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
:1. Introduction
2. Materials and Methods
2.1. Food Intake Data and Methodology
2.2. Data on Burden of Malnutrition, NCD Health, and Development Indicators
2.3. Associations between Food Clusters and Health and Development Indicators
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Code | Description |
---|---|
2905 | Cereals excluding beer (wheat, rice, barley, maize, rye, oats, millet, sorghum, other) |
2907 | Starchy roots (cassava, potatoes, sweet potatoes, yams, other) |
2909 | Sugar and sweeteners (sugar, sweeteners, honey) |
2911 + 2912 | Pulses (beans, peas, other) and tree nuts |
2913 * | Oil crops (soyabeans, groundnuts, sunflower seed, rape and mustard seed, cotton seed, coconuts, sesame seed, palm kernels, olives, other) |
2914 | Vegetable oils (soyabean oil, groundnut oil, sunflower seed oil, rape and mustard seed oil, cottonseed oil, palm kernel oil, palm oil, coconut oil, sesame seed oil, olive oil, maize germ oil, other) |
2918 + 2019 | Vegetables (tomatoes, onions, other), fruit excluding wine (oranges, lemons, grapefruit, other citrus, bananas, plantain, apples, pineapples, dates, grapes, other) |
2922 + 2923 * | Stimulants (coffee, cacao, tea) and spices (pepper, pimento, cloves, other spices) |
2924 | Alcoholic beverages (wine, beer, fermented beverages, alcoholic beverages) |
2943 | Meat (bovine, mutton/goat, pork, poultry, other) |
2945 * | Offal |
2946 | Animal fats (butter/ghee, cream, animal fat, fish body oil, fish liver oil) |
2949 | Eggs |
2948 | Milk excluding butter |
2960 | Fish, seafood (freshwater fish, demersal fish, pelagic fish, marine fish, crustaceans, cephalopods, molluscs, other) |
Factor 1 | Factor 2 | Factor 3 | ||||
---|---|---|---|---|---|---|
Food Item | Loading | Food Item | Loading | Food Item | Loading | |
Factor loadings > 0.3 | Meat Animal fats Alcoholic beverages Fish and seafood Sugar/sweeteners Milk Eggs | 0.74 0.69 0.68 0.51 0.50 0.43 * 0.44 * | Cereals Milk Animal fats Sugar/sweeteners | 0.71 0.64 0.44 * 0.42 * | Vegetable oils Eggs Sugar/sweeteners Fish and seafood | 0.76 0.53 0.43 * 0.32 * |
Factor loadings <−0.4 | - | - | Fruit and vegetables Starchy roots | −0.48 −0.83 | Pulses and tree nuts | −0.53 |
% Variance explained (Total = 54.4%) | 20.7% | 20.6% | 13.1% | |||
Type of diet | Westernised | Traditional/Westernised | Traditional/Westernised |
Cluster 1 Desert/Semi-Arid N = 12 | Cluster 2 Tropical Coastal N = 12 | Cluster 3 Equatorial N = 14 | Cluster 4 Southern African/Island N = 5 | |
---|---|---|---|---|
Countries | Botswana, Burkina Faso #, Djibouti, Ethiopia #, Gambia #, Kenya #, Lesotho *, Madagascar #, Mali #, Mauritania, Niger, Zimbabwe # | Benin, Cameroon, Comoros, Guinea, Guinea-Bissau, Liberia, Mozambique#, Nigeria #, Senegal #, Sierra Leone, Togo, Zambia * | Angola, Burundi, Central African Republic (CAR), Chad #, Republic of the Congo, Democratic Republic of the Congo (DRC) &, Gabon, Ghana, Ivory Coast, Malawi, Rwanda, São Tomé and Príncipe, Uganda, Tanzania # | Cabo Verde, Eswatini, Mauritius, Namibia, South Africa (Seychelles excluded as an outlier in the analysis) |
Description | Warm desert and warm semi-arid climate. | Mostly coastal countries with tropical savanna and tropical monsoon climate. | Tropical savanna and subtropical climate areas in the equatorial region. | Mostly southern African countries and well-developed islands, with a spread of climate regions. |
Exceptions which refer to countries above [33] | * Lesotho has cold semi-arid and tropical/sub-tropical regions. # Includes additional tropical/sub-tropical regions. | * Zambia has a humid subtropical climate. # Includes additional semi-arid regions. | # Include additional semi-arid/desert regions. & Tropical rainforest. | South Africa: 5 major climate groups. Namibia: desert/semi-arid. Mauritius: Tropical. Eswatini: subtropical/semi-arid. Cabo Verde: desert. |
Desert/Semi-Arid (Cluster 1) N = 12 | Tropical Coastal (Cluster 2) N = 12 | Equatorial (Cluster 3) N = 14 | Southern African and Islands (Cluster 4) N = 5 | Kruskal–Wallis p-Value | UK | USA | |
---|---|---|---|---|---|---|---|
2901: All food items (kcal/capita/day) | 2527 (2198–2764) | 2398 (2249–2686) | 2323 (2156–2600) | 2583 (2544–2898) | 0.211 | 3395 | 3862 |
2905: Cereals (g/capita/day) | 477 [a] (422–552) | 405 [a] (385–471) | 257 [b] (141–356) | 450 [a] (402–461) | 0.0004 ** | 361 | 301 |
2907: Starchy roots (g/capita/day) | 72 [c] (33–163) | 400 [a] [b] (306–535) | 736 [a] (431–796) | 98 [b] [c] (94–186) | <0.001 *** | 211 | 145 |
2909: Sugar and sweeteners (g/capita/day) | 66 [b] (25–91) | 33 [b] (26–45) | 33 [b] (23–39) | 110 [a] (97–134) | 0.006 ** | 105 | 181 |
2911 + 2912: Pulses and tree nuts (g/capita/day) | 31 (6–50) | 28 (12–34) | 23 (12–44) | 22 (10–27) | 0.870 | 12 | 18 |
2914: Vegetable oils (g/capita/day) | 21 [a] [b] (16–34) | 32 [a] [b] (25–35) | 21 [b] (13–25) | 25 [a] (23–42) | 0.011 * | 37 | 55 |
2918 + 2919: Fruit and vegetables (g/capita/day) | 154 (71–305) | 217 (152–365) | 341 (197–611) | 308 (180–341) | 0.078 | 433 | 586 |
2924: Alcoholic beverages (g/capita/day) | 51 (11–99) | 30 (9–83) | 67 (52–146) | 180 (124–221) | 0.022 * | 243 | 248 |
2943: Meat (g/capita/day) | 42 [b] (34–66) | 37 [b] (25–47) | 45 [b] (26–102) | 90 [a] (86–153) | 0.015 * | 216 | 352 |
2946: Animal fats (g/capita/day) | 2 [b] (1–3) | 1 [b] (1–1) | 1 [b] (0–3) | 3 [a] (2–4) | 0.006 ** | 12 | 10 |
2949: Eggs (g/capita/day) | 2 [b] (1–4) | 5 [b] (3–6) | 2 [b] (1–3) | 13 [a] (5–18) | 0.001 ** | 31 | 45 |
2948: Dairy (g/capita/day) | 93 [a] (59–181) | 22 [b] (7–40) | 21 [b] (5–42) | 111 [a] (110–111) | <0.001 *** | 575 | 632 |
2960: Fish and seafood (g/capita/day) | 10 (6–22) | 32 (26–46) | 30 (19–66) | 30 (17–31) | 0.024 * | 51 | 61 |
Desert/Semi-Arid (Cluster 1) N = 12 | Tropical Coastal (Cluster 2) N = 12 | Equatorial (Cluster 3) N = 14 | Southern African and Islands (Cluster 4) N = 5 | Kruskal–Wallis p-Value | United Kingdom | United States | |
---|---|---|---|---|---|---|---|
Child stunting %HAZ < −2SD <5 years, 2021 | 27.7 (23.7–35.7) | 30.1 (28.5–31.9) | 31.8 (21.2–37.8) | 22.1 (17.5–24.1) | 0.1950 | NA | NA |
Child overweight %WHZ > +2SD < 5 years, 2021 | 2.1 [b] (1.5–5.4) | 4.5 [b] (2.1–6.3) | 3.4 [b] (2.3–4.5) | 7.8 [a] (5.3–10.3) | 0.0848 | NA | NA |
Concurrent stunting and overweight < 5 years, 2021 | 0.8 (0.5–1.8) | 1.8 (0.7–3.5) | 1.2 (0.6–1.6) | 1.7 (1.1–2.6) | 0.3398 | NA | NA |
Females 18 years and older, overweight BMI ≥ 25, age-standardised, 2017 | 37.0 [b] (29.6–48.7) | 36.0 [b] (35.7–37.3) | 34.9 [b] (31.5–39.5) | 51.9 [a] (41.4–52.6) | 0.3130 | 60.0 | 63.2 |
Child anaemia # <5 years, 2019 Hb < 110 g/L | 52.1 [a] (43.3–72.0) | 68.6 [a] (63.6–72.4) | 58.8 [a] (56.1–62.4) | 44.1 [b] (42.7–44.4) | 0.0025 ** | 15.5 | 6.1 |
Women 15–49 years Anaemia #, 2019 Hb < 110 g/L (pregnant) and Hb < 120 g/L (non-pregnant) | 37.8 [a] (28.7–49.5) | 48.0 [a] (41.6–50.6) | 44.2 [a] (35.4–46.8) | 25.2 [b] (24.3–30.5) | 0.0098 ** | 11.1 | 11.8 |
Hypertension prevalence ## in male and female, age-standardised 30–79 years, 2019, mmHg | 36.7 (33.1–42.4) | 36.7 (33.8–40.2) | 35.6 (32.1–38.2) | 38.1 (32.7–48.8) | 0.8144 | 37.7 | 29.8 |
Females 18 years and older, type 2 diabetes ###, 2014, age- standardised | 7.0 [b] (5.4–8.7) | 6.9 [b] (6.4–7.2) | 6.3 [b] (6.0–7.6) | 11.3 [a] (8.0–12.6) | 0.0291 * | 4.9 | 6.4 |
Females’ total cholesterol, age-standardised, 18 years and older, 2018, mmol/L | 4.1 (4.1–4.3) | 4.2 (4.2–4.2) | 4.1 (4.1–4.2) | 4.2 (4.1–4.4) | 0.5390 | 4.8 | 4.7 |
Females’ LDL-cholesterol, age-standardised, 18 years and older, 2018, mmol/L | 2.9 (2.8–3.0) | 2.9 (2.9–3.0) | 2.9 (2.8–3.0) | 2.9 (2.9–3.1) | 0.8756 | 3.2 | 3.2 |
Females’ HDL-cholesterol, age-standardised, 18 years and older, 2018, mmol/L | 1.2 [a] [b] (1.1–1.2) | 1.1 [b] (1.1–1.2) | 1.2 [a] [b] (1.1–1.2) | 1.3 [a] (1.2–1.3) | 0.0335 * | 1.7 | 1.6 |
Desert/Semi-Arid (Cluster 1) N = 12 | Tropical Coastal (Cluster 2) N = 12 | Equatorial (Cluster 3) N = 14 | Southern African and Islands (Cluster 4) N = 5 | Kruskal–Wallis p-Value | United Kingdom | United States | |
---|---|---|---|---|---|---|---|
GDP Current USD, 2020 | 996.0 [b] (784.0–1828.0) | 1139.0 [b] (710.5–1416.0) | 1086.0 [b] (710.0–2276.0) | 5010.0 [a] (3916.0–6625.0) | 0.0102 * | USD 2.8 million | USD 21.0 million |
% Over 65 years (2020) | 3.1 [b] (2.5–4.0) | 2.9 [b] (2.8–3.1) | 2.7 [b] (2.5–3.0) | 4.8 [a] (4.0–5.5) | 0.0040 ** | 18.7 | 16.6 |
% Urban dwellers | 35.4 (28.5–59.0) | 44.4 (40.0–50.2) | 42.2 (23.5–66.8) | 52.0 (40.8–66.7) | 0.8288 | 83.9 | 82.7 |
% Informal urban dwellers | 57.1 (46.5–64.3) | 54.5 (50.1–69.4) | 48.3 (42.1–65.1) | 32.1 (25.6–42.3) | 0.1369 | - | - |
Gini coefficient | 41.2 [b] (36.0–46.1) | 38.0 [b] (35.2–46.0) | 41.4 [a] [b] (38.5–43.7) | 54.6 [a] (42.4–59.1) | 0.2046 | 35.1 | 41.5 |
Annual population growth (%) (2020) | 2.6 [a] (1.8–2.9) | 2.6 [a] (2.4–2.8) | 2.5 [a] (2.4–3.0) | 1.1 [b] (1.0–1.3) | 0.0081 ** | 0.6 | 1.0 |
Birth rate (2020) | 4.0 [a] (3.3–5.1) | 4.5 [a] (4.2–4.7) | 4.5 [a] (4.1–4.8) | 2.4 [b] (2.2–2.9) | 0.0043 ** | 1.6 | 1.6 |
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Nel, J.H.; Steyn, N.P. 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? Int. J. Environ. Res. Public Health 2022, 19, 16791. https://doi.org/10.3390/ijerph192416791
Nel JH, Steyn NP. 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? International Journal of Environmental Research and Public Health. 2022; 19(24):16791. https://doi.org/10.3390/ijerph192416791
Chicago/Turabian StyleNel, Johanna H., and Nelia P. Steyn. 2022. "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?" International Journal of Environmental Research and Public Health 19, no. 24: 16791. https://doi.org/10.3390/ijerph192416791