The Nutrition Transition and its Health Implications in Lower-income Countries 257consume very few food groups (five was selected) has declined while those who
consume more than ten increases.
Body Composition
One consequence of this nutrition transition has been a decline in under-nutrition
accompanied with a most rapid increase in obesity. In all age groups, there is evi-
dence of a rapid increase in obesity and also an array of dietary excess and body
composition-related health outcomes such as glucose intolerance and diabetes.
Monteiro et al36,37 (also Monteiro, forthcoming^38 ) has documented this shift away
from undernutrition most clearly for Brazil.
Programming – a potential link
David Barker and colleagues at the University of Southampton17,18 have brought
into the mainstream the notion of metabolic programming: that early insults oper-
ating at a critical period in development result in long-term changes in the struc-
ture or function of an organism. In the case of obesity, the hypothesis is that fetal
growth retardation results in metabolic changes that are adaptive under nutrition-
ally stressful circumstances in utero. A similar argument can be made for post-
natal growth retardation manifested as stunting. As the child grows, the metabolic
Table 12.6 Diversity in the Chinese diet: the number of food groups consumed by
Chinese adults aged 20–45 years, CHNS 1989–1993YearIncome thirds
Low Medium High Total
1989 Sample size 1892 1889 1834 5615
Mean score 6.5 7.7 9 7.7
Score < 5(%) 17.1 6.8 3.5 9.2
Score > 10 (%) 4.4 12.1 29.6 15.2
1991 Sample size 1855 1918 1839 5612
Mean score 7.4 8.1 9.6 8.2
Score < 5(%) 10.7 6.6 1.8 6.4
Score > 10 (%) 5.9 17.8 35.2 19.5
1993 Sample size 1749 1814 1680 5243
Mean score 7.3 8.5 9.7 8.5
Score < 5(%) 6.6 2.8 1.2 3.5
Score > 10 (%) 9 21.8 36 22Note: The range of diversity scores is 1–33.