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The Double Burden of Undernutrition and Overnutrition in Developing Countries: an Update


Many developing countries have achieved a remarkable improvement in nutrition status in the past decades. However, the prevalence of undernutrition remains a serious problem. At the same time, the prevalence of obesity is increasing substantially, and in some countries, it has approached that of developed countries. This article provides an update on this double burden of malnutrition (DBMN) in developing nations. One hundred countries (lower, middle-lower, and upper-middle income countries) were selected and analysed, and to support the analysis, a systematic review of current published studies was performed. The results show that DBMN already exists in almost all developing countries and that the DBMN ratio (i.e., overweight/underweight) has increased as income per capita has increased. DBMN may manifest within the community, household, or individual. In addition to common factors, poor nutrition in early childhood is suggested as another important driving factor behind the rising obesity rate in most developing countries. A life-course approach has been proposed to prevent undernutrition and overnutrition and should be integrated into the development of health systems to control double burden in developing countries.

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Papers of particular interest, published recently, have been highlighted as • Of importance article •• Of outstanding importance

  1. 1.•

    Kulkarni B, Hills AP, Byrne NM. Nutritional influences over the life course on lean body mass of individuals in developing countries. Nutr Rev. 2014;72(3):190–204. This article provides a strong argument for the importance of improving nutrient intake throughout the life course to reduce the prevalence of DBMN.

  2. 2.

    Popkin BM. The nutrition transition in low-income countries: an emerging crisis. Nutr Rev. 1994;52(9):285–98.

    CAS  PubMed  Article  Google Scholar 

  3. 3.••

    Tzioumis E, Adair LS. Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review. Food Nutr Bull. 2014;35(2):230–43. This article provides a thorough review of DBMN at different levels: community, household, and individual.

  4. 4.

    Cai W. Nutritional challenges for children in societies in transition. Curr Opin Clin Nutr Metab Care. 2014;17(3):278–84.

    PubMed  Article  Google Scholar 

  5. 5.

    Neufeld LM, Osendarp SJ. Global, regional and country trends in underweight and stunting as indicators of nutrition and health of populations. Nestle Nutr Inst Workshop Ser. 2014;78:11–9.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Popkin BM, Slining MM. New dynamics in global obesity facing low- and middle-income countries. Obes Rev. 2013;14 Suppl 2:11–20.

    PubMed Central  PubMed  Article  Google Scholar 

  7. 7.

    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.

    PubMed  Article  Google Scholar 

  8. 8.

    Wise J. Obesity rates rise substantially worldwide. BMJ. 2014;348:g3582.

    PubMed  Article  Google Scholar 

  9. 9.

    Roemling C, Qaim M. Obesity trends and determinants in Indonesia. Appetite. 2012;58(3):1005–13.

    PubMed  Article  Google Scholar 

  10. 10.

    Bhutta ZA, Ahmed T, Black RE, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40.

    PubMed  Article  Google Scholar 

  11. 11.

    Piwoz E, Sundberg S, Rooke J. Promoting healthy growth: what are the priorities for research and action? Adv Nutr. 2012;3(2):234–41.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  12. 12.

    Uauy R, Kain J, Mericq V, et al. Nutrition, child growth, and chronic disease prevention. Ann Med. 2008;40(1):11–20.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Shetty P. Community-based approaches to address childhood undernutrition and obesity in developing countries. Nestle Nutr Workshop Ser Pediatr Program. 2009;63:227–54. discussion 254-7, 259-68.

    PubMed  Article  Google Scholar 

  14. 14.

    Hruschka DJ, Brewis AA. Absolute wealth and world region strongly predict overweight among women (ages 18-49) in 360 populations across 36 developing countries. Econ Hum Biol. 2013;11(3):337–44.

    PubMed  Article  Google Scholar 

  15. 15.

    Monteiro CA, Moura EC, Conde WL, et al. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2004;82(12):940–6.

    PubMed Central  PubMed  Google Scholar 

  16. 16.

    McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29:29–48.

    PubMed  Article  Google Scholar 

  17. 17.

    Jones-Smith JC, Gordon-Larsen P, Siddiqi A, et al. Is the burden of overweight shifting to the poor across the globe? Time trends among women in 39 low- and middle-income countries (1991-2008). Int J Obes (Lond). 2012;36(8):1114–20.

    CAS  Article  Google Scholar 

  18. 18.

    Jones-Smith JC, Gordon-Larsen P, Siddiqi A, et al. Cross-national comparisons of time trends in overweight inequality by socioeconomic status among women using repeated cross-sectional surveys from 37 developing countries, 1989-2007. Am J Epidemiol. 2011;173(6):667–75.

    PubMed Central  PubMed  Article  Google Scholar 

  19. 19.

    Olszowy KM, Dufour DL, Bender RL, et al. Socioeconomic status, stature, and obesity in women: 20-year trends in urban Colombia. Am J Hum Biol. 2012;24(5):602–10.

    PubMed  Article  Google Scholar 

  20. 20.

    Oddo VM, Rah JH, Semba RD, et al. Predictors of maternal and child double burden of malnutrition in rural Indonesia and Bangladesh. Am J Clin Nutr. 2012;95(4):951–8.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Adair LS. Long-term consequences of nutrition and growth in early childhood and possible preventive interventions. Nestle Nutr Inst Workshop Ser. 2014;78:111–20.

    PubMed  Article  Google Scholar 

  22. 22.

    Yang Z, Huffman SL. Nutrition in pregnancy and early childhood and associations with obesity in developing countries. Matern Child Nutr. 2013;9 Suppl 1:105–19.

    PubMed  Article  Google Scholar 

  23. 23.

    Varela-Silva MI, Dickinson F, Wilson H, et al. The nutritional dual-burden in developing countries--how is it assessed and what are the health implications? Coll Antropol. 2012;36(1):39–45.

    PubMed  Google Scholar 

  24. 24.

    Uauy R, Kain J, Corvalan C. How can the developmental origins of health and disease (DOHaD) hypothesis contribute to improving health in developing countries? Am J Clin Nutr. 2011;94(6 Suppl):1759s–64.

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Corsi DJ, Finlay JE, Subramanian SV. Global burden of double malnutrition: has anyone seen it? PLoS One. 2011;6(9):e25120.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  26. 26.•

    Haddad L, Cameron L, and Barnett I. The double burden of malnutrition in SE Asia and the Pacific: priorities, policies and politics. Health Policy Plan. 2014. This article reviews the political opportunities and health system challenges of addressing the double burden issue in developing countries.

  27. 27.

    Vaezghasemi M, Ohman A, Eriksson M, et al. The effect of gender and social capital on the dual burden of malnutrition: a multilevel study in Indonesia. PLoS One. 2014;9(8):e103849.

    PubMed Central  PubMed  Article  Google Scholar 

  28. 28.

    Laillou A, Yakes E, Le TH, et al. Intra-individual double burden of overweight and micronutrient deficiencies among Vietnamese women. PLoS One. 2014;9(10):e110499.

    PubMed Central  PubMed  Article  Google Scholar 

  29. 29.

    Khan NC, Khoi HH. Double burden of malnutrition: the Vietnamese perspective. Asia Pac J Clin Nutr. 2008;17 Suppl 1:116–8.

    PubMed  Google Scholar 

  30. 30.

    Winichagoon P. Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pac J Clin Nutr. 2013;22(1):6–15.

    PubMed  Google Scholar 

  31. 31.

    Roemling C, Qaim M. Dual burden households and intra-household nutritional inequality in Indonesia. Econ Hum Biol. 2013;11(4):563–73.

    PubMed  Article  Google Scholar 

  32. 32.

    Khan SH, Talukder SH. Nutrition transition in Bangladesh: is the country ready for this double burden. Obes Rev. 2013;14 Suppl 2:126–33.

    PubMed  Article  Google Scholar 

  33. 33.

    Le Nguyen BK, Le Thi H, Nguyen Do VA, et al. Double burden of undernutrition and overnutrition in Vietnam in 2011: results of the SEANUTS study in 0.5-11-year-old children. Br J Nutr. 2013;110 Suppl 3:S45–56.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Shafique S, Akhter N, Stallkamp G, et al. Trends of under- and overweight among rural and urban poor women indicate the double burden of malnutrition in Bangladesh. Int J Epidemiol. 2007;36(2):449–57.

    PubMed  Article  Google Scholar 

  35. 35.

    Rivera JA, Pedraza LS, Martorell R, et al. Introduction to the double burden of undernutrition and excess weight in Latin America. Am J Clin Nutr. 2014;100(6):1613s–6.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Sarmiento OL, Parra DC, Gonzalez SA, et al. The dual burden of malnutrition in Colombia. Am J Clin Nutr. 2014;100(6):1628s–35.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Severi C, Moratorio X. Double burden of undernutrition and obesity in Uruguay. Am J Clin Nutr. 2014;100(6):1659s–62.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Kroker-Lobos MF, Pedroza-Tobias A, Pedraza LS, et al. The double burden of undernutrition and excess body weight in Mexico. Am J Clin Nutr. 2014;100(6):1652s–8.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Ramirez-Zea M, Kroker-Lobos MF, Close-Fernandez R, et al. The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations. Am J Clin Nutr. 2014;100(6):1644s–51.

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Freire WB, Silva-Jaramillo KM, Ramirez-Luzuriaga MJ, et al. The double burden of undernutrition and excess body weight in Ecuador. Am J Clin Nutr. 2014;100(6):1636s–43.

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Conde WL, Monteiro CA. Nutrition transition and double burden of undernutrition and excess of weight in Brazil. Am J Clin Nutr. 2014;100(6):1617s–22.

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Chaparro MP, Estrada L. Mapping the nutrition transition in Peru: evidence for decentralized nutrition policies. Rev Panam Salud Publica. 2012;32(3):241–4.

    PubMed  Article  Google Scholar 

  43. 43.

    Steyn NP, McHiza ZJ. Obesity and the nutrition transition in Sub-Saharan Africa. Ann N Y Acad Sci. 2014;1311:88–101.

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Vorster HH, Kruger A, Margetts BM. The nutrition transition in Africa: can it be steered into a more positive direction? Nutrients. 2011;3(4):429–41.

    PubMed Central  PubMed  Article  Google Scholar 

  45. 45.

    Jehn M, Brewis A. Paradoxical malnutrition in mother-child pairs: untangling the phenomenon of over- and under-nutrition in underdeveloped economies. Econ Hum Biol. 2009;7(1):28–35.

    PubMed  Article  Google Scholar 

  46. 46.

    Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol. 2002;31(2):285–93.

    PubMed  Article  Google Scholar 

  47. 47.

    Garrett J, Ruel MT. The coexistence of child undernutrition and maternal overweight: prevalence, hypotheses, and programme and policy implications. Matern Child Nutr. 2005;1(3):185–96.

    PubMed  Article  Google Scholar 

  48. 48.

    Garrett JL, Ruel MT. Stunted child-overweight mother pairs: prevalence and association with economic development and urbanization. Food Nutr Bull. 2005;26(2):209–21.

    PubMed  Google Scholar 

  49. 49.

    Dieffenbach S, Stein AD. Stunted child/overweight mother pairs represent a statistical artifact, not a distinct entity. J Nutr. 2012;142(4):771–3.

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    Doak C, Adair L, Bentley M, et al. The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China. Public Health Nutr. 2002;5(1a):215–21.

    PubMed  Google Scholar 

  51. 51.

    Doak CM, Adair LS, Bentley M, et al. The dual burden household and the nutrition transition paradox. Int J Obes (Lond). 2005;29(1):129–36.

    CAS  Article  Google Scholar 

  52. 52.

    Trowbridge FL, Marks JS, de Lopez Romana G, et al. Body composition of Peruvian children with short stature and high weight-for-height. II. Implications for the interpretation for weight-for-height as an indicator of nutritional status. Am J Clin Nutr. 1987;46(3):411–8.

    CAS  PubMed  Google Scholar 

  53. 53.

    Martorell R, Mendoza FS, Castillo RO, et al. Short and plump physique of Mexican-American children. Am J Phys Anthropol. 1987;73(4):475–87.

    CAS  PubMed  Article  Google Scholar 

  54. 54.

    Golden MH. Specific deficiencies versus growth failure: type I and type II nutrients. SCN News. 1995;12:10–4.

    PubMed  Google Scholar 

  55. 55.

    Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by "progress"? Am J Hum Genet. 1962;14:353–62.

    CAS  PubMed Central  PubMed  Google Scholar 

  56. 56.

    Speakman JR. Thrifty genes for obesity and the metabolic syndrome--time to call off the search? Diab Vasc Dis Res. 2006;3(1):7–11.

    PubMed  Article  Google Scholar 

  57. 57.

    Speakman JR. Thrifty genes for obesity, an attractive but flawed idea, and an alternative perspective: the ‘drifty gene’ hypothesis. Int J Obes (Lond). 2008;32(11):1611–7.

    CAS  Article  Google Scholar 

  58. 58.

    Speakman JR. Evolutionary perspectives on the obesity epidemic: adaptive, maladaptive, and neutral viewpoints. Annu Rev Nutr. 2013;33:289–317.

    CAS  PubMed  Article  Google Scholar 

  59. 59.

    Sellayah D, Cagampang FR, Cox RD. On the evolutionary origins of obesity: a new hypothesis. Endocrinology. 2014;155(5):1573–88.

    PubMed  Article  Google Scholar 

  60. 60.

    Gupta N, Goel K, Shah P, et al. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev. 2012;33(1):48–70.

    CAS  PubMed  Article  Google Scholar 

  61. 61.

    Joglekar CV, Fall CH, Deshpande VU, et al. Newborn size, infant and childhood growth, and body composition and cardiovascular disease risk factors at the age of 6 years: the Pune Maternal Nutrition Study. Int J Obes (Lond). 2007;31(10):1534–44.

    CAS  Article  Google Scholar 

  62. 62.

    Sachdev HS, Fall CH, Osmond C, et al. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr. 2005;82(2):456–66.

    CAS  PubMed  Google Scholar 

  63. 63.

    Barr JG, Veena SR, Kiran KN, et al. The relationship of birthweight, muscle size at birth and post-natal growth to grip strength in 9-year-old Indian children: findings from the Mysore Parthenon study. J Dev Orig Health Dis. 2010;1(5):329–37.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  64. 64.

    Kuzawa CW, McDade TW, Adair LS, et al. Rapid weight gain after birth predicts life history and reproductive strategy in Filipino males. Proc Natl Acad Sci U S A. 2010;107(39):16800–5.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  65. 65.

    Wells JC, Hallal PC, Wright A, et al. Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years. Int J Obes (Lond). 2005;29(10):1192–8.

    CAS  Article  Google Scholar 

  66. 66.

    Wells JC, Dumith SC, Ekelund U, et al. Associations of intrauterine and postnatal weight and length gains with adolescent body composition: prospective birth cohort study from Brazil. J Adolesc Health. 2012;51(6 Suppl):S58–64.

    PubMed Central  PubMed  Article  Google Scholar 

  67. 67.

    Gigante DP, Victora CG, Horta BL, et al. Undernutrition in early life and body composition of adolescent males from a birth cohort study. Br J Nutr. 2007;97(5):949–54.

    CAS  PubMed  Article  Google Scholar 

  68. 68.

    Corvalan C, Gregory CO, Ramirez-Zea M, et al. Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population. Int J Epidemiol. 2007;36(3):550–7.

    CAS  PubMed  Article  Google Scholar 

  69. 69.

    Lynch J, Smith GD. A life course approach to chronic disease epidemiology. Annu Rev Public Health. 2005;26:1–35.

    PubMed  Article  Google Scholar 

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The preliminary search of published studies was supported by Vera Nazhira, Fauzi Ali Amin, Suzana Hasan Basri, and Wardiati Yusuf from the Department of Public Health Nutrition, Faculty of Public Health, University Muhammadiyah Aceh.

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Asnawi Abdullah declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by the author.

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Correspondence to Asnawi Abdullah.

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This article is part of the Topical Collection on The Obesity Epidemic: Causes and Consequences

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Abdullah, A. The Double Burden of Undernutrition and Overnutrition in Developing Countries: an Update. Curr Obes Rep 4, 337–349 (2015).

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  • Underweight
  • Overweight
  • Obesity
  • Double burden
  • Malnutrition
  • Developing countries