World Nutrition Situation Black RE, Singhal A, Uauy R (eds): International Nutrition: Achieving Millennium Goals and Beyond. Nestlé Nutr Inst Workshop Ser, vol 78, pp 39–52, (DOI: 10.1159/000354935) Nestec Ltd., Vevey/S. Karger AG., Basel, © 2014

Addressing the Double Burden of Malnutrition with a Common Agenda Ricardo Uauy a–c  · María Luisa Garmendia a  · Camila Corvalán a   

 

a Institute

 

b Pediatric

of Nutrition and Food Technology, University of Chile, and Department, Catholic University, Santiago de Chile, Chile; c London School of Hygiene and Tropical Medicine, London, UK  

Abstract Addressing malnutrition in all its forms represents an integrated agenda addressing the root causes of malnutrition at all stages of the life course. The issue is not about choosing between addressing undernutrition in the poor versus overnutrition in the affluent. We must recognize that the interventions required to address stunting are different from those needed to reduce underweight and wasting. In most developing regions, there is a coexistence between underweight and stunting in infants and children, while in the adult population it may be overweight and stunting. Malnutrition in all its forms refers to both underweight and overweight. Underweight is defined by a low weight-for-age, a child is underweight because of wasting (low weight-for-height) or stunting (low length-for-age). Stunting refers to low height-for-age independent of their weight-for-age, some stunted children may have excess weight for their stature length. Overweight is excess weight-forlength/-height or high-BMI-for-age. The prevention of nutrition-related chronic diseases is a life-long process that starts in fetal life and continues throughout infancy and later stages of life. It requires promoting healthy diets and active living at each stage. The agenda requires that we tackle malnutrition in all its forms. © 2014 Nestec Ltd., Vevey/S. Karger AG, Basel

The burden of malnutrition and related death, disease and disability has multiple dimensions in the developing as well as in the industrialized regions of the world that are often ignored by experts and laypersons alike. The reality of nutritional problems today, in most of the world is somewhat of a paradox. Pres-

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Introduction

ently, poor countries in which most of the undernutrition burden is concentrated are also suffering rising prevalence of obesity and related noncommunicable disease (NCD) burden [1]. The same policies and programs that successfully served to prevent and control malnutrition in times of slow economic growth or during economic depression are now potentially contributing to the NCD epidemic in developing countries. These policies in most developing and transitional countries have included securing access to food energy sources (mostly cereals, fats and oils) in support of food security. Subsidizing the price of sugar, cereals (wheat, rice, bread), other refined starches, vegetable oil (soy, rapeseed and corn) and in some cases alcohol and animal fat has contributed to generating an obesogenic environment. As malnutrition and infections retreat, progressive inactivity due to changes in the nature of physical work related to productive activities and rural-urban migration serve to reduce energy expenditure during both work and leisure time. This undoubtedly has contributed to fuel the progressive epidemic rise in noncommunicable chronic diseases in developing and transitional countries [2]. International agencies, NGOs and academics dealing with malnutrition were initially reluctant to acknowledge that developing countries were facing a ‘double burden of disease’. However, the extent of NCD epidemic and a better understanding of causes and consequences has led to a present consensus that malnutrition has to be addressed considering the consequences of both deficit and excess energy. The present aim is to continue efforts to lower undernutrition without increasing obesity and the associated NCDs.

Undernutrition is no longer the dominant form of human malnutrition globally; coexistence of the dual expressions of under- and overnutrition can be exemplified globally at all levels. In 2011, the estimated number of people worldwide suffering from overweight [with a body mass index (BMI) >25] exceeded those with underweight (

Addressing the double burden of malnutrition with a common agenda.

Addressing malnutrition in all its forms represents an integrated agenda addressing the root causes of malnutrition at all stages of the life course. ...
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