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The Nutritional Transition and Diet-Related Chronic Diseases in Asia: Implications For

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The Nutritional Transition and Diet-Related Chronic Diseases in Asia: Implications For FCND DP No. 105 FCND DISCUSSION PAPER NO. 105 THE NUTRITIONAL TRANSITION AND DIET-RELATED CHRONIC DISEASES IN ASIA: IMPLICATIONS FOR PREVENTION Barry M. Popkin, Sue Horton, and Soowon Kim Food Consumption and Nutrition Division International Food Policy Research Institute 2033 K Street, N.W. Washington, D.C. 20006 U.S.A. (202) 862–5600 Fax: (202) 467–4439 March 2001 FCND Discussion Papers contain preliminary material and research results, and are circulated prior to a full peer review in order to stimulate discussion and critical comment. It is expected that most Discussion Papers will eventually be published in some other form, and that their content may also be revised. ii ABSTRACT The nutritional transition currently occurring in Asia is one facet of a more general demographic/nutritional/epidemiological transition that accompanies development and urbanization. The nutritional transition is marked by a shift away from relatively monotonous diets of varying nutritional quality toward an industrialized diet that is usually more varied, includes more preprocessed food, more food of animal origin, more added sugar and fat, and often more alcohol. This is accompanied by shift in the structure of occupations and leisure toward reduced physical activity, and leads to a rapid increase in the numbers of overweight and obese. The accompanying epidemiological transition is marked by a shift away from endemic deficiency and infectious diseases toward chronic diseases such as obesity, adult-onset diabetes, hypertension, stroke, hyperlipidaemia, coronary heart disease, and cancer. Obesity is now a major public health problem in Asia. Obesity is a problem of the urban poor as well as the rich, and the urban poor have the added predisposing factors associated with low birthweight. Costs of chronic disease are estimated for China and Sri Lanka. The current and projected costs of these diseases are estimated in terms of lost work output due to mortality and health care costs. In China in 1995, diet-related chronic diseases accounted for 41.6 percent of all deaths and 22.5 percent of all hospital expenditures. The economic costs for this diet-related component are estimated as 2.1 percent of gross domestic product. Diet-related chronic disease is projected to increase to 52.0 percent of all deaths in China by 2025. At that time, dietary factors (principally overweight) will account for an increased share of chronic disease, and childhood factors will decline in significance. In Sri Lanka, diet-related chronic diseases currently account for 18.3 percent of all deaths and 10.2 percent of public hospital expenditures (but 16.7 percent of all hospital expenditures). The current loss attributable to diet-related chronic disease is estimated as 0.3 percent of GDP. In 2025, chronic diseases are expected to account for 20.9 percent of all deaths. Currently, dietary factors account for 10-20 percent of these chronic diseases. By 2025, dietary factors (particularly overweight) will increase in importance to account for 18-40 percent of chronic disease, and the importance of low birthweight as a predisposing factor will increase. Few program and policy options to address these issues have been undertaken in Asia. Agricultural policy is important, and the relatively cheap availability of vegetable oil may have had dramatic (adverse) dietary effects in Asia. Price policy has considerable iii potential, in particular the pricing of oils. Promoting a traditional diet has been quite helpful in holding down fat intake and obesity in Korea. Health promotion efforts in Mauritius succeeded in reversing several adverse trends contributing to coronary heart disease. Thailand has successfully used mass media for other health promotion efforts and is moving to pilot schemes in the area of chronic disease. And Singapore has been the leader in the region in exercise promotion and weight control in schools. iv CONTENTS Acknowledgments...............................................................................................................ix Executive Summary.............................................................................................................x 1. Introduction......................................................................................................................1 2. The Nutritional Transition in Asia: Dietary and Related Factors Leading to Increases in Chronic Diseases .........................................................................................3 Fetal/Infant Insults and Related Effects (Lbw, Stunting) ....................................... 5 Shifts in the Structure of the Diet ........................................................................... 6 Shifts in Physical Activity Patterns....................................................................... 11 Urbanization.......................................................................................................... 12 3. The Importance of the Nutritional Transition for Health...............................................13 Diet-Related Chronic Diseases ............................................................................. 13 Diets That Increase the Risk of Chronic Diseases .......................................... 14 General Mortality Trends in Asia ................................................................... 15 Diet-Related Conditions that Increase the Risk of Chronic Diseases............. 20 Obesity: The Effect of Diet and Physical Activity on the Risk of Chronic Diseases............................................................................................. 23 The Major Chronic Diseases........................................................................... 26 Health Costs .......................................................................................................... 28 Case Study: China ........................................................................................... 30 Case Study: Sri Lanka..................................................................................... 37 4. Program Options for Diet-Related Interventions to Control Epidemic Chronic Diseases in Asia.............................................................................................................42 Agricultural Development..................................................................................... 45 Price Mechanisms ................................................................................................. 46 Preservation of Traditional Diets .......................................................................... 46 Use of Mass Media ............................................................................................... 47 School-Based Programs ........................................................................................ 48 5. Proposals for Policies and Programs Addressing Epidemic Chronic Diet-Related Diseases in Asia.............................................................................................................49 Appendix Tables ................................................................................................................54 v Figures................................................................................................................................70 References........................................................................................................................103 TABLES 1 Country groups for nutritional transition analysis ...................................................4 2 The proportion of economically able men and women aged 18 to 65 employed in each sector of work ...........................................................................11 3 The possible effects of dietary intake and body composition on noncommunicable diseases....................................................................................16 4 Trends in the proportion of deaths, by cause during the 1960s-90s ......................18 5 Current costs (economic costs of hospital resources and human costs) of major diet-related chronic disease in China ...........................................................32 6 Summary of costs of diet-related chronic disease in China...................................33 7 Estimated contribution of diet to chronic disease in China, 1995 .........................35 8 Estimated contribution of diet to chronic disease in China, 2025 .........................35 9 Summary of costs of major diet-related chronic disease in Sri Lanka ..................38 10 Estimated contribution of diet to chronic disease in Sri Lanka, 1995 ...................41 11 Estimated contribution of diet to chronic disease in Sri Lanka, 2025 ...................41 12 Low birthweight prevalence across the Asian Region (the most recent data for each country from the 1990s)...........................................................................55 13 Stunting prevalence across the Asian Region (the most recent data for each country from the 1990s for children ages 2-6).......................................................56 14 Trends in food available for consumption from 1962-96 for Asian countries grouped by income levels (annual quantity of food in kg/capita)..........57 15 Trends in the proportion of energy available for consumption, by source from 1962-96..........................................................................................................59 vi 16 TV ownership in each country grouping (per 1,000 people) .................................60
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