THE DUAL BURDEN OF MALNUTRITION IN CHILDREN IN LOW- AND MIDDLE-INCOME COUNTRIES

Tzioumis, Emma

THE DUAL BURDEN OF MALNUTRITION IN CHILDREN IN LOW- AND MIDDLE-INCOME COUNTRIES Public Deposited

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March 20, 2019

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Tzioumis, Emma
- Affiliation: Gillings School of Global Public Health, Department of Nutrition

Abstract

High levels of childhood undernutrition persist in many low- and middle-income countries (LMIC). Rapid shifts in dietary and physical activity patterns brought about by the nutrition transition have led to increased childhood obesity in these same countries, leading to the co-existence of under- and overnutrition, known as the dual burden of malnutrition. The dual burden occurs at the population, household, and individual level. We used two different data sources to address the different levels of the dual burden in children: 1) Demographic and Health Surveys (DHS) from over 35 countries to assess contemporary global anthropometric trends in children <5y and to explore the role of socioeconomic status, and 2) the Cebu Longitudinal Health and Nutrition Survey (CLHNS) to assess determinants of discordant nutritional status among mother-daughter dyads during a period of rapid economic change in the Philippines. Global malnutrition prevalence in children <5y decreased, driven by stunting decreases. Overweight increased in over a third of countries. Children <2 years experienced worse stunting and overweight trends compared to children 2-5y. Countries with nearly equal prevalence of stunting and overweight increased over time. We did not detect a pronounced shift in anthropometry with respect to wealth status as has been noted in adults, however we document a widening wealth gap between the poorest and richest households in a majority of countries. Considerable between-country heterogeneity was noted, which may make drawing global conclusions difficult. We observed a U-shaped relationship between the mother-daughter dyad’s height difference and daughter’s adult central adiposity, with the tallest and shortest daughters experiencing increased central adiposity. This is the first assessment of dual burden trends in children on a global scale. Governments and policy makers must be aware of the changing dynamics and adapt nutrition programs and policies accordingly.

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