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The global nutrition transition: trends, disease burdens and policy interventions

  • Rimante Ronto (a1), Jason HY Wu (a2) and Gitanjali M Singh (a3)

Non-communicable diseases (NCD) have increased dramatically in developed and developing countries. Unhealthy diet is one of the major factors contributing to NCD development. Recent evidence has identified deterioration in aspects of dietary quality across many world regions, including low- and middle-income countries (LMIC). Most burdens of disease attributable to poor diet can be prevented or delayed as they occur prematurely. Therefore, it is important to identify and target unhealthy dietary behaviours in order to have the greatest impact. National dietary-related programmes have traditionally focused on micronutrient deficiency and food security and failed to acknowledge unhealthy dietary intakes as a risk factor that contributes to the development of NCD. Inadequate intakes of healthy foods and nutrients and excess intakes of unhealthy ones are commonly observed across the world, and efforts to reduce the double burden of micronutrient deficiency and unhealthy diets should be a particular focus for LMIC. Interventions and policies targeting whole populations are likely to be the most effective and sustainable, and should be prioritized. Population-based approaches such as health information and communication campaigns, fiscal measures such as taxes on sugar-sweetened beverages, direct restrictions and mandates, reformulation and improving the nutrient profile of food products, and standards regulating marketing to children can have significant and large impacts to improve diets and reduce the incidence of NCD. There is a need for more countries to implement population-based effective approaches to improve current diets.

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1. World Health Organization (2014) Global Status Report on Noncommunicable Diseases 2014. (accessed July 2017).
2. Islam, SMS, Purnat, TD, Phuong, NTA et al. (2014) Non‐communicable diseases (NCDs) in developing countries: a symposium report. Global Health 10, 81.
3. Popkin, BM, Adair, LS & Ng, SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70, 321.
4. Danaei, G, Singh, GM, Paciorek, CJ et al. (2013) The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation 127, 14931502.
5. Imamura, F, Micha, R, Khatibzadeh, S et al. (2015) Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. Lancet Glob Health 3, e132e142.
6. Darmon, N & Drewnowski, A (2015) Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 73, 643660.
7. Wang, DD, Leung, CW, Li, Y et al. (2014) Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med 174, 15871595.
8. Micha, R, Khatibzadeh, S, Shi, P et al. (2014) Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ 348, g2272.
9. Dietary Guidelines Advisory Committee (2010) 2010 Dietary Guidelines for Americans. (accessed July 2017).
10. European Food Safety Authority (2017) Dietary Reference Values for Nutrients: Summary Report. EFSA Supporting Publication 2017:e15121. Parma: EFSA.
11. Powles, J, Fahimi, S, Micha, R et al. (2013) Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 3, e003733.
12. World Health Organization (2015) Guideline: Sugars Intake for Adults and Children. Geneva: WHO; available at
13. Singh, GM, Micha, R, Khatibzadeh, S et al. (2015) Global, regional, and national consumption of sugar-sweetened beverages, fruit juices, and milk: a systematic assessment of beverage intake in 187 countries. PLoS One 10, e0124845.
14. Micha, R, Khatibzadeh, S, Shi, P et al. (2015) Global, regional and national consumption of major food groups in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys worldwide. BMJ Open 5, e008705.
15. Lim, SS, Vos, T, Flaxman, AD et al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 22242260.
16. Singh, GM, Micha, R, Khatibzadeh, S et al. (2015) Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation 132, 639666.
17. He, FJ, Li, J & MacGregor, GA (2013) Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ 346, f1325.
18. Mozaffarian, D, Fahimi, S, Singh, GM et al. (2014) Global sodium consumption and death from cardiovascular causes. N Engl J Med 371, 624634.
19. Lozano, R, Naghavi, M, Foreman, K et al. (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 20952128.
20. Malik, K (2017) Sugar sweetened benerages and cardiometabolic health. Curr Opin Cardiol 32, 572579.
21. Wang, Q, Afshin, A, Yakoob, MY et al. (2016) Impact of nonoptimal intakes of saturated, polyunsaturated, and trans fat on global burdens of coronary heart disease. J Am Heart Assoc 5, e002891.
22. Mozaffarian, D & Wu, JH (2011) Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 58, 20472067.
23. Kim, Y, Keogh, JB & Clifton, PM (2017) Benefits of nut consumption on insulin resistance and cardiovascular risk factors: multiple potential mechanisms of action. Nutrients 9, E1271.
24. Afshin, A, Micha, R, Khatibzadeh, S et al. (2015) The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis. BMJ Open 5, e006385.
25. Yakoob, MY, Micha, R, Khatibzadeh, S et al. (2016) Impact of dietary and metabolic risk factors on cardiovascular and diabetes mortality in South Asia: analysis from the 2010 global burden of disease study. Am J Public Health 106, 21132125.
26. Gaziano, TA, Bitton, A, Anand, S et al. (2010) Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol 35, 72115.
27. Crino, M, Herrera, AMM, Ananthapavan, J et al. (2017) Modelled cost-effectiveness of a package size cap and a kilojoule reduction intervention to reduce energy intake from sugar-sweetened beverages in Australia. Nutrients 9, E983.
28. Webb, M, Fahimi, S, Singh, GM et al. (2017) Cost effectiveness of a government supported policy strategy to decrease sodium intake: glabal analysis across 183 nations. BMJ 356, i6699.
29. Cecchini, M, Sassi, F, Lauer, JA et al. (2010) Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet 376, 17751784.
30. Claro, RM, Levy, RB, Popkin, BM et al. (2012) Sugar-sweetened beverage taxes in Brazil. Am J Public Health 102, 178183.
31. Escobar, MAC, Veerman, JL, Tollman, SM et al. (2013) Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health 13, 1072.
32. Jensen, JD & Smed, S (2013) The Danish tax on saturated fat – short run effects on consumption, substitution patterns and consumer prices of fats. Food Policy 42, 1831.
33. Mytton, OT, Clarke, D & Rayner, M (2012) Taxing unhealthy food and drinks to improve health. BMJ 344, e2931.
34. Lachat, C, Otchere, S, Roberfroid, D et al. (2013) Diet and physical activity for the prevention of noncommunicable diseases in low-and middle-income countries: a systematic policy review. PLoS Med 10, e1001465.
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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
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