Nutrition in transition: The changing global nutrition challenge

The rapid shift in the stage of nutrition towards a pattern of degenerative disease is accelerating in the developing world. Data from China, as shown by the China Health and Nutrition Survey, between 1989 and 1993. are illus trative of these shifts. For example, an increase from 22.8 to 66.6% in the proportion of adults consuming a higher-fat diet, rapid shifts in the stru cture of dirt as income changes, and important price relationships art: exa mples that are presented. There appears to reflect a basic shift in eating preferences, induced mainly by shifts in income. prices and food availabili ty, but also by the modern food industry and the mass media. Furthermore, t he remarkable shift in the occupations structure in lower-income countries from agricultural labour towards employment in manufacturing and services i mplies a reduction in energy expenditure. One consequence of the nutrition transition has been a decline in undernutrition accompanied by a rapid incr ease in obesity. There are marked differences between urban and rural eatin g patterns, particularly regarding the consumption of food prepared away fr om home. Other issues considered are the fetal origins hypothesis, whereby the metabolic efficiencies that served well in conditions of fetal undernut rition become maladaptive with overnutrition. leading to the development of abnormal lipid profiles. altered glucose and insulin metabolism and obesit y. Furthermore, obesity and activity are closely linked with adult-onset di abetes. The shift towards a diet higher in fat and meat and lower in carboh ydrates and fibre, together with the shift towards less onerous physical ac tivity, carries unwanted nutritional and health effects. it is also clear t hat the causes of obesity must be viewed as environmental rather than perso nal or genetic.