Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review

Abstract

Background: In low- and middle-income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively.

Objective: To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years of age.

Methods: We reviewed literature since January 1, 1990, published in English, using the PubMed search terms nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. The findings were classified and described according to dual burden level (community, household, or individual).

Results: Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the extent of the dual burden, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia due to shared underlying determinants or physiologic links.

Conclusions: The dual burden of malnutrition poses a threat to children's health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing over-nutrition through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity.

Figure 1

Prevalence of stunting (HAZ <−2) and overweight (BAZ >2) for lowest wealth quintile (red circles) and highest wealth quintile (blue circles) in children under 5y [11]. Reproduced with permission.

Figure 2

Percent of children under 5 classified as stunted (HAZ <−2), wasted (WHZ <−2), and overweight (WHZ >2) for selected Latin American countries (Data source: Demographic and Health Surveys, STATcompiler)