Double burden of malnutrition in persons with obesity

Abstract

A paradoxical double challenge has emerged in the last decades with respect to nutrition and nutrition-related clinical conditions. Hunger-related undernutrition continues to represent an unacceptable burden, although its prevalence has been encouragingly reduced worldwide. On the other hand, the prevalence of overweight and obesity, defined as fat excess accumulation with negative impact on individual health, has dramatically increased due to increasingly pervasive obesogenic lifestyle changes. Undernutrition and obesity may coexist in world regions, Countries and even smaller communities and households, being referred to as double burden of malnutrition. It is however important to point out that fat accumulation and obesity may also induce additional nutritional derangements in affected individuals, both directly through metabolic and body composition changes and indirectly through acute and chronic diseases with negative impact on nutritional status. In the current narrative review, associations between fat accumulation in obesity and malnutrition features as well as their known causes will be reviewed and summarized. These include risk of loss of skeletal muscle mass and function (sarcopenia) that may allow for malnutrition diagnosis also in overweight and obese individuals, thereby introducing a new clinically relevant perspective to the obesity-related double burden of malnutrition concept.

Association between body mass index and newly diagnosed drug-resistant pulmonary tuberculosis in Shandong, China from 2004 to 2019

“…Some overweight and obese patients can also be malnourished, since BMI is only one of prognostic factors for assessing malnutrition. Fat accumulation in overweight and obese individuals may induce additional nutritional derangements, both indirectly through acute and chronic diseases with negative impact on nutritional status and directly through metabolic and body composition changes [ 28 ]. Furthermore, skeletal muscle mass and function (sarcopenia) may also contribute to malnutrition.…”

“…Secondly, this was a retrospective study, and may have information bias. Thirdly, some obese patients can also be malnourished, since BMI is only one of prognostic factors for assessing malnutrition [ 28 , 29 , 45 ]. However, we were not available for other nutritional indexes except BMI due to its retrospective study model.…”

Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease

“…Reviews of the impact of bariatric surgery on the clinical course of IBD found that it is relatively safe and reduces the risk of complications[ 69 , 70 ]; however, more robust original articles evaluating surgical outcomes must be added to the literature to increase the reliability of those findings. It should be noted that malnutrition is common in patients with IBD and that people with high BMIs may also have nutritional deficiencies[ 37 , 71 , 72 ]. Therefore, it is essential to carry out a thorough nutritional assessment of possible candidates for bariatric surgery[ 69 ].…”

Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

“…[10][11][12][13] Overnutrition can result from poor food choices, limited access to healthy foods, energy imbalance related to low physical activity, and/or to genetic predisposition to certain metabolic abnormalities. 14,15 Overnutrition and obesity are both risk factors for the development of chronic conditions such as type 2 diabetes mellitus, metabolic syndrome, atherosclerosis, and cardiovascular disease. 15 By contrast, undernutrition can occur as a result of decreased intake or inadequate absorption/ utilization of nutrients, which often occurs in the presence of gastrointestinal diseases or inflammation related to chronic diseases.…”

“…14,15 Overnutrition and obesity are both risk factors for the development of chronic conditions such as type 2 diabetes mellitus, metabolic syndrome, atherosclerosis, and cardiovascular disease. 15 By contrast, undernutrition can occur as a result of decreased intake or inadequate absorption/ utilization of nutrients, which often occurs in the presence of gastrointestinal diseases or inflammation related to chronic diseases. 16 Both underweight and overweight/obesity have been associated with adverse health outcomes related to loss of muscle mass and strength, which can affect functional status and quality of life.…”