Food system change, traditional food practices, and nutrition transition dynamics: Qualitative insights from Indonesia and implications for cardiometabolic health

Rapid urbanisation and food system change have reshaped diets across low- and middle-income countries (LMIC), contributing to a growing burden of cardiometabolic disease (CMD). However, food system change in LMIC is not uniform or linear, with traditional diets and food practices persisting alongside modernising food environments. Drawing on qualitative data from three urban communities in Yogyakarta, Indonesia, this study examines how residents experience and navigate food system and dietary change amid rapid urbanisation. Participants described shifts consistent with the nutrition transition, including a move from subsistence-based food access towards market- and cash-based systems, alongside growth in ready-made and ultra-processed foods (UPF), eating out, and digital food delivery. These changes were associated with perceived declines in food quality, increased snacking and portion sizes, and intergenerational shifts towards convenience-oriented diets. Meanwhile, traditional food practices, including home food production, food sharing, and consumption of traditional foods remained important and were adapted to changing urban conditions. The findings suggest that food system change in urban Indonesia is characterised by the coexistence of traditional and modern food systems rather than a simple transition from one to the other. Traditional food practices may offer culturally relevant opportunities for CMD prevention in rapidly urbanising LMIC settings.