Prueba de precisión en función de la transformación

Pelto et al. first described facets of the nutrition transition in their research on the ‘delocalisation’

of food production and distribution in 1983. They state that delocalisation has been key to the dramatic changes in worldwide dietary patterns over the past two centuries, and the majority of people no longer eat what they grow, or foods produced locally. These changes are associated with many positive improvements in the diversity of the diet, provided by more variety and

increased availability out of season (Pelto and Pelto, 1983). The process of globalisation has promoted the development of a global food system, However, the current food system has been implicated in promoting ‘unsustainable’ and ‘unhealthy’ diets, which are reliant on only a few key crops (i.e. wheat, maize, and rice). Such diets are also associated with exhausting natural resources such as water and phosphorus. Growing concern for environmental sustainability of food systems is fuelling significant research, and receiving increasing political attention (Lang and David, 2012, Lang and Mason, 2017).

The development of interdisciplinary networks and institutional platforms in the last decade (i.e.

Food Climate Research Network, Oxford; International Food Policy Research (IFPRI), Interdisciplinary Research Centre for Global Food Security, Cambridge; and Barilla Center for Food and Nutrition (BCFN)) demonstrates both the importance and commitment to this area of research. Literature from this field is outside the scope of the present research; however, a systematic review encompassing the determinants of dietary patterns, nutrition, and physical activity conducted by Prof. Hawkes provides a thorough introduction to the area (Hawkes et al., 2006). The review encompasses environmental, economic, and political determinants, as well as socio-economic and cultural ones.

More recently, the nutrition transition has been described as the population-wide change in diet, from one that is indigenous, high in unrefined carbohydrates, and low in fat and processed foods, to a more ‘western’ diet higher in fat, sodium, and sugar, as well as higher protein due to an increase in animal foods e.g. meat and dairy products. The concept of ‘nutrition transition’ also encompasses a shift toward lower physical activity and overweight/obesity (Vorster et al., 1999).

Figure 2:1 illustrates the five stages of the nutrition transition that populations tend to experience. The influence of urbanisation, along with shifts in the use of technology and the impact on demographic and epidemiological transitions are also indicated, particualrly for stage three: receding famine, stage four: degenerative disease, and stage five: behavioural change. In stage four, bone health problems are explicitly mentioned, indicating the association of several

41 | P a g e factors of the nutrition transition with various aspects of bone health. These will be described in more detail in Section 2.6.

Significant advances in technology have resulted in reduced physical activity in both work and leisure activities. The food industry in particular benefited and supported the development of refrigeration technologies, which enables the safe storage and efficient transport of food for many people. However, historically, the primary beneficiaries of such technology and wider food choice have been the upper social classes of western, industrialised nations. Today in HICs, there is comparatively little disparity in access to refrigeration and food choice is extensive. In contrast, in LMICs like The Gambia, much of the population rely on locally produced foods, and a large proportion of the population are subsistence farmers. There is little availability or access to labour saving devices and agricultural work is labour intensive. In resource-limited settings, struggles with poor and unreliable electricity infrastructure and inadequate access to fridges or freezers likely results in significant food spoilage (The Gambian Government, 2009).

2.1.4.1 Patterns of dietary transition

There is also accumulating evidence that dietary change in LMICs does not necessarily follow the same pattern of change that has occurred in HICs. In South Africa, transition in diet and lifestyle

Figure 2:1 Stages of the nutrition transition (Figure based on Popkin, 2002)

is not limited to only urban areas; levels of overweight and obesity are also rising in rural areas (Micklesfield et al., 2014).

Critics of the nutrition transition concept, caution that “a one-size-fits-all” model has limitations, due to the complexity of interactions between local populations and wider global processes such as globalisation and urbanisation. Himmelgreen et al. (2014) examined the role and impact of globalisation and migration on dietary patterns and quality, and energy balance over a 20-year period. They conclude that using the concept of the nutrition transition more loosely will enable its application within a wider variety of settings. Professor Hawkes describes how globalisation processes can simultaneously result in complex homogenisation and differentiation of dietary patterns (Hawkes, 2006). This is an important consideration for research in The Gambia, as specific historical and cultural practices are likely to have a strong influence on the dietary choices of Gambians as they experience transition.

Research by Drewnowski and Popkin (1997) on the nutrition transition in HIC showed that increasing wealth was associated with increasing intakes of fat. However, the increased availability of cheap vegetable oil has increased the availability and accessibility of high fat foods to societies or parts of society with low incomes.

Comparing historic and modern patterns of transition, Adair and Popkin (2005) stated that ‘the biggest difference with the developing world is that there is much more heterogeneity related to these patterns than in the developed world’. They compared patterns of snacking behaviour and out of home food consumption in China and the Philippines to the USA, stating that ‘there is little snacking or away from home intake or fast food intake in China whereas the Philippines looks more similar to the US.’ There is little evidence available from The Gambia on street food consumption, but currently, there are no large fast food chains in The Gambia. Before providing more detail of the situation concerning transition in The Gambia, Section 2.2 provides a country overview.

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