276 Diet and Health
diseases. Figure 13.2 shows the WHO prognosis of how the rates of non-communi-
cable disease are expected to rise. Factors in this health transition include diet,
demographic change (such as an ageing population) and cultural factors related to
globalization.
The Nutrition Transition
In a series of papers, Professor Barry Popkin and his colleagues have argued that
there is what they term a ‘nutrition transition’ occurring in the developing world,
associated primarily with rising wealth.13,14 The thesis, which has been extensively
supported by country and regional studies,^15 argues simply that diet-related ill
health previously associated with the affluent West is now becoming increasingly
manifest in developing countries.16,17 The ‘nutrition transition’ suggests shifts in
diet from one pattern to another: for example, from a restricted diet to one that is
high in saturated fat, sugar and refined foods, and low in fibre. This transition is
associated with two other historic processes of change: the demographic and epide-
miological transitions. Demographically, world populations have shifted from pat-
terns of high fertility and high mortality to patterns of low fertility and low mortality.
In the epidemiological transition, there is a shift from a pattern of disease character-
ized by infections, malnutrition and episodic famine to a pattern of disease with a
high rate of the chronic and degenerative diseases. This change of disease pattern is
associated with a shift from rural to urban and industrial life-style.
WHO researchers have noted that changes in dietary patterns can be driven not
just by rising income and affluence but also by the immiseration that accompanies
Source: WHO, Evidence, Information and Policy, 2000
Figure 13.2 Anticipated shift in global burden of disease 1990–2020, by disease
group in developing countries (WHO)