Poor Nutrition

mother and daughter making healthy food

Measure Breastfeeding Practices and Eating Patterns

Support breastfeeding in the hospital and community, offer healthier food options in early care and education facilities and schools, offer healthier food options in the workplace, improve access to healthy foods in states and communities, support lifestyle change programs to reduce obesity and type 2 diabetes risk.

Good nutrition is essential to keeping current and future generations healthy across the lifespan. A healthy diet helps children grow and develop properly and reduces their risk of chronic diseases. Adults who eat a healthy diet live longer and have a lower risk of obesity, heart disease, type 2 diabetes, and certain cancers. Healthy eating can help people with chronic diseases manage these conditions and avoid complications.

However, when healthy options are not available, people may settle for foods that are higher in calories and lower in nutritional value. People in low-income communities and some racial and ethnic groups often lack access to convenient places that offer affordable, healthier foods.

Most people in the United States don’t eat a healthy diet and consume too much sodium, saturated fat, and sugar, increasing their risk of chronic diseases. For example, fewer than 1 in 10 adolescents and adults eat enough fruits or vegetables. In addition, 6 in 10 young people aged 2 to 19 years and 5 in 10 adults consume at least one sugary drink  on any given day.

CDC supports breastfeeding and works to improve access to healthier food and drink choices in settings such as early care and education facilities, schools, worksites, and communities.

In the United States:

mother breastfeeding infant


are not exclusively breastfed for 6 months.

pizza, fries and canned food


consume too much sodium.

pregnant woman


have iron levels that are too low.



a year is spent on health care for obesity.

The Harmful Effects of Poor Nutrition

Overweight and obesity.

Eating a healthy diet, along with getting enough physical activity and sleep, can help children grow up healthy and prevent overweight and obesity. In the United States, 20% of young people aged 2 to 19 years and 42% of adults have obesity, which can put them at risk of heart disease, type 2 diabetes, and some cancers.

Heart Disease and Stroke

Nutritional food arranged into a heart

Two of the leading causes of heart disease and stroke are high blood pressure and high blood cholesterol. Consuming too much sodium can increase blood pressure and the risk for heart disease and stroke . Current guidelines recommend getting less than 2,300 mg a day, but Americans consume more than 3,400 mg a day on average.

Over 70% of the sodium that Americans eat comes from packaged, processed, store-bought, and restaurant foods. Eating foods low in saturated fats and high in fiber and increasing access to low-sodium foods, along with regular physical activity, can help prevent high blood cholesterol and high blood pressure.

Type 2 Diabetes

People who are overweight or have obesity are at increased risk of type 2 diabetes compared to those at a healthybecause, over time, their bodies become less able to use the insulin they make. Of US adults, 96 million—more than 1 in 3—have  prediabetes , and more than 8 in 10 of them don’t know they have it. Although the rate of new cases has decreased in recent years, the number of adults with diagnosed diabetes has nearly doubled in the last 2 decades as the US population has increased, aged, and become more overweight.

An unhealthy diet can increase the risk of some cancers. Consuming unhealthy food and beverages, such as sugar-sweetened beverages and highly processed food, can lead to weight gain, obesity and other chronic conditions that put people at higher risk of at least 13 types of cancer, including endometrial (uterine) cancer, breast cancer in postmenopausal women, and colorectal cancer. The risk of colorectal cancer is also associated with eating red and processed meat.

CDC’s Work to Promote Good Nutrition

CDC’s Division of Nutrition, Physical Activity, and Obesity  uses national and state surveys to track breastfeeding rates  and eating patterns  across the country, including fruit, vegetable, and added sugar consumption. The division also reports data on nutrition policies and practices  for each state. Data from these surveys  are used to understand trends in nutrition and differences between population groups.

CDC partners use this information to help support breastfeeding and encourage healthy eating  where people live, learn, work, and play, especially for populations at highest risk of chronic disease.

Mother breastfeeding her baby

Breastfeeding is the best source of nutrition for most infants. It can reduce the risk of some short-term health conditions for infants and long-term health conditions for infants and mothers. Maternity care practices in the first hours and days after birth can influence whether and how long infants are breastfed.

CDC funds programs that help hospitals use maternity care practices that support breastfeeding . These programs have helped increase the percentage of infants born in hospitals that implement recommended practices 1. CDC also works with partners to support programs designed to improve continuity of care and community support for breastfeeding mothers.

girl with a health lunch at school

Nearly 56 million US children spend time in early care and education (ECE) facilities or public schools. These settings can directly influence what children eat and drink and how active they are—and build a foundation for healthy habits.

CDC is helping our nation’s children grow up healthy and strong by:

  • Creating resources to help partners improve obesity prevention programs and use nutrition standards.
  • Investing in training and learning networks that help child care providers and state and local child care leaders meet standards and use and share best practices .
  • Providing technical assistance, such as training school staff how to buy, prepare, and serve fruits and vegetables or teach children how to grow and prepare fruits and vegetables.

The CDC Healthy Schools  program works with states, school systems, communities, and national partners to promote good nutrition . These efforts include publishing guidelines and tips on how schools and parents can model healthy behaviors and offer healthier school meals, smart snacks , and water access.

CDC also works with national groups to increase the number of salad bars  in schools. As of 2021, the Salad Bars to School program has delivered almost 6,000 salad bars to schools across the nation, giving over 2.9 million children and school staff better access to fruits and vegetables.

Millions of US adults buy foods and drinks while at work. CDC develops and promotes food service guidelines that encourage employers and vendors to increase healthy food options  for employees. CDC-funded programs are working to make healthy foods and drinks (including water) more available in cafeterias, snack shops, and vending machines. CDC also partners with states to help employers comply with the federal lactation accommodation law and provide breastfeeding mothers with places to pump and store breast milk, flexible work hours, and maternity leave benefits.

Mom and daughter grocery shopping

People living in low-income urban neighborhoods, rural areas, and tribal communities often have little access to affordable, healthy foods such as fruits and vegetables. CDC’s State Physical Activity and Nutrition Program , High Obesity Program , and Racial and Ethnic Approaches to Community Health program fund states and communities to improve food systems in these areas through food hubs, local stores, farmers’ markets, and bodegas.

These programs, which also involve food vendors and distributors, help increase the variety and number of healthier foods and drinks available and help promote and market these items to customers.

CDC’s National Diabetes Prevention Program  (National DPP) is a partnership of public and private organizations working to build a nationwide delivery system for a lifestyle change program proven to prevent or delay type 2 diabetes in adults with prediabetes. Participants in the National DPP lifestyle change program learn to make healthy food choices, be more physically active, and find ways to cope with stress. These changes can cut their risk of developing type 2 diabetes by as much as 58% (71% for those over 60).


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  • Food and mood: how do...

Food and mood: how do diet and nutrition affect mental wellbeing?

Read our food for thought 2020 collection.

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  • Food and mood: how do diet and nutrition affect mental wellbeing? - November 09, 2020
  • Joseph Firth , research fellow 1 2 ,
  • James E Gangwisch , assistant professor 3 4 ,
  • Alessandra Borsini , researcher 5 ,
  • Robyn E Wootton , researcher 6 7 8 ,
  • Emeran A Mayer , professor 9 10
  • 1 Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Oxford Road, University of Manchester, Manchester M13 9PL, UK
  • 2 NICM Health Research Institute, Western Sydney University, Westmead, Australia
  • 3 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
  • 4 New York State Psychiatric Institute, New York, NY, USA
  • 5 Section of Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King’s College London, London, UK
  • 6 School of Psychological Science, University of Bristol, Bristol, UK
  • 7 MRC Integrative Epidemiology Unit, Oakfield House, Bristol, UK
  • 8 NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
  • 9 G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
  • 10 UCLA Microbiome Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
  • Correspondence to: J Firth joseph.firth{at}manchester.ac.uk

Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population, say Joseph Firth and colleagues

Key messages

Healthy eating patterns, such as the Mediterranean diet, are associated with better mental health than “unhealthy” eating patterns, such as the Western diet

The effects of certain foods or dietary patterns on glycaemia, immune activation, and the gut microbiome may play a role in the relationships between food and mood

More research is needed to understand the mechanisms that link food and mental wellbeing and determine how and when nutrition can be used to improve mental health

Depression and anxiety are the most common mental health conditions worldwide, making them a leading cause of disability. 1 Even beyond diagnosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population. 2 Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed.

In recent years, the relationships between nutrition and mental health have gained considerable interest. Indeed, epidemiological research has observed that adherence to healthy or Mediterranean dietary patterns—high consumption of fruits, vegetables, nuts, and legumes; moderate consumption of poultry, eggs, and dairy products; and only occasional consumption of red meat—is associated with a reduced risk of depression. 3 However, the nature of these relations is complicated by the clear potential for reverse causality between diet and mental health ( fig 1 ). For example, alterations in food choices or preferences in response to our temporary psychological state—such as “comfort foods” in times of low mood, or changes in appetite from stress—are common human experiences. In addition, relationships between nutrition and longstanding mental illness are compounded by barriers to maintaining a healthy diet. These barriers disproportionality affect people with mental illness and include the financial and environmental determinants of health, and even the appetite inducing effects of psychiatric medications. 4

Fig 1

Hypothesised relationship between diet, physical health, and mental health. The dashed line is the focus of this article.

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While acknowledging the complex, multidirectional nature of the relationships between diet and mental health ( fig 1 ), in this article we focus on the ways in which certain foods and dietary patterns could affect mental health.

Mood and carbohydrates

Consumption of highly refined carbohydrates can increase the risk of obesity and diabetes. 5 Glycaemic index is a relative ranking of carbohydrate in foods according to the speed at which they are digested, absorbed, metabolised, and ultimately affect blood glucose and insulin levels. As well as the physical health risks, diets with a high glycaemic index and load (eg, diets containing high amounts of refined carbohydrates and sugars) may also have a detrimental effect on psychological wellbeing; data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms. 6 Clinical studies have also shown potential causal effects of refined carbohydrates on mood; experimental exposure to diets with a high glycaemic load in controlled settings increases depressive symptoms in healthy volunteers, with a moderately large effect. 7

Although mood itself can affect our food choices, plausible mechanisms exist by which high consumption of processed carbohydrates could increase the risk of depression and anxiety—for example, through repeated and rapid increases and decreases in blood glucose. Measures of glycaemic index and glycaemic load can be used to estimate glycaemia and insulin demand in healthy individuals after eating. 8 Thus, high dietary glycaemic load, and the resultant compensatory responses, could lower plasma glucose to concentrations that trigger the secretion of autonomic counter-regulatory hormones such as cortisol, adrenaline, growth hormone, and glucagon. 5 9 The potential effects of this response on mood have been examined in experimental human research of stepped reductions in plasma glucose concentrations conducted under laboratory conditions through glucose perfusion. These findings showed that such counter-regulatory hormones may cause changes in anxiety, irritability, and hunger. 10 In addition, observational research has found that recurrent hypoglycaemia (low blood sugar) is associated with mood disorders. 9

The hypothesis that repeated and rapid increases and decreases in blood glucose explain how consumption of refined carbohydrate could affect psychological state appears to be a good fit given the relatively fast effect of diets with a high glycaemic index or load on depressive symptoms observed in human studies. 7 However, other processes may explain the observed relationships. For instance, diets with a high glycaemic index are a risk factor for diabetes, 5 which is often a comorbid condition with depression. 4 11 While the main models of disease pathophysiology in diabetes and mental illness are separate, common abnormalities in insulin resistance, brain volume, and neurocognitive performance in both conditions support the hypothesis that these conditions have overlapping pathophysiology. 12 Furthermore, the inflammatory response to foods with a high glycaemic index 13 raises the possibility that diets with a high glycaemic index are associated with symptoms of depression through the broader connections between mental health and immune activation.

Diet, immune activation, and depression

Studies have found that sustained adherence to Mediterranean dietary patterns can reduce markers of inflammation in humans. 14 On the other hand, high calorie meals rich in saturated fat appear to stimulate immune activation. 13 15 Indeed, the inflammatory effects of a diet high in calories and saturated fat have been proposed as one mechanism through which the Western diet may have detrimental effects on brain health, including cognitive decline, hippocampal dysfunction, and damage to the blood-brain barrier. 15 Since various mental health conditions, including mood disorders, have been linked to heightened inflammation, 16 this mechanism also presents a pathway through which poor diet could increase the risk of depression. This hypothesis is supported by observational studies which have shown that people with depression score significantly higher on measures of “dietary inflammation,” 3 17 characterised by a greater consumption of foods that are associated with inflammation (eg, trans fats and refined carbohydrates) and lower intakes of nutritional foods, which are thought to have anti-inflammatory properties (eg, omega-3 fats). However, the causal roles of dietary inflammation in mental health have not yet been established.

Nonetheless, randomised controlled trials of anti-inflammatory agents (eg, cytokine inhibitors and non-steroidal anti-inflammatory drugs) have found that these agents can significantly reduce depressive symptoms. 18 Specific nutritional components (eg, polyphenols and polyunsaturated fats) and general dietary patterns (eg, consumption of a Mediterranean diet) may also have anti-inflammatory effects, 14 19 20 which raises the possibility that certain foods could relieve or prevent depressive symptoms associated with heightened inflammatory status. 21 A recent study provides preliminary support for this possibility. 20 The study shows that medications that stimulate inflammation typically induce depressive states in people treated, and that giving omega-3 fatty acids, which have anti-inflammatory properties, before the medication seems to prevent the onset of cytokine induced depression. 20

However, the complexity of the hypothesised three way relation between diet, inflammation, and depression is compounded by several important modifiers. For example, recent clinical research has observed that stressors experienced the previous day, or a personal history of major depressive disorders, may cancel out the beneficial effects of healthy food choices on inflammation and mood. 22 Furthermore, as heightened inflammation occurs in only some clinically depressed individuals, anti-inflammatory interventions may only benefit certain people characterised by an “inflammatory phenotype,” or those with comorbid inflammatory conditions. 18 Further interventional research is needed to establish if improvements in immune regulation, induced by diet, can reduce depressive symptoms in those affected by inflammatory conditions.

Brain, gut microbiome, and mood

A more recent explanation for the way in which our food may affect our mental wellbeing is the effect of dietary patterns on the gut microbiome—a broad term that refers to the trillions of microbial organisms, including bacteria, viruses, and archaea, living in the human gut. The gut microbiome interacts with the brain in bidirectional ways using neural, inflammatory, and hormonal signalling pathways. 23 The role of altered interactions between the brain and gut microbiome on mental health has been proposed on the basis of the following evidence: emotion-like behaviour in rodents changes with changes in the gut microbiome, 24 major depressive disorder in humans is associated with alterations of the gut microbiome, 25 and transfer of faecal gut microbiota from humans with depression into rodents appears to induce animal behaviours that are hypothesised to indicate depression-like states. 25 26 Such findings suggest a role of altered neuroactive microbial metabolites in depressive symptoms.

In addition to genetic factors and exposure to antibiotics, diet is a potentially modifiable determinant of the diversity, relative abundance, and functionality of the gut microbiome throughout life. For instance, the neurocognitive effects of the Western diet, and the possible mediating role of low grade systemic immune activation (as discussed above) may result from a compromised mucus layer with or without increased epithelial permeability. Such a decrease in the function of the gut barrier is sometimes referred to as a “leaky gut” and has been linked to an “unhealthy” gut microbiome resulting from a diet low in fibre and high in saturated fats, refined sugars, and artificial sweeteners. 15 23 27 Conversely, the consumption of a diet high in fibres, polyphenols, and unsaturated fatty acids (as found in a Mediterranean diet) can promote gut microbial taxa which can metabolise these food sources into anti-inflammatory metabolites, 15 28 such as short chain fatty acids, while lowering the production of secondary bile acids and p-cresol. Moreover, a recent study found that the ingestion of probiotics by healthy individuals, which theoretically target the gut microbiome, can alter the brain’s response to a task that requires emotional attention 29 and may even reduce symptoms of depression. 30 When viewed together, these studies provide promising evidence supporting a role of the gut microbiome in modulating processes that regulate emotion in the human brain. However, no causal relationship between specific microbes, or their metabolites, and complex human emotions has been established so far. Furthermore, whether changes to the gut microbiome induced by diet can affect depressive symptoms or clinical depressive disorders, and the time in which this could feasibly occur, remains to be shown.

Priorities and next steps

In moving forward within this active field of research, it is firstly important not to lose sight of the wood for the trees—that is, become too focused on the details and not pay attention to the bigger questions. Whereas discovering the anti-inflammatory properties of a single nutrient or uncovering the subtleties of interactions between the gut and the brain may shed new light on how food may influence mood, it is important not to neglect the existing knowledge on other ways diet may affect mental health. For example, the later consequences of a poor diet include obesity and diabetes, which have already been shown to be associated with poorer mental health. 11 31 32 33 A full discussion of the effect of these comorbidities is beyond the scope of our article (see fig 1 ), but it is important to acknowledge that developing public health initiatives that effectively tackle the established risk factors of physical and mental comorbidities is a priority for improving population health.

Further work is needed to improve our understanding of the complex pathways through which diet and nutrition can influence the brain. Such knowledge could lead to investigations of targeted, even personalised, interventions to improve mood, anxiety, or other symptoms through nutritional approaches. However, these possibilities are speculative at the moment, and more interventional research is needed to establish if, how, and when dietary interventions can be used to prevent mental illness or reduce symptoms in those living with such conditions. Of note, a recent large clinical trial found no significant benefits of a behavioural intervention promoting a Mediterranean diet for adults with subclinical depressive symptoms. 34 On the other hand, several recent smaller trials in individuals with current depression observed moderately large improvements from interventions based on the Mediterranean diet. 35 36 37 Such results, however, must be considered within the context of the effect of people’s expectations, particularly given that individuals’ beliefs about the quality of their food or diet may also have a marked effect on their sense of overall health and wellbeing. 38 Nonetheless, even aside from psychological effects, consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness. 33

At the same time, it is important to be remember that the causes of mental illness are many and varied, and they will often present and persist independently of nutrition and diet. Thus, the increased understanding of potential connections between food and mental wellbeing should never be used to support automatic assumptions, or stigmatisation, about an individual’s dietary choices and their mental health. Indeed, such stigmatisation could be itself be a casual pathway to increasing the risk of poorer mental health. Nonetheless, a promising message for public health and clinical settings is emerging from the ongoing research. This message supports the idea that creating environments and developing measures that promote healthy, nutritious diets, while decreasing the consumption of highly processed and refined “junk” foods may provide benefits even beyond the well known effects on physical health, including improved psychological wellbeing.

Contributors and sources: JF has expertise in the interaction between physical and mental health, particularly the role of lifestyle and behavioural health factors in mental health promotion. JEG’s area of expertise is the study of the relationship between sleep duration, nutrition, psychiatric disorders, and cardiometabolic diseases. AB leads research investigating the molecular mechanisms underlying the effect of stress and inflammation on human hippocampal neurogenesis, and how nutritional components and their metabolites can prevent changes induced by those conditions. REW has expertise in genetic epidemiology approaches to examining casual relations between health behaviours and mental illness. EAM has expertise in brain and gut interactions and microbiome interactions. All authors contributed to, read, and approved the paper, and all the information was sourced from articles published in peer reviewed research journals. JF is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JF is supported by a University of Manchester Presidential Fellowship and a UK Research and Innovation Future Leaders Fellowship and has received support from a NICM-Blackmores Institute Fellowship. JEG served on the medical advisory board on insomnia in the cardiovascular patient population for the drug company Eisai. AB has received research funding from Johnson & Johnson for research on depression and inflammation, the UK Medical Research Council, the European Commission Horizon 2020, the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King’s College London. REW receives funding from the National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. EAM has served on the external advisory boards of Danone, Viome, Amare, Axial Biotherapeutics, Pendulum, Ubiome, Bloom Science, Mahana Therapeutics, and APC Microbiome Ireland, and he receives royalties from Harper & Collins for his book The Mind Gut Connection. He is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and the US Department of Defense. The views expressed are those of the authors and not necessarily those of the organisations above.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of series commissioned by The BMJ. Open access fees are paid by Swiss Re, which had no input into the commissioning or peer review of the articles. T he BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in the series.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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poor diet essay

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Our Food Is Killing Too Many of Us

Improving American nutrition would make the biggest impact on our health care.

poor diet essay

By Dariush Mozaffarian and Dan Glickman

Dr. Mozaffarian is dean of the Tufts Friedman School of Nutrition Science and Policy. Mr. Glickman was the secretary of agriculture from 1995 to 2001.

The Democratic debate on health care has to date centered around who should be covered and who should pay the bill. That debate, which has been going on for decades, has no clear answers and cannot be easily resolved because of two fundamental realities: Health care is expensive, and Americans are sick.

Americans benefit from highly trained personnel, remarkable facilities and access to the newest drugs and technologies. Unless we eliminate some of these benefits, our health care will remain costly. We can trim around the edges — for example, with changes in drug pricing, lower administrative costs, reductions in payments to hospitals and providers, and fewer defensive and unnecessary procedures. These actions may slow the rise in health care spending, but costs will keep rising as the population ages and technology advances.

And Americans are sick — much sicker than many realize. More than 100 million adults — almost half the entire adult population — have pre-diabetes or diabetes. Cardiovascular disease afflicts about 122 million people and causes roughly 840,000 deaths each year, or about 2,300 deaths each day . Three in four adults are overweight or obese . More Americans are sick, in other words, than are healthy.

Instead of debating who should pay for all this, no one is asking the far more simple and imperative question: What is making us so sick, and how can we reverse this so we need less health care? The answer is staring us in the face, on average three times a day: our food.

Poor diet is the leading cause of mortality in the United States, causing more than half a million deaths per year. Just 10 dietary factors are estimated to cause nearly 1,000 deaths every day from heart disease, stroke and diabetes alone. These conditions are dizzyingly expensive. Cardiovascular disease costs $351 billion annually in health care spending and lost productivity, while diabetes costs $327 billion annually. The total economic cost of obesity is estimated at $1.72 trillion per year , or 9.3 percent of gross domestic product.

These human and economic costs are leading drivers of ever-rising health care spending, strangled government budgets, diminished competitiveness of American business and reduced military readiness .

Fortunately, advances in nutrition science and policy now provide a road map for addressing this national nutrition crisis. The “ Food Is Medicine” solutions are win-win, promoting better well-being, lower health care costs, greater sustainability, reduced disparities among population groups, improved economic competitiveness and greater national security.

Some simple, measurable improvements can be made in several health and related areas. For example, Medicare, Medicaid, private insurers and hospitals should include nutrition in any electronic health record ; update medical training, licensing and continuing education guidelines to put an emphasis on nutrition ; offer patient prescription programs for healthy produce ; and, for the sickest patients, cover home-delivered, medically tailored meals . Just the last action, for example, can save a net $9,000 in health care costs per patient per year .

Taxes on sugary beverages and junk food can be paired with subsidies on protective foods like fruits, nuts, vegetables, beans, plant oils, whole grains, yogurt and fish. Emphasizing protective foods represents an important positive message for the public and food industry that celebrates and rewards good nutrition. Levels of harmful additives like sodium, added sugar and trans fat can be lowered through voluntary industry targets or regulatory safety standards .

Nutrition standards in schools, which have improved the quality of school meals by 41 percent, should be strengthened; the national Fresh Fruit and Vegetable Program should be extended beyond elementary schools to middle and high schools; and school garden programs should be expanded. And the Supplemental Nutrition Assistance Program, which supports grocery purchases for nearly one in eight Americans, should be leveraged to help improve diet quality and health .

The private sector can also play a key role. Changes in shareholder criteria (e.g., B-Corps , in which a corporation can balance profit versus purpose with high social and environmental standards) and new investor coalitions should financially reward companies for tackling obesity, diabetes and other diet-related illness. Public-private partnerships should emphasize research and development on best agricultural and food-processing practices. All work sites should demand healthy food when negotiating with cafeteria vendors and include incentives for healthy eating in their wellness benefits.

Coordinated federal leadership and funding for research is also essential. This could include, for example, a new National Institute of Nutrition at the National Institutes of Health. Without such an effort, it could take many decades to understand and utilize exciting new areas, including related to food processing, the gut microbiome, allergies and autoimmune disorders, cancer, brain health, treatment of battlefield injuries and effects of nonnutritive sweeteners and personalized nutrition.

Government plays a crucial role . The significant impacts of the food system on well-being, health care spending, the economy and the environment — together with mounting public and industry awareness of these issues — have created an opportunity for government leaders to champion real solutions.

Yet with rare exceptions , the current presidential candidates are not being asked about these critical national issues. Every candidate should have a food platform, and every debate should explore these positions. A new emphasis on the problems and promise of nutrition to improve health and lower health care costs is long overdue for the presidential primary debates and should be prominent in the 2020 general election and the next administration.

Dariush Mozaffarian ( @Dmozaffarian ) is a cardiologist and dean of the Tufts Friedman School of Nutrition Science & Policy. Dan Glickman ( @DanRGlickman ) was the secretary of agriculture from 1995 to 2001.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region

Ayoub al-jawaldeh.

1 World Health Organization (WHO), Regional Office for the Eastern Mediterranean (EMRO), Cairo, Egypt

Marwa M. S. Abbass

2 Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt

There are 22 countries in the Eastern Mediterranean Region (EMR) expanding from Morocco in the west to Pakistan and Afghanistan in the east, containing a population of 725,721 million in 2020. In the previous 30 years, the illness burden in the EMR has transmitted from communicable diseases to non-communicable diseases such as diabetes, cardiovascular diseases, and cancer. In 2019, cardiovascular mortality in the EMR was mostly attributed to ischemic heart disease, the first reason for mortality in 19 countries in the region. Stroke was the second reason for death in nine countries followed by diabetes, which was ranked as the second reason for death in two countries. The prominent nutrition-related NCDs risk factors in EMR include obesity, hypertension, high fasting plasma glucose, and upregulated unhealthy diet consumption. Most of the EMR population are unaware of their NCDs risk factor status. These risk factors, even if treated, are often poorly controlled, therefore, inhibiting their existence by changing the lifestyle to proper dietary habits and sufficient physical activity is mandatory. In this review, the epidemiology and nutrition-related risk factors of NCDs in the EMR will be discussed and illustrated, aiming to scale up action and support decision-makers in implementing cost effective strategies to address obesity and NCDs prevention and management in the region.


The Eastern Mediterranean Region (EMR) encompasses 22 countries including [Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates (UAE), and Yemen], with a population of ~725,720 million ( 1 ).

In the past three decades, similar to other developing regions in the world, the EMR has undergone a transmission in the disease burden from primarily communicable disorders, such as lower respiratory infections, to non-communicable diseases (NCDs). NCDs include cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. In 2012, the rate of death from NCDs in the EMR (654 per 100,000 persons) was higher than the global rate (539 per 100,000 persons) and is expected to peak by 2030. In 2015, nearly 58.4% of total deaths in the EMR were due to NCDs, with the chief cause being CVDs (27.4% of total deaths) ( 2 , 3 ).

NCDs are the essential global cause of death and are responsible for over 70% of deaths worldwide ( 3 ). NCDs were responsible for 41 million of the 57 million fatalities worldwide, 15 million of which were premature (30–70 years). The burden is the greatest among low- and middle-income countries, where 78% of global NCDs fatalities and 85% of premature deaths took place ( 4 ). Moreover, globally, NCDs were responsible for 1.62 billion DALYs in 2019, with an increase from 43.2% in 1990 to 63.8% in 2019 ( 5 ). In 2019, the number of fatalities in EMR due to CVDs was 1,464,672 million, 431,312 thousand individuals died from cancer, and 186,841 thousand died from diabetes ( 6 ).

The NCDs share the key four modifiable behavioral risk factors including tobacco usage, unhealthy diet, physical inactivity, and excessive use of alcohol, these factors, in turn, lead to nutritional- physiological related risk factors including overweight/obesity, raised blood pressure, high fasting blood glucose, and high blood cholesterol. The relationship between NCDs and the risk factors involved in their incidence is intermingled and the risk factors are also associated with each other ( Figure 1 ). It is noteworthy that the behavioral risk factors linked with NCDs are closely related to the demographic and socioeconomic status (SES) in the region ( 7 ).

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The interdisciplinary relationship between unhealthy diet consumption, obesity, and other NCDs risk factors.

Despite NCDs being a critical health obstacle in all EMR countries, tackling NCDs and their key risk factors requires an imperative understanding of the current status and progress at the country and region level. This review discusses nutrition-related NCDs burden and the associated risk factors in the EMR. The current challenges and areas requiring further attention will be also highlighted.


In this paper, the prevalence of NCDs and the associated nutrition-related risk factors in the WHO-EMR are discussed and illustrated. Data for the prevalence of CVDs, diabetes, and cancer as well as different risk factors including overweight/obesity, raised blood pressure, high fasting blood glucose, and high blood cholesterol in the WHO –EMR are summarized. Age-standardized estimates were obtained from the NCDs Risk Collaboration, which in turn, are based on data provided to WHO and the NCDs Risk Factor Collaboration or obtained through a literature review ( 8 ). For those estimates, adjustments had been made to standardize risk factor definition, age groups, reporting year, and representativeness of the population. Age-standardized prevalence estimates were calculated to adjust for differences in age/sex structure between populations and to enable comparisons between countries ( 8 ). The definition of being overweight or having obesity was used for people with a BMI of 25 kg/m 2 or higher and a BMI of 30 kg/m 2 or higher, respectively.

Data regarding the number of deaths and probability of death attributed to CVDs, diabetes, and cancer among adults in EMR were obtained from the global health observatory ( 9 ). Raised fasting blood glucose, raised blood pressure, and diabetes prevalence in EMR was also obtained from the global health observatory ( 6 ). Cancer trends in EMR data including the number of cancer cases, cancer rates/100,000 (Age-standardized) as well as cumulative cancer risk were obtained from the Global Cancer Observatory ( 9 ). Data regarding the food consumption in EMR were collected from the FAO food balance sheets ( 10 ). Concerning estimated sodium intakes (g/day) for persons aged 20 and over data were attained from the systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide ( 11 ). Data relating to the mean salt intake for adults (g/day) were obtained from the non-communicable diseases country profiles ( 4 ). Saturated fat (% energy), Omega-6 PUFA (% energy), Trans fat (% energy), Dietary cholesterol (mg/d), Seafood omega-3 fat (mg/d), and Plant omega-3 fat (mg/d) data were obtained from the systematic analysis nutrition surveys including 266 countries ( 11 ). Data relating to sugar-sweetened beverage consumption in EMR were harvested from a systematic assessment of beverage intake in 187 countries ( 12 ).

The data from the Global Burden of Disease Study 2019 presented in this review included the rank of the nutrition related risk factors that caused deaths in EMR countries in 2019 as well as the percentage change in these risk factors between 2009 and 2019 ( 13 ).

The policies relating to actions to reduce NCDs in EMR, as well as the policies associated with healthy diets in the countries of the WHO-EMR, are tabulated. Data have been extracted from various sources. These include the WHO's global ( 6 ) and regional health observatories ( 14 ), data collected for the second WHO Global Nutrition Policy Review 2016–2017 ( 15 ), the WHO Global Database on the Implementation of Nutrition Action (GINA) ( 16 ), communication about country-level action from WHO country offices and national government nutrition focal points, and other relevant academic papers ( 17 – 20 ). Specifically, data were collected on the policy areas related to a healthy diet that features in the new regional nutrition strategy ( 21 ).

Data are presented in narrative or tabular form. To group countries according to the income level, the World Bank classification was used to identify the income level of each country ( 22 ). The low-income group includes Afghanistan, Somalia, Sudan, Syria, and Yemen. The lower middle-income group includes Djibouti, Egypt, Morocco, Pakistan, Tunisia, and the occupied Palestinian Territory. The upper middle-income group includes: Iran, Iraq, Jordan, Lebanon, and Libya. The high-income level includes: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE).

Nutrition Related Non-Communicable Diseases

Cardiovascular diseases.

Worldwide, in 2019, cardiovascular diseases were responsible for 393 million DALYs and 18.6 million deaths in both sexes ( 23 ). In EMR, the high number of NCDs deaths was attributed to CVDs (1,464,672 million) in 2019. Pakistan recorded the highest number (449,905) followed by Egypt (252,650), Iran (157,018) then Morocco (126,562) ( 6 ) ( Table 1 ).

Number of deaths and probability of death attributed to CVDs, diabetes, and cancer among adults in EMR ( 6 ).

Diabetes, smoking, high blood pressure, high BMI, stress, high cholesterol levels, poor nutrition, and insufficient physical exercise are all considered risk factors responsible for the incidence of CVDs ( 24 ). According to Franklin and Wong, hypertension is the main cause of cardiovascular disease, which worsens with age and may be the world's leading cause of mortality ( 25 ).

A cross-sectional study conducted among the local population of 53 cities in Punjab, Pakistan, reported that CVDs impacted 17.5% of the population, with females having a higher incidence rate than males and start occurring at a younger age. An inactive lifestyle, low level of activity and family history of disease could be disease risk factors ( 26 ). CVDs are also responsible for 40% and 37% of deaths in Egypt and Saudi Arabia, respectively. A comparative cross-sectional study involved students from two medical of both sexes from Saudi Arabia and Egypt revealed a relatively high prevalence of a sedentary life style, obesity, and abdominal obesity. Saudi students revealed a significantly higher prevalence of obesity while male Egyptian students recorded a significantly higher prevalence of hypertension. Both populations were at an elevated risk of acquiring fatal cardiovascular disease within 10 years (23.9% of Saudi students and 16.7% of Egyptian students) ( 27 ). In Iran despite the slight recession in the number of smokers, total cholesterol, and blood pressure, adverse trends in physical activity, unhealthy diet, obesity, and fasting plasma glucose must be addressed immediately at a public health level in order to battle the advancement of CVDs ( 28 ).

According to the Global Burden of Disease Study 2019, ischemic heart disease is the most common reason for death in EMR and it is the first reason for death in 19 countries in EMR (Afghanistan, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen) ( 13 ). Globally, on concomitant ischemic heart disease was the leading cause of death in people aged between 30 and 70 years in 146 (83%) countries for men and 98 (55.7%) for women. For men, the risk reached as high as 20% and for women as high as 13% in some countries. Other regions that suffer from this high risk of dying from ischemic heart disease were eastern Europe, central Asia, and south Asia ( 29 ). The highest increase in the ischemic heart disease percentage between 2009 and 2019, in the EMR, was reported in UAE (130.6%) followed by Jordan (86.3%) then Djibouti (67.9 %) and Egypt (62.9 %). Stroke is the second reason for death in nine countries (Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Palestine, Syrian Arab Republic, and Tunisia). The highest increase in stroke percentage between 2009 and 2019, was reported in UAE (105.2%) followed by Jordan (78.5%) then Djibouti (52.7%) ( 13 ).

Diabetes Mellitus

In 2019, diabetes mellitus caused 70.9 million (2.8%) of total global DALYs ( 30 ). 9.3 percent (463 million people) was the conservative estimate for the prevalence of diabetes in 2019 which is expected to rise by 2030 to 10.2% (578 million) and by 2045 to 10.9% (700 million). The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). Nearly, half of people (51%) living with diabetes are not aware of that they are diabetics. Impaired glucose tolerance affected 7.5% of the world's population (374 million) in 2019, rising to 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045 ( 31 ). Notably, in 2019 the prevalence of diabetes was the highest in the EMR (11.96%) compared with all other regions. Sudan, Qatar, Iran, Bahrain, Somalia, and Djibouti revealed the highest percentage of Diabetes among individuals aged 20–80 years (22.1, 19.9, 17.2, 16.3, 15.8, and 15.6%, respectively) ( 32 ) ( Table 2 ; Figure 2 ).

Obesity, raised fasting blood glucose, raised blood pressure, diabetes prevalence, and cancer trends in EMR ( 6 ).

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Diabetes prevalence among adults in different regions ( 6 ).

In EMR, the total number of fatalities due to diabetes was 186,841 thousand in 2019. Pakistan recorded the highest number (80,976) followed by Egypt (26,844), Iran (157,018) then Morocco (17,947) ( 6 ) ( Table 1 ). According to the 2019 Global Burden of Disease Study, diabetes is the second cause of death in two countries (Bahrain and Jordan) and the third reason for death in three countries (Iraq, Palestine, and Qatar) in the region. The highest increase in diabetes percentage between 2009 and 2019 in EMR was reported in UAE (124.2%) followed by Palestine (89.1%) then Bahrain (88.1%), Iran (80.8%), and Jourdan (69.7%) ( 13 ).

The mortality rate due to diabetes in Bahrain was 14% in 2016. A cross sectional study reported that type 2 diabetes exerts a significant pressure on Bahrain's healthcare system—primarily due to costly diabetes-related complications. Thereby, reducing the risk factors for diabetes is mandatory to minimize disabling and expensive complications ( 33 ). Additionally, multivariate analysis for a wide community-based survey in Pakistan using glycated hemoglobin revealed a significant link between type 2 diabetes and old age. Increase in body mass index, central obesity, positive family history, and having hypertension with type 2 diabetes were inversely related to education ( 34 ).

Egypt has been identified by the International Diabetes Federation as the ninth leading country in the world for the number of type 2 diabetes patients. The frequency of type 2 diabetes has nearly tripled in the last two decades in Egypt. This dramatic increase could be due to an increase in the typical risk factors for type 2 diabetes, such as obesity and physical inactivity, as well as a shift in dietary habits, or to other risk factors specific to Egypt. Increased exposure to environmental risk factors such as pesticides and a higher prevalence of chronic hepatitis C are two examples ( 35 ).

In a population-level mathematical model among Qatari, the baseline scenario revealed that type 2 diabetes prevalence would be upregulated from 16.7% in 2016 to 24.0% in 2050. By lowering obesity prevalence by 10–50%, type 2 diabetes prevalence would reduced by 7.8–33.7%, while by reducing physical inactivity prevalence by 10–50%, type 2 diabetes prevalence would reduced by 0.5–6.9% by 2050 ( 36 ).

Globally in 2019, total cancers recorded 23.6 million incident cases, 10.0 million deaths, and 250 million DALYs. Total cancers were the second-ruling reason for death and DALYs in 2019 worldwide ( 13 ). Globally in 2020, an estimated 19.3 million new cancer cases (18.1 million excluding non-melanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding non-melanoma skin cancer) occurred ( 37 ). According to long-term projections, the EMR countries will suffer from a disturbing rise in the number of cancer patients reaching a 1.8 fold by 2030 ( 38 ). The highest number of cancer cases in EMR in 2020 has been recorded in Pakistan (170,668) thousand individuals followed by Egypt (129,577), then Iran (127,548) ( 9 ) ( Table 2 ). Bahrain, Qatar, Iran, and Lebanon reported a 16% mortality rate due to cancers, Kuwait reported 15% while Egypt reported 13% ( 4 ).

Bahrain, which is among the high income gulf countries, suffers from a rising burden of cancer ( 39 , 40 ). Breast, colorectal, and lung cancers, followed by non-Hodgkin lymphoma and leukemia, are the five most frequently diagnosed cancers in Bahrain ( 41 ). Obesity, smoking, a sedentary lifestyle, and a high-fat/low-fiber diet are among the significant risk factors for colorectal cancer in Bahrain. Nearly one-third of the population of Bahrain is overweight or obese ( 42 , 43 ).

A systematic review investigating the epidemiological aspects of gastric cancer in Iran based on articles published during the years 1970–2020 showed that poor levels of economic position and food insecurity raised the probabilities of stomach cancer by 2.42- and 2.57-times, respectively. Moreover, there was a link between dairy products, processed red meat, fruit juice, legumes, smoked and salty fish, salt, strong as well as hot tea consumption with the risk of stomach cancer. There was also an inverse link between fresh fruit, citrus, and garlic consumption and stomach cancer ( 44 ).

The global age-standardized rate as reported by the American Institute for Cancer Research, 2018 for all cancers (including non-melanoma skin cancer) for both genders was 197.9 per 100,000 in 2018. Men revealed a higher rate (218.6 per 100,000) than women (182.6 per 100,000) ( 45 ). Most of the EMR countries revealed a relatively high rate of cancer incidence as nine countries in the region have cancer rates of more than (200 per 100,000). The highest cancer rates as revealed in 2020 have been reported in Egypt (258 per 100,000) followed by Lebanon (252.5 per 100,000) then Jordan (251.8 per 100,000) then Iran (245.2 per100,000) followed by Syria (241.5 per 100,000), and then Morocco (238.8 per 100,000) ( 9 ) ( Table 2 ).

In EMR, the total number of fatalities due to cancer (431,312) in 2019. Pakistan recorded the highest number (124,328) followed by Egypt (85,226), Iran (61,063), then Morocco (33,845) ( 6 ) ( Table 1 ). By 2050, a three-fold increase in cancer incidence relative to 2013 was estimated to occur in Egypt ( 46 ). The highest increase in cancer percentage between 2009 and 2019 in EMR was reported in the UAE (241.7% increase in pancreatic cancer) followed by Jordan and Qatar (103.7 and 95.2%, respectively increase in lung cancer) ( 13 ).

Risk Factors Burden

A dramatic increase in NCDs-related risk factors has been reported in the EMR in the past 10 years ( 13 ). The risk factors of NCDs comprise metabolic-physiological-related conditions (including obesity, high blood pressure, high fasting plasma glucose, high blood cholesterol) as well as behavioral-related activities (including smoking, low physical activity, unhealthy diet consumption, excessive use of alcohol). An analytic review published in 2019 reported that individuals who followed healthy lifestyle practices including regular physical activity, sound nutrition, weight management, and non-smoking revealed a significant downregulation of CVDs risk by >80% and diabetes by >90% ( 47 ). Additionally, another study outlined that around 40% of cancer cases could be prevented by reducing exposure to cancer risk factors including diet, nutrition, and physical activity ( 45 ).

Dietary Risks or Unhealthy Diet Consumption

Dietary risk is defined as eating a diet low in whole grains, nuts, seeds, fruit, vegetables, fibers, legumes, omega-3 fatty acids, PUFA, milk, and calcium as well as a diet high in sodium, trans fats, red or processed meat, and sugar-sweetened beverages (SSB). Globally in 2019, dietary risks were responsible for 188 million DALYs and 7.94 million deaths among adults aged 25 and older. It was the fifth-ruling risk factor for attributable DALYs ( 48 ). Dietary risk is the third risk factor in Syria and the fourth risk factor in 6 countries in the EMR (Afghanistan, Morocco, Oman, Pakistan, KSA, and Yemen) responsible for the most deaths and disabilities. The highest increase in dietary risk percentage between 2009 and 2019 in EMR was reported in UAE (136.9%), followed by Jordan (84.7%) then Qatar (66.8%) ( 13 ), as shown in Table 5 .

Fruits and Vegetables

An adequate daily intake of fruits and vegetables is associated with reduced risks of CVDs ( 49 ), stroke ( 50 ), type 2 diabetes ( 51 ), and certain types of cancer ( 52 , 53 ), which are the major causes of mortality and morbidity in the EMR. The 2002 Joint FAO/WHO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases recommends a minimum of 400 g per day of fruits and vegetables, an equivalent of ≥5 servings of fruits and vegetables per day, excluding starchy roots ( 54 ).

In 2013, the rate of fruits and vegetables intake among individuals living in the EMR was 280 g per day, which is lower than WHO recommendation for the prevention of NCDs. Furthermore, it has been reported that the mean daily intake of fruits in the Middle East and North Africa region was <130 g per day, and the mean intake of vegetables was less than 200 g per day ( 2 ). According to the food balance sheets 2019, the mean fruits and vegetables intake among EMR countries is 32 kg/capita/year ( 10 ), see Table 3 . It is noteworthy, that data concerning fruits and vegetables intake in EMR are limited.

Food consumption in EMR (2019) ( 10 ).

Most individuals living in the EMR have an insufficient intake of fruits and vegetables. It has been established that only 7.3% of individuals from Saudi Arabia aged 15–64 years were consuming the WHO-recommended five servings of fruits and vegetables per day and only 2.6% met the CDC guidelines for daily consumption of fruits and vegetables ( 55 ). In a more recent cross-sectional study conducted on 1,437 individuals, aged ≥ 18 years, 88% of the subjects recorded low intake of fruits and vegetables with a significant increase in fast food consumption ( 56 ). The relationship between food consumption patterns and expenditure was investigated in village Kabal in rural areas of Pakistan, using a sample size of 100 households. The study outlined that an adult consumes nearly 74.68 g of meat, 166.34 g of milk, 372.51 g of flour, 70.29 g of rice, 28.31 g of pulses, 177.12 g of vegetables, 66.39 g of fruits, 6.76 g of black tea, 53.60 g of fats, and 73.21 g of sugar daily ( 57 ). Furthermore, an assessment of fruits and vegetables consumption among 473 medical students in Egypt outlined that 8.2% of students knew the recommended five daily servings for fruits and vegetables, and 23.26% consumed the five daily servings. Healthy food items were tried by only 35.7% of students ( 58 ).

Fat Consumption

Fat consists of trans-fatty acids (TFAs), saturated fatty acids (SFA), and unsaturated fatty acids ( 59 ). Saturated fatty acids can be found in animal products like milk, butter, cheese, as well as most plant oils, particularly palm and coconut oil, which are high in SFA. Lauric acid, myristic acid, and palmitic acid (PA) are all major sources of SFA, and they all raise low-density lipoprotein cholesterol (LDL-c) ( 60 ). Increased inflammation, oxidative stress, and decreased nitric oxide and insulin signaling is some of the impacts of PA, which is found in palm oil ( 61 , 62 ). The American Heart Association recommends a healthy dietary pattern that achieves 5–6% of calories from saturated fat (about 13 g of saturated fat per day). In EMR, three countries have exceeded 13% of energy from saturated fats, Djibouti (15.2% of energy) followed by Yemen (13.9% of energy), and KSA (13.5% of energy) ( 63 ) (see Table 4 ). In Saudi Arabia, a significant positive association was found between the intake of fats, protein, and calories and the risk of breast cancer. Adjusted odds ratios for the highest quartile of intake versus the lowest were 1.88 for cholesterol, 2.12 for polyunsaturated fat, 2.25 for animal protein, 2.43 for saturated fat, and 2.69 for total energy from dietary intake ( 64 ).

Salt, fat, and sugar-sweetened beverage consumption in EMR ( 4 , 11 , 12 , 63 ).

A diet high in trans-fatty acids is defined as any intake (in percentage daily energy) of trans fat from all sources, primarily partially hydrogenated vegetable oils and ruminant products. TFAs are typically found in processed food, fast food, snack food, fried food, pies, cookies, margarine, and spreads ( 59 ). In 2019, a diet high in TFAs was responsible for 14.2 million DALYs and 645,000 deaths. It was the seventh-ruling dietary risk factor for attributable DALYs ( 65 ).

The consumption of TFAs increases the risk of death from any cause by 34% and coronary heart disease by 28% ( 66 ). An increase in coronary heart disease mortality estimated by 12% occurs as a result of every 1% increase in daily energy obtained from TFAs ( 67 ). Industrial TFAs intake has also been related to an increased risk for other NCDs and associated conditions such as ovarian cancer ( 68 ), infertility, endometriosis, Alzheimer's disease, diabetes, and obesity ( 59 , 69 ). Higher consumption of hydrogenated vegetable oils was associated with an increased risk of myocardial infarction in a cohort study conducted among an Iranian population ( 70 ).

Despite WHO recommendations that total trans fat intake should not exceed 1% of total energy intake, which translates to >2.2 g/day for a 2,000-calorie diet ( 71 ), in 2010, four countries in the region have exceeded this level (Iran, Bahrain, Pakistan, and Egypt) ( 63 ) ( Table 4 ). Laboratory analysis was conducted for profiling TFAs, saturated, and unsaturated fatty acids in the products that are mostly consumed in the major governorates in Egypt. On average, 34% of the products exceeded the TFAs limit (more than 2 g TFA/100 g of fat). The study revealed that around one third of products in the Egyptian market have a high TFAs content ( 72 ). Iran has achieved a marked improvement in the reduction of TFAs as early studies recorded 12.3 g as a mean intake in 2007, while in 2013 this has been reduced to 1.42 and 1.5 g in 2018 ( 73 – 76 ).

The 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease concluded that a diet containing reduced amounts of cholesterol and sodium could be beneficial to decrease atherosclerotic CVDs risk ( 77 ). Every increase in dietary cholesterol by 100 mg/day predicted an increase in LDL-c from 1.90 to 4.58 mg/dl depending on the model ( 78 ). The 2015 National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia, recommend limiting dietary cholesterol to <200 mg/d to lower LDL-c and non–high-density lipoprotein cholesterol (HDL-c) concentrations, however, insufficient evidence among populations doesn't exist ( 79 ). Within EMR, all of the countries are beyond the previous recommended level, particularly Egypt where the recorded dietary cholesterol level was 402 mg/day, followed by Iraq 288 mg/day, then Lebanon 287 mg/day, then KSA and Tunisia 286 mg/day ( 63 ) ( Table 4 ).

High Sugar Diet

The term “sugars” includes intrinsic sugars, from intact fruit and vegetables; milk, as well as free sugars, which are added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates ( 80 ).

There is uprising worry regarding the free sugars' intake, particularly in the form of SSB that increases the overall energy consumption and may reduce healthy food items' intake. This leads to unhealthy dietary habits, subsequent weight gain, and increased risk of NCDs ( 54 , 81 – 83 ). Another concern is the association between intake of free sugars and dental caries ( 54 , 84 – 86 ). Dental diseases are the most prevalent NCDs globally ( 87 , 88 ).

The established dietary goal for free sugars' intake is <10% of total energy but ideally less than 5% of total energy intake. This 10% ratio is equivalent to 50 g for a person of healthy body weight consuming about 2,000 calories per day ( 54 ).

Juice and SSB Consumption

A diet high in SSB is defined as any intake (in grams per day) of beverages with ≥50 kcal per 226.8 g serving, including sodas, carbonated beverages, energy drinks, and fruit drinks, but excluding 100% fruit and vegetable juices. In 2019, a diet high in sugar-sweetened beverages was responsible for 6.31 million DALYs and 242 000 deaths. It was the 13th-leading dietary risk factor for DALYs ( 89 ).

The average consumption of raw sugar in EMR is 80 g per day, while the recommended amount of sugar is equivalent to 50 g. The highest mean consumption of SSB among EMR countries has been recorded in Djibouti 0.78 serving/day followed by Lebanon 0.72, then Jordan 0.64, then Sudan 0.62, then Syria 0.52, and Bahrain 0.51. The highest juice intake in EMR has been recorded in KSA 0.34 serving/day followed by Iran 0.31, then UAE 0.25 and Bahrain 0.24 ( 12 ) (as outlined in Table 4 ).

A review of the literature reveals that SSBs contribute partly to the obesity epidemic, as reported by epidemiologic studies, which emphasized the link between SSB consumption and long-term weight gain, type 2 diabetes mellitus, and CVDs risk. It is hypothesized that SSB contribute to weight gain due to their high added sugar content, low satiety, and potential partial compensation for total energy leading to increased energy intake ( 90 , 91 ). In addition, because of their large consumed quantities besides their high contents of rapidly absorbable carbohydrates such as different forms of sugar and high-fructose corn syrup, SSB could be responsible for increased type 2 diabetes mellitus and CVDs incidence. Independent of obesity, SSB could serve as a contributor to a high dietary glycemic load leading to inflammation, insulin resistance, and impaired ß-cell function ( 92 ). Fructose from any sugar or high-fructose corn syrup may also increase blood pressure, and enhance the cumulative effects of visceral adiposity, dyslipidemia, and ectopic fat precipitation due to upregulated hepatic de novo lipogenesis ( 93 ).

Salt/Sodium Intake

Salt consumption within the WHO-recommended level for adults is <5 g per person per day (2 g per day of sodium). Excessive salt consumption is linked to adverse health outcomes, such as the increased risk of hypertension (raised blood pressure), which in turn leads to stroke and heart disease ( 94 ). The current salt intake in the Region averages more than 10 g per person per day, which is double the recommended level set by WHO. In 2010, within EMR countries the highest mean salt intake has been recorded in Bahrain (14 g/day) followed by Libya, Morocco, Qatar, Syria, and Tunisia (11 g/day) ( 11 ) (see Table 4 ). Conversely, according to more recently collected data based on urinary excretion, the highest level of salt intake was observed in Morocco (10.6 g/day), while the lowest was observed in Lebanon (5.6 g/day) and the UAE (6.8 g/day) ( 19 ). Based on dietary assessment questionnaires, the highest levels of salt intake were observed amongst Iranian children and adolescents (14.3–16.2 g/day) and adults in Bahrain (9.3–13.3 g/day) and Lebanon (10.9 g/day). Per capita estimates were also high in Oman (11.5 g/day) and Tunisia (10.2 g/day) ( 19 ). Sodium is an essential nutrient necessary for the maintenance of plasma volume, acid-base balance, the transmission of nerve impulses, and normal cell function ( 95 ). In our diet, the main source of sodium is salt, despite it can be attained from sodium glutamate, used as a food additive in many processed foods ( 95 ). In 2019, a diet high in sodium (more than 3 g) was responsible for 44.9 million DALYs and 1.89 million deaths. It was the leading dietary risk factor for causing DALYs ( 96 ). The highest mean sodium intake has been recorded in Bahrain (5.8 g/day) followed by Tunisia (4.43 g/day), then Morocco (4.31 g/day), Libya (4.24 g/day), Qatar (4.21 g/day), Syria (4.18 g/day), and Jordan (4.13 g/day) ( 11 ) (see Table 4 ).

The EMR population should be aware of how much salt they consume as the disease burden of CVDs, resulting mainly due to salt and subsequent high blood pressure, is very high in the region ( 97 ). In a recent study, the salt intake levels were estimated in 15 out of the 22 countries in EMR, national salt reduction initiatives were identified in 13 countries including Bahrain, Egypt, Iran, Jordan, KSA, Kuwait, Lebanon, Morocco, Oman, Palestine, Qatar, Tunisia, and the UAE. The majority of countries were discovered to be implementing complex reduction measures, which included two or more implementation strategies. Taxation was the least popular implementation option, whereas reformulation was the most popular (100%), followed by consumer education (77%), initiatives in specialized situations (54%), and front-of-pack labeling (46%) ( 19 ).

The prevalence of obesity (BMI ≥ 30 kg/m 2 ) has almost tripled worldwide since 1975. There were 650 million obese adults aged 18 years in 2016, with a global prevalence of nearly 13%. High body-mass index (BMI) was responsible for 160 million DALYs and 5.02 million deaths in 2019. It was the seventh-ruling risk factor for attributable DALYs in 2019 ( 98 ). Being obese is usually linked to an increased risk of hypertension and many NCDs (including diabetes, CVDs, and cancers) ( 99 ). Shifts in eating behavior toward diets containing energy-dense foods, high in fat and sugars, and less physical activity due to the sedentary nature of many forms of work and modes of transportation are contributing to the rise in obesity. The prevalence of obesity in the EMR is the third-highest across all global regions ( 4 ). The current prevalence of obesity is estimated at 25.1%, while the prevalence of overweight is around 56.41%. Among the EMR, the gulf countries revealed the highest rate of obesity. The highest prevalence of obesity in EMR has been reported in Kuwait (37.9%), Jordan (35.5%), Saudi Arabia (35.4%), Qatar (35.1), Libya (32.5%), Egypt (32%), Lebanon (32%), and UAE (31.7%). According to the latest estimates, the prevalence of excess BMI in adults in EMR has increased by 3% between 2012 and 2016 ( 6 ) ( Table 2 ; Figure 3 ).

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Overweight and obesity prevalence among adults in different regions ( 6 ).

The high prevalence of people who are overweight or have obesity in Saudi Arabia is considered a public health concern, as revealed in a cross-sectional study carried out on a representative sample of 1,681 adult patients. Being overweight and having obesity were found to be prevalent in 38.3% and 27.6% of the population, respectively. Obesity was not shown to be connected with smoking, although it was found to be associated with hypertension. The risk of overweight or obesity was significantly inversely correlated with the monthly income ( 100 ).

The most recent national survey conducted in Egypt revealed that 39.8% of adult Egyptians suffered from obesity with a more prevalent in adult females than males, nearly 25% have normal BMI while the rest are either obese or overweight ( 101 ). A study analyzing the health effects of being overweight and having obesity conducted over 25 years in 195 countries, revealed that 19 million Egyptians suffer from obesity, representing 35% of all adults, which is the highest rate in the world. Moreover, the study outlined that 3.6 million children (10.2% of Egyptian children) suffer from obesity ( 102 ).

Research published in 2020 indicated that almost three-quarters of men and women in Jordan were overweight or obese. Obesity rates in men were around twice as high in 2017 as they were in 2009. In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly linked with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age ( 103 ).

Ultimately, obesity is the first reported risk factor responsible for the total number of DALYs in 2019 in eight countries in the region (Bahrain, Jordan, Kuwait, Libya, Oman, Qatar, Saudi Arabia, and UAE). It is the second reported risk factor in the other seven countries (Egypt, Iran, Iraq, Morocco, Palestine, Syria, and Tunisia). The highest increase in obesity percentage between 2009 and 2019 in EMR was reported in UAE (133.4%) followed by Djibouti (106.5), then Jordan (96.3%), Qatar (88%), Bahrain (86.9%), and Afghanistan (80.1%). The dramatic increase in obesity involves low-income countries in the region also including Djibouti and Afghanistan ( 13 ) (as indicated in Table 5 ). The prevalence figures revealed that obesity constitutes a significant public health concern in EMR because of its significant correlation to NCDs (see Figures 4 , ​ ,5 5 ).

The rank of the nutrition related risk factors that causes deaths in 2019 and the percentage change between 2009–2019 ( 13 ).

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Correlation between the prevalence of obesity, diabetes, and cumulative cancer risk among adults in EMR ( 6 , 26 ).

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Correlation between the prevalence of obesity, probability of death due to CVDs, cancers, and diabetes among adults in EMR ( 6 ).

Physical Inactivity

In 2016 a study revealed that globally, 28% of all adults aged 18 years and older were insufficiently physically active, and not following the WHO recommendation to implement at least 150 min of moderate-intensity physical activity per week ( 104 ). According to the 2019 Global Burden of Disease Study, low physical activity was ranked 18th in attributable DALYs in 2019, accounting for 198.4 age-standardized DALYs per 100,000 and 11.1 age-standardized deaths per 100,000. The EMR has the highest prevalence of insufficient physical activity than any other region. There is a clear relationship between physical inactivity and country income group globally ( 4 ). In 2016, high-income countries had more than double the prevalence of physical inactivity (37%) than low-income countries (16%), however, the situation is reversed among EMR countries where the insufficient physical activity was the highest in Kuwait followed by Saudi Arabia and UAE while the lowest was recorded in Jordan ( 6 ). According to data from the UAE national health survey 2017–2018, 70.8% of the participants did not fulfill WHO standards for adequate physical exercise. Insufficient physical activity was reported by women at a higher rate than men (74.8 and 66.8%, respectively). When compared to non-Emirates, Emiratis had a higher percentage of insufficient physical activity (80.2 and 69.2%, respectively) ( 105 ).

Physical inactivity is also a modifiable factor that is involved in upregulating the magnitude of NCDs. People who are deficiently physically active have an enhanced risk of all-cause mortality, as compared to those who perform at least 30 min of moderate-intensity physical activity on most days of the week. Additionally, physical activity lowers the risk of stroke, hypertension, and depression ( 106 ).

Other Risk Factors Mediated by Unhealthy Diet and Obesity


Hypertension or raised blood pressure is defined as systolic and/or diastolic blood pressure greater than, or equal to, 140/90 mmHg. Hypertension is a major risk factor for heart failure, ischemic heart disease, peripheral vascular disease, renal failure, retinal hemorrhage, stroke, and dementia ( 107 ). In 2019, high blood pressure was the second-leading contributor to 235 million (95% UI 211–261) DALYs and 10.8 million (9.51–12.1) deaths in 2019 ( 108 ). Several risk factors could be involved in the upregulated blood pressure, including high salt intake, being overweight or obese, excessive use of alcohol, low or lack of physical activity, stress, air pollution, and smoking ( 95 ). Globally, in 2015, one in four men, and one in five women (i.e., 22% of the adult population aged 18 years and older) had raised blood pressure. In 2015, 28% of the population in low-income countries had high blood pressure, compared with 18% of the population in high-income countries. Reviewing the current trends demonstrated that the number of adults with high blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the peak revealed significantly in low- and middle-income countries ( 109 ).

Among all the WHO-geographical regions, EMR was the second-highest in the incidence of raised blood pressure after Africa ( 4 ). In 2015, within the EMR, the prevalence of raised blood pressure is the highest in Somalia (32.9%), then Yemen (30.7%), Afghanistan, and Pakistan (30.6% and 30.5%), respectively. In 2019, the highest prevalence of hypertension among adults was recorded in Iraq (40.7%) followed by Oman (38.6%), UAE (34.8%), Afghanistan (33.7%), Sudan (33.5%), and Kuwait (33.5%), followed by Egypt (33.2%) ( 6 ) ( Table 2 ; Figure 6 ).

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High blood pressure prevalence among adults in different regions ( 6 ).

Raised blood pressure is the second risk factor responsible for the total number of DALYs worldwide. Among EMR countries, hypertension is the first reported risk factor responsible for the total number of DALYs in six countries (Egypt, Iran, Iraq, Morocco, Syria, and Tunisia) while it is the second reported risk factor in other nine countries (Jordan, Lebanon, Libya, Oman, Saudi Arabia, Sudan, UAE, and Yemen). The highest increase in blood pressure percentage between 2009 and 2019 in EMR was reported in UAE (140.1%) followed by Jordan (87.8%), Qatar (62.3%), Djibouti (56.9%), then Bahrain (55.7%). The increase in hypertension in the region has involved high-income countries including UAE, Qatar, and Bahrain ( 13 ) ( Table 5 ).

High Fasting Blood Glucose

Accordingly, all body tissues are affected by high blood glucose including the heart, blood vessels, eyes, kidneys, and nerves, with subsequent complications including heart attack, stroke, kidney failure, lower limb amputation, blindness, and nerve damage ( 110 ). Nearly 9% of the global population had raised blood glucose levels in 2014 ( 111 ). In 2019, high fasting plasma glucose (>4.8–5.4 mmol/L) was ranked as the sixth most prevalent DALYs risk factor worldwide, accounting for 2,223.8 all-age DALYs per 100,000 and 84.0 all-age deaths per 100,000 ( 112 ). The EMR showed the highest levels (14% of the population), while 7–9% of the population from other regions had high levels of blood glucose. The upper-middle-income group tended to have higher levels (9%) ( 4 ). Within the EMR countries, the highest percentage of fasting blood glucose (≥7.0) mmol/L has been reported in Kuwait (19.6%), Qatar (18.9%), Egypt (17.9%), Saudi Arabia, Iraq (17.4%), and Jordan (16.8%) ( 6 ) ( Table 2 ).

According to the 2019 Global Burden of Disease Study, raised fasting plasma glucose is the first reported risk factor accounted for the total number of DALYs in Palestine, while it is the second reported risk factor in three countries in the region (Bahrain, Kuwait, and Qatar) and it is the third risk factor in other seven countries (Iran, Iraq, Libya, Morocco, Oman, Saudi Arabia, and Tunisia). The highest increase in fasting plasma glucose percentage between 2009 and 2019 in EMR was reported in UAE (147%) followed by Bahrain (93.8%), Jordan and Qatar (85.9%), and Egypt (72.1%) ( 13 ) ( Table 5 ).

High Cholesterol

Blood cholesterol is one of the most important risk factors for ischemic heart disease and ischemic stroke ( 113 ). The global prevalence of elevated total cholesterol (≥5 mmol/l) among adults aged ≥25 years was 38.9% (37.3% for men and 40.2% for women). Among the WHO-designated regions, the prevalence of hyper-cholesterolemia was the third highest in the EMR, at 38.4% (40.4% for women and 36.2% for men) ( 6 ). In 2018, global age-standardized mean total cholesterol was 4.6 mmol/l for women and 4.5 mmol/l for men ( 114 ) while the mean total cholesterol in the EMR is 4.4 mmol/l for both sexes, 4.4 mmol/l for men, and 4.5 mmol/l for women ( 6 ). It is noteworthy that blood non-HDL cholesterol is strongly associated with the long-term risk of atherosclerotic cardiovascular diseases. In 2018, global age-standardized mean non-HDL cholesterol was 3.3 mmol/l for women and 3.3 mmol/l (3.3–3.4) for men ( 114 ) while the mean non-HDL cholesterol in EMR in 2018, was 3.2 mmol/l for both sexes. In 2018, the highest recorded mean total cholesterol was in Lebanon 5 mmol/l followed by Kuwait and Jordan 4.8 mmol/l followed by UAE 4.6 mmol/l then Egypt and Iraq 4.4 mmol/l. Within EMR countries, the highest mean non-HDL cholesterol in 2018 was recorded in Lebanon at 3.7 mmol/l, followed by Kuwait and Jordan 3.5 mmol/l, then Oman, UAE, and Yemen 3.4 mmol/l ( 6 ) ( Table 2 ).

According to the 2019 Global Burden of Disease Study, high LDL-c was the eighth-directing risk factor for DALYs. It contributed to 98.6 million DALYs and 4.40 million deaths in 2019 ( 115 ). High LDL-c is the fifth reported risk factor in three countries in the region (Morocco, Oman, and UAE), while it is the sixth reported risk factor in six countries in the region (Egypt, Iran, Lebanon, Libya, Syria, and Tunisia). The highest increase in fasting plasma glucose percentage between 2009 and 2019 in EMR was reported in UAE (141.5%) followed by Jordan (86.9), then Bahrain (48.6%), and Yemen (47.4%) ( 13 ) ( Table 5 ).

Interdisciplinary Relationships Between NCDs and Related Risk Factors

Both overweight and obesity-related to unhealthy dietary habits as well as insufficient physical activity are the key risk factors for NCDs ( 116 ). For instance, TFA consumption induces low-grade systemic inflammation and is positively correlated with endothelial dysfunction (a non-obstructive coronary artery disease) ( 117 – 121 ). Being overweight and having obesity also enhances low-grade systematic inflammation, creates a higher concentration of pro-inflammatory cytokines, and further endothelial dysfunction, all of which are metabolic risk factors for nutrition-related NCDs, and in particular, heart disease ( 122 , 123 ) ( Figure 1 ).

Nevertheless, its association with other risk factors, including diabetes, high body cholesterol, elevated blood pressure, and metabolic syndrome, obesity could serve as an independent risk factor for CVDs ( 124 ). Since abdominal obesity is an independent risk factor for coronary heart disease, the distribution of body fat represents an additional risk. The intra-abdominal fat buildup promotes insulin resistance, which can lead to glucose intolerance, elevated triglycerides, and low HDL as well as hypertension ( 125 ). Ultimately, obesity is the key risk factor for type 2 diabetes, cardiovascular disease, cancer, and premature death ( 126 ). Individuals who decreased 7% of their body weight significantly reduced all cardiovascular risk variables except LDL cholesterol levels, however, the rate of cardiovascular events did not decrease during the trial ( 127 ).

In a statewide cross-sectional study done by phone interviews in June 2020 in Saudi Arabia, obesity was found to be prevalent at 24.7%, and overweight at 21.7%. Type 2 diabetes, hypertension, hypercholesterolemia, sleep apnea, lung diseases, rheumatoid arthritis, colon diseases, and thyroid issues have all been significantly linked to obesity ( 128 ). A further study conducted in Qatar confirmed that obesity risk factors (c-peptide, insulin, albumin, and uric acid) and obesity-related comorbidities such as diabetes (e.g., HbA1c, glucose), liver function (e.g., alkaline phosphatase, gamma-glutamyl transferase), lipid profile (e.g., triglyceride, LDL-c, HDL-c), as well as most of the dual-energy x-ray absorptiometry measurements (e.g., bone area, bone mineral composition, bone mineral density, etc.) were significantly ( p <0.05) higher in the obese group ( 129 ).

Substantially, elevated blood pressure has been linked to the consumption of food high in salt and NCDs. An intervention trial that included 9,000 adults with baseline systolic blood pressure between 130 and 180 mmHg indicated that a lower blood pressure target was accompanied by a significantly lower incidence of myocardial infarction, acute coronary syndrome, stroke, heart failure, or death ( 130 ). Diabetes also is a recognized and significant risk factor for CVDs ( 131 ). CVDs is the leading cause of morbidity and mortality among individuals with diabetes. It is therefore recommended that individuals with diabetes should have a target blood pressure of <130/80 mmHg to prevent the incidence of CVDs ( 132 ).

Discussing the Cultural and Sociodemographic Effect on the NCDs Related Risk Factors

Of the 22 countries and territories in the EMR, 16 are considered low-income or middle-income countries. Several countries in the EMR have lengthy histories of political instability, war, and social conflict, which have resulted in the large-scale internal and external displacement of citizens; half of the region's countries and territories are now under an acute or chronic state of emergency. These socioeconomic determinants of health, as well as accompanying inequities, have an impact on health status and access to care throughout the EMR as well as access to healthy food, which is unsurprising. Moreover, disease epidemiological data on disease incidence, prevalence, and management are scarce and lacking ( 133 ). Furthermore, NCDs mortality, and its social, environmental, behavioral, nutritional, and clinical determinants are not distributed evenly within countries ( 134 ). The most deprived communities have a higher risk of premature death than those in the most affluent. Therefore, reducing national-level NCDs risk requires actions that address the disproportionate burden in deprived communities ( 29 ).

The lowest risk of NCDs mortality is seen in high-income countries in western Europe, Asia-Pacific, Australia, and Canada, whereas, the highest risk was observed in low-income and middle-income countries. The highest probabilities were seen in parts of sub-Saharan Africa, and Guyana. In EMR, Yemen, and Afghanistan (one in four to one in three people are at risk of dying from NCDs), people are about 3–7 times more likely to die than those in high-income countries. Similarly, the probability of dying from NCDs between the age of 30 and 70 in EMR is 24.5% (one in four adults will die before the age of 70) ( 29 ).

Literature on this subject usually shows a positive association between socioeconomic status and obesity in low-income countries. However, contrary to this, a multinomial regression analysis study conducted in Cairo, Egypt reported no significant associations between most SES spectrum and overweight/obesity in the studied population. The study suggested that obesity programs and policies should be targeted at all socioeconomic status groups in Egypt ( 135 ). A study conducted in Jordan revealed that the prevalence of overweight/obese women was 70.6%. Furthermore, the association between age and overweight/obesity was significant ( p < 0.0001). The high prevalence of overweight/obesity among women in Jordan was related to high parity and low education level ( 136 ). Conversely, in research conducted in Saudi Arabia, the prevalence of overweight and obesity in men was 35.1% and 34.8%, respectively, and in women, it was 30.1% and 35.6%. Obesity and overweight increased in prevalence until 60 years of age, then declined in both sexes in the oldest age group. After adjusting for age, earning a postgraduate degree raised the risk of obesity in men, but increased physical activity decreased it in both sexes. Obese women had a higher risk of prediabetes and diabetes, obese males had a higher risk of hypertension, and both sexes had a higher risk of dyslipidemia. A familial history of dyslipidemia was linked to a lower risk of obesity in women, whereas women who were overweight were more liable to develop prediabetes, diabetes, and dyslipidemia, while men who were overweight were more liable to hypertension ( 137 ).

Analyzing the data from a population-based cross-sectional survey of diabetes and obesity in Kuwait, revealed that the prevalence of overweight, obesity, and central obesity were 40.6%, 42.1%, and 73.7%, respectively. Men were 26% more likely than women to be overweight, while women had 54% and seven-fold higher probabilities of obesity and central obesity, respectively. Young adults aged 18–29 years have a significant prevalence of obesity and overweight. Obesity/central obesity was associated with higher educational attainment, physical activity, and being non-Kuwaiti. Smoking history, high blood pressure, higher income, and marital status are all linked to an increased risk of obesity/central obesity ( 138 ). In another cross-sectional study conducted among 3,915 Kuwaiti adults, obesity prevalence was 40.3% (men, 36.5%; women, 44.0%); and overweight prevalence was 37% (men, 42%; women, 32.1%). Obesity prevalence was linked to female sex, age, diabetes history, and marital status in both men and women, but was inversely linked to education level in women. Men were more likely to have an increased waist-to-hip ratio (46.91%) as compared to women (37.9%). In both men and women, waist circumference, waist-hip, and waist-height ratios were found to be directly associated with diabetes and negatively associated with education level in women ( 139 ).

In a study conducted in Libya that explored the key risk and protective factors beyond the high prevalence rates of overweight and obesity, 11 factors were identified to be associated with obesity among men and women. These include socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviors, knowledge about obesity, social-cultural influences, healthcare facilities, physical activity, the effect of the neighborhood environment, sedentary behavior, food-subsidy policy, and suggestions for preventing and controlling obesity ( 140 ). Another cross-sectional survey revealed that the prevalence of obesity, overweight, and normal weight among Libyan adults was 42.4%, 32.9%, and 24.7%, respectively. Women were more likely than men to be overweight or obese (the prevalence of overweight was 33.2% in women vs. 32.4% in men, and the prevalence of obesity was 47.4% in women versus 33.8% in men) ( 141 ).

Sustainable Development Goals Target 3.4: Pathways and Forward Steps

The Sustainable Development Goals (SDGs) target 3.4 is to reduce NCDs-related premature mortality by a third by 2030 compared to 2015 levels, as well as to enhance mental health and wellbeing through prevention and treatment ( 142 ). It has been reported that the progress in most international countries is too slow to meet this goal ( 143 ).

Although SDG target 3.4 is the same, differences exist between countries in terms of risk of dying from various NCDs ( 29 , 144 ). Throughout this review, the percentages of different risk factors associated with NCDs incidence have been elaborated. This is important to highlight the pathways through which each country can achieve SDG target 3.4 and to guide governments and donors in prioritizing resources and interventions in their national NCDs response.

Based on 2010–2016 trends, women in 17 of 176 (9.7%) countries and men in 15 of 176 (8.5%) countries are expected to achieve SDG target 3.4 by 2030. The high-income countries that are on track include Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea as well as central and eastern European countries. Furthermore, NCDs death rates among men and women in EMR countries as Iran are falling quickly enough to meet the 2030 target. Kuwaiti women and Bahraini men are likewise on pace ( 29 ). In contrast, the risk of dying from NCDs is expected to remain stable or increased among women in 14 (8%) countries and men in 20 (11.4%) countries according to 2010 and 2016 trends. Bangladesh (men), Egypt (women) from EMR, Ghana (men and women), Côte d'Ivoire (men and women), Kenya (men and women), Mexico (men), Sri Lanka (women), Tanzania (men), and the United States (women) were involved. This could be referred to the changes in population size and age structure, even if the risk of dying from NCDs reduces, the number of deaths from NCDs may continue to rise ( 29 ).

According to a new World Health Organization report, if low and lower-middle income nations invest less than a dollar per person per year in the prevention and treatment of NCDs, close to seven million deaths could be avoided by 2030 ( 145 ) 1 . These include low-cost strategies for reducing tobacco and alcohol use, improving diets, increasing physical activity, lowering the risk of cardiovascular disease and diabetes, and preventing cervical cancer ( 145 ) (see text footnote 1 ).

The regional framework for action on obesity prevention 2019–2023 ( 146 ), set a road map for countries of the region to accelerate the action on NCDs and obesity prevention. It sets out six key action areas for improving nutrition and food security including, sustainable, resilient food systems for healthy diets; aligned health systems providing universal coverage of essential nutrition actions; social protection and nutrition education; trade and investment for improved nutrition; safe and supportive environm ents for nutrition at all ages; and strengthened governance and accountability for nutrition ( 17 , 146 ) 2 .

By investing in the Best Buy policies, countries will protect people from NCDs. Best Buy actions include increasing health taxes, restrictions on marketing and sales of unhealthy dietary products, food labeling, and education. They also include actions connected to managing metabolic risk factors, such as hypertension and diabetes, to prevent more severe disease or complications ( 145 ) (see text footnote 1 ). Table 6 reveals the key policies and action plans available and implemented among EMR countries ( 6 , 17 – 20 ).

The polices available and implemented in EMR countries.

The interventions have already been used successfully in many countries around the world. Among EMR countries that are on track to meet SDG target 3.4 are Iran, Kuwait, and Bahrain ( 29 ). These three countries have policies to reduce salt/sodium consumption, tax on sugar sweetened beverages, policy to eliminate industrially produced trans-fatty acids, policy to limit saturated/ trans-fatty acids intake, policy to reduce the impact of marketing of food to children, and policy on salt iodization ( 6 , 17 – 20 ) (see Table 6 ).

Among the top causes of morbidity and mortality related to nutrition in EMR are cardiovascular heart diseases followed by cancer and then diabetes. Globally, the disease burden attributable to hypertension, alcohol consumption, high body mass index, high fasting blood glucose, high sodium intake, and unhealthy diet consumption is increasing significantly, while the disease burden attributable to children being underweight, suboptimal breastfeeding, and micronutrient deficiencies have all decreased significantly. Among the EMR countries, UAE followed by Jordan revealed a significant increase in the percentage change of nearly all the risk factors that are involved in NCDs causing morbidity and mortality ( 150 ).

The data and correlation figures included in this study represent evidence that constitutes a significant public health concern about the relationship between unhealthy diet consumption and obesity that further induces other risk factors including (hypertension, insulin resistance, and a systemic inflammatory milieu), leading to NCDs ( Figure 1 ). It is therefore important to recognize the key therapeutic modalities for treating and prohibiting NCDs, which are to fight against weight gain and obesity and to advocate lifestyle-based therapies; including proper nutrition and regular physical activity. These are the key therapeutic modalities that will reduce the risk of NCDs. Additionally, body mass index should be used as a first step in establishing the criteria to judge potential health risks.

Countries in the EMR need to continue building on the achieved progress and scale up action across the region while boosting efforts in areas where concrete action is absent through the following key stakeholders to reach the agreed global and regional goals relating to nutrition and diet-related NCDs. This could be achieved through the following key stakeholders, Governments can provide and improve access to quality NCDs and obesity care, as well as develop and implement policies that promote and normalize healthy eating and living, in addition to banning the marketing of unhealthy foods and beverages high in fat, sugar, and salt. Civil society groups, including non-governmental organizations and the media, can work with individuals and communities to educate and diffuse key messages on the root causes of NCDs and obesity, the importance of prevention and treatment, as well as the impact of adopting healthy behaviors like keeping physically active and choosing healthy food and drinks. Health care professionals, whether working directly in NCDs and obesity care or supporting and working with those living with obesity, can learn more about obesity, expand their knowledge, and have up-to-date, evidence-based obesity management resources to help them understand and address the root causes of this disease. Individuals and families can adopt healthier behaviors, share experiences, as well as ask for support, whilst also supporting others to improve their health and well-being and that of their children ( 17 ) (see text footnote 2 ).

Countries in EMR are encouraged to adopt and implement the regional nutrition strategy for nutrition 2020–2030 ( 21 ), the regional framework for action on obesity prevention 2019–2023 ( 151 ), and the regional framework for action to implement the United Nations Political Declaration on the NCDs ( 152 ).

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1 Available online at: https://www.who.int/news/item/13-12-2021-investing-1-dollar-per-person-per-year-could-save-7-million-lives-in-low-and-lower-middle-income-countries .

2 Available online at: https://apps.who.int/iris/bitstream/handle/10665/346443/EMRC68INFDOC8-eng.pdf .

  • Systematic review
  • Open access
  • Published: 20 January 2021

Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review

  • Mireya Vilar-Compte   ORCID: orcid.org/0000-0001-9047-1102 1 ,
  • Soraya Burrola-Méndez 1 ,
  • Annel Lozano-Marrufo 1 ,
  • Isabel Ferré-Eguiluz 1 ,
  • Diana Flores 1 ,
  • Pablo Gaitán-Rossi 1 ,
  • Graciela Teruel 1 &
  • Rafael Pérez-Escamilla 2  

International Journal for Equity in Health volume  20 , Article number:  40 ( 2021 ) Cite this article

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There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this “urban advantage” does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition.

This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.’s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis.

Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition.


This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the “urban advantage”. A conceptual framework emerging from the existing literature is proposed to guide future studies and policies.

Systematic review registration

PROSPERO Registration number: CRD42018089788 .

Urbanization is a rising global phenomenon. Today 55% of the global population lives in urban areas, and it is estimated that by 2050 70% of the population will live in one of them [ 1 ]. Compared to rural areas, urban regions feature greater social and economic development, more labor opportunities, and access to more diverse and better essential services. However, urban areas also concentrate poverty [ 2 ]. The urban poor not only lack income and resources to ensure an adequate wellbeing, but frequently experience limited access to basic services, labor opportunities and to possibilities for social development. Prior studies highlight increasing trends in urban poverty, partially resulting from accelerating urbanization processes in low-and middle-income countries; it has been estimated that by 2035 the majority of individuals in extreme poverty (i.e. daily income less than US1.25) will live in urban areas [ 1 , 3 ].

These challenges have been addressed in the Sustainable Development Goals (SDG) [ 4 ]; specifically, SDG 11 establishes that countries need to have urban sustainable development plans to promote the wellbeing of people, especially the most socioeconomic vulnerable. Furthermore, SDG 1 states that all forms of poverty should be eradicated by 2030.

The SDGs are also strongly linked with food insecurity (FI) [ 5 ]. Urban environments imply a particular risk for FI and poor nutrition outcomes since access to food depends on the commercial supply that, in turn, is linked to income levels [ 6 , 7 ]. On the one hand, it has been previously recognized that the urban poor are particularly vulnerable to macroeconomic shocks that affect their capacity to generate income which in turn leads them to consume less healthy diets [ 8 , 9 ]. On the other hand, previous studies suggest that urban diets, on average, are better than rural diets because they are more diverse and, given the food distribution systems, there is greater access to products such as animal proteins [ 10 ]. However, this supposed urban advantage is not equally distributed as it does not extend to the poorest socioeconomic strata.

Previous research indicates that there are geographic differentials in access to food [ 11 ], which are linked to economic barriers in accessing healthy food options [ 12 ]. Hence, those with lower incomes do not have access to diets rich in heathy foods including fresh fruits and vegetables, tubers, and legumes. Instead they have relatively more access and consume higher amounts of sugars, fats, and highly processed or ultra-processed foods [ 13 ]. Although this phenomenon has been generically identified as part of the “nutritional transition”, it is important to emphasize that in urban centers, these outcomes are linked to socioeconomic inequities [ 6 ]. Ultra-processed products have a high energy density, have long shelf lives, many are ready-to-eat and they are relatively cheaper [ 14 , 15 ]. All these features make them convenient for urban and low-income individuals who may have limited resources such as household heating and cooking goods, safe drinking water supply, and sanitation, amongst other basic needs. A study of 74 countries from the Pan-American Health Organization conducted in 2015 found that sales of ultra-processed products were larger in more urbanized countries, and that the market is expanding to poorer sectors [ 16 ].

Food environments can influence the risk of malnutrition and corresponding infectious and non-communicable chronic diseases. In urban areas, food deserts and food swamps – understood as regions with very limited or difficult access to supermarkets and healthful food choices [ 17 ] – exemplify challenging food environments, which are generally more common in low-income urban areas [ 18 ]. These environments are in turn associated with unequal nutrition outcomes. For example, in Latin America, the risk of chronic malnutrition in urban children under 5 years of age is ten times higher among the poorest compared with their counterparts falling in the highest socioeconomic level [ 7 ].

Despite such compelling evidence, there are few studies that have attempted to document in detail the food access challenges and their relationship with different nutritional outcomes among poor urban populations. Therefore, the aim of this study was to conduct, from a global perspective, a systematic literature review (SLR) to assess urban poverty as a determinant of access to a healthy diet, and to document the association between urban poverty and the nutritional status of individuals.

The protocol for this systematic review was registered on PROSPERO prior to starting the literature search (CRD42018089788).

The review centered in nutrition outcomes related to: (i) access to a healthy diet as defined by the World Health Organization [ 19 ], which includes aspects of variety, quantity, balance and food safety, and (ii) nutrition outcomes related to the SDGs – anemia, overweight and obesity, micronutrient deficiency, and micronutrient malnutrition [ 20 ]. These outcomes were kept generic and subsequently categorized through the operationalizations used in the studies. The exposure variable of interest was urban poverty. Poverty was captured through different indicators such as income thresholds, poverty lines, multidimensional poverty measures, socioeconomic indexes (based on assets and services), wealth indexes, geographic areas considered highly vulnerable or lacking basic services (i.e. slums), or people participating in social programs targeted at the vulnerable/low income. Similarly, “urban” as a context where poverty happens was not defined through a unique criterion – as different countries used different criteria. Hence, “urban” was defined in terms of population size, population density, type of economic activity, level of infrastructure, or a combination of these criteria.

Inclusion and exclusion criteria

This systematic review followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 21 , 22 ]. We prepared a literature search protocol to define a priori inclusion criteria (see Table  1 ). Qualitative and quantitative studies were included if they focused on nutrition access or nutrition outcomes among urban poor populations (i.e. individuals, families, households). Quantitative studies could be observational or experimental.

Studies were excluded if they focused on the general population (i.e. without a specific focus on urban and poor settings) or if they were centered in populations with special conditions (i.e. refugees, prisoners). Only peer reviewed studies published in English or Spanish were included in the review.

Search strategy

Four bibliographical databases (PubMed, Web of Science, Scielo and EBSCO) were systematically searched for studies published between January 2000 and January 2019. The year 2000 was selected as a threshold because urbanization was recognized as key in the Millennium Development Goals (MDGs) linked to poverty and the health outcomes of individuals. Indeed, the MDGs led to specific research and interventions targeting the urban vulnerable populations [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Relevant literature was identified following the Boolean search algorithms summarized in Supplementary Table  1 . Free-text terms were used to generate search strategies for each database. Studies identified through each database were imported to Excel, and then duplicates were identified and removed. The studies were then imported to EndNote [ 31 ].

Study selection

In the first phase, abstracts were reviewed by three of the authors (DF, IF and SB) who were standardized to screen titles and abstracts of studies identified in the search. Articles were excluded if they did not meet the criteria established in Table  1 . They were included if there was an indication that access to healthful foods or any of the nutrition outcomes of interest were being described or analyzed, either through qualitative or quantitative approaches, in urban poor/vulnerable populations. In the next phase, articles were retrieved and independently assessed for eligibility (see criteria in Table  1 ). Consensus was reached in consultation with a fourth author (MVC) as needed.

Data extraction

The following information was extracted from each study: (i) methods (i.e. qualitative or quantitative study design, and corresponding details); (ii) territorial definition of the urban space (i.e. urban or semi-urban, large cities, slums, etc.); (iii) poverty definition; and (iv) operationalization of the food and nutrition variables (i.e. food access, nutrition outcomes). In addition, data were extracted to describe the study sample, confounding or mediating factors, statistical tests or data triangulation, and key findings.

Quality assessment

The studies’ quality assessment was conducted by reviewing each study according to specific guidelines. For quantitative studies, guidelines were adapted from those proposed by Khan [ 22 ] which focus on four aspects: (i) type of design; (ii) how exposure was operationalized; (iii) how outcome variables were ascertained; and (iv) if confounding variables were controlled for. Supplementary Table  2 provides further details on the definition of each of these elements. For qualitative studies a guideline was adapted from the National Institute for Health and Care Excellence (NICE) methodology checklist for qualitative studies [ 32 ]. Five quality domains were assessed for each study: (i) theoretical approach; (ii) study design; (iii) data collection; (iv) validity; and (v) analysis. Supplementary Table  3 defines how each of the areas were specifically assessed. Quality assessment was performed by two researchers (SB, IF); when there were conflicting results a third reviewer (ALM, MVC) provided input until consensus was reached. To estimate the agreement between reviewers, a Cohen’s Kappa statistic was computed.

Analysis of the systematized papers

The purpose of systematically examining the studies was to generate a common understanding about how urban poverty shapes nutrition (both in terms of access and outcomes). The analysis of the studies was based on a qualitative content and thematic analyses. The objective of such perspective was to analyze the textual data from the studies to elucidate themes [ 33 ]. Hence, a three folded analytical process was followed: (i) data from the studies was coded in NVivo 12 [ 34 ]; nodes were generated and significant information from the systematized papers was dropped in such nodes; (ii) meaning of the information in the different nodes was examined; and (iii) themes were generated. This analysis was performed by three of the authors (MVC, DF, SB) based on consensus about the nodes, meanings and themes. These findings led to proposing a conceptual framework about how urban poverty shapes nutrition.

Description of the studies

Figure  1 follows the PRISMA structure [ 22 ] and provides a detailed summary of the research results. After duplicated studies were removed, the abstracts of 717 records were screened, leading to 348 papers for full review. Sixty-eight studies met the eligibility criteria and quality assessment and were included in the review. Among these studies, the majority (81%) used quantitative methods, while fewer focused on qualitative approaches (19%). The average Cohen’s Kappa statistic between-reviewers for quantitative studies was 0.963 (an almost perfect agreement), and for qualitative studies 0.759 (a substantial level of agreement) [ 35 ].

figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Diagram

The geographical distribution of the included studies is presented in Table  2 . Based on the categorization by regions as classified by the World Bank [ 36 ], close to two thirds of the papers were based on studies conducted in the Americas (i.e. 39.7% in North America and 25% in Latin American & Caribbean), followed by 17.6% in Sub-Saharan Africa, and 17.6% in East Asia & Pacific. Only 8.8% were from South Asia, 5.9% from Europe & Central Asia, and 2.9% from Middle East & North Africa.

Tables  3 and 4 provide information on how studies operationalized the poverty construct. It was commonly defined through mainstream economic classifications such as: lower deciles or quintiles of income distribution (18.9%); low socioeconomic level, ascertained through education level, type of employment, or social class (17.6%); poverty lines or thresholds based on a minimum income to satisfy basic needs, or through more complex multidimensional measures of poverty (13.5%); composite measures such as assets indexes (5.4%) or social vulnerability indexes (2.7%); and relative household’s expenditure measures (1.4%) – which are commonly used in the economics literature due to their strong theoretical background. Together, these definitions of poverty or vulnerability were used in more than half of the studies (59.5%).

The second most common metrics used for determining poverty status was through geographical characteristics (27%). Based on community, municipality or other geographic units, the studies defined the poverty status based on access to services or gradients of human development, among others. The degree of specification of how “poor areas” were defined varied across studies. Finally, another subset of the studies included in the SLR defined poverty and vulnerability through specific unidimensional conditions such as poor housing conditions, FI or homelessness (13.5%).

Tables  3 and 4 also provide information about how the “urban” space was ascertained in the studies. More than half of the studies (54.4%) defined broadly the urban space as “cities” or “metropolitan areas”. Around one third of the studies (32.4%) centered in areas within a city, while 13.3% of the studies focused in specific peri-urban areas or slums.

Among the quantitative studies ( n  = 55), 63% analyzed food access measures as dependent variables, 30% as nutrition outcomes, and 7% as both. As portrayed in Fig.  2 , the most common operationalization of access was through food security scales, dietary diversity indexes or scores, and through assessments of access to retail food stores. On the other hand, overweight and obesity and stunting were the most commonly assessed nutrition outcomes. Qualitative studies ( n  = 13) focused in access to healthful choices from different perspectives: about half of the papers studied aspects of food security, around one quarter focused in understanding the food environment, close to one fifth addressed issues of affordability and food supply, and one study assessed coping strategies for lack of food access.

figure 2

Access measures and nutrition outcomes used as dependent variables in quantitative studies. Note: Some studies used more than one measure and/or outcome

Assessment of the quality of research

For quantitative studies, quality was assessed through three dimensions: (i) type of design, (ii) comparison group or not, and (iii) control for potential confounders (i.e. adjusted models). As summarized in Table  3 , most studies relied on cross-sectional designs (80%). The rest of the studies were a mix of geospatial analyses (9.1%), cohort and longitudinal studies (9.1%), and only one study was based on a case-control design (1.8%). About 82% of the studies had a comparison group, which was commonly operationalized as urban non-poor populations, rural poor populations, or as comparisons between different subgroups of urban poor population (i.e. differences in income within poor groups, different levels of FI, amongst others). Among studies lacking a comparison group, they were mainly cross-sectional studies [ 38 , 39 , 42 , 43 , 47 , 52 , 77 , 81 , 88 , 89 ] that intended to provide descriptions of urban poverty in terms of nutrition outcomes. Close to 70% of all quantitative studies controlled for confounders and presented adjusted models. However, none of the geospatial analyses did so [ 42 , 52 , 78 , 80 , 91 ], neither the case-control study [ 48 ]. By contrast, 75% of the cross-sectional designs [ 37 , 39 , 40 , 45 , 46 , 49 , 50 , 51 , 54 , 55 , 56 , 59 , 61 , 62 , 63 , 64 , 65 , 66 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 82 , 83 , 84 , 86 , 87 , 89 , 90 ] and all the cohort and longitudinal studies controlled for confounders [ 44 , 53 , 60 , 69 , 88 ].

Among the 13 qualitative studies included in the SLR, all showed adequate research quality (see Table  4 ). All studies were found to have an adequate theoretical approach with clear aims, and a well-established study design including sample characteristics and qualitative sampling processes. Similarly, all the studies provided a description of the data collection process, recording and transcription of study materials, the study context and participants, and addressed some potential research biases. In terms of data triangulation, which is an important validity aspect of qualitative approaches, most studies reported collecting data through different sources and linking them for purposes of analysis; the only two exceptions were the studies by Dubowitz et al. [ 97 ] and Hammelman [ 99 ]. Despite their lack of triangulation, both studies were rated as having richness in data. In fact, all studies but one were rated as having dense and rich qualitative data; with the exception of a study focusing on FI among homeless and marginally housed adults in Sydney, Australia [ 104 ]. Qualitative studies applied different data collection techniques such as in-depth interviews [ 92 , 95 , 96 , 98 , 99 , 101 , 103 , 104 ], focus groups [ 93 , 94 , 97 , 101 ], participant observation [ 95 , 101 ], open-ended questionnaires [ 102 ] and photovoice [ 100 ].

Content and thematic analysis

Given the diversity of designs, methodological and measurement approaches, instead of summarizing effect sizes or aiming at a meta-analysis, we took a qualitative thematic approach to synthesize and analyze the literature. From such perspective, four broad categories emerged: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) FI and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food.

Elements of urban poverty that affect access to healthy eating

Urban poverty exerts different pressures which lead, in many cases, to problems of access to a healthy diet that are as serious as in rural areas (Supplementary Table  4 ). One of the risk factors documented in the literature for this lack of access are the economic barriers faced by the urban poor. These studies provide evidence that healthy diets are expensive, which leads to dose-response socioeconomic inequities in food choices. For example, in urban settings budgetary restrictions in the selection of food can lead to the consumption of diets that are very low in animal protein [ 51 ], or may disrupt requirements among populations with special dietary needs [ 92 , 101 ]. Urban dwellers in the lowest income deciles, allocate a higher proportion of their family income to food consumption [ 41 , 57 ], and may find restrictions to buying healthy foods [ 93 ].

In addition, low income urban neighborhoods, tend to have less access to healthful foods, thus, linking economic constrains of the population and place of living to a magnified lack of access to healthy foods [ 78 ]. There are effects of the market structure on access to food in urban poor areas, a common finding was a lower supply of supermarkets [ 42 , 78 , 91 ] that can lead to food deserts. In addition, supermarkets in urban poor areas tend to offer less variety of healthy products (i.e. fresh produce) and oftentimes products of lower quality [ 71 ]. Such fragmented market can lead to the establishment of informal arrangements, especially in low- and middle-income countries, such as street traders and house shops that are more likely to be unstable and deregulated [ 43 , 85 ]. Corner shops are another common source to meet food demand, but this has been associated with increased consumption of ultra-processed foods and inversely associated with home meal preparation, positive beliefs and self-efficacy toward healthy food [ 55 ].

Among poor urban dwellers accessing healthier choices commonly requires “out-shopping” defined as shopping outside of your residential area, but this is limited by transportation cost and lack of public transportation access [ 42 ]. In addition, this implies additional direct costs (i.e. transportation) and opportunity cost (i.e. time spent) in food purchasing [ 99 ]. This can be an even larger barrier to access when experiencing health conditions affecting physical mobility [ 92 ].

An additional barrier faced by the urban poor is the lack of social networks that allow them to access food during difficult times. Urban studies have documented less reciprocity with food exchanges than those observed in rural areas [ 68 ].

Food insecurity and urban poverty

An important body of literature emerged documenting the relationship between FI and urban poverty. FI is defined as “the limited or uncertain availability of nutritionally adequate and safe foods; or the limited and uncertain capacity to acquire adequate food in socially acceptable ways” [ 105 ]. This literature was grouped into: quantitative studies that address the determinants of FI, quantitative studies that analyze how FI is associated with unfavorable nutrition outcomes among the urban poor, and qualitative studies documenting experiences of FI among urban vulnerable populations.

Determinants of FI in poor urban settings

Studies from all regions of the world informed the literature on determinants of FI in poor urban settings. Almost all studies operationalized FI through experience-based scales. Most of the studies were based on cross-sectional designs and logistic regression analysis (see Supplementary Table  5 ).

One of the main FI risk factors identified in the literature was low household income; among those living on urban and peri-urban areas, low income increased risk of FI [ 38 , 44 , 45 , 46 , 50 , 53 , 58 , 59 , 65 , 72 , 76 , 82 , 84 , 89 ]. Similarly, a study found that lower socioeconomic status and higher levels of unemployment were associated with a higher prevalence of FI [ 37 ]. Few studies focused on assets-based measures and FI. A study documented that households with inconsistent access to utilities such as electricity or water, medical care, cooking fuel and cash had a significantly higher prevalence of severe FI [ 66 ]. Another study reported that access to a personal vehicle was inversely associated with FI [ 64 ].

In addition to experience-based FI scales, one study assessed dietary diversity finding similar associations with socioeconomic status. More specifically it documented that lower income adults in urban areas consumed less varied diets and lower amounts of vitamin C, calcium, iron, riboflavin, and zinc –even when compared with their low-income counterparts in rural areas [ 75 ].

Association between FI and nutrition outcomes among vulnerable urban groups

Studies that examined the association of FI and nutrition outcomes were mainly from the Americas and Africa, and were based on cross-sectional designs but used different data analysis approaches (see Supplementary Table  6 ). The literature found that FI is a risk factor for malnutrition of the urban poor. Few studies assessed the association between FI and stunting, and did not reach consensus. While a study documented that in poor urban settlements children under 5 years of age living in FI households were at greater risk of stunting [ 69 ], others reported that FI was not significantly associated with stunting among adolescents [ 62 ].

Most of the studies assessed the relationship between FI and overweight and obesity leading to mixed findings, partially because study populations were diverse. For example, among schoolchildren living in urban FI households a higher prevalence of overweight was documented [ 73 ]. But such associations could not be confirmed among adolescents [ 56 , 61 ] or preschool children [ 79 , 87 ]. Similarly, the association also depended on the severity of the FI [ 67 ] and the syndemic effect with other factors like parental stress [ 49 , 61 ].

Qualitative approaches to FI in poor urban settings

The qualitative studies included in the systematic review were conducted mostly in poor urban areas of high-income countries. Collectively, these studies exemplify the complexity of food access challenges in urban areas and emphasize that food availability is a necessary but not sufficient condition for adequate food access as de facto it depends on other elements as well. Among poor urban older adults living alone with physical and motor limitations, as well as lack of transportation, and social isolation increase the risk of FI [ 98 ]. Among the homeless FI was related to insufficient income from government welfare programs, low affordability of fresh food, transportation barriers, lack of safe shelter and housing, and limited food storage capacity [ 94 ] [ 95 ]. In fact, challenges with access to a kitchen and inadequate spaces to store food emerged in other studies as factors increasing FI [ 104 ].

Qualitative studies focusing on mothers living in poverty in urban areas revealed specific food access and healthy eating challenges. In large Metropolitan areas, the major limitations for adequate family nutrition were limited time for food shopping and cooking, as well as finding time for family activities, childcare and difficulties in transportation to and from the food stores [ 97 ]. Another factor that emerged is that mothers prioritize food pricing and optimization of food usage when making food selections, oftentimes sacrificing quality [ 96 , 101 ]. Mothers living in poor urban settlements also referred to an unhealthy food environment in their communities due to the abundance of street vendors and food stores selling junk food [ 102 ].

The qualitative studies also documented FI related challenges faced by people who live in urban areas, like increased feelings of anxiety, worry, shame, and uncertainty [ 103 ]; and limited self-control for chronic disease, since it prevents access to proper nutrition [ 92 ]. Moreover, while social protection and food assistance programs, such as community kitchens, help by providing access to basic nutrition, are insufficient to fully resolve their FI related challenges [ 104 ].

Risk factors of the nutritional status of the urban poor

Urban poverty poses major challenges for adequate food access and nutrition outcomes among the urban poor, exposing them to nutritional risks with long-term consequences. Our systematic review identified associations between food access barriers and increased risk for poor nutrition outcomes through three different pathways. First, urban poor have an increased risk of consuming unhealthy and energy dense foods associated with a higher prevalence of overweight and obesity [ 47 , 86 ]. Second, urban poverty was found to increase the chances of chronic undernutrition, leading to higher obesity prevalence in future stages of life [ 88 ]. And third, the review suggested that psycho-social factors are important determinants of obesity through plausible biological links with stress and feelings of despair commonly experienced by people living in urban poverty [ 49 , 76 , 104 ].

Coping strategies for limited food access

An aspect that emerged from the literature refers to strategies used by the urban poor to obtain food and, among them, the use of food banks [ 68 , 92 , 98 ] and community kitchens [ 92 ] stand out. These studies found that beneficiaries considered such support strategies valuable but insufficient to fully mitigate hunger and lack of access to food, hence, families and individuals need other coping mechanisms like selling food on the streets to generate income, while at the same time have more access to food [ 54 ]. Other strategies implied skipping meals or eating smaller portions [ 103 , 104 ]. These unhealthy coping mechanisms were more prevalent among mothers, who buffer their children against FI [ 53 , 103 ]. Finally, other strategies included buying stolen food at a lower price or eating food from garbage [ 104 ].

Conceptual framework

Figure  3 presents a conceptual framework that intends to graphically depict the key themes that emerged from our literature review. At the center two key themes shape the relationship between nutrition and urban poverty: access to food and household food security status. These elements are determined by the factors summarized in the left part of the Figure, which are grouped in different ecological levels: community, family and the individual. These themes and factors help explain nutritional and health outcomes in the context of urban poverty including overweight and obesity, short stature and stunting. The conceptual framework also highlights the coping strategies used among the urban poor to deal with food access challenges as well as FI.

figure 3

Conceptual Framework of nutrition and urban poverty

According to previous studies, in general, urban diets are likely to be more varied than rural diets [ 10 ]. However, this urban advantage strongly diminishes as a function of socioeconomic status representing a major social and health inequity in urban setting. In cities, food, for the most part, is bought and not grown for consumption. This implies that their access to healthy foods is strongly linked to income and to the structure of the food system, including its corresponding supply and access chains; i.e., “from farm to table”. These factors are two key determinants of the type of effective policies needed for urban populations to have access to a healthy diet [ 51 , 57 ].

The systematic literature review confirms that these determinants of food access in urban areas emerge in the context of poverty and high levels of FI of different countries [ 37 , 44 , 45 , 46 , 65 , 84 ], which are highly prevalent of poor nutrition and health outcomes [ 39 , 69 , 73 , 76 ]. Empirical evidence indeed supports the existence of a socioeconomic gradient in access to healthy food in urban areas [ 51 , 92 ]. The review emphasizes that access to food in urban areas is a complex process with multiple determinants and that it cannot be assumed that this access is always better for populations in urban vs. rural areas.

An important structural economic challenge for food access among the socioeconomically disadvantaged in urban areas is that the prices of healthy foods can be higher in poor neighborhoods, which at the same time also tend to have fewer food retail stores [ 41 , 42 ]. This is a strong structural barrier for families living in urban poverty. The structural challenges surrounding the food supply systems and markets in vulnerable urban areas means that sometimes individuals need to travel to other places to access healthy food, which increases costs (i.e. transportation) and mental stress due to the physical barriers to access food in their own communities. This adverse situation for the urban poor is compounded by problems of poor transport infrastructure as well as high community crime rates [ 42 ].

An interesting phenomenon that emerged from the literature –that in future studies may help compare challenges to food access among the urban and rural poor– is related to the nature of the social fabric and networks. Specifically, studies found that because urban networks tend to be weaker and, in the case of coping with FI, it may prevent families from “borrowing” or exchanging food with others [ 68 , 98 ].

Our review also found that urban poverty leads to increased risk of poor nutrition outcomes including stunting, overweight and obesity. Three themes that may help explain this finding emerged. First, the evidence indicates that urban environments foster a greater consumption of ultra-processed foods with high content of calories, fats, salt and sugars and very low nutritional value [ 47 , 86 ]. Likewise, studies show that lack of food-access may lead to skipping meals [ 53 , 103 , 104 ]. This is of public health concern, as it is known that prolonged fasting may predispose to unfavorable metabolic responses [ 106 , 107 ]. Finally, several articles pointed out how these experiences may be leading to mental health problems as a result of shame, and despair among those affected by FI without the ability to properly cope with it [ 76 , 104 ]. FI- related mental health stressors in turn can also increase the risk of cardiometabolic alterations and nutritional status [ 108 , 109 , 110 ]. Previous studies have established a strong plausibility for linking mental stress with the risk of overweight and obesity, mainly due to the increased release of hormones and neurotransmitters that can cause an increase in visceral adiposity and changes in the areas of the brain where hunger and satiety are regulated [ 108 , 109 , 110 ].

A substantive body of FI literature was identified. It is clear that FI in urban areas is strongly driven by income limitations. Specifically, low-income households need to allocate a high proportion of their total expenditure to food and are extremely vulnerable to any external shock including unemployment, health problems and food price inflation [ 45 , 46 , 65 , 84 ]. Similarly, the literature documented that the impact of FI on poor health is compounded by the fact that low-income urban households tend to have poor sanitation and other essential housing infrastructure and goods [ 46 ].

Given the findings from this review, it is not surprising that FI among the urban poor [ 49 , 73 , 76 ] has been associated with poor nutrition outcomes. This highlights the relevance of monitoring FI in urban populations. Food insecurity experience scales (FIES) are important in capturing this phenomenon among the urban poor, and efforts should be made to capture the different severity levels (i.e. mild, moderate, severe).

Another theme of great relevance is that social protection and food assistance programs designed to facilitate food access - such as monetary or in-kind transfer schemes, community kitchens and food banks - are insufficient by themselves to fully resolve the FI problem because they do not address barriers such as lack of cooking facilities or food storage, and competing health or housing expenses. Therefore is not surprising that socially unacceptable coping strategies, such as taking food from garbage, were reported, illustrating the depth of the negative effects of urban poverty on the right to food [ 104 ]. Interestingly, these FI coping behaviors contrast with those observed in rural areas, such as food exchanges and small family agriculture for self-consumption [ 44 , 68 ].

Urban poverty poses unique and diverse challenges and pathways to food access and the ability of families to consume healthy and nutritious diets that prevent access to healthy diets. It is possible that the nature of cities including unplanned built environments and challenging social network structures prevent low income individuals from finding strategies to cope with FI and lead to socially unacceptable behaviors to access foods.

In terms of the quality of the research examined, from a quantitative standpoint, most studies relied on cross-sectional designs, which do not allow to draw causal inferences, therefore there is a literature gap that requires further research with a longitudinal approach. While in the future more robust designs would be desirable, it should also be stressed that literature using different samples and conducted in a diverse set of countries is yielding similar conclusions in terms of the food access challenges and poor nutrition outcomes among the urban poor. However, further research needs to be conducted with more explicit comparison groups (such as urban population in very small, small, medium size cities, and metropolis) to answer the following questions: i) What is the role of social protection in terms of reducing FI for the vulnerable population? ii) Should it be continuous for some groups and intermittent for others? iii) What interventions should be put in place when food prices rise or economic conditions worsen to make sure the vulnerable are protected? iv) Should economic sanctions or incentives be put in place to induce away the demand of processed food consumption? v) What channels are more effective to assure quality access to food for the poor in urban settings? Finally, vi) What combination of policies could be recommended to be exerted together rather than in isolation?

Ideally, the proposed framework that emerge from the literature review should aid in the development of future research addressing food insecurity and nutrition outcomes in the context of urban poverty.

Furthermore, the operationalization of the definitions of “urban” and “poverty” were highly heterogenous across studies, hence, limiting the comparability of their findings. Future studies are needed to better harmonized definitions of poverty and the urban space, preferably studies should stratify samples according to the urban population size. The quality of qualitative studies was high overall, although there is room for improvement in terms of triangulation and reporting more explicit details on how data were retrieved, coded and analyzed.

In addition to the lack of uniform high quality across studies, this review has other important limitations when interpreting its findings. First, search algorithms were limited to specific nutrition outcomes that, despite being the more salient ones, might have excluded studies addressing other outcomes. Second, although FI is strongly linked to poverty, it is possible that some relevant studies that did not mention the word “poverty” but are related to disadvantages or inequalities, may have been left out from the review. Third, the review only included studies published in Spanish or English which may have led to excluding relevant literature published in other languages. Fourth, the search engines used retrieved studies in published academic journals, therefore the review may have excluded relevant studies only published in the grey literature. Fifth, the review did not conduct a meta-analysis to understand effect sizes of associations. This was not possible due to the strong heterogeneity across studies including the many different ways in which “poverty” and “urban” were defined. However, in recognition of such limitation, we performed a qualitative thematic analysis of the selected studies. Perhaps future reviews could narrow the search strategy to only studies that are more homogenous with regards to operational definitions of exposures and outcomes. Sixth, it is also important to note that mixed methods studies were excluded from the analysis due to the complexity of their systematization.

The systematic literature review evidenced the intricate link between urban poverty, food access, household food security, and nutrition. A contribution of this review is that it identified distinct barriers present in urban areas, questioned the supposedly “urban advantage” regarding access to healthful food, and developed a conceptual framework that focuses on the particular difficulties to achieve household food security among the urban poor through improved food access, which should inform future research. This systematic review provides consistent evidence that the right to food among those living in urban poverty is compromised; this is particularly worrisome considering that an urban setting is where the majority of the countries’ populations now live or will be living in the near future. It is essential that the social and public health sectors engage in addressing these issues jointly due to the complexity highlighted by the framework developed based on the available scientific evidence.

Availability of data and materials

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The authors thank Ida Katerina García Appendini, Erika Germaine García Alberto, Alma Cecilia Pérez Navarro and Luis Alfredo Ortíz Vázquez for their thoughtful input during the developing of this manuscript. The authors also thank Marisol Silva Laya – one of the CO-PIs of the project – who always provided very useful critical insights.

This work was supported by the National Council of Science and Technology (CONACyT) and the Research Office of the Iberoamericana University.

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Vilar-Compte, M., Burrola-Méndez, S., Lozano-Marrufo, A. et al. Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review. Int J Equity Health 20 , 40 (2021). https://doi.org/10.1186/s12939-020-01330-0

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Unhealthy diets and malnutrition

Unhealthy diets and malnutrition

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poor diet essay

  • Unhealthy diets and the resulting malnutrition are major drivers of noncommunicable diseases (NCDs) around the world.
  • Malnutrition includes undernutrition, overweight and obesity, and other diet-related NCDs like type 2 diabetes , cardiovascular disease (heart diseases) and stroke, and some cancers .
  • What people eat has changed dramatically over the last few decades. This has been driven by shifts towards calorific and fatty foods, eating out, and an increase in food portion sizes, combined with a lower intake of fruit, vegetables, and high-fibre foods.
  • Healthy diets are unaffordable for the poor in every region of the world and people are increasingly exposed to ultra-processed, unhealthy foods and diets that lead to poorer health.
  • Policy solutions to tackle poor diets are considered low-cost. The World Health Organization (WHO) ‘Best Buys’ include interventions to reduce salt and sugar intake, such as front-of-pack labelling, fiscal tools and educational initiatives, and measures to eliminate industrial trans-fats.

Malnutrition occurs when the body is not receiving enough of the right nutrients to function properly. This can present as under-nutrition, such as wasting and stunting, but also as overweight, obesity, and diet-related NCDs such as cardiovascular disease and stroke, type 2 diabetes and some cancers.

Many countries now experience a ‘double burden’ of malnutrition. This is where under-nutrition occurs alongside over-nutrition, where unhealthy diets are contributing to unhealthy weight gain and diet-related poor health.[ 1] These unhealthy diets consist of food and drinks with high levels of energy (calories), salt, sugar, and fats, notably industrial trans fats (also known as trans-fatty acids, TFAs or iTFA).

Around the world, 1.9 billion adults are overweight or obese, while 462 million are underweight.[ 2 ] In a study that looked at global deaths from 1990 to 2017, it was found that one in every five deaths were the result of poor nutrition. [3 ]

What is a healthy diet?

According to the WHO, healthy diets are rich in fibre, fruit, vegetables, lentils, beans, nuts, and wholegrains. These diets are balanced, diverse and meet a person’s macronutrient (protein, fat, carbohydrate and fibre) and micronutrient (minerals and vitamins) needs depending on their stage of life.

Generally, healthy diets contain:

  • Fat intake of less than 30% of total energy. These should be mainly unsaturated fats, with less from saturated fats. Trans fats should not be consumed.
  • Sugar intake of less than 10% of total energy, but preferably less than 5%.
  • Salt intake of less than 5g per day.
  • Fruit and vegetables intake at least 400g per day.[ 4 ]

Food systems and changes in the way we eat

A person’s ability to maintain a healthy diet is often not within their control – it is influenced by the food environment where they live, early life nutrition, income, and accessibility.[ 5 ] The ‘food system’ refers to all processes of getting food from production to our plates. The food system is often dictated by location, climate, culture, consumer behaviour, industry practices and the regulatory environment, among other factors.

Rise in ultra-processed foods and drinks

Over several decades, dietary habits have changed dramatically around the world. Globalisation and urbanisation have paved the way for a rise in convenience food and drinks products, junk food, and eating out, with fewer people growing or making their food from scratch.

These cheap and ready-to-consume food and drinks products are often ‘ultra-processed’ and high in calories, fats, salt and sugar and low in nutrients. They are produced to be hyper-palatable and attractive to the consumer, like burgers, crisps, biscuits, confectionery, cereal bars, and sugary drinks.[ 6 ]

Ultra-processed foods and drinks typically have a long shelf life, making them appealing for businesses like supermarkets, rather than highly perishable fresh goods. Intensive marketing by the industry – especially to children – has also increased the consumption of these types of goods. Increasingly, these products are displacing fresh, nutritious, and minimally processed goods, shifting population diets and food systems.

Vulnerable populations and poorer people in all parts of the world struggle to access and maintain a healthy diet. It is in these settings where ultra-processed food and beverage products are most prevalent. An estimated three billion people cannot afford healthier food choices with poverty negatively impacting the nutritional quality of food.[ 7 ]

Which diseases are linked to unhealthy diets and malnutrition?

Unhealthy diets and resulting malnutrition are linked to several noncommunicable diseases, including:

  • Overweight and obesity – also associated with elevated blood pressure, high cholesterol, diabetes, cardiovascular disease and stroke, cancers and resistance to the action of insulin.
  • Cardiovascular disease (heart disease) and stroke.
  • Type 2 diabetes and hypertension (high blood pressure).
  • Some cancers – including oesophageal cancer; tracheal, bronchus and lung cancer; lip and oral cavity cancer; nasopharynx cancer; colon and rectum cancer.[ 8 ]

These diseases are driven by common dietary risk factors, including:

  • High salt intake – a leading dietary risk factor for death and illness worldwide. High salt consumption increases blood pressure, which increases the risk of cardiovascular disease and stroke, chronic kidney disease and some cancers.
  • High sugar intake – excess sugars can contribute to tooth decay and weight gain, leading to overweight and obesity, as well as higher blood pressure, cardiovascular disease and stroke, and some cancers.[ 9 ]
  • High trans fats intake – linked to cardiovascular disease and stroke.
  • Low fruit and veg intake – linked to several cancers, cardiovascular disease and stroke.
  • Low intake of fibres, grains, nuts, seeds, micronutrients – linked to diabetes, cardiovascular disease and stroke, and some cancers.[ 10 ]

Childhood malnutrition

Early life nutrition has important impacts on the likelihood of disease and poor health later in life. But childhood malnutrition remains one of the biggest challenges in public health today.

In 2020, an estimated 22% and 7% of children under five were affected by stunting and wasting, respectively, and 7% were overweight. Most of these children live in lower- and middle-income countries. Asia and Africa account for nine out of ten of all children with stunting and wasting and more than seven out of ten children who are affected by overweight. [11 ]

Breastfeeding is one of the most effective ways to ensure the development of a healthy immune system in children, protecting against childhood malnutrition and poor health throughout the life course. But aggressive marketing of formula and baby foods seeds doubt in mothers, compromising breastfeeding and other healthy feeding practices in early childhood.[ 12 ] Policies that protect and promote breastfeeding, including the regulation of breast milk substitute industry, are critical public health interventions.

What can be done to tackle unhealthy diets and malnutrition?

Strategies to tackle unhealthy diets and malnutrition – leading to overweight, obesity and many noncommunicable diseases – should be part of a comprehensive package of policies that aim to improve the food system.

One of the most straightforward nutrition policies is the elimination of industrially-produced trans fats, or trans fatty acids (iTFA), from the global food supply. If all countries removed this harmful compound that causes heart disease, 17 million lives could be saved by 2040. An additional estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level. [13 ]

Implementing strong nutrition policies will not only accelerate progress towards global NCD targets – but is essential to build healthier and more resilient populations that are better prepared to deal with future health emergencies, such as COVID-19.

What’s more, many nutrition measures are considered cost-effective by the WHO and included in their ‘Best Buys’ of recommended interventions to reduce the burden of NCDs around the world. [14 ]

Specific measures include:

  • Reformulation of food and drinks products to contain less salt, sugar and fats – with the goal of eliminating all trans-fats.
  • Limiting marketing and promotion of unhealthy food and drink products – especially to children and adolescents, including online and in places where they congregate.
  • Front-of-pack nutrition labels which clearly warn of the high content of ingredients including fats, sugar, and salt. Front-of-pack labelling systems have now been implemented in more than 30 countries (where governments have led and supported their development), and systems are under development in many other countries.
  • Taxes on sugar-sweetened beverages to reduce sugar consumption.
  • Subsidies on fruit and vegetables to increase intake of healthier food choices.
  • Increasing incentives for producers and retailers to grow, use and sell fresh fruit and vegetables.
  • Protecting and promoting breastfeeding.
  • Promoting awareness of better nutrition through mass media campaigns.
  • Nutrition education and counselling in preschools, schools, workplaces and health centres.

Case study: Bold action in Mexico leads the way

*NCD Alliance acknowledges support from Resolve to Save Lives in the production of this video.

Mexico has among the highest prevalence of diet-related NCDs and obesity in the world. Around three-quarters of people in Mexico live with overweight or obesity, including one-third of all children. Diet-related conditions such as type 2 diabetes and hypertension are rising in prevalence.

Mexico has been taking big steps to improve health by reducing the high prevalence of largely preventable chronic diseases like obesity, type 2 diabetes and some cancers. But the government and health civil society have faced fierce challenges from the big businesses behind the products that are making people sick. As the pandemic took hold in 2020, and world leaders debated the crisis, the Mexican Minister of Health drew attention to how neglecting to prevent NCDs had made the world’s people more vulnerable to the novel coronavirus.

Health authorities urged Mexicans to transition to healthier diets and habits to reduce the COVID-19 burden. Yet the junk food industry continues to operate despite the government’s efforts, using the pandemic food crisis to put foods high in sugar, salt and fat into children’s hands as much as possible, with no regard to the harmful impact of these foods.

So, while the Mexican federal government persists with its effective soda tax, they have also strengthened their position with strong front-of-pack labelling and trans-fats elimination to create healthier environments for the people of Mexico.

“The tax on sugar-sweetened beverages in Mexico is projected to prevent 239,900 instances of obesity, of which almost 40% would be among children.”

But impatient for Federal regulations to come into force and be implemented, Congress in the region of Oaxaca went a step further, voting to ban the sale of junk food to children altogether and placing the control of purchasing into the hands of parents. The Ley Anti Charra (Anti-Junk Food Law), applies to stores, schools and vending machines. Enforcement is complex, but there is strong public support to defend the health of the most vulnerable population: children. One thing is for sure, with rates of obesity and diet-related NCDs rising in most countries, more must take bigger, braver steps like Mexico to fix food systems and protect children from the foods and drinks that are making us all sick.

Page last updated in November 2021

Turning the table: Fighting back against the junk food industry

Turning the table: Fighting back against the junk food industry

In the lead up to World Diabetes Day on 14 November, and Nutrition for Growth Summit in December, this new blog from Lucy Westerman looks at governments taking action to ensure access to healthy diets for kids.

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Poor diets, failing food systems, and lack of physical activity are causing overweight and obesity in children, joint media release.

MANILA, 4 March 2021  – With the Philippines suffering from a triple burden of malnutrition together with other forms of undernutrition (including stunting and wasting), micronutrient deficiencies, along with overweight and obesity, the Department of Health (DOH), National Nutrition Council (NNC), FAO, WHO, and UNICEF jointly call upon the public, civil society organizations, academe, and the private sector to take action to prevent and manage childhood overweight and obesity.

According to WHO, overweight and obese children are more likely to stay obese into adulthood and to develop noncommunicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. Obese children and adolescents may also suffer from both short-term and long-term health consequences. Factors contributing to the increasing problem of overweight and obesity include poor diets, inadequate nutrition, and failing food systems. In addition, limited physical activity is likewise contributing to the growing problem on overweight and obesity. Prevention remains to be the most feasible option for curbing the childhood obesity epidemic.

Results from the Expanded National Nutrition Survey conducted by the Food and Nutrition Research Institute (FNRI) in 2019 reported a relatively low prevalence of overweight at 2.9% among children under 5 years old; medium prevalence of 9.1% and 9.8% among children aged 5 to 10 years old and 10 to 19 years old, respectively.  Among Filipino adolescents, overweight has tripled in the last 15 years. There is a higher rate of overweight and obese children in urban areas than in rural areas and higher prevalence of several risk factors and environmental conditions could rapidly increase the rates. These findings from the FNRI study, together with new studies and recommendations for action, will be shared during a dissemination forum on March 4, 2021. 

“The Department of Health recognizes the emerging problem of childhood overweight and obesity in the country and although its prevalence pales in comparison with that of undernutrition, it will be unfortunate to prejudice the public health attention it deserves to mitigate its future risk on non-communicable diseases, premature death and disability in adulthood. Further, the economic costs of this escalating problem are considerable both in terms of the enormous financial strains it will place on the health care system and lost economic productivity,” Health Secretary Francisco T. Duque III said.

“To prevent obesity, we need to start early, that is in the First 1000 Days of life when we could also prevent undernutrition, which could also result in obesity in later life” according to Dr. Azucena Dayanghirang, Executive Director of the NNC. The NNC is leading the multi-sectoral Overweight and Obesity Management and Prevention Program of the Philippine Plan of Action for Nutrition (PPAN) 2017-2022.  The PPAN targets no further increase in child obesity by 2022 by fostering a healthy food environment and promoting positive nutrition behaviors towards consumption of healthier diets.

“From a public health, economic and moral perspective, it is imperative for Government and the whole of Society to act on this issue of childhood overweight and obesity. Curbing the childhood obesity epidemic requires political commitment at all levels, and the collaboration of many public and private stakeholders. A multisectoral approach is essential, and should provide supportive environments that encourage physical activity, restrict access to unhealthy foods and drinks, support mothers to practice exclusive breastfeeding in the first 6 months and to protect children from marketing influences. It is also important to ensure that policies and laws are fully implemented and protected from undue commercial interests,” said Dr Rabindra Abeyasinghe, WHO Representative in the Philippines.

Overweight and obesity are complex and multifaceted problems that would require multisectoral and comprehensive strategies to effectively and sustainably prevent and manage. Sustainable, responsive, resilient and functional food systems can enable better and healthier diets, but while the food systems encompass a range of public and private actors, the role of government is crucial in developing and implementing programmes and policies that address the production, distribution, accessibility, and utilization of food in the country.

“Maintaining a healthy and nutritious diet is especially important at this time of a pandemic. To promote and achieve healthy and nutritious diets, sustainable, functional and responsive food systems – borne out of collaborative and multi-sectoral action – are paramount,” emphasized Ms Kati Tanninen, FAO Representative to the Philippines.

“To this end, FAO is supporting the national government through the implementation of the Philippine Plan of Action for Nutrition 2017-2022, which calls on policies and programmes to be ‘nutrition-sensitive’. Policy measures related to food systems that support healthy diets should be enforced. These policies and legislations should also be in line with – and guide the country’s actions towards – its pledges to global commitments such as the UN Decade of Action on Nutrition 2016-2025 and the Sustainable Development Goals, particularly to SDG 2 on attaining Zero Hunger and improved nutrition for all. But more importantly, such legislations should be responsive to the country’s unique health and nutrition context, objectives, and priorities,” she added.

In recent years, several legislations have been enacted by the Philippine Congress to support healthier diets and nutrition of Filipinos. The Department of Education has also issued policies on sale of healthy foods and beverages in schools, as well as the promotion of physical activity.

“While there have been positive developments to enable an environment for better nutrition in the Philippines, there should also be a clear and prompt action to address the triple burden of malnutrition and to recognize childhood overweight and obesity as a central health issue. Aside from actively working with the Philippine Government and other partners to strengthen nutrition policies and plans, UNICEF also collaborates on generating evidence to better address overweight and obesity and ensure access to healthy food for children. We remain committed to support health and nutrition initiatives for every child, especially the most vulnerable,” said Oyunsaikhan Dendevnorov, UNICEF Representative in the Philippines.

The DOH, NNC, FAO, WHO, and UNICEF jointly call on the firm and continuous enforcement of the existing legislations, and to introduce front of pack labelling of commercially produced foods, and to regulate harmful practices such as the marketing of unhealthy foods to children. We also call on public to change the way overweight and obesity is viewed by society and become advocates for change for healthy food environments and policies that prioritize obesity as a serious health issue.

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UNICEF promotes the rights and wellbeing of every child, in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.

For more information about UNICEF and its work for children in the Philippines, visit www.unicef.ph .

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The Effects of Poor Nutrition on Your Health

Closeup of home made burgers on wooden background

Poor nutrition habits can be a behavioral health issue, because nutrition and diet affect how you feel, look, think and act. A bad diet results in lower core strength, slower problem solving ability and muscle response time, and less alertness. Poor nutrition creates many other negative health effects as well.


According to a National Center of Health Statistics 2003 survey, about 65.2 percent of American adults have overweight or obesity as a result of poor nutrition. Obesity is defined as having a body mass index (BMI) of 25 or more. Having overweight puts people at risk for developing a host of disorders and conditions, some of them life-threatening.

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The National Institutes of Health reports that hypertension is one of the possible outcomes of poor nutrition. Hypertension, also known as high blood pressure, is called the silent killer, because it frequently remains undetected and thus untreated until damage to the body has been done. Eating too much ultra-processed food, fried food, salt, sugar, dairy products, caffeine and refined food can cause hypertension.

High Cholesterol and Heart Disease

Poor nutrition can lead to high cholesterol, which is a primary contributor to heart disease. High fat diets are common in the United States and Canada. The National Institutes of Health reports that more than 500,000 people in the United States die each year due to heart disease, which can be caused by a high fat diet. High cholesterol foods contain a large amount of saturated fat. Examples include ice cream, eggs, cheese, butter and beef. Instead of high fat foods, choose lean proteins such as chicken, turkey, fish and seafood and avoid processed foods.

Diabetes also can be linked to poor nutrition. Some forms of the disease can result from consuming a sugar- and fat-laden diet, leading to weight gain. According to the National Institute of Health, about 8 percent of the American population has diabetes.

A stroke that is caused by plaque that builds up in a blood vessel, then breaks free as a clot that travels to your brain and creates a blockage can be linked to poor nutrition. Strokes damage the brain and impair functioning, sometimes leading to death. Foods high in salt, fat and cholesterol increase your risk for stroke.

According to the National Institutes of Health, poor nutrition can lead to gout. With gout, uric acid buildup results in the formation of crystals in your joints. The painful swelling associated with gout can lead to permanent joint damage. A diet that is high in fat or cholesterol can cause gout. Some seafood--sardines, mussels, oysters and scallops--as well as red meat, poultry, pork, butter, whole milk, ice cream and cheese can increase the amount of uric acid in your body, causing gout.

According to the National Institutes of Health, several types of cancer, including bladder, colon and breast cancers, may be partially caused by poor dietary habits. Limit your intake of foods that contains refined sugars, nitrates and hydrogenated oils, including hot dogs, processed meats, bacon, doughnuts and french fries.

  • National Institutes of Health
  • International Association of Fire Fighters
  • National Center for Health Statistics

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150 Diet Essay Topic Ideas & Examples

🏆 best diet topic ideas & essay examples, 💡 most interesting diet topics to write about, 🎓 good research topics about diet, ⭐ simple & easy diet essay titles.

  • Why the Government Should Review and Add Laws Governing Diet Pills Introduction Although such is the case, it is important to note that, majority of diet control pills have adverse effects on individual health, if such individuals never take precaution in their usage.
  • Balanced Diet and Proper Exercise as Weight Lost Foundation Exercises It is of great importance that any person intending to lose weight embarks on exercising, as this is the other way that one gets to lose some of the weight in the body. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
  • Schools and Good Diet On the other hand, there is need for schools to include in their menus healthy diets, because it will be of no significance for schools to eliminate eateries that sale junk foods while maintaining their […]
  • Today’s Society Should Move toward Adopting Vegetarian Diet: Arguments For While it is hard for many people to reduce the necessity of eat meat-based products and to increase the use of vegetables and other vegetarian products, however, there is a necessity “to reconsider the increasing […]
  • Vegetarian or carnivorous diet However, a diet rich in meat and animal products has been found to have severe detrimental effects to people’s health. A well balanced diet that incorporates both meat and vegetables is essential.
  • Environmental Impact From Meat Based Diets The Water Education Foundation estimates that in order to produce a single pound of beef in the state of California, we require about 2,464 gallons of water.
  • When Human Diet Costs Too Much: Biodiversity as the Ultimate Answer to the Global Problems Because of the unreasonable use of the natural resources, environmental pollution and inadequate protection, people have led a number of species to extinction; moreover, due to the increasing rates of consumerist approach towards the food […]
  • Their Benefits Aside, Human Diets Are Polluting the Environment and Sending Animals to Extinction The fact that the environment and the entire ecosystem have been left unstable in the recent times is in no doubt.
  • The Problem with Calorie Restrictive Diets However, since they are on a calorie restrictive diet, it is unlikely that they would have the energy to do so.
  • How Can Societal Marketing Concept Be Used to Influence Children to Eat a Healthier Diet? Parents and other interested groups have a responsibility in ensuring that societal marketing is done as claimed by the food marketers and that those that are not doing so are pressured to adopt better promotion […]
  • Medical, Social and Diet Changes and Heart Disease in Middle-Aged Men The questions seek to establish the relationship between the potential causes of heart disease and the occurrence of the disease in the surveyed population.
  • Vegetarian Diet as a Health-Conscious Lifestyle Making a transition from omnivore to vegetarian lifestyle, besides the impact on the person’s health, people consider the public opinion and the community’s reaction on their decision.
  • Diet Food Center at the University of California This report is created with the purposes of shedding light on the benefits of establishing diet food center within the University, the need for such a project, literature supporting the idea, and provision of a […]
  • Brand Overview: Diet Coke One of such drinks is Diet Coke, a product of the Coca-Cola Company, the leading soft drink maker in the world.
  • Halal Diet Marketing Plan The last section of this plan discusses marketing control and its applicability; market implementation; the organization of marketing activities; and the contingency planning in marketing, which highlights the potential risks in marketing and alternative measures […]
  • Marketing Plan – Halal Diet in the United States The first thing will be the branding of the diet since it will give the diet the aspect of uniqueness in the market.
  • Literature Review on Organic Food and Healthy Diet This paper analyses the prevalence of chronic disease like diabetes and obesity in populations that eat junk foods as opposed to the healthy eating population. The studies of Binkley et al.reveal the link that exists […]
  • Diet and Exercise Controversies With regard to exercises, some individuals think that they have negative effects while others argue that it is important to exercise regularly.
  • Anti-Inflammatory Diet and IBD Management in Adults The study involved a review of 161 qualitative and quantitative studies to support treatment guidelines for the management of pediatric IBD in the UK.
  • Fish as a Staple of the Human Diet This resulted in the creation of the earliest agriculture and farming practices which included various means of animal domestication, in the case of fish this came in the form of the first known instances of […]
  • Nutrition: Flexitarian Diet Benefits Today I will demonstrate why adopting a flexetarian diet is good for the animals, the environment, and your health, and suggest how you can become a flexetarian.
  • Fad Diets – Temporary Satisfication These diets are referred to as fad diets, and their major characteristic is that they are extreme diets that people follow as a trend to lose weight.
  • Diet and Nutrition: European Diabetes Also, it is tough to maintain a diet regiment, and it is one of the most significant issues that are present.
  • The Effects of Capitalism on People’s Diet Food capitalism has brought about new changes in the human diet and has changed the nutritional value of foods eaten by human beings.
  • The Exercise and Diet’ Implications on Aging Studies have also shown that regular exercise and healthy eating habits among the aging population helps to improve the rate of glucose metabolism in the body.
  • The Motivation to Take a Healthy Diet Various intrinsic and extrinsic factors influence the execution of brain in motivating a person to eat a healthy diet. The limbic structure is directly responsible for reward and motivation, a prerequisite factor for changing of […]
  • Vegan vs. Vegetarian Diets: Impacts on Health However, vegetarians have the option of consuming animal products like eggs and milk, but this option is not available to vegans; vegetarians tend to avoid the intake of all the animal proteins.
  • Wellness Goal: Diets and Exercises for Gaining Lean Body Mass According to the study, the participants who had 33 grams of protein a day during the training period gained lean body mass, while the control group’s results showed no changes in lean body mass.
  • Exercise vs. Diet for Weight Loss The starting point of their research is formulated in the following hypothesis: insufficient physical activity or lack thereof is not a contributor to the global problem of obesity.
  • Lifelong Activity Plan: Movement, Relationships, Diet As long as one feels that someone will provide assistance in case of an obstacle or a problem, the possibility of following the program will increase. Contrary to what one might assume, losing a certain […]
  • American Health and Diet Improvement Content analysis and the description of American food literacy may create a solid basis for future research in terms of which it is possible to develop new interventions for the population and helpful healthy eating […]
  • Healthy You: Diets and Food This kind of diet is one of the reasons for the nation’s obesity problem. Adding more fruits and vegetables those to the menu instead of a sandwich would help me facilitate a healthier diet.
  • Vegetarian Diet: Pros and Cons On the contrary, the study A Comparison of Some of the Cardiovascular Risk Factors in Vegetarian and Omnivorous Turkish Females by Karabudak, Kiziltan, and Cigerim portrayed that vegetarians had higher risks of hyperhomocysteinaemia and lower […]
  • Healthy Diet at Los Angeles Children’s Hospital The media, the models, and the promotion of the fresh farm produce are primary methods for enhancing healthy food practices. The hospital should improve the quality of the food it is offering to the patients.
  • Atkins Diet: Pros and Cons In this regard, it is possible to conclude that Atkins diet partially meets the requirement of moderation. It is possible to conclude that Atkins diet may only partially suit the criterion of variety.
  • Vegan Parents’ Influence on Their Children’s Diet The first reason why a vegan diet should not be imposed on children is that every parent should pay close attention to the needs of their toddlers.
  • Protein Diet, Telomere Length, and Cancer Based on the premise that cancerous cells rely on the process of glycolysis in generating high energy, Ho et al.undertook a study to determine the effect of diets with low carbohydrate and high protein and […]
  • “Quit Meat” Vegetarian Diet: Pros and Cons Although many dieticians think that meat is an essential nutrient, the reality is that it is inappropriate to eat animals because it is unhealthy and unethical.
  • Oat Chocolate Cookies Recipe for Weight Loss Diet The association of cookies with weight gain and obesity has led to a significant decline in the consumption of cookies over the last few years. The role of oats in the recipe is to enrich […]
  • Avoiding the Use of Diet Pills Side effects of diet pills are unknown and rarely mentioned because they would harm the reputation of the pills that need to be promoted.
  • Food Choices: Diets and Diseases In addition, there is stress on the liver and kidneys and increases the risk of cancer. Any type of meat is mostly the muscle of animals, high in fat, protein, and cholesterol.
  • Rice as a Part of a Healthy Diet Scholars all around the world recognize rice as one of the most important nutritional crops; it is an important dietary product that serves as the source of the major portion of the daily calories of […]
  • Ambition Diabetes and Diet on Macbeths’ Example The man kills his kinsman, Duncan, because he wants to be a king but understands that he is suspected of this crime.
  • Can Vegetarian Diets Be Healthy? The analysis of the effectiveness of such a nutritional principle for the body can confirm, or, on the contrary, refute the theory about the advantages of vegetarianism and its beneficial effect on body functions.
  • Diet and Lifestyle of Italians Eating habits of the Italian people involve a variety of food groups, most of which contain a healthy balance of proteins, carbohydrates, fat, minerals, vitamins, and water.
  • Healthy Nutrition and Unhealthy Diets The lack of necessary vitamins and substances that are usually found in plants also is a danger, forcing users of the diet to employ food supplements.
  • Proteins, Fats, and Carbohydrates in Diets I, for one, think that none of the listed elements is the essential one: proteins might be the building blocks for our bodies, but fats and carbohydrates are the fuels.
  • Popular Diets: The Ketogenic Diet The diet is based on the principle of ketosis, which is a metabolic process of burning stored fats when there is a lack of glucose.
  • Preoperative Diets Implementation for Adult Patients Diets that may be offered to preoperative patients can vary, and the investigations of Mackie show that a liquid diet is one of the most terrifying for patients.
  • The Differences in Diet Between Chinese and Western People The paper presents the major aspects of Chinese and Western diets and reflects on them, discussing individuals’ needs and wants, the question of opportunity costs, and supply-demand concept.
  • Can a Plant-Based Diet Improve Earth? One of the acutest problems of modern humanity, affecting the question of its successful development in the future, is the need to preserve the ecosystem and resources of the planet.
  • Diets and Climate Change Thus, changing the diet is a feasible method to address the problem of climate change. One of the ways I try to minimize my environmental impact is to eat less meat.
  • Extending Existing Knowledge in the Area of Schools Foods and Their Influence on Children’s Diets One of the major limitations to the recent research on the matter is the lack of longitudinal studies regarding the outcomes of school-based projects that persist in participants’ adulthood.
  • Personal Diet and Physical Activity Assessment I try to avoid snacking, and in case I skip a meal, I prefer to wait for the next one instead of snacking.
  • Conjugated Linoleic Acid for Diet and Health CLA is a conjugated system, and in the United States, trans linkages in a conjugated system are not counted as trans fat for the purposes of nutritional regulations and labeling.
  • Vegetarian Diet and Proper Amount of Vitamins Issue This difference was accounted for by 14% lower zinc levels in the vegetarian diet and 21% less efficient absorption of zinc while eating it.
  • Low-Carb Diets as a Cause of Premature Death There are various claims and misconceptions in the field of nutrition due to the fact that it is highly difficult to identify the core influencing factors.
  • Cardiovascular Diseases: Statistics, Factors, Diets Some of the most highlighted diet-related information highlighted in this paper is the roles played by the dietary fats (saturated fat, MUFA, PUFA, trans-fat, carbohydrates, dietary Fibres, anti-oxidants, and much more in the prevention of […]
  • Impact of Food on Human Health and the Content of Diet People who are living in cities never get the chance to taste catfish so they even say that catfish is used by the people of low status.
  • College and University Program: Diet and Exercise This proposal for this program is as a result of careful observation of health behaviors among the citizens of Illinois and in particular the aged living at Warren Township.
  • Breast Cancer and the Effects of Diet The information in noted clause is only a part of results of the researches spent in the field of the analysis of influence of a diet on a risk level of disease in cancer.
  • Diet Pills and Government Control Companies that are in the field of diet pills do not tell the consumers of the side effects and consequences that the usage of these drugs may expose them to.
  • Fad Diets: Term Definition And millions of people are now being lured into various fad diets and their promises for miracle cures but which are nevertheless doomed to fail because they too, restrict foods that are nutritionally very essential […]
  • Right Diet as the Most Important Aspects of Good Life The obese people eat a lot of fat in their diet and the fat is mainly because of the junk food that they eat.
  • Ecological Benefits of a Vegetarian Diet The final level of the food sequence is carried out by organisms that help in the decomposition of the primary; secondary; and tertiary organisms back to the food flow by acting as nutrients and manure […]
  • A Balanced Diet: Definition and Examples Often, this feature of a person’s life is not given the same focus as what is taken in to nourish the body, and yet it is a key component to one’s mental and emotional health.
  • Current and Ideal Diet Habits for Health For me to improve my exercise habits, I would first need to appreciate the importance of physical exercise in promoting my health and wellbeing.
  • Healthy Nutrition: Low-Fat vs. Low-Carb Diet The next step of the research is based on surveying people and health specialists on the matters of eating habits and patterns associated with the consumption and usefulness of fats and carbs in the everyday […]
  • Protein Requirements in the Atkins 20 Diet The Atkins 20 diet is useful in the shedding of weight in the short term. The advantages of a high-protein diet are that it contains adequate proteins to meet the needs of people with high […]
  • Paleo Fad Diet: Advantages and Disadvantages This results in both causing the discussed diet to enjoy the reputation of being ‘tasty’, on one hand, and showing that its provisions are continually updated to correlate with the latest discoveries in the field […]
  • Understanding and Adherence to a Renal Diet After Kidney Transplantation The key goals of such an education are to develop lasting and strong knowledge and to provide the support that enhances adherence.
  • The Coffee Diet: Cut Appetite, Burn Fat, and Boost Metabolism The purpose of this paper is to discuss whether the coffee diet is applicable in most cases and express a personal opinion.
  • Is the Sirtfood Diet Effective? There is little evidence to confirm the efficiency of the sirtfood diet. Another downside to the sirtfood diet is the lack of sustainability.
  • Menopause: Medical Problems, Treatments, and a Suggested Diet Here are the most frequent medical problems that prohibit usage of this treatment: One of the common risks is a chance of breast, endometrial, and other hormone-dependent cancers.
  • Pros and Cons of Different Diets Consequently, the body uses up the ketone bodies for the generation of energy in a process that translates to increased efficiency in the burning of fats.
  • Different Types of Diets and Children’s ADHD Treatment The last factor is a trigger that can lead to the development of a child’s genes’ reaction. Thus, diet is one of the factors that can help prevent the development of ADHD.
  • Comprehensive Analysis of Diet As the functions of proteins, carbohydrates, and fat are crucial for organism operation, it is necessary to control its number in food.
  • Analysis of Low Carb and High-Fat Diets Before adopting a diet and deciding upon adapting one’s lifestyle in accordance to a specific diet, it is necessary to evaluate the amount of commitment that one is willing to give to the diet. One […]
  • Dietetics Care Plan: Gluten-Free Diet Since the diagnosis, Emily has been recommended a gluten-free diet, which she is trying to stick to. Another option for Emily is to call the manufacturer and ask for the gluten-free products, this can save […]
  • Fad Diets and Fat Burners Versus Eating Right and Exercising for Results A fad diet basically advocates the intake of macronutrients in a particular proportion or the intake or avoidance of specific foods with the intention of losing weight.
  • Vegetarian and Non Vegetarian Healthier Diet The first and foremost is that a vegetarian diet is one of the best weapons that can be used against overweight and obesity.
  • Sport-Specific Nutrition: Diet for Adam Nevertheless, it is the constant loss of weight in Adam’s case, which implies that the energy expenditures exceed the energy intake, causing the loss of weight over the period of six months.
  • The 40-30-30 Diet Overview The theory was developed in the contradiction to the popular diets of the 90-ies, which approved of low fat intake. Sears rejects the idea of necessity to limit the consumption of the products of a […]
  • Diarrhea: Nutrition and Diet Therapy Diarrhea can be treated a number of ways. Nutrition therapy can also be used for treatment of diarrhea.
  • Diet and Water as an Overlooked Essential Nutrient Water is a very important nutrient in the body because it maintains homeostasis, and enhances the transport of other nutrients and minerals from their point of absorption to other parts of the body.
  • The Diet and Nutrition Research It is therefore in the hallmark of this understanding that the author of this report engenders to account for the findings that came up upon a study on two individuals, who for confidentiality purposes were […]
  • Diabetic Diet and Food Restrictions Diabetes is a disease caused by the inability of the body to control blood sugar because of the lack or inadequate production of insulin by the B cells of the pancreas.
  • Diet, Physical Activity and Lifestyle in the Elderly The life expectancy was shorter prior to the onset of research and studies that opened a floodgate to medical cures increasing health and extending life.
  • Perfect Diet for a Women’s College Basketball Player Due to their complexity, proteins take a while in the body and that means that a lot of energy will be kept in the body only to be released at intervals when the body needs […]
  • Diet During Pregnancy and Children’s Dietary Preferences The researchers published the study in the Journal of Developmental Psychobiology. Therefore, the study suggests that the prenatal environment has the potential of triggering the chemosensory stimuli of fetuses.
  • Good Nutrition and Balanced Diet This could be due to the fact that vitamin D is important in the transmission of messages between the brain and the body.
  • Health Benefits of Probiotic Yogurt Diet In the first place, it is necessary to note that Activia is claimed to be effective due to the great number of probiotics which are regarded as important bacteria for preventing gastrointestinal diseases.
  • Diet and Digestive Modification The building blocks for protein are amino acids, whose structure is in the form of long chains. They are therefore absorbed in the form of amino acids, which are small and simple molecules.
  • Can Energy-Restricted Diets Help in Controlling Obesity? The results showed a considerable reduction in the waist size of the participating women. In addition to the weight loss, it was also noticed that the women showed fewer indications of cardiovascular diseases and breast […]
  • Ketogenic Diets and It Uses for Epilepsy Management in Children The ketogenic diet was composed of high fat and low carbohydrate in the ratio of 4:1. The efficacy of the ketogenic diet on seizure was 51.
  • Multiple Sclerosis: Use of “Best Diet” The second aspect of the process involves taking large quantities of minerals, vitamins and herbal supplements in the diet. In these patients, the wall of the gastrointestinal tract is affected to an extent that it […]
  • The Egyptian Diet: Sociology of Food and Nutrition This paper compares and contrasts the concept of food and the culinary practices of the Indian and Egyptian cultures and their effect on the health outcomes of the people.
  • Health Education: Choosing a Proper Diet Though the authors needed to consider a range of factors, particularly, the environment that creates the premises for cancer development, the properties of a range of meals, etc, they have managed to come up with […]
  • Analysis of the Diet and Recommendations for Better Nutrition Because of the necessity to take not only the type of food consumed but also the daily intake of calories, one must carry out a vast analysis of the meals eaten in the course of […]
  • Ketogenic Diets: Carbohydrate Count This literature review explores carbohydrate count by focusing on ketogenic diets because of the increased interest in the topic in the recent years as an intervention for obesity and overweight management.
  • The Dash Diet and Insulin Sensitivity by Hinderliter et al. The investigators have used the introduction section to contextualize the problem within the framework of the existing knowledge. The authors included the aspects of weight loss and exercise in the study because the baseline research […]
  • Diet Therapy & Cardiovascular Disease The authors have attributed the increase to “the combined effect of population growth, the aging of populations, and epidemiologic changes in cardiovascular disease”.
  • Consuming Chocolate in a Nutritious Diet The nutritional content of chocolate highly depends on its recipe; as natural dark chocolate differs from the majority of chocolate bars we buy in the supermarkets a lot. The main reason to include chocolate in […]
  • Unhealthy Fad Diets: Fact or Hoax Many of them can in reality undermine the person’s health and cause a physical imbalance in the organism, not to mention the mental frustration when the lost weight comes back.
  • Heart Disease and Low Carbohydrate Diets My opinion about the connection between heart diseases and low-carb diets is based on the article written by Sacks and his team for the Journal of the American Medical Association in 2014 where the authors […]
  • Cardiovascular Diet Review Forty five minutes of reasonable bodily action every day may be satisfactory to increase fitness of the heart and lungs which later diminishes risk of cardiovascular disease.
  • Pros and Cons of the New Human Chorionic Gonadotropin Diet Programme It must also be noted that such a restrictive diet is not recommended at all for active individuals due to the problems it presents in terms of fatigue, drowsiness, a distinct lack of energy, and […]
  • Obesity Diet: Low Carbohydrates Consumption and High Proteins Consumption A different study that aimed to bring some light to the issue of the most desirable diet for an obese patient recommended the consumption of the liquid diet.
  • Effects of Diet and Physical Activity on Weight Loss and Cardiometabolic Risk Factors in Severely Obese Adults The study wanted to establish whether the outcomes of the African American people differed from those of white people. In addition, the human ethics committee of the university evaluated and endorsed the study.
  • A Healthy Diet While Attending College It is however recommended that to derive the full breakfast meals benefits, the breakfast meal should have proteins, carbohydrates, and a bit of fat.
  • Diet and Nutrition: Mr. Begums’ Meal Plan The reason is that the BMI indicates a figure that is outside healthy brackets. In addition, it is important to mention that his meal plan consists of high lipoproteins and cholesterol.
  • Diet and Medication for Anemic Pregnant Women It will highlight intervention strategies intended to lessen the anemia among pregnant women with special emphasis on the dependant and independent variables The development of the maternal environment is a complicated process that involves a […]
  • Steps in Ensuring a Healthy Diet in College During their first year in college, many college students suffer from freshman 15 or a considerable gain in weight due to such factors as changes in food, diet patterns, stress and sedentary lifestyle.
  • Nutritional Science: Diets Overview A low-glycemic diet is based on the principles of the glycemic response and glycemic index of foods in nutritional science. It is solid fat such as saturated and trans fats that are negative from the […]
  • Ketogenic Diet: Overview In order to prevent unnecessary health issues and achieve the desired effect, nutritionists offer patients to use the rules of the popular ketogenic diet.
  • How a Book, Healthy Diet and Exercise Changed My Life Before I read the book, my lifestyle was far from healthy; mostly due to the lack of interest in sports and the fact that I spent almost all my time sitting.
  • Mediterranean Diet Affects Risk of Stroke The research question is as follows: “How does awareness of risk factors among the Nairobi population affect the prevention and development of cardiovascular diseases?” The study conducted by El-Hajj et al.will be used in terms […]
  • Various Approaches to Diet: Review The theories, which seem to be of particular concern, include the macrobiotic diet, the theory of Ayurveda, the Okinawan eating practice and the caveman diet.
  • Sports Nutrition: High-Protein Diet for Athletes Therefore, the necessity to conduct research on the issue of harmfulness and usefulness of a high-protein diet for female and male people, who are engaged in sports activities professionally, is evident.
  • Changing the Daily Diet as an Intervention The interest in vegan and vegetarian alternatives is becoming more and more prominent with the passage of time, due to a variety of factors.
  • A Healthy Lifestyle and a Well Balanced Diet My high inspiration and the ability to work individually and in a team is a traits that can be well-implemented in this sphere of work.
  • “Escape from the Western Diet” by Michael Pollan In the end, these two points of view disprove Pollan’s theory in terms of its usefulness in the real world. In my opinion, we should follow Maxfield’s principle to appreciate food instead of limiting ourselves […]
  • Proper Nutrition and Balanced Diet in Nursing Practice The first campaign is wooing more volunteers to come and help the community reach its goals of having a good public health status.
  • Diet and Physical Exercise in Polycystic Ovary Syndrome Management Experiments were conducted in some of the articles to determine the effective implementations in the management of PCOS. The two approaches of management produce the best outcomes when combined in the treatment and prevention of […]
  • The Gluten-Free Diet: Advantages and Disadvantages The research aims to address the advantages and disadvantages of the gluten-free diet. Therefore, gluten-free food substances will enable the individual with celiac disease to regain weight and eliminate nutritional deficiencies.
  • Keto and Gluten Free Diet Nutrition Essays The point of this approach is to place the body in a particular state, ketosis, in which it is forced to use a different type of fuel and not the usual glucose.
  • Ketogenic Diet: Potential Health Benefits and Risks The diet originated from the culture of ancient Greek and ancient Indian where physicians adopted the role of fasting and alteration of diet for disease treatment.
  • The Role of Genetics and Diet of Acne in Teenagers It is significant that the number of relapses, the duration of the course of therapy, and the increase in the number of patients with moderate and severe forms of acne directly depend on the adherence […]
  • The Issue of Western Diets for Human Health Fleming investigates the impact of the western diet and analyzes the existing psychological and physiological outcomes. Therefore, the study proves the negative effects of the western diet and prepares the reader to find out the […]
  • Social Media Campaign: Awareness of Healthy Diets The social media campaign aims to increase awareness of healthy diets among high-risk obese teenagers in Georgia’s African American and Latina communities.
  • Mediterranean Diet: Recipes and Marketing The growing trend to adopt healthy eating habits due to the pandemic has led people to embrace the Mediterranean diet due to its simplicity in preparing and the easy availability of ingredients.
  • Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
  • Importance of Healthy Diet for Immunity Proteins are vital in the diet in that they are the construction blocks of a lifetime; each cell in the human body comprises protein.
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  • Very-Low-Calorie Ketogenic Diet and Kidney Failure Thus, the purpose of the study was to assess the effect of VLCKD on health outcomes and kidney function in patients with mild kidney failure.
  • Trends in Food Sources and Diet Quality Among US Children and Adults Liu et al.conducted a case study to examine food sources and diet quality trends among US children and adults. The results also revealed that restaurants had a worse percentage of poor diet in children and […]
  • The Impact of Vegan and Vegetarian Diets on Diabetes Vegetarian diets are popular for a variety of reasons; according to the National Health Interview Survey in the United States, about 2% of the population reported following a vegetarian dietary pattern for health reasons in […]
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  • Diet Quality and Late Childhood Development The analytics of the children with low diet quality brain functioning shows the regression leading to the mental health deviation. Thus, the dieting quality is an essential factor in developing the physical and psychological health […]
  • A Healthy Diet: Influencing Factors and Culture Diets are a valuable method to assist individuals in their needs, be it health problems, lack of income, or personal beliefs, as in the case of vegans or religious restrictions.
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  • Analysis of Health Diet Benefits While there is a variety of weekly planned diets accessible on the Internet, I made an effort to monitor what I ate during the past week and see what adjustments my nutrition needs.
  • Promoting Sustainability and Diet Quality The aim of the proposed qualitative research is to identify the causes of food waste to subsequently make recommendations regarding population education and assess the factors associated with sustainability and diet quality. Identifying the main […]
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  • Aspects of the Ketogenic Diet: Pros and Cons The given evaluation will mainly focus on the weight loss claim to ensure the precision and specificity of the assessment. The reviewer is a Master of Science and a Registered Dietitian, which is why her […]
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  • Low-Carb Diets and Their Crucial Benefits Low-carb diets are the replacement for a high carbs diet which is mainly composed of carbohydrates. The effect of low-carb foods is tremendous and ensures that other nutrients are included in the diet.
  • Analyzing Personal Diet and Intake Pattern The second and fourth days have a higher intake of fats and proteins because meat and flour were the main items on the menu during the day.
  • Adding Molasses in the Dairy Cow Diet Nonetheless, there is limited evidence to indicate how adding sugar in the form of molasses in the dairy cow diet improves the cow’s rumen fermentation and fiber digestion.
  • The Need for Protein in a Diet For older individuals who consume less protein the protein synthesis of their muscle protein is increased by resistance training. To improve muscle function and mass, boost protein consumption in older adults who consume insufficient amounts […]
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Home — Essay Samples — Nursing & Health — Eating Habits — The Causes, Effects, And Solution Of Poor Nutrition In Children


The Causes and Effects of Poor Nutrition in Children

  • Categories: Eating Habits

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Words: 1240 |

Published: Nov 22, 2018

Words: 1240 | Pages: 3 | 7 min read

Table of contents

Causes of poor nutrition, what are the effects of bad nutrition (essay), works cited.

  • Roblin, J. (2007). The influence of advertising on children’s food choices. Pediatrics & Child Health, 12(2), 105–108.
  • Pollert, G. A., Kauffman, M., & Veilleux, J. (2016). The effects of poor nutrition on children. In V. R. Preedy (Ed.), Handbook of Children’s Health: Global and Local Perspectives (pp. 149-159). Springer International Publishing. https://doi.org/10.1007/978-3-319-14526-8_13
  • Brown, K. A., & Ogden, J. (2004). Children's eating attitudes and behaviour: A study of the modelling and control theories of parental influence. Health Education Research, 19(3), 261-271.
  • Cimino, A., Cerniglia, L., Paciello, M., & Alicart, H. (2019). An exploratory study on eating habits and their relation with psychological well-being in a sample of Italian primary school children. Eating and Weight Disorders, 24(4), 723–733. https://doi.org/10.1007/s40519-019-00680-3
  • Contento, I. R. (2008). Nutrition education: Linking research, theory, and practice. Jones and Bartlett Publishers.
  • Nwokocha, L. M., & Williams, D. E. (2021). Understanding the global burden of childhood malnutrition: An overview of the causes, consequences, and solutions. Journal of Global Health Reports, 5, e2021035. https://doi.org/10.29392/joghr.5.e2021035
  • Lopes, L., Pinto, A., Rodrigues, L. P., & Moreira, P. (2020). Impact of parents’ eating habits and behavior on children’s food intake and preferences. Appetite, 146, 104512.
  • Serra-Majem, L., Ribas-Barba, L., & Salvador Castell, G. (2006). What and how much do we need to know about food and nutrition in children and young people? British Journal of Nutrition, 96(S1), S3-S9.
  • Skouteris, H., McCabe, M., Swinburn, B., Hill, B., & Busija, L. (2006). A parent-focused intervention to reduce infant obesity risk behaviors: A randomized trial. Pediatrics, 117(5), 1629-1638.
  • Veugelers, P. J., & Fitzgerald, A. L. (2005). Effectiveness of school programs in preventing childhood obesity: A multilevel comparison. American Journal of Public Health, 95(3), 432-435.

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