**3. Contextualizing poverty as a proxy for food insecurity and compromised health**

Poverty is a multifaceted phenomenon that derives from the word poor— or the inability to meet basic human necessities [16]. Being a such phenomenon, poverty has various dimensions of human deprivation in terms of food consumption, health, education, dignity, security, decent employment, and voice [17].

**33**

*Poverty, Compromised Dietary Intake and Health Implications among South Africa's...*

As a concept, poverty includes the state of being vulnerable to adverse shocks. This implies that people who are poor, are burdened with having little to lack of resources such as goods, finances or means for their livelihood. In economic terms, poverty means that the income level from employment is so low that one's basic needs such as food security is highly compromised. Literature shows that poverty is increasingly recognized as a prime determinant of food insecurity. From this perspective, food poverty is the extent to which individuals live without basic resources such as money to acquire a stable supply of adequate food, and the ability to make appropriate decisions to live and maintain a lifestyle [18, 19]. Research on association between poverty related conditions such as food insecurity and mental health revealed that, individuals who are food secure are less likely to experience anxiety disorder than their food insecure counterparts [20]. Anxiety about the availability of food can affect one's social and/or mental well-being, by creating feelings of

As a concept, food insecurity is the state of being without reliable access to sufficient safe and nutritious food for consumption to enhance normal growth and to live an active and healthy life [22]. The phenomenon is one of the leading cause of chronic hunger in Sub-Saharan Africa. As highlighted in the foregoing, food insecurity may be caused an absence of any of the four fundamental element (availability; access; utilization; and stability) of food security which are—characterized by food inadequacy: to lack of resources to acquire food; utilization; improper use or consumption of food in the body; and unstable supply and consumption of nutritious food, respectively. As a complex process, food insecurity may occur in the form of, chronic or persistent food insecurity that manifests when a household or an individual is unable to meet basic food consumption requirements over a sustained period [16]. A report by the World Food Programme [23] shows that individuals who experience chronic food insecurity are unable to meet basic food necessities due to lack of sufficient economic power to acquire income, land or productive assets, or they experience high dependency ratios, acute sickness or social barriers. Such households or individuals are constantly at risk of being unable to afford or acquire adequate nutrition food over a sustained period [12, 13]. It is reasoned that chronic food insecurity could be sustainably overcome with deliberate measures used to address abject poverty and enhanced development such as education, employment, or access to productive or financial resources in the form of credits or loans. Furthermore, households affected by chronic food insecurity need more direct access to adequate food supply to enable them raise their productive capacity [22]. The importance of analyzing the notion of food security and insecurity is that it helps in fostering improved food security responses both at macro and micro levels in addition to influencing emergency interventions such as food aid programmes

and projects, and action-oriented food security policies.

**4. Malnutrition versus overnutrition: dietary intake**

Malnutrition is a public health concern that is occasioned by deficiencies, excess or imbalances in macro and/or micronutrients in humans [22]. These deficiencies could result from chronic food insecurity, hunger, and poverty [13]. Other nonfood factors that influence malnutrition are inadequate care practices, lack of health services, unhealthy environment, and ignorance. This implies that malnourished people in resource-poor communities, are at high risk of suffering from deficiencies of micronutrients caused by poverty and hunger. Hunger simply means food deprivation. Within this context, hunger and malnutrition are not only a threat to public health but are also among the leading cause of death in the middle and low

*DOI: http://dx.doi.org/10.5772/intechopen.96520*

depression and irritability [21].

*Poverty, Compromised Dietary Intake and Health Implications among South Africa's... DOI: http://dx.doi.org/10.5772/intechopen.96520*

As a concept, poverty includes the state of being vulnerable to adverse shocks. This implies that people who are poor, are burdened with having little to lack of resources such as goods, finances or means for their livelihood. In economic terms, poverty means that the income level from employment is so low that one's basic needs such as food security is highly compromised. Literature shows that poverty is increasingly recognized as a prime determinant of food insecurity. From this perspective, food poverty is the extent to which individuals live without basic resources such as money to acquire a stable supply of adequate food, and the ability to make appropriate decisions to live and maintain a lifestyle [18, 19]. Research on association between poverty related conditions such as food insecurity and mental health revealed that, individuals who are food secure are less likely to experience anxiety disorder than their food insecure counterparts [20]. Anxiety about the availability of food can affect one's social and/or mental well-being, by creating feelings of depression and irritability [21].

As a concept, food insecurity is the state of being without reliable access to sufficient safe and nutritious food for consumption to enhance normal growth and to live an active and healthy life [22]. The phenomenon is one of the leading cause of chronic hunger in Sub-Saharan Africa. As highlighted in the foregoing, food insecurity may be caused an absence of any of the four fundamental element (availability; access; utilization; and stability) of food security which are—characterized by food inadequacy: to lack of resources to acquire food; utilization; improper use or consumption of food in the body; and unstable supply and consumption of nutritious food, respectively. As a complex process, food insecurity may occur in the form of, chronic or persistent food insecurity that manifests when a household or an individual is unable to meet basic food consumption requirements over a sustained period [16]. A report by the World Food Programme [23] shows that individuals who experience chronic food insecurity are unable to meet basic food necessities due to lack of sufficient economic power to acquire income, land or productive assets, or they experience high dependency ratios, acute sickness or social barriers. Such households or individuals are constantly at risk of being unable to afford or acquire adequate nutrition food over a sustained period [12, 13]. It is reasoned that chronic food insecurity could be sustainably overcome with deliberate measures used to address abject poverty and enhanced development such as education, employment, or access to productive or financial resources in the form of credits or loans. Furthermore, households affected by chronic food insecurity need more direct access to adequate food supply to enable them raise their productive capacity [22]. The importance of analyzing the notion of food security and insecurity is that it helps in fostering improved food security responses both at macro and micro levels in addition to influencing emergency interventions such as food aid programmes and projects, and action-oriented food security policies.

### **4. Malnutrition versus overnutrition: dietary intake**

Malnutrition is a public health concern that is occasioned by deficiencies, excess or imbalances in macro and/or micronutrients in humans [22]. These deficiencies could result from chronic food insecurity, hunger, and poverty [13]. Other nonfood factors that influence malnutrition are inadequate care practices, lack of health services, unhealthy environment, and ignorance. This implies that malnourished people in resource-poor communities, are at high risk of suffering from deficiencies of micronutrients caused by poverty and hunger. Hunger simply means food deprivation. Within this context, hunger and malnutrition are not only a threat to public health but are also among the leading cause of death in the middle and low

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

national, community, and household or individual level.

the challenge of being unhealthy.

nourished.

as a condition that exists at different levels of society including international,

Therefore, food security includes factors such as availability, accessibility, utilization and stability. Within the context, availability refers to the quantity of food commodities that result from mass food production that is sufficient enough to feed the entire human population; food accessibility happens when all people have access to sufficient food or an individual's economic power to access or acquire sufficient food for consumption. This implies that high food prices can negatively affect food access. Furthermore, food, utilization refers to an individual's means to acquire safe-nutritious food that meets their basic nutritional needs. Under this notion, nutritious food and food safety includes one's food preference, its conservation and preparations, and "nutrient absorptions in the human body" [2]. Food utilization also refers to the process by which a human body detects the nutrients or calories stemming from macronutrients and micronutrients, feeding practices, and food preparations. This concept is critical to the current discourse as it unveils the importance of dietary intake as one of the key factors to a healthy lifestyle. It could be reasoned that, individuals with compromised-dietary intake are likely to meet

Among conditions that are associated with compromised-dietary intake are cardiovascular diseases such as heart failure, stroke, heart attack, cardiac arrest, obesity, and other non-communicable diseases such as malnutrition and iron deficiency anemia. An individual's nutritional status is determined by biological absorption of the food consumed [12, 13]. In this regard, the basic nutritional knowledge and good dietary habits, clean and safe water, sanitation, and health care should be considered when ensuring food security. Likewise, the food utilization aspect authenticates that nutrition is directly associated with food security and as such, there is food insecurity when the human population is not adequately

Food stability is another fundamental element when analyzing the notion of food security [12, 14]. From this perspective, an individual is food secure provided that there is stability in the other three elements of food security (availability, accessibility and utilization of the food) over time. Within this context, food security can neither be limited to a particular moment such as, a month or a year but that it should be sustainable. In other words, where there is lack of food stability, transitory or chronic food insecurity occurs. Thenceforth, if a household has adequate and nutritious food intake today, they are regarded food insecure whenever they lack a sustainable food supply because, their health or nutritional status risk being compromised by inadequate food consumption. In cases where there is credit crisis that influence food prices, food security at all levels (international, national community or household) may be difficult to achieve. For instance, the sharp rise in global food crisis in post 2000, resulted in accelerating food prices, anxiety and food riots in some parts of the world [15]. Furthermore, unfavorable weather conditions such as floods and famine, economic factors, or political instability may

impact negatively on household or individual food security status.

**3. Contextualizing poverty as a proxy for food insecurity and** 

Poverty is a multifaceted phenomenon that derives from the word poor— or the inability to meet basic human necessities [16]. Being a such phenomenon, poverty has various dimensions of human deprivation in terms of food consumption, health, education, dignity, security, decent employment, and voice [17].

**32**

**compromised health**

income countries where the population is largely impoverished. On the other hand, nutrition refers to the quality and the quantity of food consumed for a healthy living. A healthy diet consists of four basic nutrients which are, proteins, carbohydrates, minerals and vitamins (meat, dairy, starch vegetable, and fruits). Other essential nutrients recommended for quality health lifestyle include fiber and lipids. Consequently, nutritional complications not only emerge from compromiseddietary intake but have adverse effects on human health resulting in death. On the other hand, when good eating habits are practiced, nutrition is one of the fundamental factors that enables people to stay healthy. Children especially those below the age of 10 have high nutritional requirements for their growth. However, in developing countries where poverty and food insecurity are high, undernutrition and lack of adequate dietary diversity is a major contributor to child mortality [24]. Research on *Maternal and child malnutrition in low-income and middle-income countries* [25] shows that in 2011, undernutrition contributed to 45% of child mortality in the low income and middle income countries.

It is also worth noting that dietary intake refers to the daily absorption or consumption of nutrients such as protein, carbohydrate, fats and vitamins and other food components such as fiber as recommended daily allowances for a healthy living. This also implies taking sufficient amount of calories (units of energy) from the food that is consumed. Hence, good dietary intake will mean that an individual should take at least a minimum required calories per day. Dietary measurements area also keys to assessing food, and nutrient intake of households or individuals. For example, the recent global report by the World Health Organization [26] echoed that healthy diet practices means calories intake should resonate with the energy expenditure. Conversely, to avoid unhealthy weight gain, total lipid should not exceed 30% of total energy intake; while consumption of saturated fat should not be more than 10% of total energy intake. Further, free sugars intake should be less than 10% of the total energy consumption [26]. Meanwhile, public health problems such as cardiovascular diseases have been on the rise. Most recent estimates by the World Health Organization [26] also shows that cardiovascular diseases mostly originate from compromised dietary intake and lack of physical activities and that, they are a primary cause of death globally. The WHO echoed that cardiovascular diseases claim about 31% or 17.9 million lives annually, and that the diseases are characterized by high levels of blood pressure, glucose, and lipids. Other symptoms include obesity and overweight and these result in some cancers, type-2 diabetes, stroke, heart attack, and cardiac arrest [26]. The problem of obesity and overweight is also on the rise in middle-income countries such as South Africa.

To enhance nutritional health, in 2003 South Africa launched its Food-Based Dietary (FBNGs), which it revised in 2013 using a multi sectorial approach comprising the National Department of Health- Directorate of Nutrition, the medical research council, Nutritional Society of South Africa, food producer organizations, academics and the United Nations organizations such as the FAO, as the national working group. The 2003 South African FBNGs had the following items (mostly local and affordable foods) to be consumed regularly by individuals who are ≥7 years as necessity for health eating which lowers the risk of noncommunicable diseases [27]:

**35**

items [27]:

• Be active!

• Enjoy a variety of foods.

• Make starchy foods part of most meals.

• Drink lots of clean, safe water.

• Use salt and food high in salt sparingly.

• Eat plenty of vegetables and fruit every day.

• Eat dry beans, split peas, lentils and soya regularly.

• Have milk, maas (sour milk) or yoghurt every day.

• Fish, chicken, lean meat or eggs can be eaten daily.

• Use fats sparingly. Choose vegetable oils, rather than hard fats.

• Use sugar and foods and drinks high in sugar sparingly.

*Poverty, Compromised Dietary Intake and Health Implications among South Africa's...*

Use foods and drinks containing sugar sparingly, and not between meals. The limitation in the first (2003) guide was that while it recommended the consumption of food groups it neither specified the items (such as highly processed foods, energy dense food, fat and salt) whose consumption should be limited nor provided the absolute values for the recommended daily allowance or calories. The implication is that the supposed evidence based guideline to comprehensive dietary patterns and healthy lifestyles overlooked the issue of overnutrition, an emerging public health concern in high income and middle income countries including South Africa [27]. Overnutrition is the overconsumption of any food or nutrients regardless of the food group (source) such that one's health is compromised. Overnutrition can result in obesity and overweight which in turn increases the risk of metabolic syndrome, noncommunicable diseases and/or cardiovascular diseases. Additionally, studies [27–31] conducted in South Africa and around the world have shown that overnutrition is among the leading cause of metabolic syndrome in children and adolescents (conditions such as increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) and that

it increases among others, the risk of heart disease and type-2 diabetes.

The 2012-reviewed revised general FBDGs for South Africans had the following

*DOI: http://dx.doi.org/10.5772/intechopen.96520*

• Drink lots of clean, safe water.

• If you drink alcohol, drink sensibly.

• Eat fats sparingly.

• Use salt sparingly.

• Chicken, fish, meat or eggs can be eaten daily.

• Eat plenty of vegetables and fruit every day.


*Poverty, Compromised Dietary Intake and Health Implications among South Africa's... DOI: http://dx.doi.org/10.5772/intechopen.96520*


*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

in the low income and middle income countries.

income countries where the population is largely impoverished. On the other hand, nutrition refers to the quality and the quantity of food consumed for a healthy living. A healthy diet consists of four basic nutrients which are, proteins, carbohydrates, minerals and vitamins (meat, dairy, starch vegetable, and fruits). Other essential nutrients recommended for quality health lifestyle include fiber and lipids. Consequently, nutritional complications not only emerge from compromiseddietary intake but have adverse effects on human health resulting in death. On the other hand, when good eating habits are practiced, nutrition is one of the fundamental factors that enables people to stay healthy. Children especially those below the age of 10 have high nutritional requirements for their growth. However, in developing countries where poverty and food insecurity are high, undernutrition and lack of adequate dietary diversity is a major contributor to child mortality [24]. Research on *Maternal and child malnutrition in low-income and middle-income countries* [25] shows that in 2011, undernutrition contributed to 45% of child mortality

It is also worth noting that dietary intake refers to the daily absorption or consumption of nutrients such as protein, carbohydrate, fats and vitamins and other food components such as fiber as recommended daily allowances for a healthy living. This also implies taking sufficient amount of calories (units of energy) from the food that is consumed. Hence, good dietary intake will mean that an individual should take at least a minimum required calories per day. Dietary measurements area also keys to assessing food, and nutrient intake of households or individuals. For example, the recent global report by the World Health Organization [26] echoed that healthy diet practices means calories intake should resonate with the energy expenditure. Conversely, to avoid unhealthy weight gain, total lipid should not exceed 30% of total energy intake; while consumption of saturated fat should not be more than 10% of total energy intake. Further, free sugars intake should be less than 10% of the total energy consumption [26]. Meanwhile, public health problems such as cardiovascular diseases have been on the rise. Most recent estimates by the World Health Organization [26] also shows that cardiovascular diseases mostly originate from compromised dietary intake and lack of physical activities and that, they are a primary cause of death globally. The WHO echoed that cardiovascular diseases claim about 31% or 17.9 million lives annually, and that the diseases are characterized by high levels of blood pressure, glucose, and lipids. Other symptoms include obesity and overweight and these result in some cancers, type-2 diabetes, stroke, heart attack, and cardiac arrest [26]. The problem of obesity and overweight

is also on the rise in middle-income countries such as South Africa.

To enhance nutritional health, in 2003 South Africa launched its Food-Based Dietary (FBNGs), which it revised in 2013 using a multi sectorial approach comprising the National Department of Health- Directorate of Nutrition, the medical research council, Nutritional Society of South Africa, food producer organizations, academics and the United Nations organizations such as the FAO, as the national working group. The 2003 South African FBNGs had the following items (mostly local and affordable foods) to be consumed regularly by individuals who are ≥7 years as necessity for health eating which lowers the risk of noncommunicable diseases [27]:

**34**

• Enjoy a variety of foods.

• Make starchy foods the basis of most meals.

• Eat dry beans, peas, lentils and soy regularly.

• Be active.


Use foods and drinks containing sugar sparingly, and not between meals. The limitation in the first (2003) guide was that while it recommended the consumption of food groups it neither specified the items (such as highly processed foods, energy dense food, fat and salt) whose consumption should be limited nor provided the absolute values for the recommended daily allowance or calories. The implication is that the supposed evidence based guideline to comprehensive dietary patterns and healthy lifestyles overlooked the issue of overnutrition, an emerging public health concern in high income and middle income countries including South Africa [27].

Overnutrition is the overconsumption of any food or nutrients regardless of the food group (source) such that one's health is compromised. Overnutrition can result in obesity and overweight which in turn increases the risk of metabolic syndrome, noncommunicable diseases and/or cardiovascular diseases. Additionally, studies [27–31] conducted in South Africa and around the world have shown that overnutrition is among the leading cause of metabolic syndrome in children and adolescents (conditions such as increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) and that it increases among others, the risk of heart disease and type-2 diabetes.

The 2012-reviewed revised general FBDGs for South Africans had the following items [27]:

