This article explores shifts in nutrition transition from the period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). It examines the speed of these changes, summarises dietary and physical activity changes, and provides some sense of the health effects and economic costs. The focus is on the lower- and middle-income countries of Asia, Africa, the Middle East and Latin America. The article shows that changes are occurring at great speed and at earlier stages of countries' economic and social development. The burden of disease from NR-NCDs is shifting towards the poor and the costs are also becoming greater than those for under-nutrition. Policy options are identified.