To describe time trends in under- and overnutrition in different regional and income strata of the child and adult population of Brazil.

Nation-wide surveys conducted in 1975, 1989 and 1996/7 in probabilistic samples of 1–4-year-old children and adults 20 years and over. Time trends refer to stunting, wasting and overweight prevalences among children and age-adjusted underweight and obesity prevalences among adults (95% confidence intervals included).

Individuals examined by each survey in each age group ranged from 1796 young children in 1996 to 78 031 adults in 1975.

North-eastern and south-eastern regions of Brazil.

Undernutrition indicators declined intensively and continuously among children and adults in all region and income strata. Obesity remained low and relatively stable among children, but increased intensively and continuously in all regions and income strata among adult males. Obesity also increased intensively and continuously among adult women from the less economically developed region of Brazil (the north-eastern region) and among lower-income women from the more developed region (the south-eastern region). Higher-income women from the more developed region had a significant increase in obesity from 1975 to 1989, followed by a significant decline from 1989 to 1997.

Undernutrition in young children is being controlled in Brazil without evidence of increasing obesity. However, obesity is rapidly replacing undernutrition in most gender, region and income strata of the adult population. Adult obesity is already more frequent than adult undernutrition in the more economically developed region, among all higher-income groups, and also among lower-income women living in the more developed region. These lower-income women are significantly more exposed than their higher-income counterparts to both undernutrition and obesity.

The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico.

Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980–1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas.

SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased.

The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available.

SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.

The purpose of this study was to analyse the determinants and consequences of the nutrition transition in Chile and describe the related health promotion policies.

Design and setting: This is a descriptive, population-based study including data on demographic, diet, nutrition and biomedical related variables. Data came from the Food and Agriculture Organization (FAO), the National Institute of Statistics (INE), the Ministries of Planning, Health and Education surveillance systems, and national surveys.

As malnutrition decreased during the 1980s, obesity increased rapidly in all age groups. In adults, currently about 25% of women are obese (body mass index > 30 kgm−2); particularly those from low socio-economic levels. Among pre-schoolers, obesity is now 10% while in 6-year-old children it is 17.5% (weight/height greater than two standard deviations (>2SD) of the World Health Organization reference). Nutritional risk factors are prevalent, diet is changing to a ‘Western diet’ with an increasing fat consumption, and sedentarianism is constant in all groups. High blood pressure (>140/90) is greater than 10% in adults. Diabetes is increasing in urban areas, including in the indigenous population, and more than 40% of adults have a cholesterol level of more than 200mgml−1.

Promotion of healthy lifestyles is the main strategy to cope with this situation, particularly changing behaviour in food habits, physical activity and psychosocial factors. Changes in lifestyles will not only allow the prolonged life expectancy to be of better quality, but also will favour a decrease in the morbidity and mortality from chronic diseases, mainly cardiovascular diseases.

To describe and analyse the changes in diet, physical activity and body composition of the Cuban population during the 1990s and the health implications of these changes.

Design and setting: Data on national food balance and physical activity are from government agencies and the Ministry of Public Health; nation-wide and local representative surveys were used to analyse body composition and leisure activities. Data on morbidity and mortality arefrom the Ministry of Public Health.

The collapse of the European socialist countries and the Soviet Union, as well as the reinforced United States' blockade, provoked a sudden shortage of fuel, raw materials, imported foods and essential supplies. Per capita energy availability decreased, physical activity increased, and the prevalence of obesity decreased. Nutrition deficiencies were observed in the early 1990s, while the trend of morbidity from non-communicable disease continued to increase. The nutrition transition characteristics following the economic recovery in 1995–1996 resembled those of the 1980s because of the increased food availability, decreased physical activity and increased obesity prevalence.

Programmes to deal with the complex situation generated a response in a remarkably short time. Undesirable changes in diet composition and the reduction of physical activity constitute a challenge in the current post-critical stage that must be prevented.

To analyse the nutritional transition in Morocco.

Examination of Moroccan national survey data.

Morocco is undergoing a demographic, epidemiological and social transition. The urban population increased from 29% in 1960 to 53% in 1997. Per capita gross domestic product increased steadily from 1972 to 1999. Life expectancy at birth increased to 70 years in 1999 from 47 years in 1962. Both infant and juvenile mortalities have decreased, from 92/1000 and 69/1000 in 1982–87 to 46/1000 and 37/1000 in 1992–97, respectively. In parallel, the diet changed considerably: the intake of animal products increased while that of cereals and sugar remained relatively high, reflecting the specificity of Moroccan dietary habits. The rise in the consumption of meats and vegetables was accompanied by a steady consumption of bread, used to eat the sauce in which the meat and vegetables are cooked. Sugar is mainly used in tea, the very sweet, national drink consumed throughout the day. Under-nourishment persists among children under five (23% stunting and 10% underweight in 1997) while overweight is rising (9% in 1997 compared with 3% in 1987 for children under three). Among adults, overweight (body mass index (BMI) > 25 kgm−2) increased from 26% in 1984 to 36% in 1998. It is higher among women (32% in 1984 and 45% in 1998) than among males (19% in 1984 and 25% in 1998). It is also higher among urban populations (30% in 1984 and 40% in 1998) than rural populations (20% in 1984 and 29% in 1998). Obesity (BMI > 30 kgm−2) increased from 4% in 1984 to 10% in 1998. Overweight seems to be positively associated with economic status but negatively with education level.

Overweight and obesity constitute major health problems in Morocco.

To describe changing food consumption patterns in Egypt over the last several decades, current levels of overweight and obesity, and current data on obesity-related morbidity.

Secondary analysis and synthesis of existing data from national-level food consumption surveys, large recent surveys of hypertension and diabetes, and documentation of historical and policy context.

Arab Republic of Egypt.

As selected and described in primary data sources.

Results and conclusions: The nutrition transition in Egypt has occured in the context of abundant dietary energy availability, urbanisation and moderate fat intakes. The prevalence of obesity in adults is very high, particularly among women. The prevalences of diabetes mellitus and of hypertension parallel that of obesity, and both are very high. Little information is available on physical activity, but it is likely that a large proportion of the population is quite sedentary, particularly in the cities. At the same time, rates of early childhood malnutrition remain stubbornly stable and relatively high. Public awareness of the increasing prevalence of obesity and of diet-related chronic disease is increasing, and attention has turned to documenting the problem(s).

To describe the emergence of the nutrition transition, and associated morbidity shifts, in the Islamic Republic of Iran.

Review and analysis of secondary data relating to the socio-political and nutritional context, demographic trends, food utilisation and consumption patterns, obesity, and diet-related morbidity.

The nutrition transition in Iran is occurring rapidly, secondary to the rapid change in fertility and mortality patterns and to urbanisation. The transition is occurring against the backdrop of lack of sustained economicgrowth. There is considerable imbalance in food consumption with low nutrient density characterising diets at all income levels, over-consumption evident among more than a third of households, and food insecurity among 20% of the population. Obesity is an emerging problem, particularly in urban areas and for women, and both diabetes and other risk factors for heart disease are becoming significant problems.

To review data on selected risk factors related to the emergence of non communicable diseases (NCDs) in the black population of South Africa.

Data from existing literature on South African blacks were reviewed with an emphasis placed on changes in diet and the emergence of obesity and related NCDs.

Review and analysis of secondary data over time relating to diet, physical activity and obesity and relevant to nutrition-related NCDs.

Urban, peri-urban and rural areas of South Africa. National prevalence data are also included.

Black adults over the age of 15 years were examined.

Shifts in dietary intake, to a less prudent pattern, are occurring with apparent increasing momentum, particularly among blacks, who constitute three-quarters of the population. Data have shown that among urban blacks, fat intakes have increased from 16.4% to 26.2% of total energy (a relative increase of 59.7%), while carbohydrate intakes have decreased from 69.3% to 61.7% of total energy (a relative decrease of 10.9%) in the past 50 years. Shifts towards the Western diet are apparent among rural African dwellers as well. The South African Demographic and Health Survey conducted in 1998 revealed that 31.8% of African women (over the age of 15 years) were obese (body mass index (BMI) ≥ 30 kgm−2) and that a further 26.7% were overweight (BMI ≥ 25 to <30 kgm−2). The obesity prevalence among men of the same age was 6.0%, with 19.4% being overweight. The national prevalence of hypertension in blacks was 24.4%, using the cut-off point of 140/90 mmHg. There are limited data on the population's physical activity patterns. However, the effects of the HIV/AIDS epidemic will become increasingly important.

The increasing emergence of NCDs in black South Africans, compounded by the HIV/AIDS pandemic, presents a complex picture for health workers and policy makers. Increasing emphasis needs to be placed on healthy lifestyles.

The purpose of this paper is to describe social and economic changes related to shifts in diet and activity and to present prevalences for chronic diseases associated with the nutrition transition.

Observations about social changes are descriptive, based on published reports and personal observations. Prevalence and trends data are based on a Ministry of Health published report and, for infants and toddlers, on primary data.

Disease prevalences for diabetes mellitus and hypertension are taken from four sites, representing underdeveloped, semi-developed and well-developed rural communities and Dar es Salaam, the largest city in Tanzania. The prevalences of underweight and overweight for infants and toddlers are taken from a small periurban clinic in Tanzania.

Adults over 15 years of age are included in the prevalence data for chronic disease. The urban sample is stratified by occupation and ethnicity. The data for infants and toddlers include newborns to those aged 23 months.

An increase in the prevalence of diabetes and hypertension was observed. Simultaneously, there have been rapid changes in diet and physical activity related to urbanisation and modernisation. The highest prevalences for diabetes and hypertension were among high-ranking executives.

The increase in chronic disease could be related to the rise in the number of high-ranking executives. Simultaneously, per capita income has gone down, and malnutrition prevalence has risen. Programmes are being developed to simultaneously monitor trends in overweight while preventing protein-energy malnutrition and micronutrient deficiency.

To fully explore the long-term shifts in the nutrition transition and the full implications of these changes in the Chinese diet.

A descriptive, population-based study.

Data come from nationally representative surveys: the China Health and Nutrition Survey (1989–1997), the China National Nutrition Survey (1982 and 1992), the annual household consumption surveys of the State Statistical Bureau, and the Annual Death Report of China.

During the first part of the major economic transformation in China (before 1985), cereal intake increased but decreased thereafter. There was also a long-term reduction of vegetable consumption that has now stabilised. Intake of animal foods increased slowly before 1979 and more quickly after the economic reforms occurred. While the total energy intake of residents has decreased, as has energy expenditure, large changes in the composition of energy have occurred. The overall proportion of energy from fat increased quickly, reaching an overall average of 27.3% and 32.8% for urban residents in 1997. Over a third of all Chinese adults and 60.1% of those in urban areas consumed over 30% of their energy from fat in 1997. Large shifts towards increased inactivity at work and leisure occurred. These changes are linked with rapid increases of overweight, obesity and diet-related non-communicable diseases (DRNCDs) as well as total mortality for urban residents.

The long-term trend is a shift towards a high-fat, high-energy-density and low-fibre diet. The Chinese have entered a new stage of the nutrition transition.

The primary objective of this review is to examine the demographic and nutrition transition in India in relation to its contribution to the emerging epidemic of chronic non-communicable diseases in this country.

India, the country as a whole and its different states with a population exceeding 1 billion in 2001.

The review examines demographic changes in the population with consequent effects on the population pyramid, the rapidity and rates of urbanisation with striking variations in chronic disease patterns and the trends in obesity between rural and urban communities, attempting to relate their prevalence with the diet and lifestyle changes accompanying them.

The review is based largely on representative large-scale surveys in the country and other reliable documented data on population characteristics. It also includes a review of the published literature.

The results indicate that the demographic changes, rates of urbanisation and changes in dietary patterns are contributing to the changing trends in chronic disease in India.

There is clear evidence of a demographic, epidemiological and nutrition transition in India that is fuelling the epidemic of chronic diseases and obesity, particularly in the urban areas.

To explore and describe the nutrition and health transition in Thailand in relation to social and economic changes, shifts in food consumption patterns and nutritional problems, as well as morbidity and mortality trends.

This report reviews the nutrition and health situation and other related issues by compiling information from various reports and publications from several sources. Yearly statistics and reports from the National Statistical Office were used as well as data from the Food and Agriculture Organization (FAO) and national surveys on the nutrition and health situation of the Thai population.

Thailand has undergone social and economic transitions during the past three decades and is approaching the post-demographic transitional period. These are evidenced by an increase in life expectancy at birth of the population, and declines in the total fertility and infant mortality rates. The economic structure has also moved from agricultural to industrial. Industrial growth has surpassed that of the agricultural sector as indicated by a steady rise in the share of the industrial sector in the gross domestic product, which is greater than that of other sectors. At the same time, results from several nation-wide surveys indicate that the food consumption pattern of the population has changed considerably; Thai staples and side dishes are being replaced by diets containing a higher proportion of fats and animal meat. A shift in the proportion of expenditure on food prepared at home and that expended on purchased, ready-to-eat food, in both rural and urban settings, gives another reflection of the change in food consumption of the Thai population. The prevalence of overweight and obesity among children and adolescents has increased dramatically during the past 20 years and is more pronounced in children from private schools and urban communities than in those from public schools or rural areas. Among adults, results from two national surveys in 1991 and 1996 indicated that the problem of overweight and other risk factors for cardiovascular disease have increased significantly. In considering the overall causes of death among the Thai population, the leading causes are diet-related chronic degenerative diseases. Diseases of the circulatory system have become the number one cause of death in Thailand and cancer has ranked as the number three cause of death since the late 1980s.

The rapid changes in food intake and lifestyle patterns in Thailand clearly demonstrate a significant impact on the shifting pattern of disease burden of the population. These changes should be monitored carefully and must be reversed through appropriate behaviour modification and the promotion of appropriate eating practices and physical activities.

The purposes of this paper are to describe the unique aspects of the nutrition transition in South Korea, including trends in food consumption and obesity, patterns of morbidity and mortality; to focus on efforts to maintain the traditional diet in the midst of rapid economic growth and the introduction of Western culture; and to provide insights for other countries.

We analysed secondary dietary intake, anthropometric, morbidity and mortality datafrom published reports and articles.

In South Korea, the level and rate of increase in fat intake have remained very low, whereas vegetable intake has been high and fruit intake has increased greatly. South Kore also has a relatively low prevalence of obesity compared with other Asian countries. The traditional Korean diet is a low-fat and high-vegetable diet. Therefore, the government and nutrition specialists have been initiating numerous efforts to advertise and teach the public that the traditional diet is a healthy diet. They are also working on revival of the traditional dietusing an approach that is acceptable to contemporary Koreans.

The nutrition transition in South Korea is unique. A range of government, nutrition specialists and some private organisation efforts has worked to retain healthful elements of the traditional diet in South Korea. The continued low level of total fat in the overalldiet and the high intake of fruits and vegetables bode well for South Korea.

This paper explores the unique nutrition transition shifts in diet and activity patterns from the period termed the receding famine pattern to the one dominated by nutrition-related non-communicable diseases (NR-NCDs). The paper examines the speed and timing of these changes; unique components, such as the issue of finding both under- and overnutrition in the same household; potential exacerbating biological relationships that contribute to differences in the rates of changes; and political issues.

The focus is on lower-and middle-income countries of Asia, Africa, the Middle East and Latin America.

These changes are occurring at great speed and at earlier stages of these countries economic and social development. There are some unique issues that relate to body composition and potential genetic factors. The significance of the high number of persons exposed to heavy insults during pregnancy and infancy (foetalorigins hypothesis) and the subsequent rapid shifts in energy imbalance remains to be understood. Countries that are still addressing major concerns of undernutrition are not ready to address these NR-NCDs.

The developing world needs to give far greater emphasis to addressing the prevention of the adverse health consequences of this shift to the nutrition transition stage of degenerative diseases.

The goal of this paper is to explore the hypothesis that the nutrition transition is related to households having an underweight and an overweight member simultaneously (under/over households and under/over pairs).

The 1993 China Health and Nutrition Survey (CHNS) was used to test the association between being an under/over household and household characteristics related to the nutrition transition. Sociodemographic and diet patterns were tested for the main age combination of the under/over pairs.

In China, 8.1% of all households were found to have underweight and overweight members within the same household.

Results are from the 1993 China Health and Nutrition Survey and are based on a sample of 13814 persons from 3340 households.

The under/over household was more urban, had a higher income and was more likely to have assets such as a television, a motor vehicle and a washing machine, even after controlling for sociodemographic confounders. The under/over household had a diet that was higher in fat and protein compared with the underweight and normal weight households. There were no significant differences between the under/over and overweight households, with many of the associations near unity. Comparisions of the under/over subgroups by age of the under/over pairs showed some differences by income and occupation, but not for diet.

It is imperative, as more individuals become exposed to the diet and lifestyle patterns of the nutrition transition, to find effective public health programmes that can simultaneously promote a healthy lifestyle, improve diet quality and address both undernutrition and chronic disease.

Trends in the nutritional status for developing countries that are undergoing rapid economic growth indicate a decrease in protein-energy malnutrition (PEM) with an associated rise in obesity prevalence.

This paper analyses how supplementary feeding programmes may contribute to rising obesity trends, what factors may explain this phenomenon, and potential strategies to avoid obesity in malnutrition prevention efforts.

Design and setting: This is a descriptive study of changes in nutritional status of infants and young children in Chile and the possible impact of supplementary feeding programmes on the rise in prevalence of obesity. We explored the changes in anthropometric indices before and after receiving food programme benefits and the use of targeting strategies as a way to combine the need to promote optimal growth while preventing obesity.

Evaluation of the change in nutritional status from participants in Chilean supplementary feeding programmes has shown that targeting strategies have been inadequate as children mainly modify their weight-for-age and weight-for-height, while their length-for-age remains practically unchanged.

Monitoring length-for-age as well as weight-for-length is necessary to permit the identification of stunted overweight and obese children, as they should not be given excess energy. Energy supplementation should be adjusted according to activity level, securing adequate micronutrient density. PEM prevention programmes need periodic evaluation, including targeting of beneficiaries, definition of real needs and possible effect on obesity.

To review the available data on risk factors for cardiovascular disease (CVD), the influence of urbanisation of Africans on these risk factors, and to examine why stroke emerges as a higher risk than ischaemic heart disease (IHD) in the health transition of black South Africans.

A review of published data on mortality from and risk factors of CVD in South Africans.

South Africa.

South African population groups and communities.

The available data on the contribution of stroke and IHD to CVD mortality in South Africa are briefly reviewed, followed by a comparison of published data on the prevalence and/or levels of CVD risk factors in the different South African population groups. The impact of urbanisation of black South Africans on these risk factors is assessed by comparing rural and urban Africans who participated in the Transition and Health during Urbanisation of South Africans (THUSA) study.

Results and conclusions: The mortality rates from CVD confirmed that stroke is a major public health problem amongst black South Africans, possibly because of an increase in hypertension, obesity, smoking habit and hyperfibrinogenaemia during various stages of urbanisation. The available data further suggest that black South Africans may be protected against IHD because of favourable serum lipid profiles (low cholesterol and high ratios of high-density lipoprotein cholesterol) and low homocysteine values. However, increases in total fat and animal protein intake of affluent black South Africans, who can afford Western diets, are associated with increases in body mass indices of men and women and in total serum cholesterol. These exposures may increase IHD risk in the future.