Context

Study finds there is a relationship between undernutrition, overweight and obesity.

What is Double Burden of Malnutrition?

The double burden of malnutrition is characterized by the coexistence of undernutrition along with overweight, obesity or diet-related Non Communicable Diseases (NCDs), within individuals, households and populations, and across the life-course.

Who is affected by double burden of malnutrition?

The double burden of malnutrition can manifest at three levels:

• At individual level:
  • It occurs at individual level through the simultaneous development of two of more types of malnutrition – for example obesity with nutritional anaemia or any vitamin or mineral deficiencies or insufficiencies.
  • It can also occur across the life-course and be temporally separated, owing to contrasting nutrition environments resulting from a shift in economic or other circumstances. For example overweight in an adult who was previously stunted from chronic undernutrition during childhood.
• At the household level:
  • An example would include nutritional anaemia in a mother, with a child or grandparent who is overweight or has diabetes (type 2).
  • The dual-burden household is more common in middle-income countries undergoing rapid nutrition transition.
• At the population level:
  • This burden is also observed at population level with both undernutrition and overweight, obesity or NCDs prevalent in the same community, region or nation.
  • Undernutrition and overweight, obesity or NCDs now coexist in many countries, with women disproportionately affected at the population level.

While rates of undernutrition are declining in many countries, the dramatic increases in overweight, obesity and associated NCDs place heavy tolls on individuals, families, economies and health-care systems.

What are the drivers and detriments of the double burden of malnutrition?

The causes of the double burden of malnutrition relate to a sequence of epidemiological changes known as the nutrition transition, the epidemiological transition and the demographic transition.

• The nutrition transition: It describes the shift in dietary patterns, consumption and energy expenditure associated with economic development over time, often in the context of globalization and urbanization. This change is associated with a shift from a predominance of undernutrition in populations to higher rates of overweight, obesity and NCDs.
• The epidemiological transition: It describes the changes in overall population disease burden associated with the increase in economic prosperity – with a shift from a predominance of infection and diseases related to undernutrition to rising rates of NCDs.
• The demographic transition: It describes the shift in population structure and lengthening lifespans. This sees a transformation from populations with high birth rates and death rates (related to the above transitions), with relatively high proportions of younger people, to populations with increasing proportions of older people (with age also being a risk factor for many NCDs).

Global status of burden:

• In 2014, more than 1.9 billion adults worldwide, 18 years and older, were overweight while 462 million were underweight.
• More than 600 million were obese. In the same year, 42 million children under the age of five were overweight or obese but 156 million were affected by stunting (low height-for-age).
• While 50 million children were affected by wasting (low weight-for-height). Poor nutrition continues to cause nearly half of deaths in children under five, while low- and middle-income countries now witness a simultaneous rise in childhood overweight and obesity – increasing at a rate 30% faster than in richer nations.

Prevalence of indicators of non-communicable diseases alongside indicators of undernutrition in India:

• Nearly 10% of children in the age group of 5-9 years and adolescents in the age group of 10-19 years are pre-diabetic, 5% are overweight and another 5% suffer from blood pressure.