An overview on the nutrition transition and its health implications: The Bellagio meeting

Introduction This supplement is based on papers presented at the Bellagio Conference on the Nutrition Transition. The meeting was organised to allow us to assess current low and moderate-income industrialising countries’ experience related to the nutrition transition and provide ideas for pushing forth a broader public health agenda in this area. More specifically, the meeting focused on changes in patterns of behaviour (diet, smoking, drinking, activity) that lead to rapid increases in obesity, cardiovascular disease (CVD) and cancer. The nutrition-related noncommunicable diseases (NR-NCDs) were once referred to as diseases of affluence. For decades this has not been true among higher-income countries, and as we now show, this is increasingly not the case in the lower- and middle- income countries

Odyssey of a small-town midwestern boy to a scholarly path

I grew up in Superior, Wisconsin, in a strongly connected, education-oriented family. My father was a high school graduate, and my mother spent 1 month in college before leaving to support her siblings. Both of my parents, as well as my grandmother, stressed the importance of education. Every Sunday we visited my mother’s large clan in Duluth for a full day of play. I with eight or ten cousins would laugh and run, while my parents conversed with the other adults. We were close, literally. Within 100 m, I could find my family, my grandmother, who was next door as was my uncle and aunt, who lived with their two kids. Annual family gatherings were normal, and family was important, a strong element in my life

Mexican cohort study predates but predicts the type of body composition changes expected from the mexican sugar-sweetened beverage tax

Important lessons can be learned from studies of the Mexican sugar-sweetened beverage (SSB) tax and related studies on the health effects of the tax. The Mexican government instituted a nationwide one peso per liter excise tax on SSBs that was effective on January 1, 2014. The tax applies to all nonalcoholic beverages with added sugar and represents an approximate 10% increase in prices. The Mexican SSB tax rate is less than the 20% rate in Philadelphia, Pennsylvania, and scholars globally recommend that the rate be at least 20% or larger to have a meaningful impact

Rural areas drive increases in global obesity

The global rise in the prevalence of obesity has been seen as an urban problem. A large-scale study challenges this view by showing that weight gain in rural areas is the main factor currently driving the obesity epidemic

Part II. What is unique about the experience in lower- and middle-income less-industrialised countries compared with the very-high-income industrialised countries? The shift in stages of the nutrition transition in the developing world differs from past experiences!

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

Sweetening of the global diet, particularly beverages: Patterns, trends, and policy responses

Evidence suggests that excessive intake of added sugars has adverse effects on cardiometabolic health, which is consistent with many reviews and consensus reports from WHO and other unbiased sources. 74% of products in the US food supply contain caloric or low-calorie sweeteners, or both. Of all packaged foods and beverages purchased by a nationally representative sample of US households in 2013, 68% (by proportion of calories) contain caloric sweeteners and 2% contain low-calorie sweeteners. We believe that in the absence of intervention, the rest of the world will move towards this pervasiveness of added sugars in the food supply. Our analysis of trends in sales of sugar-sweetened beverages around the world, in terms of calories sold per person per day and volume sold per person per day, shows that the four regions with the highest consumption are North America, Latin America, Australasia, and western Europe. The fastest absolute growth in sales of sugar-sweetened beverages by country in 2009-14 was seen in Chile. We believe that action is needed to tackle the high levels and continuing growth in sales of such beverages worldwide. Many governments have initiated actions to reduce consumption of sugar-sweetened beverages in the past few years, including taxation (eg, in Mexico); reduction of their availability in schools; restrictions on marketing of sugary foods to children; public awareness campaigns; and positive and negative front-of-pack labelling. In our opinion, evidence of the effectiveness of these actions shows that they are moving in the right direction, but governments should view them as a learning process and improve their design over time. A key challenge for policy makers and researchers is the absence of a consensus on the relation of beverages containing low-calorie sweeteners and fruit juices with cardiometabolic outcomes, since decisions about whether these are healthy substitutes for sugar-sweetened beverages are an integral part of policy design

Birth weight, maturity and proportionality in Filipino infants

In order to improve assessment of risk and poor postnatal health and growth and developmental outcomes, groups of infants were defined using low birth weight status (LBW ≤ 2,500 g) and an index of body proportions at birth (Rohrer's Index, RI = weight X 100/length3). The sample, dreived from a prospective study of infant-feeding practices, health and survival in the Philippines, cnsisted of 1971 mother-infant pairs from randomly selected urban and rural communities of metro Cebu. Multi-nominal logistic regressions assessed how the probability of belonging to a particular risk group was influenced by a set of maternal and infant biological and behavioral variables. Increased risk of falling into a LBW risk grou was associated with low gestational age (GA), low maternal stature, and primiparity. Proportionate and disproportionately grown LBW infants could be differentiated by the magnitude of the effects of gestational age, mother's height, and primiparity (all stronger determinants of proportionate small size) and rural residence, low maternal arm fat area, and smoking during pregnancy (all of which increased risk of being proportionately small by had no effect on risk of being disproportionate). The analyses show that the determinants of weight and proportionality at birth differ markedly. RI, by capturing information about patterns of prenatal growth that contribute to proportionality, should prove to be an important predictor of postnatal outcomes when used along with birth weight

37 year snacking trends for US children 1977–2014

Background: Previous studies have indicated that snacking is contributing to increased calorie intake of American children and that the energy density of snacks in US diets has increased in recent decades. Objective: Examine short-term and long-term trends in the energy density and food sources of snacks for US children from 1977 to 2014, and examine whether trends differ between socio-demographic groups. Methods: We used data collected from eight nationally representative surveys of food intake in 49,952 US children age 2–18 years, between 1977 and 2014. Overall patterns of snacking, trends in energy intake from snacking, trends in food and beverage sources and energy density of snacks across race-ethnic, age, gender, education and income groups were examined. Results: In all socio-demographic groups, there was a significant increase in per capita energy intake deriving from snacks from 1977 to 2014 (P < 0.01). Salty snack intake doubled over the study period, and sugar-sweetened beverage intake decreased overall from 1977 to 2014 but increased in Non-Hispanic Blacks. Non-Hispanic Blacks had the largest increase in per capita intake from foods as a snack from 1977 to 2014. Children in the lowest poverty level and household education groups had more than 100% increase in calorie intake from snacks from 1977 to 2014. Conclusions: We found that snacking behaviour in the USA differs between race-ethnic, household education, gender and income groups, yet snacking remains a significant component of children's diets and the foods consumed at these snacks are not the types of foods recommended by the US dietary guidelines

90th Anniversary Commentary: Consumption of Sweetened Beverages Predicts the Occurrence of Type 2 Diabetes

Carbohydrate and sugar are recurring themes in the history of diet and disease. After the agricultural revolution 10,000 y ago, nutrition changed from a hunter-gatherer way of life to one in which food could be grown in one locale, avoiding the challenges of continuing to move to find food. The domestication of animals and the development of many grains and other crops allowed civilizations to develop and reduced most effects of seasonality on food supplies for many countries. The agricultural revolution also led to the growth of cities and, with it, a group of infectious diseases that dominated the health of people for thousands of years and led to the continued development of many new caloric foods and beverages over the last 10,000–12,000 y

Intergenerational diabetes and obesity—A cycle to break?

Globally, efforts to prevent diabetes and obesity have attained mixed success. Although prevalence of adult-onset diabetes is declining in some countries, the prevalence of childhood obesity and young-onset diabetes, with risk of associated complications, continues to increase in many high- and lower-income countries. More than 1. 9 billion children and adults are overweight and obese, and prevalence is rapidly rising, with the greatest increase found among children