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date: 13 November 2019

Abstract and Keywords

An imbalance of energy intake, expenditure, and storage substantially increases the risk of chronic, deadly conditions, including heart disease, stroke, type 2 diabetes mellitus (T2DM), certain cancers, and depression. Our understanding of the physiological, lifestyle, and environmental factors that contribute to poor energy regulation and balance can be informed in meaningful ways in the context of evolutionary medicine. There is a substantial mismatch, or discordance, between ancestral environments (environments of evolutionary adaptedness (EEAs)) and most modern environments with regards to the availability and accessibility of food, and the connection between physical activity energy expenditure and energy acquisition. Evolutionary medicine can inform research and approaches to reduce the disease burden associated with an imbalance of energy based on the discordance model for diet and activity, and further applying life history theory to understand physical activity. Challenges to the evolutionary approach to chronic disease are thought-provoking, but they do not negate its value. Novel approaches incorporating insights that consider human evolutionary history and integrate across Tinbergen’s levels of analysis can lead to the development of interventions that are more compatible with evolved physiology and psychology and environments that are more conducive to lifestyles that reduce the risks of chronic diseases.

Keywords: evolutionary medicine, Palaeolithic diets, modern diets, physical activity, energy balance, hunter-gatherers, discordance model, fetal programming, thrifty phenotype hypothesis, mismatch

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