959. Systematic Review on Double Burden of Malnutrition in Low- and Middle-Income Countries

Malnutrition encompasses both undernourishment (insufficient energy intake) and overnutrition (excessive energy intake: overweight and obesity), diet-related noncommunicable diseases (NCDs), and deficiencies of essential micronutrients such as vitamins and minerals. These conditions often coexist, resulting in a double or triple burden of malnutrition.
 
In many low- and middle-income countries (LMICs), there's been a rapid shift away from traditional diets, leading to a concurrent rise in overnutrition alongside the prevailing focus on undernutrition. This phenomenon, known as the double burden of malnutrition (DBM), is characterized by the simultaneous presence of undernutrition and overnutrition, particularly overweight and obesity or diet-related noncommunicable diseases.
 
A recent systematic review published in The Lancet Global Health (Escher et al., 2024), along with a commentary by Sahiledengle & Mwanri (2024), sheds light on this issue.
 
The review suggests that more than one-third of LMICs may be addressing DBM at the national level. The Lancet series on DBM underscores the need to address both overnutrition and undernutrition simultaneously, rather than in isolation. The World Health Organization (WHO) has called for double-duty actions that address both over- and undernutrition simultaneously, but evidence on their effectiveness remains limited.
 
This review summarizes interventions targeting undernutrition and overnutrition in LMICs, using data from 2000 to 2023. Twenty nutrition-specific interventions, including those focused on maternal and child health and school-based programs, and six nutrition-sensitive interventions were identified. These interventions were classified into five categories based on their impact on DBM: beneficial, potentially beneficial, neutral, potentially harmful, and harmful.
 
While many interventions were found to be beneficial for addressing DBM, some studies showed potential adverse effects. In particular, seven out of eight studies of mother-child interventions that provided food or supplements showed possible adverse effects on overweight. In addition, studies of conditional cash transfers showed benefits for children but potential harms for maternal overweight. Other interventions, such as family planning and education reform, also raised concerns about long-term adverse effects on obesity.
 
The studies included in the review varied widely in terms of design, target populations, outcome measures, intervention duration and quality. Future research should aim for greater diversity in study designs and populations. It's also important to recognize that interventions targeting undernutrition may inadvertently exacerbate obesity, and to report outcomes for both undernutrition and overnutrition comprehensively.
 

Reference

Nora A Escher, Giovanna C Andrade, Suparna Ghosh-Jerath, Christopher Millett, Paraskevi Seferidi. The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review. The Lancet Global Health (2024). https://doi.org/10.1016/S2214-109X(23)00562-4

Biniyam Sahiledengle, Lillian Mwanri. Unveiling the crisis of the double burden of malnutrition. The Lancet Global Health (2024). https://doi.org/10.1016/S2214-109X(24)00001-9

Contributor: SHIRATORI Sakiko (Information and Public Relations Office)