Addressing the Double Burden of Malnutrition using the Life Course Perspective

@#The double burden of malnutrition refers to the coexistence of undernutrition which is typically characterised by stunting and wasting, alongside overnutrition at all levels of the population. The objective of this article is to review the current issues in addressing the double burden of malnutrition using the life course approach. Studies addressing life course approach in DBM were identified through PubMed & EMBASE databases. Relevant studies were critically appraised. The challenges, opportunities and way forward in addressing DBM through the life course concept were discussed. The review showed that the DBM dilemma could be addressed via a holistic perspective through a life course concept as nutrition plays an important role in influencing health from pre-conception to old age. The life course concept proposes that environmental exposures, including biological, physical, social, and behavioral factors, including life experiences, throughout life, influence health outcomes in current generations and their offspring.

Doble carga de malnutrición en prescolares, escolares y adolescentes bolivianos que viven a gran altura, municipio de La Paz / Double burden of malnutrition in Bolivian preschool, school age children and adolescents living at high altitudes, municipality of La Paz

INTRODUCCIÓN: la presencia simultánea del retraso del crecimiento y del exceso de peso en una persona representa una de las principales paradojas en la salud pública global y es de creciente preocupación en Bolivia, donde ambas condiciones en su conjunto no han sido abordadas y ocurren en un contexto de transición nutricional en el que se encuentra el país. OBJETIVO: describir la coexistencia de la doble carga de malnutrición a nivel individual en la población escolar (3-19 años) del municipio de La Paz. MÉTODOS: se realizó un estudio observacional de corte transversal analítico con datos antropométricos de 7.654 escolares pertenecientes al municipio de La Paz del año 2019. Se determinaron las prevalencias y los intervalos de confianza al 95% para emaciación, retraso en el crecimiento, sobrepeso, obesidad y sobrepeso + obesidad por sexo y grupo de edad. A nivel poblacional, la doble carga de malnutrición (DCM), se estimó en base a los umbrales de alta prevalencia sugeridos por organizaciones internacionales, a saber, prevalencias por encima del 20% y 10% para retraso en el crecimiento y sobrepeso, respectivamente. Para los análisis a nivel individual, la DCM se definió como la coexistencia de retraso en el crecimiento y sobrepeso + obesidad en los tres grupos de estudio y se comparó con su valor esperado, bajo el supuesto de distribuciones independientes de cada condición. RESULTADOS: a nivel poblacional, la prevalencia de emaciación para toda la muestra analizada fue de 3,7%, sin diferencias significativas por sexo. La prevalencia de retraso del crecimiento para el año 2019 no superó el 20% en todos los grupos de edad analizados. La prevalencia de sobrepeso fue mayor al 10% para el grupo de escolares y adolescentes. A nivel individual la doble carga de malnutrición se encontró en 2,8%, 1,9% y 2,9% en prescolares, escolares y adolescentes, respectivamente. Valores que se encontraron por debajo de lo esperado. CONCLUSIONES: las prevalencias de doble carga de malnutrición, retraso del crecimiento y sobrepeso + obesidad a nivel individual, fueron menores de lo esperado en los tres grupos de estudio, asumiendo distribuciones independientes de las dos condiciones. A pesar de ello, la coexistencia de la doble carga poblacional (municipio de La Paz) debe ser abordada en políticas y programas adecuados de salud pública(AU).

INTRODUCTION: the simultaneous presence of growth retardation and excess weight in a person represents one of the main paradoxes in global public health and is of growing concern in Bolivia, where both conditions as a whole have not been addressed and occur in a context of nutritional transition in which the country finds itself. OBJECTIVE: to describe the coexistence of the double burden of malnutrition at the individual level in the school population (3-19 years) of the municipality of La Paz. METHODS: an analytical cross-sectional observational study was carried out with anthropometric data from 7,654 schoolchildren belonging to the municipality of La Paz in 2019. The prevalences and 95% confidence intervals were determined for wasting, stunting, overweight, obesity and overweight+obesity, by sex and age group. At the population level, the double burden of malnutrition (DBM) was estimated based on thresholds of high prevalence suggested by international organizations, namely, prevalence above 20% and 10% for stunting and overweight, respectively. For individual level analyzes, DBm was defined as the coexistence of stunting and overweight + obesity in the three study groups and was compared with its expected value, under the assumption of independent distributions of each condition. RESULTS: at the population level, the prevalence of wasting for the entire sample analyzed was 3.7%, with no significant differences by sex. The prevalence of stunting for the year 2019 did not exceed 20% in all the age groups analyzed. The prevalence of overweight was higher than 10% for the group of schoolchildren and adolescents. At the individual level, the double burden of malnutrition was found in 2.8%, 1.9% and 2.9% in preschool, schoolchildren and adolescents, respectively. Values that turned out to be lower than expected. CONCLUSIONS: the prevalence of double burden, growth retardation and overweight and obesity at the individual level, were lower than expected in the three study groups, assuming independent distributions of the two conditions. Despite this, the coexistence of the double burden in the municipality of La Paz must be addressed in appropriate public health policies and programs(AU).

Existence of double burden of malnutrition among Filipino children in the same age-groups and comparison of their usual nutrient intake

@#Introduction: This study aimed to determine the prevalence of underweight and overweight children in the same age-groups and if differences existed in their usual nutrients intake. Methods: Data were obtained from 8992 children aged 3-12 years who participated in 2013 National Nutrition Survey. Dietary intake information was collected using two days non-consecutive dietary recall. Usual intakes and distributions of energy and nutrients were estimated in pre-schoolers (3-5 years, n=2427), younger (6-9 years, n=3594) and older schoolchildren (10-12 years, n=2971) using PC Software for Intake Distribution Estimation (PC-SIDE) from Iowa State University. Energy inadequacy was assessed by the Estimated Energy Requirements (EER) method calculated using the equation of Institute of Medicine. The prevalence of nutrient inadequacy was estimated as the proportion of individuals with usual food intakes below the estimated average requirement (EAR). Results: The prevalence of underweight among preschool, younger and older schoolchildren was 22%, 30% and 16%, respectively, and 4%, 9% and 10%, respectively, among overweight. The average usual energy and nutrient intake of underweight was significantly lower than overweight. The major source of energy of underweight and overweight was from carbohydrates. However, contribution of fats to total energy was higher among overweight. Most nutrients were below EAR in underweight while only folate (50-79%) and calcium (58-84%) in overweight. Conclusion: The double burden of malnutrition co-exists in children of the same age-groups with higher prevalence nutrient inadequacies in underweight children. Percentage of fat contribution to energy intake was higher among overweight than the underweight.

Double burden of malnutrition among mother-child DYADS in urban poor settings in India

Introduction: Low-and middle-income countries are undergoing nutrition transition wherein presence of under and over-nutrition in the same household is increasing. Aims & Objectives: This study explored the coexistence of under and over-nutrition among mother-child dyads in an urban poor setting in India. Material & Methods: Data was collected from 225 dyads in urban poor settings of Delhi. Anthropometric measurements (weight, height, waist-circumference, hip circumference in mothers and weight, height, MUAC in children) were taken from a random sample of mothers aged >18 years with children aged 3-5 years. Prevalence of underweight, stunting, wasting and overweight/obesity were determined in children, while corresponding proportions of underweight and overweight/obesity were determined in mothers, based on BMI and waist circumference. Results: Of the 225 children, 19% were stunted, 12% were underweight, 4.8% were wasted, while 20% were overweight/obese. Among their mothers, 8.4% were underweight, 20% were overweight/obese and 23% had waist circumference > 88cm. A large proportion of overweight and obese mothers (33% and 30% respectively) had stunted, wasted or underweight children. Among the overweight/obese children, 12% had underweight, and 22% had overweight/obese parentage. Among, all dual burden households, the nutritional status of child correlates with that of mother. Conclusion: One-third mother-child dyads revealed the existence of double burden of malnutrition characterized by high prevalence of undernutrition, stunting and wasting in children, and overweight/obesity in mothers within the same household. It is crucial to understand the pathways to this coexistence, and to test effectiveness of context-specific interventions to curb associated future health risks

Comparison of maternal nutrition literacy, dietary diversity, and food security among households with and without double burden of malnutrition in Surabaya, Indonesia

@#Introduction: Double burden of malnutrition in the form of stunted child and overweight/obese mother has been increasing in countries experiencing nutrition transition. This study aimed to compare maternal nutrition, literacy, dietary diversity, and food security of households categorised by nutritional status of mother-child pairs. Methods: This cross-sectional study included a total of 685 children under 5 years of age from 14 community health centres (posyandu) in a poor urban area of Surabaya, Indonesia. The Lemeshow formula was used to compute sample size. The children and their mothers were categorised into motherchild pairs based on maternal body mass index (BMI) and height-for-age z-score for the child: non-overweight mother-non-stunted child (NM), non-overweight mother and stunted child (SC), overweight/obese mother and non-stunted child (OWT), stunted child and overweight/obese mother (SCOWT). Nutrition literacy was determined using questionnaires, dietary diversity was estimated using household dietary diversity scores, and food security was determined using the Household Food Insecurity Access Scale (HFIAS). Results: The prevalence of households with SCOWT double burden of malnutrition was 21.2%, OWT 37.7%, SC 15.3% and 25.8% were normal (NM). There were significant differences in maternal nutrition literacy, dietary diversity and household food security status. Households with NM pairs were shown to be most food secure followed by OWT, SC and lastly, the SCOWT pairs. Conclusion: Households with double burden of malnutrition have relatively lower nutrition literacy, dietary diversity, and food security. This study indicates the importance of developing nutritional strategies to enable low-income households to make healthy food

La transición alimentaria y la doble carga de malnutrición: cambios en los patrones alimentarios de 1961 a 2009 en el contexto socioeconómico mexicano

El propósito de este trabajo fue identificar si existieron cambios en la composición de los patrones alimentarios de 1961 a 2009, si el gasto en algunos alimentos por nivel de ingresos y el aumento en el precio de ciertos alimentos básicos de la dieta en el contexto socioeconómico mexicano, podrían explicar la transición alimentaria y la doble carga de malnutrición. Se llevó a cabo un estudio ecológico con la información de las Hojas de Balance de la FAO. Para conformar los patrones alimentarios se realizó análisis de conglomerados. Además, con los datos de la Encuesta Nacional de Ingresos y Gastos en los Hogares 2012 del Instituto Nacional de Estadística y Geografía se construyeron curvas de Engel para calcular la evolución del precio relativo de algunos alimentos. La dieta se definió en tres patrones alimentarios. La disponibilidad total de energía aumentó de 2316 kcal/persona/ día en 1961 a 3146 en 2009. Las modificaciones del patrón alimentario están en consonancia con la transición alimentaria y nutricional y con la doble carga de malnutrición. Se observó que la energía derivada de los cereales y la proveniente de las leguminosa (frijol) se redujo considerablemente, y de manera simultánea la energía procedente de azúcares, alimentos de origen animal y grasas vegetales tuvieron un aumento notable. El gasto en alimentos fue diferencial de acuerdo al nivel de ingresos. La malnutrición está mediada por la inequitativa distribución del ingreso, el bajo costo relativo de los alimentos ricos en energía, el encarecimiento de alimentos nutritivos y el escaso apoyo a la agricultura.

The nutrition transition and the double burden of malnutrition: changes in dietary patterns 1961-2009 in the Mexican socioeconomic context.. The purpose of this study was to identify whether there were changes in the composition of dietary patterns from 1961 to 2009, if food patterns by income level and the increase in the price of certainbasic foods of the diet in the socioeconomic Mexican context, could explain the nutrition transition and the double burden of malnutrition. We conducted an ecological study with data from FAO balance sheets. To construct eating patterns cluster analysis was performed. Engel curves were developed with data from the 2012 INEGI ENGH survey and evolution of therelative price of some foods was calculated. The diet was defined in three dietary patterns. The increase in the total availability of energy increased from 2316 kcal/person/day in 1961 to 3146 in 2009. Dietary pattern modifications are in line with the nutrition transition and the double burden of malnutrition. It was observed that the energy derived from cereals andfrom legume (common beans) was significantly reduced, and simultaneously, the energy from sugars, animal foods and vegetable fats had a dramatic increase. Spending on food was differential according to income level.Malnutritionis mediated by theunequal distribution of income, the relatively lowcost ofenergy-dense foods, the increased cost of nutritious foods, and limited support to agriculture.

La doble carga de desnutrición y obesidad en venezuela / The double burden of undernutrition and obesity in venezuela

La doble carga nutricional, la coexistencia del déficit y del exceso nutricional es el resultado de la Transición Alimentaria y Nutricional acelerada en los países en vías de desarrollo que no habrían resuelto sus problemas de déficit nutricional antes de que les alcanzaran el sobrepeso, la obesidad y las enfermedades crónicas relacionadas con la nutrición. Los cambios en el estilo de vida del venezolano como resultado de la rápida urbanización y la migración masiva hacia las ciudades es el fenómeno más relevante; se discuten los aspectos relacionados con el crecimiento prenatal y posnatal temprano y su asociación con las enfermedades crónicas relacionadas con la nutrición. Factores demográficos perfilan a Venezuela como de alto riesgo: el embarazo de adolescentes con tasas altas en la Región Latinoamericana, el peso bajo al nacer, el aumento de la mortalidad materna y de la mortalidad infantil, la lactancia materna exclusiva que disminuye con la edad del recién nacido. En el primer estudio de sobrepeso y obesidad en la población venezolana, del INN, entre los 7 a los 17 años de edad, 21-28% presentaban exceso y 15- 17% déficit, un reflejo de la “doble carga”, cuya distribución resulta heterogénea en el país, el déficit en los niños parece ser mayor que el exceso en estados rurales como Apure así como en los estratos más bajos. En los adultos el sobrepeso y la obesidad aumentan con la edad. Se presenta una aproximación a la prevención de la “doble carga” y de los problemas de salud pública derivados de esta(AU)

The double burden of malnutrition, the coexistence of nutritional deficit and excess is the result of the Food and Nutrition Transition accelerated in developing countries that would had not have solved their problems of nutritional deficiency before they were reached by overweight, obesity and chronic diseases related to nutrition. Changes in the lifestyle of the Venezuelan population as a result of rapid urbanization and migration to the cities, is the most important phenomenon; aspects of prenatal and early postnatal growth and its association with chronic diseases related to nutrition are discussed. Demographic factors outline the Venezuelan population as high risk: teenage pregnancy prevalence is among the highest in the Latin American region, low birth weight, increased maternal mortality and infant mortality; exclusive breastfeeding decreasing’s the with age of the newborn. In the first study of overweight and obesity in the Venezuelan population, INN, in ages 7 to 17 years olds 21-28% were overweight and 15-17% were undernourished, a reflection of the “double burden”, whose distribution is heterogeneous in the country, the deficit in children appears to be larger than the excess overweight in rural states like Apure and in the lower socioeconomic strata. In adults, overweight and obesity increase with age. An approach to the prevention of the “double burden” and the public health problems resulting from this is presented(AU)