The document discusses the nutrition transition, which refers to the shift in dietary consumption and energy expenditure that occurs alongside economic, demographic, and health changes in societies. Specifically, it involves the transition from traditional diets high in grains and fiber in developing countries to more westernized diets high in sugars, fats, and processed foods. Two frameworks are described for understanding nutrition transition - Omran's concept of the epidemiological transition and Popkin's nutrition transition theory. Popkin's theory posits five broad dietary patterns that societies progress through during the nutrition transition.

1. NUTRITION
TRANSITION

2. DEFINITION
• Nutrition transition is the shift in
dietary consumption and energy
expenditure that coincides with
economic, demographic,
and epidemiological changes.
• Specifically the term is used for the transition
of developing countries from traditional diets
high in cereal and fiber to more Western
pattern diets high in sugars, fat, and animal-
source food.

3. • The world is experiencing rapid shifts in structures of
diet and body composition with resultant important
changes in health profiles.
• In many ways these shifts are a continuation of large
scale changes that have occurred repeatedly over time;
however that the changes facing low and moderate
income countries are very rapid.
• Broad shifts have and continue to occur around the
world in population size and age composition, disease
patterns, and dietary and physical activity patterns.
• The former two sets of dynamic shifts are termed the
demographic and epidemiological transitions.
• The latter, whose changes are reflected in nutritional
outcomes, such as changes in average stature and body
composition, is termed the nutrition transition.

4. • Two historic processes of change occur
simultaneously with or precede the ‘nutrition
transition’.
• One is the demographic transition – the shift from
a pattern of high fertility and mortality to one of
low fertility and mortality (typical of modern
industrialized countries).
• The second is the epidemiological transition, first
described by Omran (Omran, 1971): the shift from
a pattern of high prevalence of infectious disease,
associated with malnutrition, periodic famine and
poor environmental sanitation, to one of high
prevalence of chronic and degenerative disease,
associated with urban-industrial lifestyles

5. OMRAN CONCEPT
Omran divided the epidemiological transition of mortality into three phases. These phases
are:
• The Age of Pestilence and Famine: Mortality is high and fluctuating, precluding
sustained population growth, with low and variable life expectancy vacillating between
20 and 40 years. It is characterized by an increase in infectious
diseases, malnutrition and famine. Before the first transition, the hominid ancestors
were hunter-gatherers and foragers, a lifestyle partly enabled by a small and dispersed
population, however unreliable and seasonal food sources put communities at risk for
periods of malnutrition.
• The Age of Receding Pandemics: Mortality progressively declines, with the rate of
decline. Average life expectancy increases steadily from about 30 to 50 years.
Population growth is sustained and begins to be exponential.
• The Age of Degenerative and Man-Made Diseases: Mortality continues to decline and
eventually approaches stability at a relatively low level. Mortality is increasingly related
to degenerative diseases, cardiovascular disease (CVD), cancer, violence, accidents,
and substance abuse, some of these due primarily to human behavior patterns. The
average life expectancy rises gradually until it exceeds 50 years. It is during this stage
that fertility becomes the crucial factor in population growth.

13. POPKIN THEORY
• The nutrition transition model was proposed in 1993 by Barry Popkin,
and is the most cited framework in literature regarding the nutrition
transition, although it has been subject to some criticism for being
overly simplified.
• Popkin posits that two other historic transitions affect and are affected
by nutritional transition. The first is the demographic transition,
whereby a pattern of high fertility and high mortality transforms to one
of low fertility and low mortality. Secondly, an epidemiological
transition occurs, wherein a shift from a pattern of high prevalence
of infectious diseases associated with malnutrition, and with periodic
famine and poor environmental sanitation, to a pattern of high
prevalence of chronic and degenerative diseases associated with
urban-industrial lifestyles is shown. These concurrent and dynamically
influenced transitions share an emphasis on the ways in which
populations move from one pattern to the next.
• Popkin used five broad patterns to help summarize the nutrition
transition model.

14. • The first pattern is that of collecting food, a characterization
of hunter-gatherers, whose diets were high in
carbohydrates and low in fat, especially saturated fat.
• The second pattern is defined by famine, a marked scarcity
and reduced variation of the food supply.
• The third pattern is one of receding famine. Fruits,
vegetables, and animal protein consumption increases, and
starchy staples become less important in the diet.
• The fourth pattern is one of degenerative diseases onset by
a diet high in total fat, cholesterol, sugar, and other refined
carbohydrates and low in polyunsaturated fatty acids and
fiber. This pattern is often accompanied by an increasingly
sedentary lifestyle.
• The fifth pattern, and most recently emerging pattern, is
characterized by a behavioral change reflective of a desire
to prevent or delay degenerative diseases.