A reconsideration of Andean nutrition

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A reconsideration of Andean nutrition
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A RECONSIDERATION OF ANDEAN NUTRITION












A paper prepared for presentation at
the Annual Meetings of the
American Anthropological Association
November, 1979

by

Winifred L. Mitchell
Michigan State University












The Aymara Indians of the Peruvian altiplano are frequently described

as undernourished, as are other indigenous highland populations. Peruvian

government officials, U. S. medical teams, and other observers routinely

assume an inadequate altiplano diet to be the root of various health

problems. Hall, for example, states,

Inadequate nutrition contributes to the high mortality caused
by infectious disease. Estimates made by the [Peruvian] National
Institute of Nutrition suggest that almost one-third of the rural
coastal and two thirds of the rural sierra residents consume less
than 75 percent of the calories and proteins essential for adequate
nutrition (1969:15).

While such nutritional problems are reported for some regions, dietary

analyses reveal ecological zones in which indigenous food consumption is

quite adequate (see Mazess and Baker 1964 and Picon-Reategui 1976). This

paper presents a preliminary assessment of the dietary staple of a rural

altiplano community where the native population also appears to be

satisfactorily nourished.

Challapujo, a rural Aymara community in which the author resided

from September 1976 to June 1977, is located eleven kilometers from the

market town of Ilave in the Department of Puno, in southern Peru. Situated

on the shores of Lake Titicaca, the community is at an altitude of 3800

meters. The economy is agricultural with the principal cultigens being

potatoes, quinoa (a grain, Chenopodium quinoa) and barley. Each family

owns two to three cattle and may also keep sheep, chickens, pigs or donkeys.

Llamas and alpacas are not raised in the community. As is typical of the

region, animals and their products are only rarely consumed. Their primary

use is for plowing, burden carrying, or production of products or offspring

to sell. (Fcr a complete description of the community's agricultural

ecology, see Brown 1978.)









The staple of the ChallapuJo diet is the potato, indigenous to

the region. It supplies roughly 50 percent of the caloric intake in the

diet and a major share of many nutrients, as discussed below. Reliance

on a single crop for the bulk of daily food consumption is frequently

condemned by investigators as a precarious base for good nutrition. It

is the heavy dietary reliance on the potato that leads local officials,

development personnel and scientific observers of the Aymara to assume

that their diet is inadequate. The Challapujo diet does not offer the

"well-balanced" combination of meat, cereals and vegetables traditionally

posited for good nutrition (For example, see Buck, Sasaki and Anderson

1968:40). Nor does it offer frequent consumption of animal protein which

is often relied on as "probably the most sensitive indicator of the quality

of nutrition in a community"(Buck, SasakiandAnderson 1968:40).

The people of Challapujo, however, appearAthe non-medically-t.ained

ODServer, at least, to jbe remarkably robust ,nd healthy ror a population

that does not follow the consumption patterns of "good nutrition". That is,

obvious signs of undernourishment are not present. Kwashiorkor does not

occur in the children. Other readily observable signs such as emaciation,

lack of energy, depigmentation or dryness of skin or hair are also absent.

These facts are not, of course, tantamount to proof of the complete

adequacy of the Challapujo diet or of the total health of the population.

However, they raise questions about the over-hasty condemnation of reliance

on the potato. In order to clarify this issue, I have analysed the potato

consumption of adult Aymara males in Challapujo. While such an analysis

cannot tell us whether young children or women also consume an adequate

diet, it suggests the need for a closer examination before the entire

population is dismissed as undernourished










The key to the contribution of the potato in the diet is the large

quantity in which it is consumed. Active adult Aymara men between the

ages of 18 and 45 were observed to consume a typical daily portion of

1500 grams of potatoes. During the months that this observation was made,

the majority of potatoes were consumed in their fresh form, although some

dehydrated potatoes, or chiio, were also eaten.

This figure is compatible with the amounts of potatoes and chufio

reported to be consumed in the district of Nu'noa, a high altitude zone

near Cuzco, Peru, by Mazess and Baker (1964) and Picon-Reategui (1976),

although they report that more than half of the potatoes consumed in Nunoa

are eaten as chuo. The more mild climate of the Titicaca Basin may reduce

the reliance on chuno in favor of the fresh potato which can be stored

successfully all winter and is eaten throughout the year when the harvest

has been normal. The dehydration process reduces the bulk of the potato

somewhat, which Mazess and Baker (1964: 345) suggest may facilitate consuming

such large quantities. However, since chuo is rehydrated to some extent

before it is eaten, the bulk remains considerable.

This bulk is distributed throughout the day, with potatoes usually

being consumed for breakfast and supper in soups with the additional

ingredients of the grains guinoa or barley. Onions, habas (broad beans:

Vicia faba) and condiments such as oregano or 2 a hot red pepper, may

also be included. Soups may be water or broth based and occasionally contain

bits of meat, poultry or fish or animal fats. Cheese and eggs are occasionally

included in a meal but in very limited quantities. At midday, people at

work in the fields consume a meal of dry boiled potatoes, sometimes with

a grain added.










The other ingredients of the diet are much more variable than the

potato, and exact quantities are not known. However, the information on

the nutrients supplied by 1500 grams of potatoes provides a basis for

preliminary judgement of the whole diet. Fifteen hundred grams of potatoes

supply 30 grams of protein and approximately 1500 calories. Table I

lists various nutrients present in the potato, with quantities supplied

by 1500 grams and percentages of recommended daily allowances shown.

Caution should be exercised in the interpretation of these figures since

they are based on analysis of U.S.-grown potatoes. The many varieties

and vastly different growing conditions for altiplano potatoes may result

in significantly different analyses. The papa negra, a dark purple variety,

may, for example, contain significantly higher quantities of iron. However,

Table I is offered here to demonstrate that over half the nutrients

listed are provided in quantities that meet or exceed the recommended

allowances. Yet, we are considering only approximately 50 percent of the

caloric intake of the average Challapujo male, calculated as follows:

Picon-Reategui (1976: 223-224) estimates the caloric needs of a

standard man in the district of Nunoa to be 2719 calories, 400 calories.

His calculation is based on a "reference man" 157.7 cm in height, weighing

57.6 kg, whose subsistence activity is herding, performed approximately

8 hours per day and using 123 calories per hour. I have taken Picon-

Reategui's calorie expenditure figures for daily activities except for

herding which I have assumed to be less strenuous than agriculture.

Substituting Harris's (cited in Brown 1978:61) 150 calories per hour

estimate for rigorous activity, I have arrived at an estimate of 3000

calories needed for the energy expenditure of a working Aymara man

weighing approximately 57 kilos. (This weight is from Buck, Sasaki and









TABLE I

NUTRITION IN 1500 GRAMS OF RAW POTATOES


Amount in 1500 grams


Percent of U.S. RDA (1973)
adjusted for 57 kg body weight"


Calories*
Protein*
Fat*
Carbohydrate*
Calcium
Phosphorus
Iron
Sodium
Potassium
Vitamin A
Thiamine
Riboflavin
Niacin
Vitamin C
Vitamin B6
Copper
Magnesium
Iodine
Folic Acid
Zinc
Fiber


1500 kcal
30 g
2 g
338 g
105 mg
795 mg
9 mg
45 mg
6 g
trace
1.5 mg
.6 mg
23 mg
300 mg
28 mg
31 mg
.4 mg
.4 mg
231 mcg
6 mg
ca. 6 g


(See Table II)
(See Table II)
NA
NA
t2
97
62

NA
NA


123
4_3

139
369
169
192
96
278
91
47
123


Source: The Potato Board 1978--all but *
M Mazess and Baker 1964: 344.

Note: The Potato Board reported exceptionally low figures for calories,
carbohydrates, and fats for the potato; while their figures may
be accurate, the figures from Mazess and Baker are more typical
of those used in other literature.
**This adjustment suggested by Quandt (1979). Original Potato Board
values are for U.S. average 70 kg males.


Nutrient









Anderson's (1968:42) analysis of the altiplano community of Pusi.)

Potatoes thus supply roughly 1500 calories or 50 percent of the calories

required in this reference man's diet. Table II shows the percent of

daily requirements of protein and calories supplied. Since it was

observed that healthy adults maintain their body weights and activity

levels, we can conclude that the other 1500 calories are provided by the

rest of the diet (Brues 1979). As noted above, well over 50 percent of

the nutrients listed in Table I are provided by the potatoes.






TABLE II

CALORIE AND PROTEIN CONTRIBUTIONS OF
1500 GRAMS: OF POTATOES TO THE CHALLAPUJO DIET




Quantity Total Daily Percent of
supplied supplied requirement daily
in 100g in 1500g for Aymara requirement
potatoes man provided




Calories 100 kcal/g 1500 kcal 3000 kcal 50

Protein 2 g/100g 30 g 46 g 65










Derivation of the protein figure is more complex. The 30 grams of

protein supplied by potatoes are not all usable by the human body because

of amino acid patterning. There are eight essential amino acids which

must be consumed by the human body for protein synthesis*. Moreover,

they must be consumed in the correct proportions and be present in the

digestive tract simultaneously in order for absorption and utilization

by the body to occur. (See Lappe 1971 for an excellent introductory

discussion of essential amino acids.) Most vegetable proteins contain

the eight essential amino acids (EEAAs) in proportions different from

human needs while proteins of animal origin are closer to the human pattern

and thus more efficient for us to consume. It is this limit to

vegetable proteins which makes some observers heSitant about

the quality of a diet which derives its protein primarily from plant

sources. However, as Lappe (1971) points out, if vegetable proteins

are combined to complement their mutual EEAA deficiencies, adequate

protein can be gained from plant sources. Similarly, if a vegetable

product is eaten in enough quantity, even the limiting amino acids will

be present in sufficient amounts for the body to utilize quite a bit of

protein. The proportions of the EEAAs do not vary, but the gross quantity

of usable protein will obviously increase with the quantity of food. For

this analysis, the EEAAs in the potato have been compared to the propor-

tions of the same amino acids in human milk (iag per g of nitrogen). While

the hen's egg is often used as a reference protein (FAO 1970: 2), human

milk seems a better indicator of human needs (Brues 1979).


*Robinson (1978:43) reports that a ninth amino acid, histidine, has
been shown to be necessary for adults as well as children. This paper ha-
only dealt with the eight previously reported.




8



The protein in the potato must therefore be analysed for its gross

protein quantity--grams of protein per 100 grams of potatoes--and for

its quality or protein score. The protein score is derived from the

relative proportion of the EEAAs in the protein of a food to the proportion

of EEAAs in human milk protein (FAO 1957:30). The protein scores for the

EEAAs of the potato compared to human milk are given in the first column

in Table III. From these scores, the limiting amino acid, that present

in the lowest ratio, appears to be threonine, with a score of 70. That

is, the potato protein contains 70 percent of the threonine present in

human milk protein. This means that only 70 percent or 21 grams of the

potato protein consumed by ChallapuJo men is useful to the body.*

The figure for the percent of daily protein allowance given in Table

II is calculated as follows: The FAO (1973, cited in Hamilton and Whitney

1979:574) suggests a safe protein allowance of .57 grams per kilo of

body weight. This figure is then multiplied by the protein score of the

diet divided into 100, to allow for the usability of the protein. If we

assumesfor the purposes of this analysis, that nothing else is eaten to

raise the protein quality score, taking the score just for potatoes, we

have the following:

.57 gm/kg X 57kg = 32 gm usable protein required
100
32 gm X--;- = 46 gm potato protein required

Thus, Table II shows that the potato supplies 65 percent of the 46

grams of protein needed if the diet has an overall protein score of 70.

This 46-gram figure is generous compared to the 30-40 gm figure reported as

adequate by Hegsted (cited in Picon-Reategui 1976: 226-7) for a vegetable

diet consumed by 70 kg subjects. It is likely, therefore, that potatoes

supply more than 65% of the dietary protein without reducing the allotment

below safe levels.

*Investigators have reported protein utilization scores 6r biological
values of from 60 CLappg 1971:93) to 80 (FAO 1957: 28) for the potato.






TABLE III

PROTEIN SCORES OF SINGLE FOODS AND
FOOD COMBINATIONS COMPARED TO HUMAN MILK


Essential 1500g 1500g 1500g
Amino Acid Potatoes Quinoa Habas potatoes potatoes potatoes
+100 g + 50 g +-i00g quinoa:
quinoa habas + 50g habas


Isoleucine 76 100 86 84 79 84


Leucine 75 76 97 80 81 83


Lysine 84 97 99 88 88 90


Methionine 110 160 125 89 110


Phenylala- 120 94 110 110 118 110
nine

Threonine 0 100 72 0


Tryptophan 98 51 89 85 81


Valine 99 70 100 93 100 95



Source for the amino acid content of foods, mg/g of nitrogen, FAO 1970.

*Note: This score is for total sulfur containing amino acids. The
methionine score for habas is .36, but some cystine (score 52) may
replace the low methi-oe(USDA 1957: 5), so the average of the two
is given.
Lowest scores for each colunm (limiting amino acids) are circled.










A diet based on a protein score or biological value of 70 or more is

considered satisfactory for human growth and maintenance (FAO 1957: 30)

if sufficient calories and protein quantities are present. The data

in Table II suggest that such is the case for Challapujo men since we

know that sufficient calories must be available or the body weights and

activity levels could not be maintained. It is reasonable to expect that the
remaining 35 percent or less of required daily protein could be obtained

from the other foods providing the other 50 percent of the calories in the

diet, We can conclude, then, that the potato offers a sound basis for

adequate protein consumption in the diet of Challapujo men.

It is also possible that the foods which are combined with the potato

in the daily diet may increase the quality of the dietary protein, raising

the overall protein-score by several points, i.e. increasing the utiliza-

tion of the protein consumed. This would occur if the EEAA pattern in

other foods complements that of the potato. Soup and meal recipes regularly

include the combinations of some quinoa, barley, habas or animal products

with the staple potatoes, making such protein complementarity likely.

In order to draw conclusions about such combinations we would need the

specific amounts of all foods as they are consumed together., Average

quantities per day per person are not specific enough to determine the

action of protein combinations since the EEAAs must be present in the

digestive tract simultaneously~for the combinations to result in increased

protein utilization.

Table IIIcolumns 2 and 3 /show the protein scores for quinoa and

habas, with the limiting amino acid scores circled. Columns 4. 5, and 6

of Table III show the results of hypothetical combinations of 1500 grams

of potatoes with 100 grams of guinoa, with 50 grams of habas and with all








three foods together. Vhile the limiting amino acid in the combinations

remains threonine, that of the potato, the scores go up 7 to 9 points.

The results of these increased scores on food combination protein utiliza-

tion are shown in Table IV. A combination of 100 grams of quinoa

and 1500 grams of potatoes results in a protein utilization score of 79

as compared to quinoa (63) or potatoes (70) eaten separately. This means

that while 100 grams of quinoa supplies 12 grams of protein, only 7.6

grams are usable due to the low tryptophan content. When quinoa is combined

with 1500 grams of potatoes, however, the protein derived from the total

42 grams becomes 33.2 grams. This is an increase of 16 percent over 28.6

grams, the total amount of usable protein if the foods are eaten separately.

Putting this 42 gram figure into the formula on page 8, above, we find that

this protein combination with a score of 79 would exceed daily needs by .5 grams!


32 gm X = 40.5 gm potato/quinoa protein required
79

Similarly, protein score increases of 13 percent can be seen for habas

and potatoes and 22 percent for all three foods together.

While the exact consumption figures used above are hypothetical, they

suggest promising possibilities for the actual daily diet. Since such

combinations do occur, they may be the factor which results in a sufficient

protein intake for the Challapujen'os. The key to understanding the adequacy

of the altiplano diet lies in the study of the exact nature of these

combinations and the nutritional status derived from them. The preliminary

evidence, outlined in this paper, that the adult male diet is adequate due

to such protein combinations is certainly justification for further study.

Seasonal variation in food combinations, exact daily quantities

consumed, and eating habits for individuals of different age, sex, and

activity level should be analysed. Diet variations due to differences










TABLE IV

INCREASED PROTEIN UTILIZATION-FROM POSSIBLE FOOD COMBINATIONS


Limiting Protein Protein, Calories- Usable protein
amino score per per if eaten if
acid portion portion separately combined


Potatoes Threonine .70 30g 1500 21g
(1500g)

Quinoa
(100g) Tryptophan 63 12g 345 7.6g

Habas Sulfur
(50g) Containinc 45 11.7g 55 5.3g

1500g-potatoes
+ 100g quinoa Threonine 79 42g 1845 28.6g 33.2g
(16% increase)
1500g potatoes
+ 50g habas Threonine 71 41.7g 1555 26.3g 29,6g
(13% increase)
1500g potatoes
+ 100g quinoa Threonine 77 53.7g 1900 33.9g 41.3g
+ 50 g habas (22% increase)


Table IV 'is modeled after Lapp6's(1971)food combination charts*










in social stratification would be of minimal concern in a traditional

community like Challapujo where economic variation, is very slight, but age

and sex variables may be important. Questions about whether the diet is

minimally adequate or whether it includes a margin for stress, disease,

growth, pregnancyt etc. are of particular relevance. Also, there is the

question of altiplano towns like Pusi, studied by a Johns Hopkins University

health team, where potatoes were reported as a staple food in only 27

percent of the households (Buck, Sasaki, and Anderson 1968: 48). Do

other staples like wheat replace the nutrition of the potato, or are

inhabitants of small towns like Pusi less well nourished than the

more traditional residents of the countryside? Finally, the importance of

applying the results of this type of research could be considerable.

It is possible that the study of such food combinations could reveal that

only slight alterations in proportions of foods could substantially

improve or deplete a diet.

The peasants of the altiplano have survived many centuries and numerous

political systems. Their traditional nutrition may be a vital part of

their successful adaptation and is worthy of our continued attention.








REFERENCES CITED


Brown, Paul F.
1978 Fuerza por Fuerza: Ecology and Culture Change Among the
Aymara of Southern Peru. Doctoral dissertation. Univ. of
Colorado, Boulderg Colorado.

Brues, Alice M.
1979 Personal communication.

Buck, Alfred A., Tom T. Sasaki, and Robert I. Anderson
1968 Health and Disease in Four Peruvian Villages. Baltimore,
Md: The Johns Hopkins Press.

FAO(Food and Agriculture Organization of the United Nations)
1957 Protein Requirements. FAO Nutritional Studies No. 16. Rome: FAO.

1970 Amino Acid Content of Foods and Biological Data on Proteins.
FAO Nutritional Studies No. 24. Rome: Food Policy and Food
Science Service, Nutrition Division, FAO.

Hall, Thomas J,
1969 Health Manpower in Peru: A Case Study in Planning. Baltimore,
Md: The Johns Hopkins Press.

Hamilton, Eva May Nunnelley and Elanor Noss Whitney.
1979 Nutrition: Concepts and Controversies. St. Paul, Minn. West
Pub. Co.

LappS, Frances Moore
197.1 Diet for a Small Planet. New York: Ballantine.

Mazess, R.B. and P. T. Baker
1964 Diet of Quechua Indians Living at High Altitude: Nunoa, Peru.
American Journal of Clinical Nutrition 15: 341-351.

Pic6n-Re'tegui, Emilio
1976 Nutrition. In Baker, Paul T. and Michael A. Little. Man in
the Andes: A Multidisciplinary Study of High-Altitude Quechua.
Stroudsburg, Pa.: Dowden, Hutchinson and Ross, Inc.

The Potato Board
1977 The Whole Potato Catalogue. Denver: The Potato Board.

Quandt, Sara
1979 Personal communication.

Robinson, Corinne H. with Emma S. Weigley
1978 Fundamentals of Normal Nutrition. 3rd ed. New York: Mac-
millan.

U.S. Department of Agriculture
1957 Amino Acid Content of Foods. (Written by M. L. Orr and B.K.
Watt.) Home Economics Research Report No. 4. Washington D.C.:
U.S. Government Printing Office.