Why we are still failing to measure the nutrition transition

Summary boxMuch of the global burden of malnutrition, particularly shifts towards an increased prevalence of overweight and obesity, is driven by dietary changes described as the ‘nutrition transition’.The nutrition transition appears to be driven by shifts in diets towards more ‘ultraprocessed’ foods high in sugar, fat, salt, low in fibre and less nutrient dense - but  little is known about actual food consumption in many populations.Standard instruments used for measuring diets in low-income and middle-income countries are inadequate for assessing changing diets in the context of the nutrition transition, as they do not provide appropriate provision in response to categories for consumption of ultraprocessed food products.There is a need for a validated standardised food frequency questionnaire designed to measure changing dietary patterns that have appropriate provision for highly processed food types - and with the implementation of such questonnaires there is a need to consider food source and the importance of capturing foods eaten outside of the home as well as in the home.Malnutrition in all its forms—both underweight and micronutrient deficiencies, as well as overweight, obesity and associated non-communicable disease—is a global health issue, with the majority of cases arising in low-income and middle-income countries (LMICs).1 Much of this malnutrition, particularly shifts towards an increased prevalence of overweight and obesity, is driven by dietary changes described as the ‘nutrition transition’, whereby populations move from traditional diets high in fibre and micronutrients, to more highly processed diets high in sugar, fat, salt, low in fibre and less nutrient dense–with these dietary changes accompanied by changes in eating behaviours and physical activity patterns.2 Ultraprocessed food products have been defined by Monteiro et al as ‘not entirely or mostly made from foods, but from industrial ingredients and additives, and are highly profitable’.3 Distinctions are made between processed …