The nutrition transition to 2030. Why developing countries are likely to bear the major burden

Changes in the overall dietary energy supply (DES)

At the most general level, the nutrition transition can be characterized by the changes in per capita energy supplies. The comparison of today’s per capita energy availability with that of 40 years ago shows an almost universal trend towards higher Dietary Energy Supply (DES) levels.
At the beginning of the 1960s, the entire developing world - with few exceptions - was suffering from substantive calorie deficits, chronic under-nourishment and in some cases outright and population-wide famines. Many developed countries by contrast were already approaching or even exceeding DES levels of about 3000 kcals/person/day (even among the rich countries large differences remained).
The last three decades brought about a radical change in the nutritional situation for many developing countries. Energy supply increased swiftly throughout much of East Asia, Latin America and the Near-East/North African region. By the end of the 1990s, the rather homogeneous picture of low DES levels and hunger of the 1960s had changed drastically. The prevalence of undernourishment had fallen in all major developing regions except for sub-Saharan Africa and a few countries in South Asia to levels below 10%.
Outside these areas populations in the more rapidly developing countries have begun to experience the consequences from oversupply of food energy and a growing rise in obesity. And, with unequally distributed incomes in most developing countries, hunger and obesity now often co-exist in the same country or region, creating a growing ‘‘double burden of malnutrition’’.
The transition is expected to continue at a fast pace in the next decades. The speed of the nutrition and lifestyle transition, and thus the incidence of overweight people and obesity may even gather pace. A growing number of countries will move into per capita energy supply levels of 2700 kcals and more over the next 30 years. On average, consumers in developing countries will have nearly 3000 kcals per day at their disposal. The number and prevalence of chronically undernourished people will continue to decline; by 2030 only 6% of the developing countries’ population are estimated to remain chronically undernourished (Bruinsma 2003); by then, the hunger problem should be largely limited to sub-Saharan Africa.
These averages, however, mask substantial differences both within and across countries. Where the income disparities remain high, hunger and overnutrition are likely to co-exist within the same country. The overall result would be that the double burden of malnutrition will remain unresolved.

Change in the composition of the diet

The transition has not and will not be limited to higher food energy supplies, it will also bring about a marked shift in the composition of the diet.
In this perspective the first step of the transition could be described as an ‘‘expansion’’ effect. At low income levels the additional calories come largely from cheaper foodstuffs of vegetable origin (this seems to take place regardless of cultural and religious factors, food traditions or agricultural production patterns).
The second step is largely a ‘‘substitution’’ effect and reflects a shift from carbohydrate rich staples (cereals, roots and tubers) to vegetable oils, sugar and foodstuffs of animal sources. This effect exhibits much more country-specificity and is often influenced by cultural or religious food traditions. These factors determine both the extent to which animal products substitute for vegetable products as well as the composition of animal products that enter the diet.
Growth in calories intake from animal products was particularly pronounced in East Asia in the past while sub-Saharan African countries showed no growth at all. The rapid expansion in East Asia was dominated by soaring (pig) meat consumption in China. Both China’s and India’s growth in consumption of animal products are projected to continue over the next 30 years, albeit at a somewhat slower pace.
Meat and milk consumption will continue to rise in Latin America and the Near East/North African region. The expansion in the Near East/North Africa region will be driven by higher milk, eggs and poultry consumption, while higher beef and poultry consumption will continue to dominate the expansion in Latin America.
The shift towards higher meat and milk consumption has some positive effects on health (increasing both the quantity and the quality of protein, essential minerals and vitamins).
Yet, these benefits decline rapidly as intake levels rise further and high intakes are associated with considerable risk and detrimental health effects. Increased consumption of red meat tends to increase the risk of some cancers and increased intakes of saturated fat and cholesterol from meat, dairy products and eggs increases the risk of cardiovascular diseases.
In addition, rapid urbanization has and will continue to affect both consumption patterns and energy expenditure. Urbanization creates a new and im¬proved marketing and distribution infrastructure, attracts supermarkets and their food handling systems, improves the access of foreign suppliers and promote a globaliza¬tion of dietary patterns. Particularly for the urban poor, the shift towards fast and convenience foods may also imply a shift towards a much more sugary, salty, and fatty diet (Smil, 2000). Moreover a more sedentary lifestyle associated to urban life will reduced calorie expenditures.
The adverse impacts of the rapid nutrition transition are likely to be compounded by a number of other factors that are specific to developing countries. Its adverse impacts are likely to be felt more strongly there.

The nutrition transition in developing countries

In many developed countries, the shift in consumption patterns and lifestyles has already resulted in a rapid increase in the prevalence of overweight individuals, obesity and related non-communicable diseases (NCDs). Many developing countries are in the process of a similar transition and the health impacts of this transition could be severe while the capacities to deal with adverse health impacts are more limited.
The main compounding factors of these nutritional changes are a phenotypic and genotypic predisposition towards developing obesity and NCDs. The phenotypic predisposition is exemplified by how hunger and malnutrition ‘‘programme’’ the next generation to a higher risk of obesity and related NCDs (Hales and Barker 2001). The genotypic predisposition may be important in certain population or ethnic groups which increases their risk of NCDs.
The human and economic toll could be dramatic and for many the exit out of food-poverty may be associated with a straight entry into healthpoverty. This means that, while fewer people will suffer from hunger and chronic undernourishment, more will have health problems related to being overweight, obese and NCDs.
The effects of NCDs will be felt more severely in developing countries as fewer people have access to appropriate medical treatment even if they can afford more food.
The policy messages from these developments are twofold. First, fighting hunger today and thus minimizing the phenotypic predisposition to develop obesity and NCDs should receive extra attention by national policy makers and the international community. Particularly food programmes that help improve pregnancy and pre-pregnancy nutrition should be promoted. By helping to curb a likely NCD epidemic, these programmes will yield an extra return in the future - over and above their current antihunger dividend. Second, given the speed of the nutrition transition and the higher susceptibility of consumers in developing countries towards developing obesity and NCDs, there is a need to design and devise policy measures that help avoid adverse nutritional outcomes in developing countries as soon as possible.

References

• Bruinsma, J. (Ed.) (2003). World agriculture: Towards 2015/2030, An FAO Perspective . Rome: FAO and London: Earthscan
• Smil, V. (2000). Feeding the world - a challenge for the twenty-first century. Cambridge . MA: The MIT Press.
• Hales, C. N., & Barker, D. J. P. (2001). The thrifty phenotype hypothesis. British Medical Bulletin, 60, 5-20.
• Schmidhuber, J. & Shetty, P. (2005) The nutrition transition to 2030. Why developing countries are likely to bear the major burden. Acta Agriculturae Scand Section C, 2, 150-166.