Food system transformation and NCD outcomes in Central Asia: An exploratory assessment of dietary exposure and health risks

This paper examines the relationships between food system indicators, body weight outcomes, metabolic risks, and non-communicable diseases (NCDs) mortality across four Central Asian countries: Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan. Using a structured transmission pathway from dietary exposure to intermediate nutrition outcomes and health risks, the analysis applies a correlation-based approach to assess whether observed patterns are consistent with the nutrition transition framework. Over the past two decades, countries in the region have undergone a gradual transformation of their food systems. Economic growth, urbanization, and the expansion of food supply chains have increased the availability of energy-dense foods, including products high in sugars and fats. At the same time, non-communicable diseases (NCDs) have become the dominant source of mortality, accounting for the majority of deaths. This pattern is consistent with the global nutrition transition framework, under which economic development and urbanization are associated with shifts toward calorie-dense and processed diets, contributing to rising levels of overweight, obesity, and diet-related NCDs (Popkin and Ng, 2022; Popkin, Adair, and Ng, 2012). The results indicate that fat supply is more strongly and immediately associated with body weight outcomes than sugar supply, whose effects emerge with a time lag. Both overweight and obesity exhibit a high degree of alignment with metabolic risks, particularly diabetes, reflecting shared upward trends. At the same time, NCD mortality has declined even as risk factors have risen, a divergence most plausibly attributed to improvements in healthcare systems rather than to a reduction in underlying risk exposure. The findings highlight the importance of dietary composition, temporal dynamics, and system-level factors in shaping health outcomes in Central Asia.本研究针对哈萨克斯坦、吉尔吉斯斯坦、塔吉克斯坦与乌兹别克斯坦四个中亚国家，探析食品系统指标、体重结局、代谢风险与非传染性疾病（non-communicable diseases, NCDs）死亡率之间的关联。研究采用从膳食暴露到中间营养结局与健康风险的结构化传导路径，运用基于相关性的分析方法，检验观测到的模式是否契合营养转型框架。 近二十年来，该区域各国的食品系统历经渐进式变革。经济增长、城镇化推进与食品供应链扩容，大幅提升了高糖、高脂等高能量密度食品的供给水平。与此同时，非传染性疾病已成为人群死亡的主导病因，占总死亡人数的绝大多数。这一特征与全球营养转型框架高度一致：经济发展与城镇化进程与高热量加工膳食的消费转向相关联，进而推动超重、肥胖及膳食相关非传染性疾病患病率持续上升（Popkin与Ng, 2022；Popkin、Adair与Ng, 2012）。 研究结果表明，脂肪供给与体重结局的关联更强且更为即时，而糖类供给的影响则存在时滞。超重与肥胖均与代谢风险（尤以糖尿病为甚）呈现高度一致性，二者均呈同步上升趋势。此外，尽管各类风险因素水平持续攀升，非传染性疾病死亡率却有所下降，这一背离现象最合理的解释应为医疗保健系统的优化，而非潜在风险暴露的降低。 本研究结果凸显了膳食组成、时间动态特征以及系统层面因素在塑造中亚地区健康结局中的关键作用。