Nutrition Transition

Increased consumption of unhealthy foods compounded with increased prevalence of overweight in middle-to-low-income countries is typically referred to as the “Nutrition Transition.” It occurs in conjunction to the Epidemiological Transition and has serious implications in terms of public health outcomes, risk factors, economic growth and international nutrition policy. Nutrition transition is malnutrition ensuing not merely from a need for food, but the need for high-quality nourishment. Foods rich in vitamins, minerals, and micronutrients such as fruits, vegetables, and whole grains have been substituted by foods heavy in added sugar, saturated fat, and sodium. This trend, which began in developed, industrialized countries, has spread to developing countries. These developing countries still stressed and struggling with hunger are now dealing with health problems associated with obesity. Malnutrition once identified by emaciated bodies, is now also associated with obesity. [Burslem, Chris, IFPRI.(2004) Obesity in Developing Countries: People are Overweight But Still Not Well Nourished. Available online as of 5/7/2008 at: http://www.worldhunger.org/articles/04/global/burslem.htm]

In Developing Countries

For developing countries, nutrition transition is a more advanced problem in urban areas than in rural ones. As countries develop, becoming more industrialized, cities arise. Cities offer more imported foods from industrialized countries. Along with more choices come a variety of food, many with high-fat content. More women are working out of the home in cities, and have less time for growing produce, shopping for ingredients, and even preparing healthy meals. This combined with the fewer calories burnt in urban jobs than in rural toil, and more sedentary time and the abundance marketing of processed foods that accompanies available televisions, obesity is advancing more rapidly in developing countries' cities than in rural areas. [Obesity: developing world's new burden. [http://www.fao.org/FOCUS/E/obesity/obes2.htm] ]

Measurements and Dietary Changes

Issues common to wealthy and transitional countries include disaggregation of recipes and careful measurement of added oils and condiments. Yet problems unique to transitional countries deal with the measurement of ingredients used in food. Difficulties stem from incomplete measurement of fiber and various nutrients, absence of added sugar measurement, or lack of measurement of the food as processed. For example, in urban areas of China, a study of the same recipe containing pork and egg showed that there was a noticeable increase in the amount of pork and egg in the dish from 1997 to 2000. In the recipe, the amount of pork increased by 9.7 grams and the amount of egg increased by 2 grams in those three years. [Popkin, Barry. (2002) Stages of the Nutrition Transition: Dynamic Global Shifts Appear to be Accelerating. Available online as of 5/7/2008 at: http://www.sne.org/conference/documents/BarryPopkin-NutritionTransition.pdf]

As a Cause of Childhood Obesity

Childhood obesity in developing counties is also of concern. The largest concentration is in Middle Eastern and Eastern European developing countries, while the frequency of obesity in children in Sri Lanka and India is the lowest. This overall increase is of concern to health professionals because childhood obesity is likely the precursor to a rise in cases of pediatric metabolic syndrome. Metabolic syndrome, more commonly referred to as insulin resistance, often leads to many chronic diseases. The concern is that this rise in pediatric metabolic syndrome will probably create a huge public health and socioeconomic burden for developing countries in the future as childhood obesity regularly precedes hyperinsulinemic state. Due to few studies of childhood obesity in emerging markets, little is known on the topic. Findings do show that the increased consumption of white flour products and solid hydrogenated fat leads to an increased rate of metabolic syndrome in children in developing countries while increased physical activity leads to its decrease. [Kelishadi, Roya. (2007) Childhood Overweight, Obesity, and Metabolic Syndrome in Developing Countries.]

Emerging Markets and Nutritional Transition

Obesity's health implications are deadly; they include increased prevalence of diabetes, coronary heart disease, and stroke. [WHO technical report series 916. (2003) Diet, nutrition, and the prevention of excess weight gain and obesity. Report of a joint WHO/ FAO expert consultation. Geneva: WHO. Available online as of 7/1/2007 at:http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf] [Darnton-Hill I, Nishida C, James WP. (2004) A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutrition, 7 (1A):101-121.] [National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106:3143-3421, 2002.] [Janssen I, Katzmarzyk PT, Ross R. (2002) Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Archives of Internal Medicine, 162 (18):2074-2079.] [WHO Global Strategy on Diet, Physical Activity and Health. (2004) Obesity and overweight. Geneva: WHO. Available online as of 7/1/2007 at:http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/] Subsequent population level economic impacts are equally serious, most notably lost productivity and significant strain on health care systems. [Chou SY, Grossman M, Saffer H. (2004) An economic analysis of adult obesity: Results from the behavioral risk factor surveillance system. Journal of Health Economics, 23: 565-587.] [Cawley J. (2004) The impact of obesity on wages. Journal of Human Resources, 39 (2): 451-474.] [Lakdawalla D, Philipson T. (2002) The growth of obesity and technological change: A theoretical and empirical examination (working paper 8946). Cambridge, MA: National Bureau of Economic Research.] [WHO technical report series 894. (2000) Obesity: Preventing and managing the global epidemic. Geneva: WHO.] [Wolf AM, Manson JE, Colditz GA. (2002) The economic impact of overweight, obesity and weight loss. Ed. Eckel R in Obesity: Mechanisms and clinical management. Lippincott, Williams & Williams, 2003.]

The obesity spotlight has, until recently, focused almost exclusively on prevalence in the developed world. But in the last few years, rising rates of obesity in developing countries have raised apprehension among researchers, policy-makers and public-health practioners alike. Rapidly transitioning countries, often referred to as emerging markets, are of particular concern. [Popkin BM, Gordon-Larsen P. (2004) The nutrition transition: worldwide obesity dynamics and their determinants. International Journal of Obesity, 28:S2-S9.] This is because these countries are experiencing very high rates of economic development and the trend toward increased prevalence of overweight is now occurring most rapidly in conjunction to accelerated economic growth. Citizens of these emerging market countries (e.g. Brazil, China, India and Mexico) have more disposable income than ever before, and they are spending it on foods that are often highly processed and unhealthy. [Drewnowsky A, Popkin BM. (1997) The nutrition transition: New trends in the global diet. Nutrition Reviews, 55:31-43.] This trend is compounded by the fact that many transnational food companies (e.g. Kentucky Fried Chicken, Nestle, and McDonalds) have launched aggressive marketing campaigns to penetrate consumer bases in these nations, precisely because of increased disposable income. Processed foods high in fat, sugar and sodium and low in vitamins, fiber and other nutrients (foods of minimal nutritional value or “FMNVs”) are increasingly ubiquitous in many middle-to-low-income countries. [Mendez M, Popkin BM. (2004) Globalization, urbanization and nutritional change in the developing world. "Journal of Agricultural and Development Economics".]

Nutrition Transition and Health Outcomes

Countries experiencing rapid economic growth typically undergo a period of epidemiological transition: prevalence of infectious disease and parasitic disease (e.g. malaria, measles, respiratory infections, diarrheal disease) decreases and prevalence of non-communicable disease (e.g. diabetes, stroke, coronary heart disease, renal disease) increases. This pattern is paralleled by the nutrition transition. Infectious and parasitic diseases are very often predicated and/or exacerbated by macro and micro-nutrient deficiencies. Conversely, non-communicable disease is closely linked to overweight and consumption of foods that are high in saturated fat, sodium and cholesterol. [WHO technical report series 916. (2003) Diet, nutrition, and the prevention of excess weight gain and obesity. Report of a joint WHO/ FAO expert consultation. Geneva: WHO. Available online as of 7/1/2007 at:http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf] [Darnton-Hill I, Nishida C, James WP. (2004) A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutrition, 7 (1A):101-121.] [National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106:3143-3421, 2002.] [Janssen I, Katzmarzyk PT, Ross R. (2002) Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Archives of Internal Medicine, 162 (18):2074-2079.] [WHO Global Strategy on Diet, Physical Activity and Health. (2004) Obesity and overweight. Geneva: WHO. Available online as of 7/1/2007 at:http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/]

Implications for Health Policy

Economic development does not affect all demographics equally; even in countries showing high rates of economic growth, poverty continues to be a problem in many areas, and continued incidence of undernutrition remains a threat. [Haddad L, Ruel M, Garrett J. (1999) Are urban poverty and undernutrition growing? Some newly assembled evidence. International Food Policy Research Institute. Available online as of 7/1/2007 at:http://www.ifpri.org/divs/fcnd/dp/papers/dp63.pdf] [FAO (2004) Chronic undernutrition among children. Available online as of 7/1/2007 at:http://www.fao.org/sd/dim_en3/en3_040101_en.htm] What is surprising about nutrition transition trends is that, in many of the emerging market countries, overweight is becoming an issue among poorer sections of the population. That is, in addition to the rather obvious pattern of increased adiposity among richer demographics, a propensity towards overweight is also manifesting in many lower-income communities. In certain areas, overweight and obesity is now occurring within populations that are also prone to undernutrition. [Monteiro CA, Conde WL, Lu B, Popkin BM. (2004) Is obesity fueling inequities in health in the developing world? University of North Carolina Manuscript: Chapel Hill, NC. ] [Doak CM, Adair LS, Bentley M, Monteiro C, Popkin BM (2005) The dual burden household and the nutrition transition paradox. International Journal of Obesity, 29:129-136.] [Du S, Mroz TA, Zhai F, Popkin BM (2004) Rapid income growth adversely affects diet quality in China – particularly for the poor! Social Science and Medicine, 59:1505-1515.] Health policy in countries experiencing this double-burden must learn to balance continued efforts at reducing under-nutrition with new policies targeted at reducing intake of highly processed, unhealthy foods.

References

ee also

* Detox diet
* List of basic nutrition topics

External links

* [http://www.who.int/topics/obesity/en/ WHO Obesity]
* [http://www.cpc.unc.edu/projects/nutrans UNC Nutrition Transition Program]