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Zulfiqar A. Bhutta
Centre for Global Child Health, Hospital for Sick Children
Peter Gilgan Centre for Research and Learning (PGCRL)
686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON M5G 0A4 (Canada)
Published online:
Biesalski HK (ed): Hidden Hunger and the Transformation of Food Systems. How to Combat the Double Burden of Malnutrition? World Rev Nutr Diet. Basel, Karger, 2020, vol 121, pp 31–41 (DOI:10.1159/000507492)
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Africa’s Changing Food Environments and Nutritional Effects on Adults and Children
Kathrin M. DemmleraMatin Qaimb
aKnowledge Leadership, Global Alliance for Improved Nutrition (GAIN), London, UK; bDepartment of Agricultural Economics and Rural Development, University of Goettingen, Goettingen, Germany
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Abstract
Many low- and middle-income countries (LMICs) are experiencing profound changes in food environments, including a rapid growth of supermarkets and other modern retailers. Changing food environments can influence people’s diets, nutrition, and health. While in many LMICs, undernutrition and micronutrient deficiencies are still widespread, problems of overweight, obesity, and related non-communicable diseases are also massively on the rise. Supermarkets seem to contribute to overweight and obesity among adults, but effects on children and adolescents could possibly be different. Here, we review the available evidence about the implications of supermarkets for people’s diets, nutrition, and health. Particular emphasis is placed on recent studies from urban Kenya that used panel data and differencing techniques to identify causal effects on different age cohorts. The results from Kenya show that shopping in supermarkets contributes to higher consumption of processed and highly processed foods and lower consumption of unprocessed foods. These dietary changes lead to significant increases in the body mass index and the probability of being overweight/obese and pre-diabetic among adults. For children, the same increases in overweight are not observed. Instead, supermarket shopping increases child height-for-age Z-scores. Despite higher food processing levels, supermarkets enhance food variety and dietary diversity in the relatively poor households. The results confirm that the growth of supermarkets affects adult and child nutrition differently; while the effects on adults are negative, the effects on children are positive, especially in the Kenyan context where child undernutrition is still widespread. Better understanding the effects of changing food environments on different age cohorts and in different contexts is important to design strategies that can help to make food choices in LMICs healthier. More research in different geographical settings will be useful.
© 2020 S. Karger AG, Basel
Malnutrition in all its forms is holding back the development and well-being of people worldwide. Overall, more than 820 million people are currently undernourished [1], over 2 billion people are affected by micronutrient deficiencies, and another 2 billion people are overweight or obese with an elevated risk of developing diet-related non-communicable diseases (NCDs), including diabetes, hypertension, stroke, and cancer [2, 3]. All countries worldwide are currently affected by at least one form of malnutrition, 88% of all countries even face two forms, and 29% three forms of malnutrition [2]. Especially, low- and middle-income countries (LMICs) and their economies and health systems are under pressure, facing infectious and chronic diseases at the same time at national and community level, but sometimes also at household and even individual level.
In order to fight malnutrition in all its forms and to establish access to safe, nutritious, and sustainable diets, “business as usual” is no longer an option. A transformation of food systems towards healthier and safer food with lower environmental effects is urgently needed. Over the last decades, transformation in diets could be observed in many LMICs. However, these transformations were mainly driven by urbanization, technological innovations, and an expansion of mass media, and have led to an increased intake of processed foods, meat and dairy products, saturated and total fats, sugar, and energy-dense beverages [4,
