Report on Activities of the Task Force on the Nutrition in Transition

FROM:     Barry M. Popkin, Chair
Carlos Monteiro, Vice Chair
DATE:     October 28, 2005

We feel the Task Force should continue.  The plans are noted below.

International Congress of Obesity

The Task Force met twice over the course of the meeting.  The decision was made by all involved to create a Bellagio + 7 meeting.  That would attempt to accomplish several things:

First it would systematically document dynamics and changes in a set of countries, including countries represented by those on the committee, but also 7-10 other developing countries.  A template is being developed for this initiative and then we will begin to work on which countries to invite, which individuals to involve, etc.

Second, it would critically lay out what is being done in each country to address the shifts of the pattern of the Nutrition Transition toward the stage linked with chronic degenerative diseases, including obesity.

Third, it would look at new emerging cross-cutting issues the committee will define over the next two years.

Fouth, all members wished to remain on the committee and we added two members—one, a young faculty from the Netherlands and the second, an older one from the US.  We are continuously searching for young professionals who fit our goals and criteria of excellence.  We have identified 5 potential young persons and will be watching them and considering them over the next year.

Fifth, the only two persons who could truly take over leadership are Carlos Monteiro and Gail Harrison and my sense is that for now, I remain the best option to keep this moving.

Committee activities June 2004-June 2005

The committee has been very active in a number of countries in pushing forward research and programmatic work in this area but has not undertaken any coordinated cross-national effort during this period. We try to highlight a few of the key initiatives underway linked with our key focal countries and committee members.

Brazil:  Carlos Monteiro lead the Brazilian task force that analyzed the most recent national food and nutrition survey conducted in Brazil in 2002/2003 on a random sample of 48 thousand families. This task force was integrated by researchers and representatives of the MoH and IBGE (the federal office for official statistics in Brazil). The publication of the main survey findings (available from the IBGE site under the title: Pesquisa de Orcamento Familiar 2002/2003) updated the nutrition transition showing increasing obesity rates in the country, particularly in the poorest regions and families, and a shifting of the diet towards increasing fat content, increasing saturated fat content and increasing sugary, salty, processed foods with no changes in the low consumption of fruits and vegetables. This publication had enormous repercussions in the nutrition community and also in the national media, particularly in light of the strong emphasis placed by the federal government on “anti-hunger” measures (Fome Zero program). Carlos also acted as a consultant for the WHO/FAO fruits and vegetables initiative participating in technical meetings in Geneva and Kobe that discussed and proposed ways to implement the initiative in developing countries. In Brazil, Carlos is assisting the federal government and selected municipalities in the implementation of the fruits and vegetable initiative. A recent community trial conducted by Carlos and his group at the University of São Paulo in a poor, underserved area of São Paulo city provided evidence that feasible actions combining education and improvements in the supply of fruits and vegetables can increase significantly the consumption of these foods by low income families. A large-scale replication of the intervention is being planned for the near future.

Mexico: Juan Rivera has led a major initiative to focus a great deal more work on noncommunicable diseases and related risk factors in Mexico.

• They conducted an analysis of the 1999 Mexican Nutrition Survey which used cluster analysis to identify different dietary patterns. They further studied the association of the dietary patterns with NCD risk factors.
• They are studying the prevalence of NCD risk factors such as blood lipids, glucose, and insulin in a probabilistic sample of adolescent and adult Mexicans studied in 2000. They are analyzing the nature of the association of the risk factors with BMI and other anthropometric indices.
• They are participating in a project organized by the FAO Food and Nutrition Division entitled “Assessment of Dietary Changes and their Health Implications in Countries facing the ‘double burden’ of malnutrition”. They are in charge of preparing a document describing the situation and the trends in Mexico using data from several cross sectional surveys on food purchases, diet, anthropometry, chronic diseases and mortality.
• They are conducting the evaluation of a poverty alleviation program which provides cash transfers as well as nutrition and health services to 5 million low income families in Mexico. Cash transfers are used as incentives for investment in nutrition, health, and education. They are studying the effects of the program on food intakes, body weight and composition, and chronic diseases.
• They developed a proposal that was pre-selected for funding by ILSI/PAHO/CDC. The project will study the elements in the environment of public schools that promote overweight. With the use of formative research, interventions aimed at changing the environment to promote physical activity and a healthful diet for the prevention of obesity in children will be developed and their effects will be tested.
• They have acquired funds to conduct this year the third national nutrition survey that will include a random sample of 40,000 households. They will use comparable methodology to the first (1988) and the second (1999) national nutrition surveys, which will allow the study of trends in diet and in under and overnutrition and chronic diseases in the Mexican population.
• They have created, in collaboration with INTA (Chile) a network of research centers in nutrition in LA with support from UNU/IUNS. The two main Institutions are INTA Chile and INSP Mexico. Fernando Vio (INTA Director) and Juan Rivera are the regional coordinators of the UNU Nutrition Program in LA. The first activity involved a diagnosis of the main nutrition problems and an inventory of research institutions in nutrition, their capacity and their publications conducted in 8 LA countries. As a result of the diagnosis, research priorities were identified and working groups created. Each working group is developing multicenter proposals that will be sent to donors. One major group addresses obesity and chronic diseases. One of the projects is work with Industry in LA to reduce or eliminate trans fatty acids. We have another group dealing with childhood obesity. Each group involves investigators from INTA, INSP and other research institutions in the region.

Geoffrey Cannon:  He has led a worldwide group focused on creating a newer broader vision of nutrition. In addition, he is playing a major role with the World Cancer Research Federation in reviewing diet and cancer relationships within the context of the dynamic worldwide shift in stages of the Nutrition Transition. This Panel has Juan Rivera, a task force member, on it.

United States:  Barry Popkin is leading a group of scholars to develop a beverage guidance system for the US. Given the very high percentage of calories from beverages in the US (over 21%), this is viewed as a key way to continue to fight the obesity increases in that country. Barry Popkin has also presented aspects of the Nutrition Transition at a plenary talk as part of the Sixth International Conference on Preventive Cardiology Iguaçu, Brazil. He also created and received funding for an NIH Roadmap Center on Obesity that features a large component on the nutrition transition and involves 71 faculty members from over 35 departments and six schools on the UNC campus as well as other institutions in the region.

China-United States:  A national conference in China this summer will highlight the nutrition transition and Barry Popkin will be a key plenary speaker. The group is also working with the Chinese Ministry of Health to consider ways to prevent further increases in obesity in China.

South Africa:  With two very active committee members and nutrition viewed as a major concern by the government, Committee members have been most active there. South Africa is a country in transition, experiencing a quadruple burden of disease and the coexistence of both under-and overnutrition often within the same communities, and even within households.

The nutrition transition has been an integral focus of the Food-Based Dietary Guideline process in SA (initiated by Este Vorster in 1997). Since both the coexistence of under-and over-nutrition as well as changes/shifts in dietary intake with development and urbanization from local evidence has been incorporated. Primordial prevention of diseases of lifestyle (e.g., specific attention to intakes of types of fats, legumes and fruit and vegetables and physical activity are incorporated in the health messages). The South African Department of Health officially approved the FBDGs (comprising 11 Guidelines) in 2003, and the professional and national launches took place in 2004. Lesley Bourne was part of the core working group throughout this period and was tasked with/convened the Pediatric FBDGs (PFBDGs ages 0 – 7years). As with the core process all steps outlined in FAO/WHO have been followed and the database is extensive. Este and Lesley have convened over 25 meetings.

Another major issue is the South African leg of the PURE study, in which the health transition of Africans (urban and rural) is monitored over 12 years. Part of this study also monitors the nutrition transition. Este Vorster’s group is handling this.

The South African group has had a great deal to do with the ICN. Dr. Vorster has played a lead role as has Dr. Bourne. The latter has organized the Focus Asia symposium.

A third major issue relates to the linkage of HIV/AIDS and nutrition. It has become a major issue in South Africa.

Thailand:  One major effort was the organization and implementation of the Thai National Food Consumption Survey. A second has been the development in Thailand of a coordinated research agenda on the nutrition transition and cardiovascular disease. There are several agencies involved including national research council, Thailand research fund as well as the National Health

Foundation. Dr. Vongsvat was central to the organization of this as it relates nutrition to CVD and diabetes.

One initiative coming out of this is a large research effort she will lead on the Thai Muslim population related to the identification of the environmental contributing factors of noncommicable diseases.

Morocco:  They have also worked to develop a food based dietary guide. Further, they are working to understand how the Mediterranean diet, viewed as an excellent way to fight obesity in Morocco, is being followed there. There is also a joint Moroccan-Dutch study on  Moroccan women immigrants in the Netherlands.

Attachment A: Members of the International Union for Nutritional Sciences

Task Force on the Nutrition Transition as of September 24, 2005

Dr. Barry M. Popkin, Chair Professor of Nutrition Mailing Address Carolina Population Carolina University of North Carolina at Chapel Hill CB # 8120 University Square 123 W. Franklin St. Chapel Hill, NC  27516‑3997 Phone:  (919) 966‑1732 Fax:  (919) 966‑9159 E‑Mail: POPKIN@UNC.EDU	Dr. Carlos A. Monteiro, Vice Chair São Paulo University Center for Epidemiological Studies in  Health and Nutrition (NUPENS/USP) Av. Dr. Arnaldo, 715 01246‑904 ‑ Sao Paulo SP‑Brazil Phone:  (55‑11) 64‑6068 Fax: 55‑11‑852‑6748 E-Mail:  carlosam@usp.br
Dr. Juan Rivera, Director Center for Research in Population Health Instituto Nacional de Salud Publica Av. Universidad 655, Col. Sta. Ma. Ahuacatitlan, Cuernavaca, Mor. CP 62508 Mexico Tel/Fax: 011-52‑73‑11‑22‑19 E-mail:  jrivera@insp3.insp.mx	Dr. Lesley Bourne National Health & Development Research Programme Medical Research Council 19070 Tygerberg 7505 South Africa Phone:  011‑27‑21‑938‑0313 Fax:   011‑27 21‑938‑0342 E-Mail:  lesley.bourne@mrc.ac.za
Mr. Geoffrey Cannon Director of Science World Cancer Research Fund 105 Park St. London W1Y 3FB U.K. Phone:  011‑44‑171‑343‑4200 Fax:  011‑44‑171‑343‑4201 E-Mail: g.cannon@wcrf.org.uk	Professor  Dr. Vongsvat Kosulwat Institute of Nutrition Mahidol University Salaya, Phutthamonthon Nakhon Pathom, Thailand 73170 tel Off: 011-66-2-889-3820/800-238 fax Off: 011-66-2-441-9344 email: grvpt@mahidol.ac.th
Professor  Sabah Benjelloun Département des Sciences Alimentaires et Nutritionnelles Institut Agronomique et Vétérinaire Hassan II BP 6202 Rabat‑Instituts 10101 Rabat, MAROC Tél: Office: (212) 37 77 17 45 Home:   (212) 37 73 56 22 Fax:    (212) 37 77 81 35 Mobil:212 64 55 07 49 E-Mail: jelloun@iav.ac.ma	Zhai Fengying, Professor and Head Department of Public Nutrition Institute of Nutrition and Food Safety Chinese Center for Disease Control and Prevention 29 Nan Wei Road Beijing, China Phone:  86‑10‑6304‑1362 /631‑1875 Fax:  011‑86‑10‑63011875 E-Mail:  infh@public.bta.net.cn
Professor H.H. Vorster Dept. Home Economics and Dietetics University of Potchefstroom Potchefstroom  2520 South Africa Phone: 011-27-0148 2992469 Fax: 011-27‑148 2992464 or (27‑148) 99 2799 E-Mail:  VGEHHV@puknet.puk.ac.za	Dr. Gail HarrisonDept. of Community Health Sciences UCLA School of Public Health 10833 LeConte Avenue Los Angeles, CA 90095 Bus: (310) 825-3738, 206-8444 B Fax: (310) 794-1805 Home: (Phone) 805-496-5886 B (Fax) 805-496-2334 E-mail: gailh@ucla.edu
Dr. Colleen Doak Assistant Professor, Department of Nutrition and Health Institute of Health Sciences, Vrije University Amsterdam De Boelelaan 1085 1081 HV Amsterdam The Netherlands Work phone: +31 20 598 9282 Work fax: +31 20 598 6940 Email: colleen.doak@falw.vu.nl Email for large attachments: colleen.doak@gmail.com	Home address: Kapelsteeg 3 1381 XK Weesp The Netherlands Home phone: +31 29 441 1290