The Nutrition Transition and the Double Burden of Malnutrition in Sub-Saharan African Countries: How Do These Countries Compare with the Recommended LANCET COMMISSION Global Diet?

Abstract

Background: Over the last two decades, many sub-Saharan African (SSA) countries have undergone dietary and nutrition transitions fuelled by rapid urbanisation, economic development, and globalisation. The aim of the current study was to examine outcomes of the nutrition transition and the epidemiologic transition in SSA countries in terms of food intake, health, and socioeconomic and development factors.

Methods: Food balance sheet data-specifically, per capita energy intake per day and per capita gram intake per day-from the CountrySTAT framework of the Food and Agricultural Organization (FAO) were analysed for major food commodities. Additionally, selected health and development indicators supplied by UNICEF, the WHO and the World Bank were analysed.

Results: Four dietary patterns emerged. The diet of the southern African/island cluster (South Africa, Mauritius, Eswatini, Namibia, Cabo Verde, and the outlier Seychelles) resembles a Westernised diet, with median values high on sugar/sweeteners, alcohol, meat, animal fats, eggs, and dairy. On the other hand, the diet of countries in the other three clusters appears to be more traditional, with countries in the desert/semi-arid cluster consuming more cereals and pulses/tree nuts, countries in the tropical coastal cluster consuming more fish and vegetable oils, and countries in the equatorial cluster consuming more starchy roots and fruit and vegetables. The resulting median values of health indicators also indicate a higher prevalence of non-communicable diseases in the southern African/island cluster, whereas stunting and anaemia are higher in the other three clusters.

Conclusions: SSA countries are in different stages of the nutrition transition. By superimposing clusters generated using macronutrient intake values on a map of the climatic regions in Africa, one can clearly see the importance of climate on the availability of food and food intake patterns. Climate change presents a great challenge to healthy eating, as the link between climate regions and diets is illustrated.

Keywords: climate change; diet; dietary patterns; double burden; food security; malnutrition; non-communicable diseases; sub-Saharan Africa.

Figure 1

(a) Clustering of countries in SSA based on EFA and cluster analyses of food intake per day, measured in kcal/capita/day. Cluster 5 in this figure includes North African countries which were not used in the clustering process. (b) Africa map demonstrating the Köppen climate classification [44].

Figure 2

Data from food balance sheets for 2019 indicating gram per capita intake per day for (a) cereals, (b) starchy roots, (c) sugar and sweeteners, and (d) pulses and tree nuts. Red columns indicate medians of clusters; source: [25].

Figure 2

Data from food balance sheets for 2019 indicating gram per capita intake per day for (a) cereals, (b) starchy roots, (c) sugar and sweeteners, and (d) pulses and tree nuts. Red columns indicate medians of clusters; source: [25].

Figure 3

Data from food balance sheets for 2019 indicating gram per capita eaten per day for animal products. (a) meat, (b) fish/seafood, (c) milk, and (d) eggs. Red columns indicate medians of clusters; source: [25].

Figure 4

Data from food balance sheets for 2019 indicating per gram per capita intake per day for (a) vegetable oil, (b) animal fat, (c) fruit and vegetables, and (d) alcohol. Red columns indicate medians of clusters; source: [25].

Figure 5

Data from food balance sheets for 2019 indicating per capita (kcal) of total food supply energy intake per day. Red columns indicate medians of clusters; source: [25].

Figure 6

A Venn diagram showing SSA countries lying in the top tertiles for under five child stunting and child overweight (only those in the top tertile are in the diagram). Sao Tome & Pr: Sao Tome and Principe.

Figure 7

A Venn diagram showing the double burden of malnutrition in SSA countries illustrated by under-five child stunting and women overweight/obese (only those in the top tertile are in the diagram).

Figure 8

A Venn diagram showing evidence of the epidemiological transition in SSA countries (only those in the top tertile are in the diagram, i.e., 17 are not).

Figure 9

Venn diagram illustrating the nutrition transition in SSA countries. Those in highest tertile for meat, oil, and sugar intakes count as one risk factor each, while those with the lowest tertile for fruit and vegetables count as one. (only those in the top tertile are in the Venn circles of the diagram, i.e., 13 are not).

Figure 10

Venn diagram of development indicators for countries in SSA (only those in the top tertile are in the diagram, i.e., 16 are not). %65 Plus = people 65 years and older.