Scrimshaw N S
United Nations University, Harvard Center for Population Studies, Cambridge, MA 02138.
Annu Rev Public Health. 1990;11:53-68. doi: 10.1146/annurev.pu.11.050190.000413.
For many decades there has been adequate information for the elimination of acute dietary deficiency diseases. Scurvy, beri-beri, and pellagra, once serious scourges, are now seen only rarely. The severe forms of protein-energy malnutrition, kwashiorkor and marasmus, have also decreased greatly. Nonetheless, mild to moderate forms of protein-energy deficiency, exacerbated by infection, continue to impair growth and development in a majority of the low-income pre-school age populations of most developing countries. Deficiencies of iron, iodine, and vitamin A are still widespread in developing countries. Fortunately, the success of the WHO/UNICEF "Child Survival and Development Revolution" in persuading most developing countries to introduce expanded programs of immunization, growth monitoring, and appropriate feeding of young children, control of diarrheal disease, and specific campaigns against avitaminosis A, iodine deficiency disorders, and the functional consequences of iron deficiency, will accelerate the decline of acute deficiency diseases in the developing world. Diets are changing among the more affluent in these countries, however, and it is time for them to stress dietary goals for the health of rich and poor alike. For the first time there is enough information regarding dietary risk factors for chronic disease to provide an opportunity in the 1990s to accelerate the dietary changes that have already brought significant health benefits to some populations in North America and Europe. The changes, which include a lower dietary intake of fat, particularly saturated fat, less salt, and more green and yellow vegetable and whole grain cereals, can be expected to influence favorably morbidity from cardiovascular diseases and some kinds of cancer. For maximum benefit, these measures need to be combined with the avoidance of obesity, reasonable physical activity, abstention from, or moderate use of, alcohol, and avoidance of tobacco in any form. Since there is already considerable momentum toward these changes in North America and some European countries, the 1990s are likely to see substantial further progress in the reduction of chronic diseases known to be influenced by diet.
几十年来，已有足够的信息用于消除急性饮食缺乏病。坏血病、脚气病和糙皮病，曾经是严重的灾祸，如今已很少见。严重形式的蛋白质 - 能量营养不良，如夸希奥科病和消瘦症，也大幅减少。尽管如此，轻度至中度的蛋白质 - 能量缺乏在大多数发展中国家低收入学龄前儿童中依然普遍，感染会使其加剧，继续影响生长发育。缺铁、缺碘和维生素A缺乏在发展中国家仍很普遍。幸运的是，世界卫生组织/联合国儿童基金会的“儿童生存与发展革命”成功说服大多数发展中国家推行扩大免疫规划、生长监测、幼儿合理喂养、控制腹泻病以及针对维生素A缺乏症、碘缺乏症和缺铁功能性后果的专项运动，这将加速发展中世界急性缺乏病的减少。然而，这些国家较富裕人群的饮食正在发生变化，现在是时候强调惠及贫富人群健康的饮食目标了。首次有了足够多关于慢性病饮食风险因素的信息，这为20世纪90年代加速饮食变化提供了契机，这些变化已给北美和欧洲的一些人群带来了显著的健康益处。这些变化包括减少脂肪尤其是饱和脂肪的摄入量、少盐，增加绿色和黄色蔬菜以及全谷物谷物的摄入，预计将对心血管疾病和某些癌症的发病率产生有利影响。为了获得最大益处，这些措施需要与避免肥胖、合理的体育活动、戒酒或适度饮酒以及避免任何形式的烟草使用相结合。由于北美和一些欧洲国家在这些变化方面已经有了相当大的势头，20世纪90年代在减少已知受饮食影响的慢性病方面可能会取得更大进展。
