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. 2021 Feb 25;16(2):e0247856.
doi: 10.1371/journal.pone.0247856. eCollection 2021.

The double burden of malnutrition in India: Trends and inequalities (2006-2016)

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The double burden of malnutrition in India: Trends and inequalities (2006-2016)

Phuong Hong Nguyen et al. PLoS One. .

Abstract

Rapid urban expansion has important health implications. This study examines trends and inequalities in undernutrition and overnutrition by gender, residence (rural, urban slum, urban non-slum), and wealth among children and adults in India. We used National Family Health Survey data from 2006 and 2016 (n = 311,182 children 0-5y and 972,192 adults 15-54y in total). We calculated differences, slope index of inequality (SII) and concentration index to examine changes over time and inequalities in outcomes by gender, residence, and wealth quintile. Between 2006 and 2016, child stunting prevalence dropped from 48% to 38%, with no gender differences in trends, whereas child overweight/obesity remained at ~7-8%. In both years, stunting prevalence was higher in rural and urban slum households compared to urban non-slum households. Within-residence, wealth inequalities were large for stunting (SII: -33 to -19 percentage points, pp) and declined over time only in urban non-slum households. Among adults, underweight prevalence decreased by ~13 pp but overweight/obesity doubled (10% to 21%) between 2006 and 2016. Rises in overweight/obesity among women were greater in rural and urban slum than urban non-slum households. Within-residence, wealth inequalities were large for both underweight (SII -35 to -12pp) and overweight/obesity (+16 to +29pp) for adults, with the former being more concentrated among poorer households and the latter among wealthier households. In conclusion, India experienced a rapid decline in child and adult undernutrition between 2006 and 2016 across genders and areas of residence. Of great concern, however, is the doubling of adult overweight/obesity in all areas during this period and the rise in wealth inequalities in both rural and urban slum households. With the second largest urban population globally, India needs to aggressively tackle the multiple burdens of malnutrition, especially among rural and urban slum households and develop actions to maintain trends in undernutrition reduction without exacerbating the rapidly rising problems of overweight/obesity.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Prevalence and absolute change in undernutrition and overnutrition among Indians by residential area, 2006 to 2016.
(A) Girls (0-5y) stunting, (B) Boys (0-5y) stunting, (C) Girls (0-5y) overweight/obese, (D) Boys (0-5y) overweight/obese, (E) Women (15-49y) underweight, (F) Men (15-54y) underweight, (G) Women (15-49y) overweight/obese, (H) Men (15-54y) overweight/obese.
Fig 2
Fig 2. Socio-economic and residential inequality1 in undernutrition and overnutrition among Indian children and adults, 2006 and 2016.
(A) Girls (0-5y), (B) Boys (0-5y), (C) Women (15-49y), (D) Men (15-54y). 1Within each residential area in a given year, each dot represents the prevalence of a given burden for a quintile subgroup and the spread of the dots indicates the inequality in the burden of malnutrition; 2Negative values mean that the burden is more concentrated in the poor and positive values mean that the burden is more concentrated in the wealthy.

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