Double Burden Of Malnutrition Research Articles

Double Burden of Malnutrition among Female Adolescent Students in Bahir Dar City, Amhara, Ethiopia.

Background Globally, nearly a third of the population suffers from at least one form of malnutrition. Both over- and undernutrition are a growing concern in developing countries particularly among female adolescents. This study was aimed at assessing nutritional status and associated factors among female adolescents in secondary schools of Bahir Dar City, Amhara, Ethiopia, 2019. Methods A school-based cross-sectional study was conducted in secondary schools of Bahir Dar City among 682 female adolescent students in 2019. A simple random sampling technique with proportional allocation was used to select study participants. Data were collected using a self-administered questionnaire. Data were entered into Epi Info version 7.1 and analyzed by SPSS version 21. Underweight and overweight statuses of the participants were determined by using the WHO cutoff point. Bivariable and multivariable logistic regressions were used to identify the significance of association at a 95% confidence interval. P value < 0.05 was used to declare statistical significance. Results In this study, the prevalence of underweight, overweight, and obesity was 15%, 8.4%, and 4.7%, respectively. Female adolescents found between age groups of 14-16.5 years old (AOR: 1.7, 95% CI: 1.03-2.69), family size ≥ 4 (AOR: 2.8, 95% CI: 1.05-4.99), participants who did not eat meat once per week (AOR: 1.6, 95% CI: 1.90-2.82), and no onset of menarche (AOR: 4.4, 95% CI: 1.21-15.75) were found to be more likely underweight. In addition, adolescents with family monthly income above 6500 Ethiopian birr (AOR: 12.7, 95% CI: 2.47-65.62), who ate meat two times and more per week (AOR: 2.07, 95% CI: 1.47-9.14), and who ate fruit at least once a week (AOR: 0.20, 95% CI: 0.05-0.78) were more likely to be overweight compared with counterparts. Conclusion and Recommendation. The prevalence of underweight and overweight was found to be high. Design evidence-based adolescent nutritional intervention shall be emphasized by the government and other concerned bodies to avert the dual burden of malnutrition.

Economic Status Moderates the Association Between Early-Life Famine Exposure and Hyperuricemia in Adulthood.

The double burden of malnutrition (DBM), undernutrition in early life and an obesogenic environment later on, influences later risk of chronic disorders. The Great Famine in China from 1959 to1962 and remarkable economic development from the 1980s provided such a burden for a large number of people in their 60s. We aimed to analyze the effect of economic status on the association between famine exposure in early life and hyperuricemia in adulthood. Participants numbering 12 666 were enrolled in China based on the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) Study from 2014 to 2016. Participants with fetal or childhood famine exposure (birth year 1949-1962) formed the exposure group. Hyperuricemia was defined as uric acid (UA) > 420 μmol/L for men and > 360 μmol/L for women. The association of famine with hyperuricemia was assessed via regression analyses. Early-life famine exposure was negatively associated with UA levels (P = .045) but was not associated with hyperuricemia (P = .226) in the whole study population. Economic status could moderate the association of famine exposure with UA and hyperuricemia (P ≤ .001). In participants with high economic status, early-life famine exposure was positively associated with UA levels (unstandardized coefficients 7.61, 95% CI 3.63-11.59, P < .001), and with hyperuricemia (odds ratio 1.47, 95% CI 1.19-1.81, P < .001). Economic status could moderate the association between exposure to famine in early life and hyperuricemia in adulthood, indicating that the DBM might affect hyperuricemia in an opposite direction of the effects of undernutrition in early life alone.

Anthropometric nutritional status, and social and dietary characteristics of African and Indian adolescents taking part in the TALENT (Transforming Adolescent Lives through Nutrition) qualitative study.

To describe the anthropometry, socioeconomic circumstances, diet and screen time usage of adolescents in India and Africa as context to a qualitative study of barriers to healthy eating and activity. Cross-sectional survey, including measured height and weight and derived rates of stunting, low BMI, overweight and obesity. Parental schooling and employment status, household assets and amenities, and adolescents' dietary diversity, intake of snack foods, mobile/smartphone ownership and TV/computer time were obtained via a questionnaire. Four settings each in Africa (rural villages, West Kiang, The Gambia; low-income urban communities, Abidjan, Cote D'Ivoire; low/middle-class urban communities, Jimma, Ethiopia; low-income township, Johannesburg, South Africa) and India (rural villages, Dervan; semi-rural villages, Pune; city slums, Mumbai; low-middle/middle-class urban communities, Mysore). Convenience samples (n 41-112 per site) of boys and girls, half aged 10-12years and another half aged 15-17years, were recruited for a qualitative study. Both undernutrition (stunting and/or low BMI) and overweight/obesity were present in all settings. Rural settings had the most undernutrition, least overweight/obesity and greatest diet diversity. Urban Johannesburg (27 %) and Abidjan (16 %), and semi-rural Pune (16 %) had the most overweight/obesity. In all settings, adolescents reported low intakes of micronutrient-rich fruits and vegetables, and substantial intakes of salted snacks, cakes/biscuits, sweets and fizzy drinks. Smartphone ownership ranged from 5 % (West Kiang) to 69 % (Johannesburg), higher among older adolescents. The 'double burden of malnutrition' is present in all TALENT settings. Greater urban transition is associated with less undernutrition, more overweight/obesity, less diet diversity and higher intakes of unhealthy/snack foods.

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

ABSTRACTBackgroundChild overweight prevalence is increasing globally, but micronutrient deficiencies persist.ObjectivesWe aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting.MethodsWe analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao–Scott chi-square test and examined predictors of DBM and its components with logistic regression.ResultsDBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%–19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6–23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components.ConclusionsIntraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

Intraindividual double burden of overweight or obesity and micronutrient deficiencies or anemia among women of reproductive age in 17 population-based surveys

Background:Rising prevalence of overweight/obesity (OWOB) alongside persistent micronutrient deficiencies suggests many women face concomitant OWOB and undernutrition.Objectives:We aimed to 1) describe the prevalence of the double burden of malnutrition (DBM) among nonpregnant women of reproductive age, defined as intraindividual OWOB and either ≥1 micronutrient deficiency [micronutrient deficiency index (MDI) > 0; DBM-MDI] or anemia (DBM-anemia); 2) test whether the components of the DBM were independent; and 3) identify factors associated with DBM-MDI and DBM-anemia.Methods:With data from 17 national surveys spanning low- and middle-income countries (LMICs) and high-income countries from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (n = 419 to n = 9029), we tested independence of over- and undernutrition using the Rao–Scott chi-square test and examined predictors of the DBM and its components using logistic regression for each survey.Results:Median DBM-MDI was 21.9% (range: 1.6%–39.2%); median DBM-anemia was 8.6% (range: 1.0%–18.6%). OWOB and micronutrient deficiencies or anemia were independent in most surveys. Where associations existed, OWOB was negatively associated with micronutrient deficiencies and anemia in LMICs. In 1 high-income country, OWOB women were more likely to experience micronutrient deficiencies and anemia. Age was consistently positively associated with OWOB and the DBM, whereas the associations with other sociodemographic characteristics varied. Higher socioeconomic status tended to be positively associated with OWOB and the DBM in LMICs, whereas in higher-income countries the association was reversed.Conclusions:The independence of OWOB and micronutrient deficiencies or anemia within individuals suggests that these forms of over- and undernutrition may have unique etiologies. Decision-makers should still consider the prevalence, consequences, and etiology of the individual components of the DBM as programs move towards double-duty interventions aimed at addressing OWOB and undernutrition simultaneously.

Tackling child malnutrition in Jamaica, 1962\u20132020

On the eve of independence in 1962, malnutrition was the largest single cause of death in Jamaica for children under one. Although child malnutrition rates have rapidly declined since 1962, today Jamaica experiences a double burden of malnutrition: the coexistence of pockets of high child malnutrition with rising levels of childhood obesity. Based on a wide range of sources, including public documents, newspaper reports, scientific studies and reports by international agencies, this article examines a gradual decline in child malnutrition and the rise of the double burden of malnutrition in Jamaica from independence to the present. It will first of all show that changes in the global economy and overseas loans and aid both aided and limited the ability of the Jamaican government to lower child malnutrition levels and also contributed to a rise in childhood obesity. Second, it will illustrate that a traditional deficit-led approach to child malnutrition was followed in post-independent Jamaica, focussing on the public and individuals as targets for intervention and using quantitative measures to trace progress. And third, it will question whether the double burden of child malnutrition will give rise to ‘healthy publics’—‘dynamic collectives of people, ideas and environments that can enable health and well-being’.

A Simulator to Determine the Evolution of Disparities in Food Consumption between Socio-Economic Groups: A Brazilian Case Study

Food is a fundamental right that deserves attention but is usually dealt with from the supply side in aggregated models that use macroeconomic variables to forecast the demand and the required supply. This study challenges this paradigm by developing a simulator to analyze food consumption from the demand side and estimate the evolution of disparity in food consumption over time with respect to region, sex, ethnicity, education, and income. This novel approach was applied to Brazil using household expenditure surveys to feed serial neural networks. Results show that the ‘poorer’ north and northeast of Brazil encounter the lowest consumption of food and are therefore the most food vulnerable regions. This trend continues to 2040. The ‘richer’ south and southeast regions have higher food consumption, which varies according to sex, ethnicity, education, and income. Brazil has contrasting issues with some groups having considerably higher food consumption, while other groups still have less than the threshold for healthy consumption. Now, the country not only has to deal with the food access by the most vulnerable due to the latest economic declines but also to deal with excess consumption, the so-called “double burden of malnutrition”.

The Double Burden of Malnutrition: A Systematic Review of Operational Definitions.

ABSTRACTBackgroundDespite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions.ObjectivesTo identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment.MethodsFollowing a structured search of peer-reviewed articles with terms describing “overnutrition” [e.g., overweight/obesity (OW/OB)] and “undernutrition” (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles.ResultsWe organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73).ConclusionsExisting DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.

Factors associated with double burden of malnutrition among mother-child pairs in India: A study based on National Family Health Survey 2015–16

Sustainable Development goal 2 focusses on preventing all forms of malnutrition by 2030. Therefore, it is important to understand the double burden of malnutrition (DBM) in mother-child pairs in India. This study attempted to explore the coexistence of DBM among mother-child pairs in India. Also, this study tries to explore various factors associated with DBM in India. The study utilized data from national representative cross-sectional fourth round of National Family Health Survey (NFHS-4) conducted in 2015–16. The study used anthropometric indices such as height-for-age, weight-for-height, and weight-for-age to examine the nutritional status of children aged 0–59 months. Further, the study used body mass index (BMI) of women and classified according to WHO cut-off values (normal BMI: 18.5 to <24.99 kg/m2 and overweight/obesity: ≥25.0 kg/m2). The bivariate and multivariate logistic regression analysis were applied to assess the factors associated with DBM. It was found that 4.1 percent, 3.3 percent, and 2.1 percent of mother-child pairs in the same household were a combination of Overweight/Obese women with stunted children (OM/SC), Overweight/Obese women with underweight children (OM/UC), and Overweight/Obese women with wasted children respectively (OM/WC). Additionally, 6% of mother-child pairs in the same household were suffering from DBM. Mothers with secondary education were more likely to face risk of DBM as compared to uneducated mothers [OR: 1.17, p < 0.01]. DBM was higher among mother-child pairs, which belong to rich wealth quintile than mother-child pairs from poor wealth quintile [OR: 1.98, p < 0.01]. Interventions need to be scaled up to target undernutrition as well as obesity at the same time in a household. Isolated focus on undernourished children may not be sufficient, and it is recommended to address different nutritional problems simultaneously. Another important recommendation is to formulate nutrition interventions keeping in mind the inclusion of wealthier families, as DBM is higher among such families.

Representación geográfica de la malnutrición en niños y adolescentes de Medellín, Colombia

Introducción: Describir la malnutrición por deficiencia y por exceso en niños y adolescentes de 0 a 17 años, con base a la representación espacial geográfica (REG) de Medellín, Colombia. Material y métodos: Estudio poblacional, transversal, con muestra multietápica y aleatoria (n= 6075), representativa de las 16 comunas y 5 corregimientos de Medellín. Se incluyeron variables demográficas, sociales, educativas, salud, nutrición y actividad física. Se construyeron los indicadores peso-talla (PT), talla-edad (TE), peso-edad (PE) e Índice de Masa Corporal-edad (IMC-edad) en &lt;5 años y TE e IMC-edad en &gt;5 años, recomendados por la Organización Mundial de la Salud (OMS). Con los paquetes Antrho y Antrho Plus se obtuvieron puntajes Z, con el SPSS se realizaron análisis descriptivos y con Argis 10.0 se construyó la REG de las prevalencias de malnutrición. Estudio aprobado por el comité de ética de la Universidad CES. Resultados: En &lt;5 años (n=1598), 0,9 % presenta desnutrición aguda, 6,4 % talla baja, 1,3 % desnutrición global, 20,8 % riesgo de sobrepeso, 5,2 % sobrepeso y 0,9 obesidad. Uno de cada 4 niños (25%) realiza actividad física (11 min/día). A partir de los 5 años (n=4477) se presentó 3,9% de baja talla, 1,6% delgadez, 21% sobrepeso y 8,9% obesidad. La mitad (50,9%) de estos niños realiza actividad física (21 min/día). Diez áreas urbanas de Medellín representan las áreas geográficas con mayor sobrepeso y obesidad. Conclusiones: La REG permite detectar gráficamente las áreas de mayor vulnerabilidad nutricional. La REG muestra que la coexistencia de la malnutrición por deficiencia y exceso varía según el área geográfica. Instituciones deben considerar esta doble carga de la malnutrición: un problema social complejo, que padece Medellín y el mundo entero, de acuerdo a la OMS.

The double burden of malnutrition in under-five children at national and individual levels: observed and expected prevalence in ninety-three low- and middle-income countries.

ObjectiveTo assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels.DesignWe selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child.SettingNationally representative surveys from ninety-three LMIC.ParticipantsA total of 825 633 children were studied.ResultsDBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt.ConclusionsThe observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.

The Co-Occurrence of Overweight and Micronutrient Deficiencies or Anemia among Women of Reproductive Age in Malawi

Background:In low-resource settings, urbanization may contribute to the individual-level double burden of malnutrition (DBM), whereby under- and overnutrition co-occur within the same individuals. Objective:We described DBM prevalence among Malawian women by urban-rural residence, examined whether urban residence was associated with DBM, and assessed whether DBM prevalence was greater than the prevalence expected by chance given population levels of under- and overnutrition, which would suggest DBM is a distinct phenomenon associated with specific factors. Methods:We analyzed nationally representative data of 723 nonpregnant women aged 15–49 y from the 2015–2016 Malawi Micronutrient Survey. DBM was defined as co-occurring overweight or obesity (OWOB) and ≥1 micronutrient deficiency or anemia. We used Poisson regression models to examine the association between urban residence and DBM and its components. The Rao-Scott modified chi-square test compared the observed and expected DBM prevalence. Results:Nationally, 10.8% (95% CI: 7.0, 14.5) of women had co-occurring OWOB and any micronutrient deficiency and 3.4% (95% CI: 1.3, 5.5) had co-occurring OWOB and anemia. The prevalence of co-occurring OWOB and any micronutrient deficiency was 2 times higher among urban women than rural women [urban 32.6 (24.1, 41.2) compared with rural 8.6 (5.2, 11.9), adjusted prevalence ratio: 2.0 (1.1, 3.5)]. Co-occurring OWOB and anemia prevalence did not significantly differ by residence [urban 6.9 (0.6, 13.2) compared with rural 3.0 (0.8, 5.3)]. There were no statistically significant differences in observed and expected prevalence estimates of DBM. Conclusions:This analysis shows that co-occurring OWOB and any micronutrient deficiency was higher among women in urban Malawi compared with rural areas. However, our finding that co-occurring OWOB and any micronutrient deficiency or anemia may be due to chance suggests that there may not be common causes driving DBM in Malawian women. Thus, there may not be a need to design and target interventions specifically for women with DBM.

Prevalence, Changes, and Factors of the Double Burden of Malnutrition at the Individual Level: A Multilateral Analysis

Abstract Objectives The double burden of malnutrition (DBM) is a major public health problem in the world. Overweight and obesity with concurrent stunting (called stuntingoverweight) is one of the specific forms of DBM at the individual level, and it has been documented in several low- and middle-income countries (LMICs). However, the changes in country-level prevalence of stuntingoverweight has not been known. The impact of socioeconomic inequalities on the prevalence of stuntingoverweight also have not been done across LMICs. Thus, this study aimed to investigate the changes of stuntingoverweight prevalence among children under five-years, and to assess socioeconomic inequality in the prevalence in LMICs. Methods Secondary data analysis was conducted in 58 LMICs between 2006 and 2018, comprising 692,704 children under five years old by using the Demographic and Health Surveys (DHS). For stuntingoverweight, the following values were estimated: rate ratio, mean difference, the slope index of inequality (SII), and the relative index of inequality (RII). Results The range of the prevalence of stuntingoverweight was lower than the ranges in the country-level prevalence of stunting and overweight. The relative index of inequality (RII) by wealth status ranged from 0.16 (Peru) to 2.31 (Nepal). RII by maternal education ranged from 0.06 (Kyrgyz Republic) to 15.11 (Tajikistan). Stuntingoverweight was found more in the poorest households. Among 31 LMICs, 27 countries reduced the prevalence of stuntingoverweight except four countries. However, to what extent the prevalence of stuntingoverweight reduced varied between countries. Conclusions The prevalence of stuntingoverweight had been reduced in most countries, and socioeconomic inequalities existed in the prevalence and its change. Governments require health policies in addition to preventing stunting to ensure that children who are already stunted have a healthy life without becoming overweight concurrently. Funding Sources N/A.

Double Burden of Malnutrition Among Women of Reproductive Age in Low- and Middle-Income Countries: Progress Achieved and Opportunities for Meeting the Global Target

Abstract Objectives To monitor progress, make projections and examine inequalities in women's underweight and overweight in low- and middle- income countries (LMICs). Methods We used nationally representative Demographic and Health Survey (DHS) data of 2,337,855 women of reproductive age (15–49 years, mean age 29.7 y, SD ± 9.6) from 55 LMICs, to study the current and projected prevalence of underweight (Body Mass Index &amp;lt; 18.5 kg/m2) and overweight (BMI ≥ 25.0 kg/m2). Bayesian linear regression analyses were performed for trend and projection analysis. Current and projected trends of women's malnutrition were studied, and national as well as subnational level variations, particularly in the context of sociodemographic factors, were explored. Results In 2030, over 20% of women in eight LMICs will be underweight, with Madagascar (36.8%), Senegal (32.2%) and Burundi (29.2%) projected to experience the highest burden of underweight. Whereas, over 50% women in 22 LMICs are projected to be overweight, with Egypt (94.7%), Jordan (75.0%), and Pakistan (74.1%) projected to have the highest burden of overweight. We project that in 2030, 24 LMICs would experience DBM. There is considerable variation in the prevalence of underweight and overweight across national and subnational levels. Wealth, education, and place of residence are seen to have the highest impact on the current and future prevalence of underweight and overweight. It is projected that between 2020 and 2030, socioeconomically disadvantaged groups in LMICs will experience the sharpest increase in the prevalence of overweight. We also found none of the 55 LMICs will be able to eradicate overweight or underweight (barring Egypt) by 2030. Conclusions Overall, the prevalence of underweight in women of reproductive age in LMICs has declined in the past three decades. However, the decrease in the rate of underweight has been superseded by the dramatic increase in the prevalence of overweight. Therefore, it is unlikely that any of the 55 LMICs will be successful in eradicating malnutrition by 2030. Funding Sources None.

Double Burden of Malnutrition Among Elderly People in Bangladesh: Evidence from the National Nutrition Surveillance Study

Abstract Objectives Double burden of malnutrition (DBM), referred as the coexistence of undernutrition and overnutrition, is an evolving public health concern. There is a paucity of data about DBM among elderly people in Bangladesh. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we assessed the prevalence and determinants of DBM among elderly people. Methods In the NNS, we collected data from 30,005 persons in 6 population groups from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. We collected socio-demographic, life-style and anthropometric data from 4817 respondents aged &amp;gt;60 years. Underweight was defined as body mass index (BMI) &amp;lt;18.5 kg/m2 and overweight/obesity as BMI ≥ 23 kg/m2. Results The weighted prevalence of underweight was 26.8%, and was higher among elderly aged ≥70 years (34.4%), male (28.5%), non-diabetic (28.5%), rural residents (27.1%) and with inadequate fruits and vegetables consumption (27.1%). The weighted prevalence of overweight was 27.0%, and was higher among elderly aged 60–69 years (29.8%), female (30.8), diabetic (51.0%), urban residents (48.2%), with poor physical activity (31.3%), and with inadequate fruits and vegetables consumption (27.4%). As education and wealth status increased, the prevalence of underweight decreased and the prevalence of overweight and obesity increased. In multivariable logistic regression, male gender (AOR: 1.33, 95% CI: 1.18,1.51), being non-diabetic (AOR: 1.50, 95% CI: 1.23,1.82), having no education (AOR: 1.73, 95% CI: 1.35,2.22), and having adequate physical activity (AOR: 1.19, 95% CI: 1.05,1.35) were associated with underweight. However, urban residency (AOR: 1.73, 95% CI: 1.41,2.12), 60–69 years age (AOR: 1.59, 95% CI: 1.36,1.85), being female (AOR: 1.81, 95% CI: 1.56,2.10), having diabetes (AOR: 2.52, 95% CI:2.07,3.08), being Muslim (AOR: 1.25, 95% CI: 1.04,1.53), and having inadequate physical activity (AOR: 1.36, 95% CI: 1.18,1.57) were associated with overweight. Conclusions The overall prevalence of undernutrition and overnutrition is very high among elderly population in Bangladesh. The government together with national and international organizations should implement population-based interventions to prevent and control DBM. Funding Sources Ministry of Health and Family Welfare, Bangladesh.

The Dual Burden of Malnutrition in Brazil Among Children 4–13.9 Years of Age

Abstract Objectives To evaluate the prevalence of underweight, overweight and obesity among children aged 4 to 13.9 years in Brazil. Methods Caregivers of a cross-sectional random sample of children aged 4–13.9 years (n = 970) identified in three census regions in Brazil were surveyed. Children's body weight and height were measured using a calibrated scale and a stadiometer following U.S. Centers for Disease Prevention and Control procedures. Reference cut-points generated from a previous sample of Brazilian children using the LMS method to calculated sex specific BMI growth curves that intersected BMIs of 17.5, 25 and 30, at 20 years of age, were used to define underweight, overweight and obese children, respectively. Results Among older children, the prevalence of underweight and obesity decreased while overweight remained relatively stable across all age groups. The percentage (% ± SE) for underweight, overweight, and obese among 4–6.9 year olds (n = 319) were 5.7 ± 1%, 36 ± 4%, and 17 ± 3%, respectively. For 7–10.9 year olds (n = 396), these percentages were 3.1 ± 1%, 38 ± 3%, and 13 ± 2%; and for 11–13.9 year olds (n = 255), 3.2 ± 2%, 37 ± 5%, and 10 ± 3%. The overall percentage of underweight, overweight, and obese for males (n = 508) were 2.8 ± 1%, 34 ± 3%, and 11 ± 2%; and for females (n = 462), 4.9 ± 1%, 40 ± 3%, and 16 ± 2%. The prevalence of malnutrition among females was higher than for males for each condition and across all age categories except among 7–10.9 year olds with overnutrition. Conclusions Brazil is a middle-income country undergoing a rapid nutrition transition. A shift in dietary patterns and consumption and energy expenditures can result in the double burden of malnutrition, characterized by the coexistence of undernutrition and overweight and obesity within the population. Both are serious health problems, particularly when they occur in childhood as the effects can linger into adulthood. In 2019, the prevalence of overweight and obesity remain elevated, as does underweight, particularly among females. Promotion of physical activity and encouraging healthy dietary habits are needed to curtail obesity and overweight rates, with poverty reduction efforts enhanced to address the prevalence of underweight children. Funding Sources This project was funded by Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland.

Nutritional assessment among adult patients with suspected or confirmed active tuberculosis disease in rural India.

ObjectivesOur study goal was to evaluate a set of nutritional indicators among adults with confirmed or suspected active tuberculosis disease in southern India, given the limited literature on this topic. Study objectives were to assess the: I) double burden of malnutrition at individual and population levels; II) relative performance of anthropometric indicators (body mass index, waist circumference) in diabetes screening; and III) associations between vitamin D and metabolic abnormalities.DesignCross-sectional study.SettingHospital in rural southern India.ParticipantsAmong adult patients (n = 834), we measured anthropometry, body composition, and biomarkers (vitamin D, glycated hemoglobin, hemoglobin) of nutritional status. Subsets of participants provided blood and sputum samples.ResultsAmong participants, 91.7% had ≥ 1 malnutrition indicator; 34.6% had both undernutrition and overnutrition indicators. Despite the fact that >80% of participants would be considered low-risk in diabetes screening based on low body mass index and waist circumference, approximately one-third had elevated glycated hemoglobin (≥ 5.7%). The lowest quintile of serum 25-hydroxyvitamin D was associated with an increased risk of glycated hemoglobin ≥ 5.7% (adjusted risk ratio 1.61 [95% CI 1.02, 2.56]) compared to the other quintiles, adjusting for age and trunk fat.ConclusionsMalnutrition and diabetes were prevalent in this patient population; since both can predict poor prognosis of active tuberculosis disease, including treatment outcomes and drug resistance, this emphasizes the importance of dual screening and management of under- and overnutrition-related indicators among patients with suspected or active tuberculosis disease. Further studies are needed to determine clinical implications of vitamin D as a potential modifiable risk factor in metabolic abnormalities, and whether population-specific body mass index and waist circumference cut-offs improve diabetes screening.

Concerned and conscious, but defenceless - the intersection of gender and generation in child malnutrition in Indonesia: a qualitative grounded theory study

ABSTRACT Background: Several studies in Indonesia have shown the protective effect of women-headed households on the double burden of malnutrition (coexistence of undernutrition and overnutrition in a household). Many other studies have presented a positive impact on children’s health and conditions when women are educated, have higher social capital and have control of income and its intra-household allocation. However, how women’s status affects the nutritional status of a household and, in particular, of children still remains understudied. Objective: In this study, our aim was to explore the role of gender relations and contextual factors for overnutrition and undernutrition among children within a household. Method: We conducted a qualitative study in two provinces of Indonesia: Central Java (urban and rural) and Jakarta (central and suburban) among 123 community members (59 men and 64 women). We utilised principles of constructivist grounded theory in conducting this study, and focus group discussions were chosen as a tool to collect data. Results: Three categories were constructed, capturing the significance of: (i) the man is dominant within the family (gendered power relations), (ii) the environment that makes the unhealthy choice the easy choice (the emerging obesogenic environment) and (iii) parents’ being concerned but unable to control their children’s eating habits (intersection of gender and generational relations) in child malnutrition. Conclusion: Community health and nutrition programmes should help both women and men within the context of households to acknowledge and respect women’s status. More importantly, these programmes should involve men when it comes to children’s nutritional habits and consider them as an important factor in the realisation of gender equality and empowerment. Furthermore, it is increasingly important to recognise the implication of the availability and accessibility of junk food among children.

English

The incidence of diabetes has been growing over the years with serious and costly consequences, both in terms of human and economic capital, particularly in low- and middle-income countries. Medicinal plants could be usefully included in the treatment of diabetes in an optimized strategy for better cost-effectiveness, given the high cost of pharmaceuticals and their side effects on patients. A total of 36 studies (articles, thesis and final dissertations) were included in the review, including 67% of ethnobotanical studies and 33% of biological and clinical trials. In ethnobotanical studies, the different parts of the plant (leaves, seeds, fruits or pods, flowers, bark and roots) were cited in all series. In contrast, in the bioassays, only leaves, seeds and roots were used in the experiments. However, leaves remain the most widely used organ, with an efficacy that has been demonstrated in bioassays confirming ethnobotanical surveys. In view of the results collected, in-depth studies on the use of M. oleifera in the management of diabetes particularly in Sahelian countries would be relevant in the fight against the double burden of malnutrition. Key words: Moringa oleifera, diabete, antidiabetic properties. &nbsp;

Are dietary intake and nutritional status influenced by gender? The pattern of dietary intake in Lao PDR: a developing country

BackgroundRecognition of discrepancies between men and women in nutritional intake is important to tackle food and nutrition insecurity and the often-double burden of malnutrition. The purpose of this study was to assess nutritional status and dietary intake of the Lao population, with a focus on possible influences of gender.MethodsDietary intake was assessed in a national cross-sectional study of 1771 randomized participants aged from 1.01 to 89 years, using 24-h dietary recall. Dietary reference intakes were used to assess nutrient insufficiency. Chi-square test was used to evaluate gender differences and multiple univariate logistic regression to examine associations between gender, nutritional status, demographics and nutrient insufficiency.ResultsNutrient insufficiencies were higher among pregnant and lactating women than other adult men and women, especially for protein and micronutrients such as vitamin B3, B1, C and other vitamins. Dietary intake and BMI were similar between men and women; all had insufficient intake of all types of nutrients, except sodium. However, women had lower intake than men for almost all nutrients and age groups. The prevalence of overnutrition was higher among those aged 18 years and over for both sexes. Among adult women (15–49.9 years old) and older adult women (50 years old or above), the proportions were: underweight 8.6% (both groups), overweight 18.4 and 20.5%, and obese 34.2 and 39.1%, respectively. Among pregnant and lactating women, the rates of underweight were 7.5 and 1.4%, of overweight were 17.8 and 27.1%, and obese, 21.9 and 40.0%. Among adult and older men, 3.2 and 8.3% were underweight; 21.0 and 18.6% were overweight and 28.2 and 27.6% were obese. Multiple univariate logistic regressions revealed that the factors rural area, dry season and Northern-Lowland region were associated with inadequate micronutrient intake among children, adolescents and adults of both genders.ConclusionsDietary intakes were alarmingly micronutrient-insufficient. Macronutrient imbalance and double burden of malnutrition were confirmed in both sexes. Gender differences were limited; men and women had similarly insufficient intakes, but pregnant and lactating women were disproportionately affected. Nutritional interventions should also take men and older people into account to solve nutrition problems.