Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-20T05:40:21.400Z Has data issue: false hasContentIssue false

The nutrition transition and its health implications in lower-income countries

Published online by Cambridge University Press:  01 March 1998

Barry M Popkin*
Department of Nutrition, University of North Carolina at Chapel Hill, North Carolina, USA
*Corresponding author: E-mail POPKIN@UNC.EDU
Rights & Permissions [Opens in a new window]


Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition.

Design and Setting:

Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992–96 and the nationwide China Health and Nutrition Survey from 1989–93 are examined in detail.


Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted.


The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

Research Article
Copyright © The Nutrition Society 1998


1Popkin, BM. Nutritional patterns and transitions. Popul. Devel. Rev. 1993; 19: 138–57.CrossRefGoogle Scholar
2Popkin, BM. The nutrition transition in low-income countries, an emerging crises. Nutr. Rev. 1994; 52: 285–98.CrossRefGoogle Scholar
3Omran, AR. The epidemiologic transition, a theory of the epidemiology of population change. Milbank Mem. Fund Q. 1971; 49: 509–38.CrossRefGoogle ScholarPubMed
4Webster's Third New International Dictionary of the English Language Unabridged: Encyclopedia Britannica Series. Chicago: Benton & G C Merriam, 1966.Google Scholar
5Popkin, BM, Ge, K, Zhai, F, Guo, X, Ma, H, Zohoori, N. The nutrition transition in China: a cross-sectional analysis. Eur. J. Clin. Nutr. 1993; 47: 333–46.Google Scholar
6FAOSTAT.PC. Food Balance Sheets 1961–94. Rome: Food and Agriculture Organization of the United Nations, 1996.Google Scholar
7WHO Expert Committee. Physical Status: the Use and Interpretation of Anthropometry: Report of a WHO Export Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995.Google Scholar
8Haines, PS, Hungerford, DW, Popkin, BM, Guilkey, DK. Eating patterns and energy and nutrient intakes of US women. J. Am. Diet. Assoc. 1992; 92: 698704, 707.CrossRefGoogle ScholarPubMed
9Popkin, BM, Bisgrove, EZ. Urbanization and nutrition in low-income countries. Food Nutr. Bull. 1988; 10: 323.CrossRefGoogle Scholar
10United Nations, Department for Economic and Social Information and Policy Analysis, Population Division. World Urbanization Prospects: the 1994 Revision: Estimates and Projections of Urban and Rural Populations and of Urban Agglomerations. New York: Population Division, Department for Economic and Social Information and Policy Analysis, United Nations, 1995.Google Scholar
11Churchill, AA. Shelter, Poverty and Basic Needs Series. Washington, DC: World Bank, 1980.Google Scholar
12Marmot, MG, Syme, SL, Kagan, A, Hiroo, K, Rhoads, G. Epidemiologic studies of CHD and stroke in Japanese men living in Japan, Hawaii, and California: prevalence of coronary and hypertensive heart disease and associated risk factors. Am. J. Epidemiol. 1975; 102: 514–25.CrossRefGoogle ScholarPubMed
13Prior, I, Tasman-Jones, C. New Zealand Maori and Pacific Polynesians. In: Trowell, HC, Burkitt, DP, eds. Western Diseases: Their Emergence and Prevention. Cambridge, MA: Harvard University Press, 1981.Google Scholar
14Toor, M, Katchalsky, A, Agmon, J, Allalouf, D. Serum-lipid and atherosclerosis among Yemenite immigrants in Israel. Lancet 1957; 1: 1270–3.CrossRefGoogle Scholar
15Worth, RM, Kato, H, Rhoads, GG, Kagan, K, Syme, SL. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: mortality. AM. J. Epidemiol. 1975; 102: 481–90.CrossRefGoogle ScholarPubMed
16Popkin, BM, Udry, JR. Adolescent obesity in the United States: the national longitudinal study of adolescent health. J. Nutr. 1998; 128.CrossRefGoogle ScholarPubMed
17Barker, DJP. Fetal and Infant Origins of Adult Disease. London: British Medical Journal, 1992.Google Scholar
18Barker, DJP. Mothers, Babies and Disease in Later Life. London: BMJ Publishing, 1994.Google Scholar
19Popkin, BM, Pacratakul, S, Zhai, F, Ge, K. Dietary and environmental correlates of obesity in a population study in China. Obesity Res. 1995; 3: 135S–43S.CrossRefGoogle Scholar
20Herrin, AN. Rural electrification and fertility change in the Southern Philippines. Popul. Dev. Rev. 1979; 5: 6186.CrossRefGoogle Scholar
21Bisgrove, EZ. Work and income as determinants of urban Filipino women's nutrient intake from commercially prepared and home prepared food. PhD dissertation, Chapel Hill, University of North Carolina, 1991.Google Scholar
22Bisgrove, EZ, Popkin, BM. Does women's work improve their nutrition: evidence from the urban Philippines. Soc. Sci. Med. 1996; 43: 1475–88.CrossRefGoogle ScholarPubMed
23Chen, CM. Dietary Guidelines for food and agriculture planning in China. In: Proceedings of International Symposium on Food Nutrition and Social Economic Development. Beijing: Chinese Academy of Preventive Medicine. 1991: 40–8.Google Scholar
24Ma, H, Popkin, BM. Income and food consumption behavior in China: a structural shift analysis. Food Nutr. Bull. 1995; 16: 155–65.CrossRefGoogle Scholar
25Drewnowski, A, Popkin, BM. The nutrition transition: new trends in the global diet. Nutr. Rev. 1997; 55: 3143.CrossRefGoogle ScholarPubMed
26Chaudri, R, Timmer, CP. The Impact of Changing Affluence on Diet and Demand Patterns for Agricultural Commodities. World Bank Staff Working Papers 785. Washington, DC: World Bank, 1986.Google Scholar
27Timmer, CP, Falcon, WP, Pearson, SR, Food Policy Analysis. Baltimore: Johns Hopkins University Press, 1984.Google Scholar
28Mincer, J. Market prices, opportunity costs, and income effects. In: Christ, CF, Friedman, M, Goodman, La, et al. , eds. Measurement in Economics. Stanford, CA: Stanford University Press, 1963.Google Scholar
29Brunner, EJ, Marmot, MG, White, IR, et al. Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II study. Atherosclerosis 1993; 102: 195207.CrossRefGoogle ScholarPubMed
30Sobal, J, Stunkard, A. Socioeconomic status and obesity: a review of the literature. Psychol. Bull. 1989; 105: 260–75.CrossRefGoogle ScholarPubMed
31Briscoe, , Brazil, J.. The new Challenge of Audit Health. A World Bank Country Study. Washington, DC: the World Bank, 1990.Google Scholar
32Duncan, BB, Schmidt, MI, Achutti, AC, Polanczyk, CA, Benia, LB, Maia, AAG. Socioeconomic distribution of noncommunicable disease risk factors in urban Brazil: the case of Porto Alegre. Bull. PAHO 1993; 27: 337–49.Google ScholarPubMed
33Levitt, NS, Katzenellenbogen, JM, Bradshaw, D, Hoffman, MN, Bonnici, F. The prevalence and identification of risk factors for NIDDIM in urban Africans in Cape Town, South Africa Diabetes Care 1993; 16: 601–7.CrossRefGoogle Scholar
34Bourne, LT, Langenhoven, ML, Steyn, K, Jooste, PL, Laubscher, JA, Van Der Vyver, E. Nutrient intake in the urban African population of the Cape Peninsula, South Africa: the BRISK Study. Cent. Afr. Med. J. 1993; 39: 238–47.Google ScholarPubMed
35Bourne, LT, Langenhoven, MT, Steyn, K, Jooste, PL, Nesamvuni, AE, Launscher, JA. The food and meal pattern in the urban African population of the Cape Peninsula, South Africa: the BRISK Study. Cent. Afr. Med. J. 1994; 40: 140–8.Google ScholarPubMed
36Monteiro, CA, Mondini, L, de Souza, ALM, Popkin, BM. The nutrition transition in Brazil. Eur. J. Clin. Nutr. 1995; 49: 105–13.Google ScholarPubMed
37Monteiro, CA, Benicio, MHD'A, Iunes, RF, Gouveia, NC, Taddei, JAAC, Cardoso, MAA. Nutritional status of Brazilian children: trends from 1975 to 1989. Bull. WHO 1992; 70: 657–66.Google ScholarPubMed
38Monteiro, CA. The Changing Nature of Nutritional Disorders in the Developing Countries: the Case of Brazil. Proceedings of the International Congress of Nutrition. Montreal: Canadian Federation of Biological Sciences, forthcoming.Google Scholar
39Bjorntorp, P. Visceral obesity: a ‘civilization syndrome’. Obesity Res. 1993; 1: 206–22.CrossRefGoogle ScholarPubMed
40Popkin, BM, Richards, MK, Monteiro, CA. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J. Nutr. 1996; 126: 3009–16.CrossRefGoogle ScholarPubMed
41Popkin, BM, Richards, MK, Adair, LS. Stunting is associated with child obesity: dynamic relationships, In: Johnston, FE, Zemel, BS, Eveleth, PB, eds. Human Growth and Development, 1998: Proceedings of the Eighth International Congress of Auxology Philadelphia: Smith-Gordon, forthcoming.Google Scholar
42Forrester, T, Wilks, R, Bennett, F, et al. Obesity in the Caribbean. In: Chadwick, DJ, Cardew, G, eds. The Origins and Consequences of Obesity. Ciba Foundation Symposium 201. Chichester, Wiley, 1996: 1731.Google Scholar
43Popkin, BM. The obesity epidemic is a worldwide phenomenon: trends in transitional societies. Unpublished manuscript, Carolina Population Center, the University of North Carolina at Chapel Hill, 1997.Google Scholar
44Ge, K, Weisell, R, Guo, X, et al. The body mass index of Chinese adults in the 1980s. Eur. J. Clin. Nutr. 1994; 48: S148S154.Google ScholarPubMed
45United Nations Administrative Committee on Coordination, Subcommittee on Nutrition. Update on the Nutrition Situation 1996: Summary of Results for the Third Report on the World Nutrition Situation. Geneva: ACC/SCN, 1996.Google Scholar
46Hodge, AM, Dowse, GK, Gareeboo, H, Tuomilehto, J, Alberti, KGMM, Zimmet, PZ. Incidence, increasing prevalence, and predictors of change in obesity and fat distribution over 5 years in the rapidly developing population of Mauritius. Int. J. Obesity 1996; 20: 137–46.Google ScholarPubMed
47Hodge, AM, Dowse, GK, Toelupe, P, Collins, VR, Zimmet, PZ. The association of modernization with dyslipidaemia and changes in lipid levels in the Polynesian population of Western Samoa. Int. J. Epidemiol. 1997; 26: 297306.CrossRefGoogle ScholarPubMed
48World Cancer Research Fund in association with American Institute for Cancer Research. Food, Nutrition and the Prevention of Cancer: a Global Perspective. Washington, DC: American Institute for Cancer Research, 1997.Google Scholar
49Beaglehole, R. Cardiovascular disease in developing countries: an epidemic that can be prevented. Br. Med. J. 1992; 305: 1170–1.CrossRefGoogle Scholar
50Byers, T, Marshall, J. The emergence of chronic diseases in developing countries. SCN News 1995; 13; 1419.Google Scholar
51Zimmet, PZ. Kelly West Lecture. Challenges in diabetes epidemiology – from west to the rest. Diabetes Care 1991; 15: 232–52.CrossRefGoogle Scholar
52Zimmet, PZ, McCarty, DJ, de Courten, MP. The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome. J. Diabet. Comp. 1997; 11; 60–8.CrossRefGoogle ScholarPubMed
53Valdez, R, Athens, MA, Thompson, GH, Bradshaw, BS, Stern, MP. Birthweight and adult health outcomes in a biethnic population in the USA. Diabetologia 1994; 37: 624.CrossRefGoogle Scholar
54Ford, ES, Williamson, DF, Liu, S. Weight change and diabetes incidence: findings from a national cohort of US adults. Am. J. Epidemiol. 1997; 146: 214–22.CrossRefGoogle ScholarPubMed
55O'Dea, K, Patel, M, Kubisch, D, Hopper, J, Traianedes, K. Obesity, diabetes, and hyperlipidemia in a Central Australian Aboriginal community with a long history of acculturation. Diabetes Care 1993; 16: 1004–10.CrossRefGoogle Scholar
56Galanis, DJ, Sobal, J, McGarvey, ST, Pelletier, DL, Bausserman, L. Ten-year changes in the obesity, abdominal adiposity, and serum lipoprotein cholesterol measures of western Samoan men. J. Clin. Epidemiol. 1995; 48: 1485–93.CrossRefGoogle ScholarPubMed
57Chadha, SL, Radhakrishnan, S, Kaul, U, Gopinath, N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J. Med. Res. 1990; 92: 424–30.Google ScholarPubMed
58INCLEN Multicentre Collaborative Group. Risk factors for cardiovascular disease in the developing world. A multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN). J. Clin. Epidemiol. 1992; 45: 841–7.CrossRefGoogle Scholar
59Steyn, K, Jooste, PL, Bourne, LT, et al. Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study. S. Afr. Med. J. 1991; 79: 480–5.Google ScholarPubMed
60Milio, N. Nutrition policy for Food-Rich Countries: a Strategic Analysis. Baltimore: the Johns Hopkins University Press, 1990.Google Scholar
61Milio, N. Nutrition and health: patterns and policy perspectives in food-rich countries. Soc. Sci. Med. 1989; 29: 413–23.CrossRefGoogle ScholarPubMed
62Milio, N. Toward healthy longevity: lessons in food and nutrition policy development from Finland and Norway. Scand. J. Soc. Med. 1991; 19: 209–17.CrossRefGoogle ScholarPubMed