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Review
. 2023 May 3;16(5):963-978.
doi: 10.1111/eva.13549. eCollection 2023 May.

Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective

Affiliations
Review

Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective

Anthony R Mawson. Evol Appl. .

Abstract

Human populations adapting to diverse aspects of their environment such as climate and pathogens leave signatures of genetic variation. This principle may apply to people of West Central African descent in the United States, who are at increased risk of certain chronic conditions and diseases compared to their European counterparts. Less well known is that they are also at reduced risk of other diseases. While discriminatory practices in the United States continue to affect access to and the quality of healthcare, the health disparities affecting African Americans may also be due in part to evolutionary adaptations to the original environment of sub-Saharan Africa, which involved continuous exposure to the vectors of potentially lethal endemic tropical diseases. Evidence is presented that these organisms selectively absorb vitamin A from the host, and its use in parasite reproduction contributes to the signs and symptoms of the respective diseases. These evolutionary adaptations included (1) sequestering vitamin A away from the liver to other organs, to reduce accessibility to the invaders; and (2) reducing the metabolism and catabolism of vitamin A (vA), causing it to accumulate to subtoxic concentrations and weaken the organisms, thereby reducing the risk of severe disease. However, in the environment of North America, lacking vA-absorbing parasites and with a mainly dairy-based diet that is high in vA, this combination of factors is hypothesized to lead to the accumulation of vA and to increased sensitivity to vA as a toxin, which contribute to the health disparities affecting African Americans. vA toxicity is linked to numerous acute and chronic conditions via mitochondrial dysfunction and apoptosis. Subject to testing, the hypothesis suggests that the adoption of traditional or modified West Central African-style diets that are low in vA and high in vA-absorbing fiber hold promise for disease prevention and treatment, and as a population-based strategy for health maintenance and longevity.

Keywords: African Americans; adaptation; chronic disease; evolution; genetics; health disparities; health profile; liver; parasitemia; structural racism; tropical diseases; vitamin A.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Ancestral origins of African Americans.
FIGURE 2
FIGURE 2
Metabolism of vitamin A.
FIGURE 3
FIGURE 3
Theory of the health profile of people of West Central African descent. Malaria parasites selectively absorb vitamin A and spend over a week in the liver, the main storage site of vA. Endemic exposure to Plasmodia and other common parasites in the original environment is hypothesized to have led to evolutionary adaptations involving (1) the sequestration of vA from the liver to subcutaneous adipose and other tissues, to reduce its accessibility to the parasite; and (2) reduced vA enzymatic metabolism and catabolism, causing it to accumulate to sub‐toxic concentrations and weaken the parasite, thereby reducing the risk of severe disease. These adaptations may have reduced the severity of malaria, yellow fever, dengue, and the risk of NAFLD in people of West Central African descent. However, in North America, where major parasites are absent and high vA‐containing diets are the norm, these adaptations may cause vA to accumulate in the tissues, thereby increasing the risk and severity of many chronic diseases. They may also have led to an enhanced sensitivity to vA as a cellular toxin, and increased risks of allergy. These adaptations may be contributing to the emergence of a similar health profile in West Central Africa.
FIGURE 4
FIGURE 4
Consumption of cheese in the United States, 1970–2010.

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