Skip to main content

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

  • Barry M Popkin (a1)

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The nutrition transition and its health implications in lower-income countries
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      The nutrition transition and its health implications in lower-income countries
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      The nutrition transition and its health implications in lower-income countries
      Available formats
Corresponding author
*Corresponding author: E-mail POPKIN@UNC.EDU
Hide All
1Popkin BM. Nutritional patterns and transitions. Popul. Devel. Rev. 1993; 19: 138–57.
2Popkin BM. The nutrition transition in low-income countries, an emerging crises. Nutr. Rev. 1994; 52: 285–98.
3Omran AR. The epidemiologic transition, a theory of the epidemiology of population change. Milbank Mem. Fund Q. 1971; 49: 509–38.
4Webster's Third New International Dictionary of the English Language Unabridged: Encyclopedia Britannica Series. Chicago: Benton & G C Merriam, 1966.
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.
6FAOSTAT.PC. Food Balance Sheets 1961–94. Rome: Food and Agriculture Organization of the United Nations, 1996.
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.
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.
9Popkin BM, Bisgrove EZ. Urbanization and nutrition in low-income countries. Food Nutr. Bull. 1988; 10: 323.
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.
11Churchill AA. Shelter, Poverty and Basic Needs Series. Washington, DC: World Bank, 1980.
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.
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.
14Toor M, Katchalsky A, Agmon J, Allalouf D. Serum-lipid and atherosclerosis among Yemenite immigrants in Israel. Lancet 1957; 1: 1270–3.
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.
16Popkin BM, Udry JR. Adolescent obesity in the United States: the national longitudinal study of adolescent health. J. Nutr. 1998; 128.
17Barker DJP. Fetal and Infant Origins of Adult Disease. London: British Medical Journal, 1992.
18Barker DJP. Mothers, Babies and Disease in Later Life. London: BMJ Publishing, 1994.
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.
20Herrin AN. Rural electrification and fertility change in the Southern Philippines. Popul. Dev. Rev. 1979; 5: 6186.
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.
22Bisgrove EZ, Popkin BM. Does women's work improve their nutrition: evidence from the urban Philippines. Soc. Sci. Med. 1996; 43: 1475–88.
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.
24Ma H, Popkin BM. Income and food consumption behavior in China: a structural shift analysis. Food Nutr. Bull. 1995; 16: 155–65.
25Drewnowski A, Popkin BM. The nutrition transition: new trends in the global diet. Nutr. Rev. 1997; 55: 3143.
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.
27Timmer CP, Falcon WP, Pearson SR, Food Policy Analysis. Baltimore: Johns Hopkins University Press, 1984.
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.
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.
30Sobal J, Stunkard A. Socioeconomic status and obesity: a review of the literature. Psychol. Bull. 1989; 105: 260–75.
31Briscoe , Brazil J.. The new Challenge of Audit Health. A World Bank Country Study. Washington, DC: the World Bank, 1990.
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.
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.
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.
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.
36Monteiro CA, Mondini L, de Souza ALM, Popkin BM. The nutrition transition in Brazil. Eur. J. Clin. Nutr. 1995; 49: 105–13.
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.
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.
39Bjorntorp P. Visceral obesity: a ‘civilization syndrome’. Obesity Res. 1993; 1: 206–22.
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.
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.
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.
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.
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.
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.
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.
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.
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.
49Beaglehole R. Cardiovascular disease in developing countries: an epidemic that can be prevented. Br. Med. J. 1992; 305: 1170–1.
50Byers T, Marshall J. The emergence of chronic diseases in developing countries. SCN News 1995; 13; 1419.
51Zimmet PZ. Kelly West Lecture. Challenges in diabetes epidemiology – from west to the rest. Diabetes Care 1991; 15: 232–52.
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.
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.
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.
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.
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.
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.
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.
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.
60Milio N. Nutrition policy for Food-Rich Countries: a Strategic Analysis. Baltimore: the Johns Hopkins University Press, 1990.
61Milio N. Nutrition and health: patterns and policy perspectives in food-rich countries. Soc. Sci. Med. 1989; 29: 413–23.
62Milio N. Toward healthy longevity: lessons in food and nutrition policy development from Finland and Norway. Scand. J. Soc. Med. 1991; 19: 209–17.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 11
Total number of PDF views: 1233 *
Loading metrics...

Abstract views

Total abstract views: 1466 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.