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Transformative Education (2019) 1:1, 5-10. 
DOI  10.14434/gjte.v1i1.26141

Open Access

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Nutrition Transition in Africa:  
Consequences and Opportunities

Teresia Mbogori1 and Winnie Mucherah2

Abstract
Nutrition transition, defined as a shift in dietary patterns and energy expenditure, is a major concern world-

wide and especially in low- and middle-income countries. Nutrition transition is linked to an increased preva-
lence of metabolic disorders and non-communicable diseases such as obesity, diabetes and cardiovascular dis-
eases. In regions such as the sub-Saharan Africa, prevalence of overweight and obesity has steadily increased 
in the recent years despite the high prevalence of hunger and malnutrition. Factors that have contributed to 
nutrition transition include urbanization, socio-economic developments and technological advancements. 
Food consumption in some households has shifted to diets rich in fats and oils, calorie-based sweeteners, and 
animal-based products high in saturated fats (diets commonly referred to as “western diets”), from traditional 
African diets based on legumes, whole grain products and traditional vegetables.  Opportunities to slow down 
the effects of nutrition transition in Africa may exist through education and policy changes that are culturally 
sensitive.

Keywords: Nutrition transition, Health and development, Malnutrition, Traditional African diet

Full listing of authors and contacts can be 
found at the end of this article.

Introduction
Malnutrition, a condition that refers to deficiencies, 
excesses or imbalances in a person’s intake of energy 
and/or nutrients, remains a major hindrance to the 
social and economic development of a country espe-
cially in Sub-Saharan Africa (Bain et al., 2013). Mac-
ronutrient and micronutrient malnutrition in women 
and children increases their vulnerability to infections 
which increases the levels of childhood and maternal 
mortality (Stein, 2010). Stunting due to chronic hunger 
is associated with inadequate cognitive development 
which reduces the learning abilities and productivity 
of the child later in life and leads to the vicious cycle 
of poverty and malnutrition (Vorster, 2010). Similarly, 
overweight and obesity causes an economic and social 
burden to the country due to high costs of its manage-
ment (Allender & Rayner, 2007). Many Sub-Saharan 
African countries are struggling with both undernutri-
tion and overweight, also known as the double burden 
of malnutrition. This has been attributed to the rapid

nutrition transition being witnessed all over the world 
and especially in developing countries.

Nutrition transition, defined as a shift in dietary 
patterns and energy expenditure, is a major concern 
worldwide and especially in low and middle-income 
countries (Popkin, 1994; Popkin, Adair, & Ng, 2012). 
Nutrition transition in the Africa is linked to increased 
prevalence of metabolic disorders and non-commu-
nicable diseases such as obesity, diabetes and cardio-
vascular diseases (Bosu, 2015). In sub-Saharan Africa, 
prevalence of overweight and obesity has steadily in-
creased in the recent years despite the high prevalence 
of hunger and malnutrition (Tzioumis, Kay, Bentley, & 
Adair, 2016). Consumption of high energy dense foods 
such as soft drinks and deep fried foods has replaced 
the traditionally consumed foods that were high in 
whole grain cereals and vegetables in most African 
homes. In addition, improvement in infrastructure and 
economic status has reduced the duration and intensity 
of physical activity among children and adults (Steyn & 
McHiza, 2014). 



Mbogori & Mucherah, Nutrition Transition in Africa  6 

Several studies have reported on the extent and 
consequences of nutrition transition and the double 
burden of malnutrition in Africa (Abrahams, McHiza, & 
Steyn, 2011; Steyn & McHiza, 2014; Steyn, Nel, Parker, 
Ayah, & Mbithe, 2012). Some of the main consequences 
include development of chronic diseases such as dia-
betes, high cholesterol levels and high blood pressure 
and cardiovascular diseases (Albala, Vio, Kain, & Uauy, 
2002). These consequences are of great impact espe-
cially on the health care systems in African countries as 
these countries are still struggling with maternal and 
childhood undernutrition and micronutrient deficien-
cies.

Childhood is a very critical period in the develop-
ment of an individual. While nutrition transition affects 
all stages of development, infancy and childhood stages 
are more likely to experience a greater impact. For-
tunately, it is easier to change or modify behaviors at 
young ages than it is to change behavior of adults. Most 
studies done on nutrition status in children in African 
countries mainly focus on increasing food intake to 
prevent undernutrition and very few studies investi-
gate the changes in dietary patterns of the children that 
could lead to overweight and obesity later in life. There-
fore, the purpose of this paper is to describe nutrition 
transition and highlight some of its consequences in 
children as well as to suggest some opportunities to 
mitigate the effects of nutrition transition within the 
African context.

Nutrition Transition 
Nutrition transition was first described by Popkin 
(1994) as shifts in dietary patterns that are reflected 
through changes in body size and composition. Popkin 
proposed five patterns of nutrition transition which 
represent the different stages of dietary changes in a 
population. First pattern is referred to as “hunter gath-
erer” and it describes the diets consumed in the hunter 
gatherer period if human evolution. These diets were 
high in carbohydrate, fiber and low in saturated fat. 
Also, activity levels were high and obesity rates were 
very low. The second pattern is referred to as “famine” 
and it describes a period in time where there was food 
shortage that led to a decrease in dietary diversity and 
adequacy. Also, towards the end of this period agricul-
tural revolution occurred and societies that were more 
civilized were able to feed their population. Although 
this stage mainly occurred in the 18th century in the 
developed countries, many places in sub-Saharan Africa 
are still dealing with famine today.

“Receding famine” is the third pattern and it is one 
where many countries made great progress in reducing 
chronic hunger and famine and the consumption of 
fruits, vegetables and animal products increased. How-
ever, at this stage, physical activity levels started to de-
crease which could have been attributed to technolog-
ical development.  The fourth pattern “overeating and 
obesity related diseases” is characterized by diets that 
are high in fat, cholesterol, refined sugars, accompanied 
by sedentary lifestyles. This pattern is currently being 
observed all over the world especially in developing 
countries. Finally, is the behavior change pattern which 
describes behaviors similar to the first stage where 
there is increase in intake of fruits and vegetables and 
reduction in the consumption of refined carbohydrates. 
These changes are currently being observed mainly in 
developed countries as a response to increase in chron-
ic diseases. Most of the work in nutrition transition 
mainly focuses on the fourth and fifth patterns. 

For the African population, nutrition transition 
could be described following patterns three through 
five with most of the population quickly moving to-
wards stage four (Popkin, 2004). As undernutrition 
and micronutrient deficiencies persist, overweight and 
obesity rates in African countries have shown a steady 
increase that has exceeded the prevalence of under-
weight since 1980 (Black et al., 2013). Shifts in dietary 
patterns have been mostly observed within the adult 
population, however, there are concerns that changes in 
infant and children feeding practices might soon shift to 
the young population as has been observed in devel-
oped countries.

Traditionally, the main types of food introduced to 
infants across Africa were plant based cereals made 
from mainly maize, sorghum, wheat or millet (Gibson, 
Ferguson, & Lehrfeld, 1998).  Although intake of cereal 
based complementary foods is usually associated with 
insufficient intakes of iron, calcium and zinc (Gibson et 
al., 1998), in some communities, amaranths, milk, soy, 
fish and edible termites are used to enrich cereal based 
foods (Konyole et al., 2012). With changing diets and 
improvement of social economic status among African 
families, infants are now introduced to foods high in 
fats and sugars as part of complementary foods (Popkin 
et al., 2012). These foods are energy dense instead of 
nutrient dense and research has shown that such foods 
may lead to adulthood diseases such as type 2 diabetes 
during childhood and later in adult life (Steyn & McHi-
za, 2014).

Global Journal of Transformative Education (2019) 1:1



Mbogori & Mucherah, Nutrition Transition in Africa 7 

Global Journal of Transformative Education (2019) 1:1

Consequences of nutrition transition
In general, nutrition transition affects everyone in 

the population regardless of age. The most common 
outcomes are chronic diseases such as diabetes and car-
diovascular diseases (Delisle, Agueh, & Fayomi, 2011). 
While the developed countries have the resources to 
deal with the rise in these conditions, African countries 
are still dealing with undernutrition especially in chil-
dren which in itself exerts a lot of strain to the health 
care system in Africa (Salam et al., 2015).

Maternal malnutrition during pregnancy, inade-
quate breastfeeding and poor complementary feeding 
practices are associated with malnutrition in children. 
During pregnancy and lactation, nutrient needs in-
crease making these periods nutritionally-vulnerable 
stages for women of child-bearing age (Khayat, Fanaei, 
& Ghanbarzehi, 2017). Undernutrition in mothers is a 
cause for concern due to the impact adequate maternal 
nutrition has during the critical 1,000-day period from 
pregnancy to the first two years of the child’s life (Woo 
Baidal et al., 2016). Similarly, obesity during pregnancy 
has been associated with poor health outcomes of the 
pregnancy such as increased risk of caesarian delivery, 
childhood overweight and obesity, diabetes in later life 
for mothers and obesity in adolescence for the children 
(Poston, Harthoorn, & van der Beek, 2011; Valsamakis, 
Kyriazi, Mouslech, Siristatidis, & Mastorakos, 2015). 

The immediate effect of poor nutrition during the 
early years of a child is morbidity and mortality and, 
delayed cognitive, social-emotional and motor devel-
opment (da Cunha, Leite, & de Almeida, 2015),  While 
the long-term effects include impairment in, intellec-
tual ability, work capacity, reproductive outcomes and 
overall health during adolescence and adulthood (da 
Cunha et al., 2015). Infants born to undernourished 
mothers are likely to be undernourished as well at birth 
and if they experience rapid weight gain in childhood, 
they are much more likely to suffer from diabetes and 
cardiovascular diseases later in life than children who 
were not undernourished at birth (Victora et al., 2008). 
This means that in developing countries such as sub-Sa-
haran Africa, greater efforts should be directed towards 
minimizing rapid dietary shifts towards consumption of 
high energy dense foods by children to mitigate possi-
ble development of chronic diseases in future life.

Opportunities to slow nutrition transition in Africa
Nutrition transition is inevitable as countries 

continue to expand their infrastructure and economic 
development. However, there are ways that the society

can be more vigilant in order to slow down the pro-
gression. Many countries globally are working towards 
behavior change so that people can move from con-
sumption of highly processed energy dense foods to 
increased intake of fruits and vegetables. However, in 
Africa there are communities, still experiencing famine, 
consuming diets high in fruits, vegetables and whole 
grains, and those that have adapted more westernized 
diets. This means that when planning interventions 
to slow down nutrition transition, these three levels 
should be considered. Interventions are needed to 
improve food production for those experiencing famine, 
nutrition education on the importance of maintain-
ing traditional African diets are needed for those who 
are still consuming diets high in fruits, vegetables and 
whole grains and behavior modification interventions 
are needed for those who have adopted a more west-
ernized diet. 

Education
One avenue that nutrition and health related informa-
tion is shared is through the formal schooling system. 
Nutrition and health related programs that are offered 
through school platforms have been shown to improve 
the health and nutrition status of the poor and vulner-
able children in low and middle income countries (Sarr 
et al., 2016).  For example, school meal programs com-
mon among many African countries encourage children 
to go to school because of the promise of a meal (Al-
derman, Hoddinott, & Kinsey, 2006). For the most part, 
foods served in schools are sourced from local farmers 
and local markets and are therefore more likely than 
not to include traditional African diets rich in vegeta-
bles and whole grains. However, as nutrition transition 
progresses, there is a possibility that foods offered in 
schools might change into a more westernized diet that 
is more convenient and cheaper for the schools.

In a school setting, nutrition education can 
benefit the children, teachers as well as staff by 
providing them with the tools for healthy eating. 
Including nutrition education in the school curric-
ulum is could help slow down the effects of nutri-
tion transition, however, it has to be sensitive to the 
African context. Nutrition education curricula need to 
be linked to locally grown foods, cultures and diversity 
as well as environmental sustainability.  This means 
that examples used in instruction should be based on 
healthy foods that are locally available and accessible to 
the children instead of using examples of foods that are



Mbogori & Mucherah, Nutrition Transition in Africa 8 

Global Journal of Transformative Education (2019) 1:1

foreign to the community. 
Some studies that have evaluated the impact of nu-

trition education in schools especially and have shown 
positive outcomes in the nutrition and health status 
of the students. However, these studies focus more on 
undernutrition and not overweight and obesity (Walsh, 
Dannhauser, & Joubert, 2002).  It is noteworthy that 
prevalence of overweight and obesity in children is 
still low in sub Saharan Africa and therefore could be 
the reason behind lack of obesity-based interventions. 
However, this makes it the ideal time to introduce 
nutrition education in the school curricula to minimize 
adoption of unhealthy dietary patterns among school 
going children. 

Research and policy 
Researchers and policymakers have an opportunity 
to work with individuals and communities in African 
countries to try and slow down the negative effects of 
nutrition transition especially on children. From the 
documented literature, it is evident that there are a 
number of intervention activities that focus on miti-
gating the effects of acute food shortage. These inter-
ventions are mainly funded by international donor 
agencies. The main challenge with donor agency funded 
interventions is that they tend to focus on the agency’s 
key interests that might not entirely reflect the needs 
of the society. For instance, many UN agencies work in 
the dry areas to provide food aid in form of ready to 
eat formulas for severely malnourished children and 
food rations for the moderately malnourished children. 
While this is a noble cause that has been done over the 
years, the real cause of severe malnutrition, which is 
poverty and low productivity has not been adequately 
addressed.  Therefore, a cycle develops whereby mal-
nourished children are rehabilitated but when they are 
out of danger, they fall back into the malnourished state 
due to the conditions that initially made them mal-
nourished. In addition, most of the international donor 
agencies are very unlikely to engage in behavior change 
interventions that are needed for slowing down the 
effects of nutrition transition. 

To effectively address nutrition transition, stake-
holders need to work with communities to ensure 
that the magnitude and severity of adopting a western 
lifestyle are understood by the community members. To 
that end, there are a number of questions about peo-
ple’s perception of the changing nutrition status and 
dietary intake that need to be evaluated. For example, 
1) How do individuals in African settings perceive

consumption of westernized diets high in refined sugar 
and fat as compared to consumption of traditional diets 
high in fruits and vegetables and whole grains? 2) How 
does the community view overweight and obesity ei-
ther in a child or an adult?  3) Are community members 
educated on the dangers of overweight and obesity that 
result from high calorie intake with sedentary behav-
ior? 4) What are African governments doing to ensure 
that overweight and obesity do not reach alarming lev-
els as those being witnessed in some of the developed 
countries? Some of these questions have been explored 
to some extent. For example in South Africa, a qualita-
tive study among children found that some teenagers 
perceived being overweight and obese to be desirable 
especially by parents because it was an indication of 
happiness (Puoane, Tsolekile, & Steyn, 2010). Another 
study found that being underweight might be perceived 
as suffering from HIV or AIDS hence undesirable (Okop, 
Mukumbang, Mathole, Levitt, & Puoane, 2016). Such 
feedback indicates that before beginning a behavior 
modification intervention, education is needed to dis-
count some of those beliefs and come up with mutually 
acceptable interventions. Also, some countries have 
developed policy documents that are geared towards 
curbing the increase in overweight and obesity. Howev-
er, evaluation of such policies needs to be done.

Conclusion
There is sufficient documentation on nutrition tran-
sition in African countries. Consequences of nutrition 
transition are more severe in African countries than in 
developed countries as they pose a double burden of 
undernutrition and obesity to the community, house-
holds and individuals. Children in such households end 
up with developmental challenges and are more likely 
to develop adult diseases such as type 2 diabetes in 
childhood. Very few studies investigate the understand-
ing and perception of individuals and communities 
towards the components of nutrition transition such 
as increase in energy intakeor increase in adiposity. 
Such studies are important because it is sometimes 
perceived that consumption of western diets and being 
overweight or obese are a sign of improved social eco-
nomic status. This, therefore, may hinder government 
and other stakeholders’ efforts towards slowing down 
the effects of nutrition transition. There are opportu-
nities to slow down the effects of nutrition transition 
through education, policy and research. Food and nutri-
tion topics that emphasize on consumption of tradition-
al African diets and discourage the consumption of 



Mbogori & Mucherah, Nutrition Transition in Africa 9 

Global Journal of Transformative Education (2019) 1:1

western diets could be introduced into the schools’ 
curriculum. At policy level, national programs aimed at 
reducing hunger and malnutrition could focus more on 
ensuring intake of nutritious foods that are culturally 
appropriate and locally grown where possible.

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1 Teresia Mbogori (tnmbogori@bsu.edu) is an Assistant 
Professor in the Department of Nutrition and Health 
Sciences at Ball State University, Muncie, Indiana, USA.

2 Winnie Mucherah (wmucherah@bsu.edu) is a Professor 
in the Department of Educational Psychology at Ball 
State University, Muncie, Indiana, USA.

Authors


