (by 343%) and oil (by 535%) than the Tsimane. Conclusions A high-energy diet rich in complex carbohydrates is associated with low cardiovascular disease risk when coupled with a physically active lifestyle. A transition away from a high-fiber and low-fat, low-salt, and low-processed-sugar diet is a salient health risk for transitioning populations. Evidence of a nutrition transition in Bolivia parallels trends of increasing body fat and body mass index, which suggests that a low prevalence of cardiovascular disease may not persist.

Longitudinal Changes in Measures of Body Fat and Diet Among Adult Tsimane’ Forager‐Horticulturalists of Bolivia, 2002‐2010

“…However, recent population growth, encroachment on land, reductions in game and fish, loss of traditional ecological knowledge, and growing opportunities for wage labor may provide impetus and means for greater reliance on market‐purchased refined grain products (e.g., flour, bread, pasta), sugar, cooking oil, and domesticated meat and eggs to supplement their traditionally labor‐intensive diets . A recent study reported that Tsimane’ intake of total calories, carbohydrates, sugar, and cooking oil rose significantly between 2010 and 2015 . This analysis did not, however, explore the degree to which increases in BMI, body fat percentage, or risk of overweight or obesity depended on specific dietary characteristics or changes.…”

“…Yet as shifts from traditional subsistence‐ to modern market‐based diets often co‐occur with reductions in physical activity, separating the effect of diet versus other lifestyle factors on weight gain is difficult. Few studies have quantified dietary changes among small‐scale subsistence‐oriented societies across time or examined which market‐based foods are most strongly associated with increased adiposity during economic and nutrition transitions. However, prospective research among small‐scale societies with variable consumption of market‐based foods provides a valuable addition to the mostly ecological and cross‐sectional studies among more economically developed populations that fuel unresolved debates about the role of fat versus sugar in the development of obesity .…”

“…Tsimane’ forager‐horticulturalists in Amazonian Bolivia still live a primarily subsistence‐based lifestyle , and their limited and variable access to commercial markets across households and communities creates a unique circumstance for exploring the role of distinct market foods in the promotion of weight gain and adiposity. Tsimane’ consume a relatively high‐carbohydrate, high‐fiber, high‐protein, low‐fat diet consisting predominantly of cultivated starchy crops (e.g., plantain, rice, manioc, maize) supplemented with lean game, freshwater fish, and occasional fruit and honey . However, recent population growth, encroachment on land, reductions in game and fish, loss of traditional ecological knowledge, and growing opportunities for wage labor may provide impetus and means for greater reliance on market‐purchased refined grain products (e.g., flour, bread, pasta), sugar, cooking oil, and domesticated meat and eggs to supplement their traditionally labor‐intensive diets .…”

“…Tsimane’ consume a relatively high‐carbohydrate, high‐fiber, high‐protein, low‐fat diet consisting predominantly of cultivated starchy crops (e.g., plantain, rice, manioc, maize) supplemented with lean game, freshwater fish, and occasional fruit and honey . However, recent population growth, encroachment on land, reductions in game and fish, loss of traditional ecological knowledge, and growing opportunities for wage labor may provide impetus and means for greater reliance on market‐purchased refined grain products (e.g., flour, bread, pasta), sugar, cooking oil, and domesticated meat and eggs to supplement their traditionally labor‐intensive diets . A recent study reported that Tsimane’ intake of total calories, carbohydrates, sugar, and cooking oil rose significantly between 2010 and 2015 .…”

Old friends and friendly fire: Pregnancy, hookworm infection, and anemia among tropical horticulturalists

“…The Tsimane are a population of~16 000 Amerindian forager-horticulturalists who inhabit over 90 villages in the Maniqui River basin in the Beni department of Amazonian Bolivia (Gurven et al, 2017). They fish, hunt, and engage in subsistence-level horticulture of plantains, rice, sweet manioc, and corn (Kraft et al, 2018). The Tsimane health environment differs from industrialized contexts by its high pathogen burden, including endemic hookworm, energetic limitations, and high fertility (Blackwell, Trumble, Suarez, Stieglitz, et al, 2016;Costa, Trumble, Kaplan, & Gurven, 2018).…”