Part II. What is unique about the experience in lower-and middle-income less-industrialised countries compared with the very-highincome industrialised countries?

Abstract

Objective: 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 change; and political issues. Setting: The focus is on lower-and middle-income countries of Asia, Africa, the Middle East and Latin America. Results: 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 (foetal origins 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. Conclusions: 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.

Urbanization and obesity in The Gambia: a country in the early stages of the demographic transition

“…Several studies, in developing countries, identified the link between urbanization, improvement of SES, and obesity as an established phenomenon and consequently, since obesity is considered a symbol of wealth and characteristic of 'elite groups', it could be difficult to find effective strategies for the control of obesity (Brown and Konner, 1987;Popkin, 1999Popkin, , 2002.…”

“…Sub-Saharan countries have not yet completed their epidemiological and demographic transition (Caldwell, 2001;Walker et al, 2002), and still suffer high levels of infectious diseases. Against this background, the sharp rise in obesity and noncommunicable diseases (NCDs) is creating an unsustainable double burden to health budgets (Walker et al, 2001;Popkin, 2002;Reddy, 2002).…”

“…The rise in obesity and NCDs in developing countries has been linked to urbanization and the nutrition transition, which have led to increased inactivity and the consumption of high-energy dense food (Delpeuch and Maire, 1997;Popkin, 2002). Solomons and Gross (1995) predicted a major shift of populations living in developing countries towards urban areas and this phenomenon has been already documented in The Gambia, where the increase in urbanization has already created a difference in obesity prevalence between rural and urban areas.…”

Trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City, Vietnam, from 2002 to 2005

“…The shift towards overweight and obesity compared with underweight taking place in the developing world today has been suggested to be faster than that observed earlier in developed countries such as the USA or Europe (1,2) . Rapid socio-economic development and urbanization are important determinants for the current changes in disease patterns in the developing world, where infectious diseases and malnutrition are decreasing and overnutrition and its complications are increasing (1)(2)(3) .…”

“…Rapid socio-economic development and urbanization are important determinants for the current changes in disease patterns in the developing world, where infectious diseases and malnutrition are decreasing and overnutrition and its complications are increasing (1)(2)(3) .…”