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NUTRITION TRANSITION: WORLDWIDE DIET CHANGE

be examined. Thus, the shift in diet, over time, in the proportion of energy derived from fat has been explored (Guo et al., 2000).

The dramatic changes in the aggregate income–fat relationship from 1962 to 1990 are found in China. Most significantly, by 1990 even poor nations (having a gross national product [GNP] of only $750 per capita) had ac- cess to a relatively high-fat diet, which derived 20 per- cent of its energy from fat; in 1962 the same diet was associated with countries having a GNP of $1,475 (both GNP values in 1993 dollars). This dramatic change arose from a major increase (from 10 to 13 percent) in the con- sumption of vegetable fats by poor and rich nations alike. Increases (of 3 to 6 percent) also occurred in middle- and high-income nations.

At the same time, there were decreases in the con- sumption of fat from animal sources for all except the low-income countries. The availability of animal fats con- tinued to be linked to income, though less strongly in 1990 than in 1962. These decreases, combined with the increase in vegetable-fat intake for countries rich and poor, resulted in an overall decrease in fat intake for moderate-income countries of about 3 percent, but an in- crease of about 4 to 5 percent for low- and high-income countries.

In 1990 vegetable fats accounted for a greater pro- portion of dietary energy than animal fats for the poor- est 75 percent of countries (all of whom had incomes below approximately $5,800 per capita). The absolute level of vegetable-fat consumption increased, but there remained, at most, a weak association of GNP and vegetable-fat intake. Changes in vegetable-fat prices, supply, and consumption equally affected rich and poor countries, but the net impact was much greater on lower-income countries.

There has been an equally large and important shift in the proportion of energy from added sugar in the di- ets of lower-income countries (Drewnowski and Popkin, 1997).

Examination of the combined effect of these various shifts in the structure of rural and urban Chinese diets reveals an upward shift in the energy density of the foods consumed. Energy intake from foods and alcohol in both urban and rural Chinese adult diets increased over 10 per- cent between 1989 and 1997. These numbers represent a very rapid shift in energy density. (It is important to note that the Chinese Food Composition Table, from which these data were extracted, measures only a few bev- erages [milk, coconut juice, sugarcane juice, spirits, beer, wine, champagne, and brandy] and excludes many bev- erages, in particular tea and coffee, included in normal measures.) Other clinical studies have found that the con- sumption of higher-density diets is associated with in- creased total energy intake. Energy density changes in the diet of China, and most likely in other developing countries, are critical components to be monitored.

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The Importance of Rapid Social Change, Including Urbanization, Demographic Change, and Behavioral Changes

Diets have shifted far more dramatically in urban than in rural areas. Some critical sociodemographic issues in- clude:

• rapid reductions in fertility that have speeded shifts in age distribution;

• unabated urbanization in Asia and Africa that will leave more of the poor residing in urban than rural areas in future decades;

• economic changes, in particular increased income and income inequality, that appear to define changes in many regions of the developing world;

• globalization of mass media that faces countries at an earlier stage of economic development than in the past.

Urbanization. The structure of diet has shifted markedly as populations have urbanized (Drewnowski and Popkin, 1997). This relationship will, by itself, shift the structure of national diets significantly as the pro- portion of the population in urban areas grows.

Structural shifts in income-diet relationships. Econo-

mists speak of two types of behavioral change. One re- lates to shifts in the “population composition” of society toward the educated, rich, or urban. The other is “be- havioral” and relates to the way people with different characteristics behave, particularly their economic be- havior. At the same level of education or income, a per- son might buy different amounts or types of commodities at different points in time. Research conducted in China shows there have been profound behavioral shifts since the 1980s. For each extra dollar of income, additional high-fat foods are being purchased, when compared with previous years (Guo et al., 2000). This suggests that the demand pattern for food has changed, so that for the same income level patterns of demand are significantly differ- ent from those in earlier periods. The explosion in ac- cess to goods and exposure to mass media may well have created this situation.

Mass media. There is no doubt that access to modern mass media has grown very rapidly. It is most useful to look at the proportion of households in a country that own television sets. Overall, 88.5 percent of Chinese households owned televisions in 1997. Not only the pro- portion of people with access to television but also the types of programs and access to Western influences were shifting. In the 1980s cable systems in China did not pro- vide outside programming; by 1997 many provinces pro- vided access to China Star, a Hong Kong system that relies heavily on U.S. and British programming and mod- ern advertising.

While there are not extensive data on the propor- tions of Chinese households with access to mass media

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