The Double Burden of Malnutrition GCHB 6780 Roger Shrimpton John Mason Lisa Saldanha

1. The Double Burden of MalnutritionGCHB 6780Roger ShrimptonJohn MasonLisa Saldanha 16 January 2012 Class 2 : DBM definitions and dimensions

2. Content • Syllabus and Readings • Malnutrition: excesses as well as deficiencies • The life-cycle dimension of the DBM • Definitions of under and overnutrition • Most common forms of DBM • Trends in undernutrition and overnutrition • Secular trend • Conclusions

7. Syllabus Reading assignment • Presentations on readings (two per class): • Each student will select one class (from class 5, 6, 7, 8, or 9) and prepare a brief (5 minute) presentation summarizing one of the readings, including one discussion question Case studies – further details to be provided

8. What is the Double Burden of Malnutrition? “Malnutrition” Is both under and overnutrition

9. MALNUTRITION = • Undernutrition: • Wasting • (weight for height) • Underweight • (weight for age) • Stunting • (height for age) • Micronutrient deficiencies • Iodine • Iron (anaemia) • Vitamin A • Zinc + • Overnutrition: • Overweight • Obesity • (weight for height and BMI or Body Mass Index)

10. What is the DBM? • The process of young child growth faltering wasting underweight stunting Source: Victora et al 2010

11. What is the DBM? THE DBM is undernutrition and overnutrition in the same population across the life course THIS

12. Source: WHO 2000

13. Source: WHO 2000

14. Who is most affected by DBM • Women are most affected by the DBM, with populations frequently having women that are excessively thin, as well as those that are overweight. • Another form of the DBM, is overweight mothers and stunted children in the same household, although this is most common in Latin America. • The commonest type of DBM is anaemia and obesity, which again especially affects women at the individual level. Even the USA has this form of DBM.

15. Overweight in urban women aged 20-40y in 36 LMICS by income and education level Source: Mendez et al 2005

16. Source: Garrett and Ruel 2005

17. Source: Garrett and Ruel 2005

18. Iron deficiency in overweight/obese children in USA Source: Pinhas-Hamiel et al 2003

19. Who is most affected by DBM • Children are less obese than women, but the combination of stunting and accelerated weight growth is important • Stunting is a reflection of adequacy of growth from conception to two years • Accelerated weight growth after two years in stunted children increases the risk of obesity in later life. • Asians are more affected than Caucasians • In adults the definition of overweight is BMI >25 and obese is >30 • In Asians the BMI cut offs are> 23 and >27

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23. The double burden of malnutrition Underweight vs obesity in women in 36 high-stunting burden countries* *Of these 36 countries, data on both underweight and obesity prevalence among adult females were available only for 24 countries Source: WHO Global Database on Child Growth and Malnutrition

24. Source: Wang et al 2011

27. Secular trend in adult height Source: Malina 2004

28. Source: Baten and Blum

33. Conclusions • The double burden of malnutrition (DBM) is affecting most countries, including industrialized and LMICS • Stunting in early childhood increases the risk of becoming obese later in the life course • The common forms of DBM include • overweight and iron deficiency in same individual • Overweight and underweight women in same population • Overweight mother and stunted child in same household • Global trends seem to be increasing for overnutrition and obesity while undernutrition is decreasing much more slowly • A secular trend has existed for height over the last century, but increases in obesity seem much more recent