the nutrition transition program the university of north carolina at chapel hill popkin, public...

The Nutrition Transition ProgramThe University of North Carolina at Chapel Hill

Popkin, Public Health Nutrition, Feb 2002

THE NUTRITION TRANSITION AND ITS IMPLICATIONS FOR HEALTH IN THE DEVELOPING WORLD

What has happened? What are some unique elements of the shifts in diet, activity, obesity, and other measures of morbidity and mortality in each region of the world?

What is unique about the experience in lower and middle income less industrialized countries compared with the very high income industrialized countries?



The shift in stages of the nutrition transition in the developing world

differs from past experiences!

Barry Popkin

Department of Nutrition

The School of Public Health

The University of North Carolina at Chapel Hill



Stages of Health, Nutrition, and Demographic Change

Focus on family planning,infectious disease control

Focus on faminealleviation/prevention

Nutrition Transition

High prevalence undernutrition

Receding famine

Diet-related noncommunicablediseases predominate

Epidemiologic Transition

High prevalence infectious disease

Receding pestilence, poorenvironmental conditions

Chronic diseasespredominate

Demographic Transition

High fertility/ mortality

Reduced mortality,changing age structure

Reduced fertility,aging

Focus on medical intervention,policy initiatives, behavioral change

Focus on healthy aging spatial redistribution



Stages of the Nutrition Transition

Urbanization, economic growth, technological changes for work, leisure, & food processing, mass media growth

Pattern 3Receding Famine

Slow mortality decline

• increased fat, sugar, processed foods

• shift in technology ofwork and leisure

Pattern 4Degenerative Disease

accelerated life expectancy,shift to increased DR-NCD,increased disability period

• reduced fat, increased fruit, veg,CHO,fiber

• replace sedentarianism with purposeful changes

in recreation, other activity

Pattern 5Behavioral Change

extended health aging,reduced DR-NCD

MCH deficiencies, weaning disease,stunting

• starchy, low variety, low fat,high fiber

• labor-intensive work/leisure

obesity emerges,bone density problems

reduced body fatness,improved bone health



Assertion 1. The shifts in patterns of diet, physical activity and body composition seem to be occurring more rapidly

The obesity patterns are much higher for the level of development than heretofore found

The rates of change are very rapid or at least the data we have seem to lead to that conclusion

– child trends-comparison

– adult patterns and trends



-0.4

-0.2

0

0.2

0.4

4 5 6 7 8

Log of Per Capita Household Income

Cha

nge

in I

ncom

e E

last

icity

Changes in the Income Elasticity for Edible Oil Food Consumption in China

(Increases in Income Elasticity Between 1989-93)

Amount of Edible Oil Users Consume

95% Confidence Interval

95% Confidence Interval

Source: Guo et al. (2000). Econ Dev Cult Chg 48:737



Assertion: Biological differences accentuate and speed up the effects of nutritional changes

There are important body composition differences that lead to shifts in BMI-disease patterns. The Asian recommendation to reduce the BMI cutoff for overweight and obesity are examples.

The rapid shift in the stage of the nutrition transition enhances the effects of fetal and infant insults. Stunting may affect fat metabolism (Hoffman et al, AJCN. 72: 702–7).

Unclear effects of different disease profiles.



*

*

*

**

0

2

4

6

8

18.5 - 22.9 23 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 > = 31.0

BMI (kg/m2)

Od

ds

ratio

Chinese

White

BlackMexicanAm

Compared to US-White males, the odds of prevalent hypertension were significantly higher for Chinese men at every level of BMI above the range 18.5-22.9 kg/m2. Adjusting for waist:hip ratio attenuated the ethnic differences but did not eliminate them.

Source: Bell et al, AJE (in press)* p < 0.05 from US-White men



103 103

101

107 107

105

111

110109

95

100

105

110

115

lowest middle highest

BMI Tertile at Birth

Sys

tolic

BP

(m

m H

g)

lowest middle highest 15-16

Fetal insults: Systolic Blood Pressure Among Cebu Male Adolescents According to BMI at Birth and Age 15-16

Source: Adair et al, 2001.



The politics differ!

When undernutrition/hunger are still important, it is more difficult to create a focus and agenda for DR-NCD’s. Still, large proportions of households with underweight persons also have overweight persons (see Doak presentation).

Public health systems have not had any time to adjust to this new reality.

Our array of tested prevention options is limited. The Nutrition Transition supplement of Public Health Nutrition in February 2002 will highlight some program and policy options.

the nutrition transition program the university of north carolina at chapel hill popkin, public...

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