1. The Nutrition Transition Program The 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?

2. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 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

3. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 Stages of Health, Nutrition, and Demographic Change Focus on family planning, infectious disease control Focus on famine alleviation/prevention Nutrition Transition High prevalence undernutrition Receding famine Diet-related noncommunicable diseases predominate Epidemiologic Transition High prevalence infectious disease Receding pestilence, poor environmental conditions Chronic diseases predominate 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

4. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 Stages of the Nutrition Transition Urbanization, economic growth, technological changes for work, leisure, & food processing, mass media growth Pattern 3 Receding Famine Slow mortality decline increased fat, sugar, processed foods shift in technology of work and leisure Pattern 4 Degenerative 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 5 Behavioral 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

5. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 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

6. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 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 Source: Guo et al. (2000). Econ Dev Cult Chg 48:737

7. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 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.

8. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 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/m 2. 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

9. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 Fetal insults: Systolic Blood Pressure Among Cebu Male Adolescents According to BMI at Birth and Age 15-16 Source: Adair et al, 2001.

10. The Nutrition Transition Program The University of North Carolina at Chapel Hill Popkin, Public Health Nutrition, Feb 2002 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.