Poverty, malnutrition, underdevelopment and cardiovascular disease: a South African perspective

SUMMARY: This article explores possible mechanisms to explain the known relationships between poverty, undernutrition, underdevelopment and cardiovascular disease (CVD) in developing countries. Poverty is a multidimensional concept. It is both a cause and consequence of undernutrition. The article shows how malnutrition during pregnancy could lead to low birth-weight babies, who are not only at increased risk of mental and physical underdevelopment, but also ‘programmed’ to be at increased risk of CVD and other noncommunicable diseases in adult life. The underdevelopment leads to decreased ‘human capital and competence’ with an inability to create food security and an enabling environment for self and family to escape poverty and undernutrition in the next generation. It is accepted that a lack of education and knowledge in the poor for primary prevention of CVD through healthy eating patterns and lifestyles, as well as limited access to healthcare services for secondary prevention and treatment contribute to CVD. This article postulates that the link between poverty and CVD in South Africa can be explained by the high prevalence of undernutrition in one- to nine-year-old children (9% underweight, 23% stunted and 3% wasted), the high prevalence of overweight and obesity in adults (54.5% in white men and 58.5% in African women) as well as the negative trends in nutrient intakes when Africans (the population group with the largest numbers of poor people) urbanise, acculturate and adopt westernised eating patterns that will increase CVD risk. In conclusion, we plead for a holistic, integrated but transdisciplinary and multisectorial approach to break the vicious circle of poverty and undernutrition for the longterm prevention of CVD.