Nutrition transition in South Asia: the emergence of non-communicable chronic diseases

Abstract

Overview: South Asian countries have experienced a remarkable economic growth during last two decades along with subsequent transformation in social, economic and food systems. Rising disposable income levels continue to drive the nutrition transition characterized by a shift from a traditional high-carbohydrate, low-fat diets towards diets with a lower carbohydrate and higher proportion of saturated fat, sugar and salt. Steered by various transitions in demographic, economic and nutritional terms, South Asian population are experiencing a rapidly changing disease profile. While the healthcare systems have long been striving to disentangle from the vicious cycle of poverty and undernutrition, South Asian countries are now confronted with an emerging epidemic of obesity and a constellation of other non-communicable diseases (NCDs). This dual burden is bringing about a serious health and economic conundrum and is generating enormous pressure on the already overstretched healthcare system of South Asian countries.

Objectives: The Nutrition transition has been a very popular topic in the field of human nutrition during last few decades and many countries and broad geographic regions have been studied. However there is no review on this topic in the context of South Asia as yet. The main purpose of this review is to highlight the factors accounting for the onset of nutrition transition and its subsequent impact on epidemiological transition in five major South Asian countries including Bangladesh, India, Nepal, Pakistan and Sri Lanka. Special emphasis was given on India and Bangladesh as they together account for 94% of the regional population and about half world's malnourished population.

Methods: This study is literature based. Main data sources were published research articles obtained through an electronic medical databases search.

Keywords: South Asia; Nutrition Transition; Epidemiological Transition, Non-communicable diseases; Healthcare.

Figure 1.. Shows the percent distribution of underweight children in South Asia and the rest of the world.

Source: Global disease burden 2010 ( http://goo.gl/Tp7fS1)

Figure 2.. Illustrates the trend of urbanization in South Asia.

Pakistan has highest urban population in the region while Nepal has the highest rate of urbanization. Source: UN Population Database, State of world cities ( http://goo.gl/6G7S3h)

Figure 3.. Shows the trend in total meat consumption trend in South Asia over the past two decades.

Per capita meat consumption rate (shown on the Y-axis) has increased in almost all countries with Sri Lanka having the highest rate. Pakistan has the highest per capita meat consumption and is currently world’s tenth largest consumer of beef. Source: USDA ( http://goo.gl/p0dehO), Thepoultrysite ( http://goo.gl/Slh83n)

Figure 4.. This photo was taken from a super-shop in Janakpurdham district in Nepal.

Janakpurdham is known for many historical and religious sites and has very little traces of industrialization. Photo credit: Mr. Sudeep Sharma

Figure 5.. Illustrates the situation of double burden of malnutrition (DBM) in South Asia.

The proportion of stunting and underweight is higher than rest of the world, while that of overweight is about one-third. Source: WHO, UNICEF ( www.childinfo.org)

Figure 6.. This photo was taken from a grocery shop nearby a high school in Dhaka city.

The picture shows that a variety of junk foods are made available to school students. Most of these products are sold at extremely cheap prices (> $0.15). Photo credit: Sharmistha Ghosh