**1. Introduction**

South Africa (SA) is a middle-income country that is characterised by contrasting living conditions ranging from wealthy urban suburbs to lower-income, underdeveloped areas. [1] SA has faced many socio-economic challenges such as high levels of poverty, inequality and unemployment [1, 2] despite having the second largest economy on the African continent. Since the country's transition to democracy in 1994, progress has been made, but unemployment rates and poverty levels remain high. [1] Poverty is the main underlying factor contributing to food insecurity. [3, 4] The food insecure often use strategies to cope with the inability to access food. One of these include reducing the quality and quantity of food consumed, thus consuming poor diversity diets which can have detrimental consequences such as hunger, malnutrition [5, 6] and increased prevalence of metabolic and cardiovascular diseases (CVDs) [7] due to it hindering individuals' ability to choose the most appropriate foods and beverages for an adequate diet. [8] A disadvantage

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*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

[51] Okop KJ, Ndayi K, Tsolekile L, Sanders D, Puoane. Low intake of commonly available fruits and vegetables in socio-economically disadvantaged communities of South Africa: influence of affordability and sugary drinks intake. BMC Public

[52] World Health Organisation. WHO Reveals Leading Causes Of Death And Disability Worldwide: 2000-2019. 2020b. Available from: https://www. who.int/news/item/09-12-2020-whoreveals-leading-causes-of-deathand-disability-worldwide-2000-2019

Health; 2019. **19**(1): 1-14.

[Accessed 2021/1/6].

[53] World Health Organisation. Cardiovascular Diseases. 2020c. Available from: https://www.who. int/health-topics/cardiovasculardiseases#tab=tab1 [Accessed 2021/1/7]. of food insecurity is thus monotonous diets with consumption of more affordable energy-dense staples and foods that may have detrimental health outcomes such as obesity and its chronic disease comorbidities. [9] Food insecurity thus does not only cause under-nutrition, but also in over-nutrition such as obesity and its comorbidities, especially in low-income communities. [10] SA is a country in health transition and suffers from a quadruple burden of (a) poverty and nutrition-related chronic diseases of lifestyle [CDL], (b) communicable diseases, (c) peri-natal, maternal and injury-related disorders, [11] and (d) a nutrition transition. A recent study has found that this quadruple burden of disease is predominantly present in the black African population. [1] Urbanisation and westernisation of the Black African population of SA is marked not only by demographic transition, but also by increased animal protein, total dietary fat and added sugar intakes [11] and a health transition resulting in an increased prevalence of obesity [6] and CDL such as CVD. [11, 12]
