Childhood Dual Burden of Under- and Overnutrition in Low- and Middle-inCome Countries: A Critical Review

Abstract

Background In low- and middle income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively. Objective To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years. Methods We reviewed literature since January 1, 1990, published in English, using the PubMed search terms: nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. Findings were classified and described according to dual burden level (community, household, individual). Results Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the dual burden’s extent, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia, due to shared underlying determinants or physiologic links. Conclusions The dual burden of malnutrition poses a threat to children’s health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing overnutrition, through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity.

Does mid upper arm circumference identify all acute malnourished 6–59 month old children, in field and clinical settings in Nigeria?

“…1 In some communities and even families, both co-exist; and, it is commonly termed "double-burden malnutrition". 1,2 Nutritional status of children is determined by several anthropometric measurements in relation to the age of the child using either single or derived indices.…”

“…1 In some communities and even families, both co-exist; and, it is commonly termed "double-burden malnutrition". 1,2 Nutritional status of children is determined by several anthropometric measurements in relation to the age of the child using either single or derived indices. 3 The World Health Organisation (WHO) recommends the use of weight-for-height (WHZ) and body mass index for age z-scores (BAZ) in determination of underweight and overweight, respectively; though both parameters can measure the deviations with no statistical difference in outcome if inter-changed.…”

La coexistencia de problemas nutricionales en niños menores de 5 años en el Perú 2007-2010

“…Esta pobre nutrición fomenta de alguna manera un fenotipo ahorrador que va a aumentar la eficiencia del depósito de grasa (21) .…”

Análisis espacial del sobrepeso y la obesidad infantil en el Perú, 2014

“…Bajo un escenario de aumento de los problemas nutricionales por sobrepeso y obesidad, se han propuesto variadas intervenciones a nivel mundial (2,6) que requieren como primer paso una estimación de los factores de riesgo y de la carga de enfermedad poblacional o subpoblacional (5) . Sin embargo, muchos países, sobre todo los de bajos y medianos ingresos, presentan una doble carga de enfermedad, coexistiendo el sobrepeso y la obesidad con la inseguridad alimentaria y la desnutrición (7,8) . Por lo tanto, la planificación de intervenciones eficaces se complica aun más cuando no se disponen de análisis adecuados de la problemática.…”