Nutrition transition in Zambia: Changing food supply, food prices, household consumption, diet and nutrition outcomes

Abstract

The nutrition transition literature has generally drawn on epidemiologic and demographic changes to make its argument, because in many cases broader data are not available on the drivers of nutrition change. Going further, this paper draws on wider food systems literature, and includes food price and expenditure data, to join the dots from macroeconomic and food system change to food sources, production, and price; to household-level expenditures; to changing diets and nutrition and health outcomes, illustrated through the case of Zambia. Many of the economic and demographic drivers of the nutrition transition are present in Zambia, including rising GDP, high urbanization and increasing supermarket penetration. Food supply data show a reduction in calories available per capita over several decades, and low levels of nutrient-rich plant and animal source foods which make up a diverse, nutritious diet. National food price data show that while the cost of food has reduced overall, nutrient-rich foods are more expensive relative to staple foods over time. Expenditure on staple foods has reduced in the past two decades while spending on fruits and vegetables, animal source foods, fats and sugars, and processed foods has increased, with these change greater in rural areas in recent years, but already more advanced in urban areas. Finally, while undernutrition is reducing slowly from very high levels and hunger persists, overweight and obesity and non-communicable chronic diseases are increasing; and data are strikingly lacking on modern Zambian diets. The Zambia case study is placed within regional and global trends to illustrate nutrition transition changes that are now happening in rapidly changing lower-middle income countries. Policy responses include promoting the availability of diverse nutrient-dense foods, and concurrent attention to preventing under-and over-nutrition in surveillance and policy. This paper also sheds light on the gaps in information that would greatly improve our understanding of the food system drivers of the nutrition transition, and hence our ability to create relevant policy.

Effects of Modern Food Retailers on Adult and Child Diets and Nutrition

“…In Zambia and many other developing countries, food environments are changing rapidly, with modern retailers gaining in importance. Most households use both modern and traditional retailers for their food purchases, but the share of the food budget spent in modern retail outlets is rising [ 13 , 25 ]. According to our data, the average household in Lusaka spends about 42% of its food budget for purchases in modern retail outlets.…”

“…We used cross-section observational data collected in urban Zambia. Like many other countries in sub-Saharan Africa, Zambia is characterized by a high prevalence of different forms of malnutrition and a rapid modernization of food environments [ 13 , 25 ].…”

Modernization of African Food Retailing and (Un)healthy Food Consumption

“…Ultra-processed foods are generally considered less healthy than unprocessed foods, because they often have high sugar, fat, and salt contents, and low fiber and micronutrient contents. Research has shown that high consumption of ultra-processed foods is associated with obesity and increased risks of chronic diseases such as coronary heart diseases, stroke, and diabetes [17,28,33,34]. Separate indicators of dietary patterns that we use are the quantities of different food groups consumed by the households during the 7-day recall period.…”

“…Understanding the links between changing food environments and food consumption patterns is important to promote food security and healthy diets. This is especially true in Africa, where poverty and undernutrition are still widespread, but where being overweight and obesity are also on the rise [16][17][18] Available research suggests that the modernization of food retailing may make calories more affordable for urban consumers but-at the same time-may foster the nutrition transition towards more highly processed foods that are rich in fat, sugar, and salt, but contain low amounts of micronutrients and other ingredients for healthy nutrition [1,12,19,20]. Recent studies with data from different countries in Africa, Asia, and Latin America suggest that the growth of supermarkets may contribute to increased consumption of processed foods and a higher body mass index (BMI), after also controlling for household income [13,18,[21][22][23][24].…”

“…Zambia is an interesting empirical setting for this analysis, because it has recently experienced rapid growth of supermarkets, hypermarkets, and other modern retailers [5]. Moreover, Zambia is experiencing a triple burden of malnutrition, where undernutrition and micronutrient malnutrition coexist with rising overweight and obesity [17,28]. Hence, our results may help to project how diets evolve with further changes in retail environments and what type of policy responses might be useful.…”