Nutrition Transition Diet Change And Its Implications

B M Popkin, University of North Carolina, Chapel Hill, NC, USA

© 2005 Elsevier Ltd. All rights reserved.

The world is experiencing rapid shifts in structures of diet and body composition with resultant important changes in health profiles. In many ways, these shifts are a continuation of large-scale changes that have occurred repeatedly over time; however, the changes facing low- and moderate-income countries appear to be very rapid. Broad shifts continue to occur throughout the world in population size and age composition, disease patterns, and dietary and physical activity patterns. The former two sets of dynamic shifts are termed the demographic and epi-demiological transitions. The latter, whose changes are reflected in nutritional outcomes, such as changes in average stature and body composition, is termed the nutrition transition. These three relationships are presented in Figure 1.

Human diet and activity patterns, and nutritional status, have undergone a sequence of major shifts, defined as broad patterns of food use and their corresponding nutrition-related diseases. During the past three centuries, the pace of dietary and activity change appears to have accelerated to varying degrees in different regions of the world. Furthermore, dietary and activity changes are paralleled by major changes in health status as well as by major demographic and socioeconomic changes. Obesity emerges early in these shifting conditions, as does the level and age composition of morbidity and mortality. Although there are five broad nutrition patterns dating back to the origins of modern man, the focus of this article is on the three most recent periods (Figure 2). For convenience, the patterns are outlined as historical developments; however, 'earlier' patterns are not restricted to the periods in which they first arose but, rather, they continue to characterize certain geographic and socioeconomic subpopulations. The first two patterns relate to earlier periods in the evolution of man— the first pattern of collecting food and the second

Demographic Transition Epidemiologic Transition Nutrition Transition

Demographic Transition Epidemiologic Transition Nutrition Transition

Changes Nrition Transtion Aduit
Figure 1 Stages of health, nutritional, and demographic change. (From Popkin BM (2002) The shift in stages of the nutrition transition in the developing world differs from past experiences! Public Health Nutrition 5(1A): 205-214.)

pattern of famine. The following are the three later periods:

Pattern 3: Receding famine: The consumption of starchy staples had predominated and continues to do so, but these items become less important in this low-fat diet as limited amounts of fruits, vegetables, and animal protein are increasingly added to the low-fat and high-fiber diet. Many earlier civilizations made great progress in reducing chronic hunger and famines, but only in the last third of the past millennium have these

Urbanization, economic growth, technological changes for work, leisure,&

food processing, mass media growth

Pattern 4 Degenerative Disease

Pattern 5 Behavioral Change

Urbanization, economic growth, technological changes for work, leisure,&

food processing, mass media growth

Pattern 4 Degenerative Disease reduced fat, increased fruit, veg, CHO, fiber replace sedentarianism with purposeful changes in recreation, other activity

Changes Nrition Transtion Aduit

Slow mortality decline accelerated life expectancy, shift to increased NR-NCD, increased disability period

Figure 2 Stages of the nutrition transition. (From Popkin BM (2002) The shift in stages of the nutrition transition in the developing world differs from past experiences! Public Health Nutrition 5(1A): 205-214.)

Slow mortality decline accelerated life expectancy, shift to increased NR-NCD, increased disability period

Pattern 5 Behavioral Change reduced fat, increased fruit, veg, CHO, fiber replace sedentarianism with purposeful changes in recreation, other activity extended health aging, reduced NR-NCD

Figure 2 Stages of the nutrition transition. (From Popkin BM (2002) The shift in stages of the nutrition transition in the developing world differs from past experiences! Public Health Nutrition 5(1A): 205-214.)

changes become widespread, leading to marked shifts in diet. However, famines continued well into the eighteenth century in portions of Europe and remain common in some regions of the world. Activity patterns start to shift and inactivity and leisure become a part of the lives of more people. Pattern 4: Nutrition-related noncommunicable disease (NR-NCD): A diet high in total fat, cholesterol, sugar, and other refined carbohydrates, low in polyunsaturated fatty acids and fiber, and often accompanied by an increasingly sedentary life is characteristic of most high-income societies (and increasing proportions of the population in low-income societies), resulting in increased prevalence of obesity and contributing to the degenerative diseases that characterize the final epidemiologic transition stage. Pattern 5: Behavioral change: A new dietary pattern appears to be emerging, evidently associated with the desire to prevent or delay degenerative diseases and prolong health. Whether these dietary changes, instituted in some countries by consumers and in others also prodded by government policy, will create a large-scale transition in dietary structure and body composition remains to be seen.

Our focus is increasingly on patterns 3-5, particularly the rapid shift in much of the world's low-and moderate-income countries from the stage of receding famine to NR-NCD. Figure 2 presents this focus. The concern about this period is so great for many that the term 'nutrition transition' is synonymous with this shift from pattern 3 to 4.

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