Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Science and Society
  • Published:

Understanding global nutrition dynamics as a step towards controlling cancer incidence

Nature Reviews Cancer volume 7, pages 61–67 (2007)Cite this article

Abstract

As we look to understand future forces that will affect cancer risk, poor dietary patterns, overweight and obesity are significant concerns. In the past two decades these factors have shifted from issues that face higher-income countries to a global pandemic, and are rapidly becoming less a problem of affluence and more a problem of poverty. Rapid shifts in food systems, food pricing and marketing are the causes that underlie this trend. It is imperative to understand these factors and implement global interventions to slow this pandemic. The alternative is an acceleration of the incidence of the main nutrition-related cancers, primarily in developing countries.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The prevalence of overweight and obesity in selected countries.
Figure 2: Annual absolute changes in the prevalence of overweight and obesity in selected countries.
Figure 3: Trends in diet, activity and obesity in China.

References

  1. International Agency for Research on Cancer. Weight control and physical activity (ed. International Agency for Research on Cancer — WHO) (IARC Press, Lyon, 2002).

  2. Calle, E. E., Rodriguez, C., Walker-Thurmond, K. & Thun, M. J. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U. S. adults. N. Engl. J. Med. 348, 1625–1638 (2003).

    PubMed  Google Scholar 

  3. Bianchini, F., Kaaks, R. & Vainio, H. Overweight, obesity, and cancer risk. Lancet Oncol. 3, 565–574 (2002).

    PubMed  Google Scholar 

  4. Lunet, N., Lacerda-Vieira, A. & Barros, H. Fruit and vegetables consumption and gastric cancer: a systematic review and meta-analysis of cohort studies. Nutr. Cancer 53, 1–10 (2005).

    PubMed  Google Scholar 

  5. Gonzalez, C. A. The European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr. 9, 124–126 (2006).

    PubMed  Google Scholar 

  6. Larsson, S. C., Hakansson, N., Naslund, I., Bergkvist, L. & Wolk, A. Fruit and vegetable consumption in relation to pancreatic cancer risk: a prospective study. Cancer Epidemiol. Biomarkers Prev. 15, 301–305 (2006).

    PubMed  Google Scholar 

  7. Smith-Warner, S. A. et al. Fruits, vegetables and lung cancer: a pooled analysis of cohort studies. Int. J. Cancer 107, 1001–1011 (2003).

    CAS  PubMed  Google Scholar 

  8. Willett, W. C. Diet and cancer. Oncologist 5, 393–404 (2000).

    CAS  PubMed  Google Scholar 

  9. Bianchini, F., Kaaks, R. & Vainio, H. Weight control and physical activity in cancer prevention. Obes. Rev. 3, 5–8 (2002).

    PubMed  Google Scholar 

  10. Larsson, S. C., Rutegard, J., Bergkvist, L. & Wolk, A. Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men. Eur. J. Cancer 42, 2590–2597 (2006).

    PubMed  Google Scholar 

  11. Meyerhardt, J. A. et al. Physical activity and survival after colorectal cancer diagnosis. J. Clin. Oncol. 24, 3527–3534 (2006).

    PubMed  Google Scholar 

  12. Tehard, B., Friedenreich, C. M., Oppert, J. M. & Clavel-Chapelon, F. Effect of physical activity on women at increased risk of breast cancer: results from the E3N cohort study. Cancer Epidemiol. Biomarkers Prev. 15, 57–64 (2006).

    PubMed  Google Scholar 

  13. Friedenreich, C. M. Physical activity and breast cancer risk: the effect of menopausal status. Exerc. Sport Sci. Rev. 32, 180–184 (2004).

    PubMed  Google Scholar 

  14. International Agency for Research on Cancer Working Group. IARC Working Group on the Evaluation of Cancer-Preventive Strategies (eds Vanio, H. & Bianchini, F.) (IARC Press, Lyon, France, 2002).

  15. Holmes M. D. & Willett W. C. Does diet affect breast cancer risk? Breast Cancer Res. 6, 170–178 (2004).

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Patel, A. V. et al. Obesity, recreational physical activity, and risk of pancreatic cancer in a large U. S. Cohort. Cancer Epidemiol. Biomarkers Prev. 14, 459–466 (2005).

    PubMed  Google Scholar 

  17. Chiu, B. C. et al. Dietary factors and risk of colon cancer in Shanghai, China. Cancer Epidemiol. Biomarkers Prev. 12, 201–208 (2003).

    PubMed  Google Scholar 

  18. Giovannucci, E. Modifiable risk factors for colon cancer. Gastroenterol. Clin. North Am. 31, 925–943 (2002).

    PubMed  Google Scholar 

  19. Satia, J. A. et al. Diet, lifestyle, and genomic instability in the North Carolina Colon Cancer Study. Cancer Epidemiol. Biomarkers Prev. 14, 429–436 (2005).

    CAS  PubMed  Google Scholar 

  20. Carmichael, A. R. & Bates, T. Obesity and breast cancer: a review of the literature. Breast 13, 85–92 (2004).

    CAS  PubMed  Google Scholar 

  21. Loi, S. et al. Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol. Biomarkers Prev. 14, 1686–1691 (2005).

    PubMed  Google Scholar 

  22. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360, 187–195 (2002).

  23. World Cancer Research Fund. Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective (World Cancer Research Fund in association with the American Institute for Cancer Research, Washington DC, 2007, in the press).

  24. Henry, S. H., Bosch, F. X. & Bowers, J. C. Aflatoxin, hepatitis and worldwide liver cancer risks. Adv. Exp. Med. Biol. 504, 229–233 (2002).

    CAS  PubMed  Google Scholar 

  25. Calle, E. E. & Kaaks, R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nature Rev. Cancer 4, 579–591 (2004).

    CAS  Google Scholar 

  26. Popkin, B. M., Horton, S., Kim, S., Mahal, A. & Shuigao, J. Trends in diet, nutritional status, and diet-related noncommunicable diseases in China and India: the economic costs of the nutrition transition. Nutr. Rev. 59, 379–390 (2001).

    CAS  PubMed  Google Scholar 

  27. Moore, M. A., Kunimoto, T., Park, C. B. & Tsuda, H. Cross-country comparisons suggest shared risk factors for carcinomas, including male lung adenocarcinoma and colon cancer development. Lung Cancer 24, 149–155 (1999).

    CAS  PubMed  Google Scholar 

  28. Kono, S. Secular trend of colon cancer incidence and mortality in relation to fat and meat intake in Japan. Eur. J. Cancer Prev. 13, 127–132 (2004).

    CAS  PubMed  Google Scholar 

  29. Tamakoshi, K. et al. A prospective study of body size and colon cancer mortality in Japan: the JACC Study. Int. J. Obes. Relat. Metab. Disord. 28, 551–558 (2004).

    CAS  PubMed  Google Scholar 

  30. World Health Organization Expert Committee. Physical Status: The use and interpretation of anthropometry: Report of a WHO Expert Committee. WHO Technical Report Series 854 (World Health Organization, Geneva, 1995).

  31. World Health Organization/Food and Agricultural Organization. Expert Consultation on Diet, Nutrition, and the Prevention of Chronic Diseases Report of the joint WHO/FAO expert consultation (World Health Organization, Geneva, 2003).

  32. Cole, T. J., Bellizz, M. C., Flegal, K. M. & Dietz, W. H. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 1240–1243 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Popkin, B., Conde, W., Hou, N. & Monteiro, C. Is there a lag globally in overweight trends for children as compared to adults? Obes. 14, 1846–1853 (2006).

    Google Scholar 

  34. Popkin, B. M. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am. J. Clin. Nutr. 84, 289–298 (2006).

    CAS  PubMed  Google Scholar 

  35. Zimmet, P. Z., McCarty, D. J., de Courten, M. P. The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome. J. Diabetes Complications 11, 60–68 (1997).

    CAS  PubMed  Google Scholar 

  36. King, H., Aubert, R. E. & Herman, W. H. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21, 1414–1431 (1998).

    CAS  PubMed  Google Scholar 

  37. Jee, S. H., Kim, H. J. & Lee, J. Obesity, insulin resistance and cancer risk. Yonsei Med. J. 46, 449–455 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Rose, D. P., Komninou, D. & Stephenson, G. D. Obesity, adipocytokines, and insulin resistance in breast cancer. Obes. Rev. 5, 153–165 (2004).

    CAS  PubMed  Google Scholar 

  39. Bruce, W. R., Wolever, T. M. & Giacca, A. Mechanisms linking diet and colorectal cancer: the possible role of insulin resistance. Nutr. Cancer 37, 19–26 (2000).

    CAS  PubMed  Google Scholar 

  40. Soliman, P. et al. Association between adiponectin, insulin resistance and endometrial cancer. Cancer 106, 2376–2381 (2006).

    CAS  PubMed  Google Scholar 

  41. Du, S., Mroz, T. A., Zhai, F. & Popkin, B. M. Rapid income growth adversely affects diet quality in China —particularly for the poor! Soc. Sci. Med. 59, 1505–1515 (2004).

    PubMed  Google Scholar 

  42. Popkin, B. M., Kim, S., Rusev, E. R., Du, S. & Zizza, C. Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases. Obes. Rev. 7, 271–293 (2006).

    CAS  PubMed  Google Scholar 

  43. Malik, V. S., Schulze, M. B. & Hu, F. B. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am. J. Clin. Nutr. 84, 274–288 (2006).

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Popkin, B. M. et al. A new proposed guidance system for beverage consumption in the United States. Am. J. Clin. Nutr. 83, 529–542 (2006).

    CAS  PubMed  Google Scholar 

  45. Rolls, B. J. & Bell, E. A. Dietary approaches to the treatment of obesity. Med. Clin. North Am. 84, 401–418 (2000).

    CAS  PubMed  Google Scholar 

  46. Bray, G. A., Nielsen, S. J. & Popkin, B. High fructose corn sweeteners and the epidemic of obesity. Am. J. Clin. Nutr. 79, 537–543 (2002).

    Google Scholar 

  47. Rolls, B. J., Roe, L. S. & Meengs, J. S. Salad and satiety: energy density and portion size of a first-course salad affect energy intake at lunch. J. Am. Diet. Assoc. 104, 1570–1576 (2004).

    PubMed  Google Scholar 

  48. Prentice, A. & Jebb, S. Energy intake/physical activity interactions in the homeostasis of body weight regulation. Nutr. Rev. 62, S98–S104 (2004).

    PubMed  Google Scholar 

  49. Stubbs, J., Ferres, S. & Horgan, G. Energy density of foods: effects on energy intake. Crit. Rev. Food Sci. Nutr. 40, 481–515 (2000).

    CAS  PubMed  Google Scholar 

  50. Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P. & Schaefer, E. J. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293, 43–53 (2005).

    CAS  PubMed  Google Scholar 

  51. Foster, G. D. et al. A randomized trial of a low-carbohydrate diet for obesity. N. Engl. J. Med. 348, 2082–2090 (2003).

    CAS  PubMed  Google Scholar 

  52. Schoeller, D. A. & Buchholz, A. C. Energetics of obesity and weight control: does diet composition matter? J. Am. Diet Assoc. 105, 24–28 (2005).

    Google Scholar 

  53. Popkin, B. M. & Nielsen, S. J. The sweetening of the world's diet. Obes. Res. 11, 1325–1332 (2003).

    PubMed  Google Scholar 

  54. Popkin, B. & Drewnowski, A. Dietary fats and the nutrition transition: new trends in the global diet. Nutr. Rev. 55, 31–43 (1997).

    PubMed  Google Scholar 

  55. Drewnowski, A. & Popkin, B. M. The nutrition transition: new trends in the global diet. Nutr. Rev. 55, 31–43 (1997).

    CAS  PubMed  Google Scholar 

  56. Williams, G. W. Development and future direction of the world soybean market. Qtly J. Int. Agr. 23, 319–337 (1984).

    Google Scholar 

  57. Bray, G. A., Nielsen, S. J. & Popkin, B. M. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am. J. Clin. Nutr. 79, 537–543 (2004).

    CAS  PubMed  Google Scholar 

  58. Schulze, M. B. et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 292, 927–934 (2004).

    CAS  PubMed  Google Scholar 

  59. Delgado, C. L. A food revolution: rising consumption of meat and milk in developing countries. J. Nutr. 133, 3907S–3910S (2003).

    CAS  PubMed  Google Scholar 

  60. Khan, A. A. & Bidabadi, F. S. Livestock revolution in India: its impact and policy response. South Asia Res. 24, 99–122 (2004).

    Google Scholar 

  61. Delgado, C. L. Rising consumption of meat and milk in developing countries has created a new food revolution. J. Nutr. 133, 3907S–3910S (2003).

    CAS  PubMed  Google Scholar 

  62. Du, S., Lu, B., Zhai, F. & Popkin, B. The nutrition transition in China: a new stage of the Chinese diet. in The nutrition transition: diet and disease in the developing world (eds Caballero, B. & Popkin, B.) 205–222 (Academic Press, London, 2002).

    Google Scholar 

  63. Lopez, A. D. & Murray, C. C. The global burden of disease, 1990–2020. Nature Med. 4, 1241–1243 (1998).

    CAS  PubMed  Google Scholar 

  64. Rolls, B. J., Roe, L. S., Beach, A. M. & Kris-Etherton, P. M. Provision of foods differing in energy density affects long-term weight loss. Obes. Res. 13, 1052–1060 (2005).

    PubMed  Google Scholar 

  65. DellaValle, D. M., Roe, L. S. & Rolls, B. J. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? Appetite 44, 187–193 (2005).

    PubMed  Google Scholar 

  66. Obarzanek, E. et al. Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) trial. Am. J. Clin. Nutr. 74, 80–89 (2001).

    CAS  PubMed  Google Scholar 

  67. Adair, L. S. & Popkin, B. M. Are child eating patterns being transformed globally? Obes. Res. 13, 1281–1299 (2005).

    PubMed  Google Scholar 

  68. Popkin, B. M. Technology, transport, globalization and the nutrition transition. Food Policy 31, 554–569 (2006).

    Google Scholar 

  69. Reardon, T., Timmer, P, Berdegue, J. The rapid rise of supermarkets in developing countries: induced organizational, institutional, and technological change in agrifood systems. Electron. J. Agr. Dev. Econ. 1, 168–183 (2004).

    Google Scholar 

  70. Reardon, T., Timmer, C. P., Barrett, C. B. & Berdegue, J. A. The rise of supermarkets in Africa, Asia, and Latin America. Am. J. Agri. Econ. 85, 1140–1146 (2003).

    Google Scholar 

  71. Reardon, T. & Berdegué J. A. The rapid rise of supermarkets in Latin America: challenges and opportunities for development. Dev. Policy Rev. 20, 371–388 (2002).

    Google Scholar 

  72. Pinstrup-Andersen, P. Food ubsidies in Developing Countries Costs, Benefits, and Policy Options (ed. Pinstrup-Andersen, P.) (Johns Hopkins University Press (for IFPRI), Baltimore, Maryland, 1988).

    Google Scholar 

  73. Alderman, H. Food subsidies and the poor. in Essays on Poverty, Equity, and Growth (ed. Psacharopolous, G.) 172–202 (Pergamon Press, Oxford, 1991).

    Google Scholar 

  74. Guo, X., Popkin, B. M., Mroz, T. A. & Zhai, F. Food price policy can favorably alter macronutrient intake in China. J. Nutr. 129, 994–1001 (1999).

    CAS  PubMed  Google Scholar 

  75. Lantz, P. M. et al. Investing in youth tobacco control: a review of smoking prevention and control strategies. Tob. Control 9, 47–63 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  76. Chaloupka, F. J., Cummings, K. M., Morley, C. P. & Horan, J. K. Tax, price and cigarette smoking: evidence from the tobacco documents and implications for tobacco company marketing strategies. Tob. Control 11 (Suppl. 1), 162–172 (2002).

    Google Scholar 

  77. Warner, K. E. The need for, and value of, a multi-level approach to disease prevention: the case of tobacco control. in Promoting Health: Intervention Strategies from Social and Behavioral Research (ed. Institute of Medicine, Smedley, B. & Syme, S. L.) 417–449 (National Academy Press, Washington DC, 2000).

    Google Scholar 

  78. Nestle, M. & Jacobson, M. F. Halting the obesity epidemic: a public health policy approach. Public Health Rep. 115, 12–24 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  79. Brownell, K., Horgan, K. Food Fight: The inside story of the food industry, America's obesity crisis, and what we can do about it. (Contemporary Books, New York, 2004).

    Google Scholar 

  80. Puska, P., Pirjo, P. & Uusitalo, U. Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme- experiences from Finland. Public Health Nutr. 5, 245–251 (2002).

    Google Scholar 

  81. Kim, S., Moon, S. & Popkin, B. M. The nutrition transition in South Korea. Am. J. Clin. Nutr. 71, 44–53 (2000).

    CAS  PubMed  Google Scholar 

  82. Milio, N. Making healthy public policy: developing the science by learning the art: an ecologic framework for policy studies. Health Promot. 2, 263–274 (1988).

    Google Scholar 

  83. Milio, N. Nutrition policy for food-rich countries: a strategic analysis (The Johns Hopkins University Press, Baltimore, 1990).

    Google Scholar 

  84. Popkin, B. M., Conde, W., Hou, N., Monteiro, C. Why the lag globally in obesity trends for children as compared to adults? Obes. 14, 1–8 (2006).

    Google Scholar 

  85. Committee on Food Marketing and the Diets of Children and Youth. Food Marketing to Children and Youth: Threat or Opportunity? (National Academies Press, Washington DC, 2005).

  86. Zhao, X. & Shen, F. Audience reaction to commercial advertising in China in the 1980s. Int. J. Advertising 14, 374–390 (1995).

    Google Scholar 

  87. Weber, I. G. Challenges facing China's television advertising industry in the age of spiritual civilization: an industry analysis. Int. J. Advertising 19, 259–281 (2000).

    Google Scholar 

  88. Key, T. J. et al. Diet, nutrition and the prevention of cancer. Public Health Nutr. 7, 187–200 (2004).

    PubMed  Google Scholar 

  89. World Cancer Research Fund in association with American Institute for Cancer Research. Food, nutrition and the prevention of causes: A global perspective. (American Institute for Cancer Research, Washington DC, 1997).

  90. Baer, H. J. et al. Adult height, age at attained height, and incidence of breast cancer in premenopausal women. Int. J. Cancer 119, 2231–2235 (2006).

    CAS  PubMed  Google Scholar 

  91. van den Brandt, P. A. et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am. J. Epidemiol. 152, 514–527 (2000).

    CAS  PubMed  Google Scholar 

  92. World Health Organization. Global strategy on diet, physical activity and health: Obesity and overweight. (World Health Organization, Lyon, 2004).

Download references

Acknowledgements

B.M.P. is supported by the US National Institutes of Health. The author thanks Frances Dancy and Tom Swasey for their administrative and graphics help, and Martin Wiseman and Geoffrey Cannon of World Cancer Research Fund International. Robert Sandler, Marilie Gammon, and Jessie Satia, UNC-CH, provided invaluable assistance. All are thanked. See www.nutrans.org for further information.

Author information

Authors and Affiliations

  1. the the Department of Nutrition, and the Department of Economics, Interdisciplinary Obesity Center, Schools of Public Health and Medicine, University of North Carolina, Carolina Population Center, 123 West Franklin Street, Chapel Hill, 27516-3997, North Carolina, USA

    Barry M. Popkin

Authors
  1. Barry M. Popkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Related links

Related links

DATABASES

National Cancer Institute

FURTHER INFORMATION

The Nutrition Transition Program

Australian Diabetes, Obesity and Lifestyle Study

The National Nutrition Survey 1995

Pesquisa de Or¸amentos Familiares

The China Health and Nutrition Surveys

2000 Indonesia Family Life Surveys

The Russian Longitudinal Monitoring Survey

The Health Survey for England

National Health and Nutrition Examination Surveys

Rights and permissions

Reprints and permissions

About this article

Cite this article

Popkin, B. Understanding global nutrition dynamics as a step towards controlling cancer incidence. Nat Rev Cancer 7, 61–67 (2007). https://doi.org/10.1038/nrc2029

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrc2029

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing