Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990–2012

Abstract

Objective To describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC). Design Using repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years. Setting Demographic and Health Surveys from thirty-six LMIC between 1990 and 2012. Subjects Children <5 years. Results Overall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0.3–10.9 % of children <5 years were stunted and overweight, and 0.6–37.8 % of stunted children <5 years were overweight. Conclusions The dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic.

Child‐level double burden of malnutrition in the MENA and LAC regions: Prevalence and social determinants

“…Our findings confirm that in these regions, chronic undernutrition (stunting) is consistently rooted in poverty, with the odds of stunting significantly decreasing with increasing wealth and maternal education, consistent with global literature (Hong, ; Keino et al, ; D Makoka, ; Semba et al, ; Tzioumis et al, ; Vollmer et al, ). Our results also highlight the differential association of maternal education on stunting across the two regions.…”

“…These findings suggest that in the MENA region, the stunted–overweight child is a true phenomenon rather than a statistical artefact. Potential explanations for the existence of the stunted–overweight child include poor quality diets with limiting micronutrients, but sufficient caloric density (Fernald & Neufeld, ; Mamabolo et al, ; Barry M Popkin et al, ; Said‐Mohamed et al, ; Varela‐Silva et al, ; Wang et al, ), in‐utero epigenetic alterations (Barker, ; Kitsiou‐Tzeli & Tzetis, ), or poor early nutrition that alters the physiology of stunted children to accumulate fat instead of lean mass (Freire et al, ; Kroker‐Lobos et al, ; Ramirez‐Zea et al, ; Tzioumis et al, ).…”

Programming maternal and child overweight and obesity in the context of undernutrition: current evidence and key considerations for low- and middle-income countries

“…With respect to children under 5 years of age, Malawi, Mozambique, Nigeria, Rwanda and Zambia have a prevalence of overweight greater than 7 % ( 7 ) , which is the global nutrition target for childhood overweight set by the WHO ( 8 ) .…”

The role of pulses in sustainable and healthy food systems

“…There has been significant progress in reducing the prevalence of stunting in LMICs over the past 25 years. However, slow and uneven declines, particularly in Africa south of the Sahara and Southeast Asia, and variable progress within the same country mean there is still important work for researchers and policymakers …”

“…At the same time, the number of children and adults who are overweight and obese is rising in all regions and nearly all countries, including in LMICs. Some countries that have reduced undernutrition—like Brazil, China, and Chile—have seen rapid increases in the prevalence of obesity and related chronic disease . There are 20 countries where high prevalence of the three forms of malnutrition—under‐5 stunting, women of reproductive age with anemia, and adult overweight and obesity—overlap…”