Trends in nutrition transition: Pakistan in focus.

The world ‘is experiencing an accelerated epidemic of diet-related non-communicable diseases. Unbalanced and excessive food and nutrient intakes, often closely associated with other changes in lifestyle that include less physical activity, stress, tobacco smoking and excessive alcohol consumption, underlie a range of these diseases. These include coronary heart disease, hypertension and stroke, various cancers, non-insulin dependent diabetes mellitus, obesity, dental caries, gall bladder disease and osteoporosis. Obesity has emerged as a world wide epidemic not only prevalent in the affluent and developed countries, but is also appearing rapidly in less wealthy and developing countries. One of the explanations for obesity and other non-conimunicable diseases is the ‘Barker’s Hypothesis’, the basic concept of which is that factors affecting the fetus and the young have long lasting effects and are important causes of diseases later on in life. Under-nutrition in utero and in infancy may cause ‘programming’ of the body in such a way that it may lead to a number of diseases in adulthood, including obesity. Popkin and other researchers have presented another hypothesis of the Developmental and Nutrition Transition. Various papers from the developing world describe the concept of the nutrition transition, which is a sequence of characteristic dietary and nutritional patterns resulting from large shifts in the overall structure of the diet, correlated with changing economic, social, demographic and health factors. These changes are associated with a high prevalence of obesit , particularly childhood obesity. Pakistan is still in the early stages of the nutrition transition. High rates of intra—uterine growth retardation. low birth weight and subsequent malnutrition are seen. Most work done on children has concentrated on malnutrition, and obesity has not been studied adequately. However. the National Health Survey data set clearly shows the double burden of under—nutrition and over-weight in adolescents and adults. More adolescents are under weight than overweight, while the opposite is true for adults. With the high prevalence of stunting in children and a shift in dietary and lifestyle patterns, countries like Pakistan may experience a larger burden of stunted-obese individuals in the next few decades. There is a great need to coiiduct representative surveys of the population to study the changing trends in the dietary and life style pattern of Pakistani families and their consequences on the health of the population. It is essential to analyse whether obesity is more closely associated with stunted children in Pakistan: to see whether these trends follow into adulthood: to assess whether there is evidence to prove the hypotheses mentioned earlier. This paper is a review of the relevant literature. The main focus is on the developmental transition and its impact on the developing countries. A number of people have studied these changes in vanous countries. The present paper analyses the situation in Pakistan. in the light of the international literature and the limited local data that are available. The paper further assesses Pakistan’s stage of development and discusses the implications of this transition on health. Some recommendations are made especially in terms of directions for policy makers.