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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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.
Popkin BM. The nutrition transition in low-income countries: an emerging crisis. Nutr Rev. 1994;52(9):285–98.
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.
Cai W. Nutritional challenges for children in societies in transition. Curr Opin Clin Nutr Metab Care. 2014;17(3):278–84.
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.
Popkin BM, Slining MM. New dynamics in global obesity facing low- and middle-income countries. Obes Rev. 2013;14 Suppl 2:11–20.
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.
Wise J. Obesity rates rise substantially worldwide. BMJ. 2014;348:g3582.
Roemling C, Qaim M. Obesity trends and determinants in Indonesia. Appetite. 2012;58(3):1005–13.
Bhutta ZA, Ahmed T, Black RE, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40.
Piwoz E, Sundberg S, Rooke J. Promoting healthy growth: what are the priorities for research and action? Adv Nutr. 2012;3(2):234–41.
Uauy R, Kain J, Mericq V, et al. Nutrition, child growth, and chronic disease prevention. Ann Med. 2008;40(1):11–20.
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.
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.
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.
McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29:29–48.
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.
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.
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.
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.
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.
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.
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.
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.
Corsi DJ, Finlay JE, Subramanian SV. Global burden of double malnutrition: has anyone seen it? PLoS One. 2011;6(9):e25120.
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.
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.
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.
Khan NC, Khoi HH. Double burden of malnutrition: the Vietnamese perspective. Asia Pac J Clin Nutr. 2008;17 Suppl 1:116–8.
Winichagoon P. Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pac J Clin Nutr. 2013;22(1):6–15.
Roemling C, Qaim M. Dual burden households and intra-household nutritional inequality in Indonesia. Econ Hum Biol. 2013;11(4):563–73.
Khan SH, Talukder SH. Nutrition transition in Bangladesh: is the country ready for this double burden. Obes Rev. 2013;14 Suppl 2:126–33.
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.
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.
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.
Sarmiento OL, Parra DC, Gonzalez SA, et al. The dual burden of malnutrition in Colombia. Am J Clin Nutr. 2014;100(6):1628s–35.
Severi C, Moratorio X. Double burden of undernutrition and obesity in Uruguay. Am J Clin Nutr. 2014;100(6):1659s–62.
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.
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.
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.
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.
Chaparro MP, Estrada L. Mapping the nutrition transition in Peru: evidence for decentralized nutrition policies. Rev Panam Salud Publica. 2012;32(3):241–4.
Steyn NP, McHiza ZJ. Obesity and the nutrition transition in Sub-Saharan Africa. Ann N Y Acad Sci. 2014;1311:88–101.
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.
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.
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.
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.
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.
Dieffenbach S, Stein AD. Stunted child/overweight mother pairs represent a statistical artifact, not a distinct entity. J Nutr. 2012;142(4):771–3.
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.
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.
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.
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.
Golden MH. Specific deficiencies versus growth failure: type I and type II nutrients. SCN News. 1995;12:10–4.
Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by "progress"? Am J Hum Genet. 1962;14:353–62.
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.
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.
Speakman JR. Evolutionary perspectives on the obesity epidemic: adaptive, maladaptive, and neutral viewpoints. Annu Rev Nutr. 2013;33:289–317.
Sellayah D, Cagampang FR, Cox RD. On the evolutionary origins of obesity: a new hypothesis. Endocrinology. 2014;155(5):1573–88.
Gupta N, Goel K, Shah P, et al. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev. 2012;33(1):48–70.
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.
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.
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.
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.
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.
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.
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.
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.
Lynch J, Smith GD. A life course approach to chronic disease epidemiology. Annu Rev Public Health. 2005;26:1–35.
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.
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). https://doi.org/10.1007/s13679-015-0170-y
- Double burden
- Developing countries