Global nutrition 1990-2015: A shrinking hungry, and expanding fat world

Abstract

Objectives: Following its publication in 2008, the Global Nutritional Index (GNI) which captures the triple burden of malnutrition, has been updated to assess the overall nutritional status and nutritional trends of countries, regions and the world, including both under-nutrition and over-nutrition.

Methods: The GNI was modeled on the Human Development Index, using geometric means of three normalized indicators: protein-energy malnutrition (PEM, measured by Disability-Adjusted Life Years (DALYs) from PEM), micronutrient deficiency (MID, measured by DALYs from MID), and penalizing obesity (percent female obesity). GNI (range 0-1) was calculated from 1990-2015 for 186 countries, in seven World Bank income and WHO region groupings.

Results: World GNI increased from 0.433 to 0.473 as decreased deficits overcompensated for the rise in obesity. GNI for African low- and middle-income countries (LMIC) (median 0.301 to 0.392) and South-East Asian LMIC (0.456 to 0.564) improved significantly (P<0.001), while for high-income countries (0.657 to 0.611) worsened significantly (P<0.001). GNI for American LMIC (0.459 to 0.457), European LMIC (0.571 to 0.575), Eastern Mediterranean LMIC (0.484 to 0.483) and Western Pacific LMIC (0.433 to 0.494) were unchanged. The disaggregation of the GNI showed that in nearly all the seven country groups there was a significant decrease in both PEM and MID (all P<0.01) (except in HIC where only PEM dropped), and a significant increase in obesity (all P<0.001).

Conclusion: These trends are the result of the reciprocal changes between decreased under-nutrition and increased over-nutrition, which has become a major cause of malnutrition worldwide. We suggest, therefore, that future Sustainable Development Goals should include alongside "zero hunger"-"reduce obesity".

Fig 1. GNI and its indicators for the world from 1990 to 2015.

PEM, protein-energy malnutrition. MID, micronutrient deficiency. Dotted lines above and below the lines in B, C and D represent the upper- and lower- limits of 95% uncertainty intervals.

Fig 2. Box-whisker plots of GNI by World Bank and WHO group for 1990, 2005 and 2015.

Groups—1, High-income countries (n = 52); 2, African low-and middle-income countries (LMIC) (n = 45); 3, American LMIC (n = 26); 4, South-East Asian LMIC (n = 11); 5, European LMIC (n = 20); 6, Eastern Mediterranean LMIC (n = 16); 7, Western Pacific LMIC (n = 16). Thick line in the box—median; upper- and lower- borders of box—75% and 25% percentile; whiskers—maximum and minimum. In group 6 and 7, because some country has one of the maximum values of the three indicators, the GNI of which appears to be zero when calculated by the geometric mean. P values are derived from Friedman’s Exact test.

Fig 3. Top and bottom 30 countries in GNI ranking in 1990, 2005 and 2015.

WB, World Bank; WHO, World Health Organization; HIC, high-income countries; LMIC, low- and middle-income countries; W-P, Western Pacific.

Fig 4. Disaggregation of GNI by country group for 1990 and 2015.

LMIC, low- and middle- income countries; PEM, protein-energy malnutrition; MID, micronutrient deficiency. Each dimension of the triangle is represented by the mean of the dimension-specific score.