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The Double Burden of Malnutrition
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The Double Burden of Malnutrition

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (10 December 2019) | Viewed by 30723

Special Issue Editor

Prof. Dr. José Luis Peñalvo

E-Mail Website
Guest Editor
Non-Communicable Diseases Unit, Institute of Tropical Medicine, B-2000 Antwerp, Belgium
Interests: non-communicable diseases; obesity; diabetes; dietary patterns; lifestyle; malnutrition; double burden of malnutrition; vulnerable populations; effectiveness of dietary interventions; modeling; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The coexistence of undernutrition along with overweight and obesity, and diet-related noncommunicable diseases (NCDs) is known as the double burden of malnutrition. Demographic shits, rapid economic growth, unplanned urbanization, and cultural globalization are the main causes of these contrasting forms of malnutrition and the accelerated rise of NCDs observed across low- and middle-income countries. In these settings, while undernutrition and stunting remain highly prevalent, the burden of malnutrition shift progresively to obesity with rising country income and unseemly nutrition transitions. This complex intersection may take place at the population, household or individual level, and at different times throughout the lifecourse. Furthermore,  low-income strata and women withstand a significantly higher risk of double burden, hence potentially worsening the health disparity gap between gender, and income levels.

Althought the determinants of the onset of the double burden of malnutrition are dependent on the setting and underlying socio-economic drivers, the outcomes of this double threat represent a public health priority. The notion of double-duty actions incorporate interventions and strategies capable of tackling simultaneously manutrition in all forms. These strategies offer a unique opportunity for integrated approaches that can contribute to the realization of SDGs, and curbing global NCDs burden.

For this special issue of Nutrients, we welcome research reporting the quantification of the double burden of malnutrition at the individual, community, or country level. Manuscripts dealing with the development and implementation, and evaluation of direct and integrated interventions to tackle malnutrition and improving the nutritional status and health of vulnerable populations, are particularly appreciated.

Prof. José L Peñalvo
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • malnutrition
  • noncommunicable diseases
  • double burden
  • double-duty actions

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Published Papers (5 papers)

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Research

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20 pages, 10949 KiB  
Article
Using Group Model Building to Describe the System Driving Unhealthy Eating and Identify Intervention Points: A Participatory, Stakeholder Engagement Approach in the Caribbean
by Leonor Guariguata, Etiënne AJA Rouwette, Madhuvanti M Murphy, Arlette Saint Ville, Leith L Dunn, Gordon M Hickey, Waneisha Jones, T Alafia Samuels and Nigel Unwin
Nutrients 2020, 12(2), 384; https://doi.org/10.3390/nu12020384 - 31 Jan 2020
Cited by 29 | Viewed by 7068
Abstract
Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the [...] Read more.
Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the complex dynamic systems driving unhealthy eating and to identify potential points for intervention in three dissimilar countries. Stakeholders from across the food system in Jamaica (n = 16), St. Kitts and Nevis (n = 19), and St. Vincent and the Grenadines (n = 6) engaged with researchers in two group model building (GMB) workshops in 2018. Participants described and mapped the system driving unhealthy eating, identified points of intervention, and created a prioritized list of intervention strategies. Stakeholders were also interviewed before and after the workshops to provide their perspectives on the utility of this approach. Stakeholders described similar underlying systems driving unhealthy eating across the three countries, with a series of dominant feedback loops identified at multiple levels. Participants emphasized the importance of the relative availability and price of unhealthy foods, shifting cultural norms on eating, and aggressive advertising from the food industry as dominant drivers. They saw opportunities for governments to better regulate advertising, disincentivize unhealthy food options, and bolster the local agricultural sector to promote food sovereignty. They also identified the need for better coordinated policy making across multiple sectors at national and regional levels to deliver more integrated approaches to improving nutrition. GMB proved to be an effective tool for engaging a highly diverse group of stakeholders in better collective understanding of a complex problem and potential interventions. Full article
(This article belongs to the Special Issue The Double Burden of Malnutrition)
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14 pages, 1511 KiB  
Article
Nutrition Transition in the Post-Economic Crisis of Greece: Assessing the Nutritional Gap of Food-Insecure Individuals. A Cross-Sectional Study
by Eleni Chatzivagia, Aleks Pepa, Antonis Vlassopoulos, Olga Malisova, Konstantina Filippou and Maria Kapsokefalou
Nutrients 2019, 11(12), 2914; https://doi.org/10.3390/nu11122914 - 2 Dec 2019
Cited by 22 | Viewed by 5383
Abstract
Food insecurity has risen by 40% in Europe’s post-economic crisis, linked to the economic turmoil and austerity. Despite the intensification of efforts to fight all forms of poverty, including the implementation of programs targeted to the most deprived, the study of individuals at [...] Read more.
Food insecurity has risen by 40% in Europe’s post-economic crisis, linked to the economic turmoil and austerity. Despite the intensification of efforts to fight all forms of poverty, including the implementation of programs targeted to the most deprived, the study of individuals at risk of food insecurity has been largely neglected. This study aimed to map the nutritional habits and needs of the most deprived in Greece, one of the countries most affected by the economic crisis. Individuals classified as most deprived under the Fund for the European Aid to the Most Deprived (FEAD) criteria (n = 499) from across Greece and an age matched control from the general population (n = 500) were interviewed between December 2017 and December 2019. Participants provided information about demographic characteristics, and self-reported anthropometric measures and nutritional intake of the past month via a food frequency questionnaire (FFQ). Protein and energy malnutrition were defined as daily intake <1.950 kcal and ≤0.75 g/kg body-weight accordingly. Protein and energy malnutrition were high among FEAD recipients (52.3% and 18.6% respectively, p < 0.001), alongside a high prevalence of overweight and obesity (BMI > 25: 68.4% versus 55.1%; p < 0.001). The diet of FEAD recipients included higher amounts of carbohydrates, lower amounts of monounsaturated fat (MUFA) and polyunsaturated fat (PUFA; p < 0.001 compared to control), larger amounts of plant-based proteins (5.81 ± 1.7 versus 4.94 ± 1.3% E respectively, p < 0.001) and very limited intake of fish (0.07 portions/day). Despite being enrolled in a food assistance program, protein and energy malnutrition is prevalent among Greece’s most deprived who experience not only lower diet quality but also the double burden of malnutrition. Full article
(This article belongs to the Special Issue The Double Burden of Malnutrition)
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10 pages, 410 KiB  
Article
Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE
by Mirey Karavetian, Nada Salhab, Rana Rizk and Kalliopi Anna Poulia
Nutrients 2019, 11(11), 2771; https://doi.org/10.3390/nu11112771 - 14 Nov 2019
Cited by 32 | Viewed by 5165
Abstract
(1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare [...] Read more.
(1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria. Full article
(This article belongs to the Special Issue The Double Burden of Malnutrition)
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12 pages, 983 KiB  
Article
Dietary Patterns and the Double Burden of Malnutrition in Mexican Adolescents: Results from ENSANUT-2006
by Arli Guadalupe Zárate-Ortiz, Alida Melse-Boonstra, Sonia Rodríguez-Ramírez, Sonia Hernández-Cordero and Edith J. M. Feskens
Nutrients 2019, 11(11), 2753; https://doi.org/10.3390/nu11112753 - 13 Nov 2019
Cited by 15 | Viewed by 5106
Abstract
Mexico is facing the double burden of malnutrition, and adolescents are not an exception. Diet plays an important role, both in causing overweight and undernutrition. This study aimed to describe the dietary patterns (DPs) of Mexican adolescents and to examine its association with [...] Read more.
Mexico is facing the double burden of malnutrition, and adolescents are not an exception. Diet plays an important role, both in causing overweight and undernutrition. This study aimed to describe the dietary patterns (DPs) of Mexican adolescents and to examine its association with nutritional status using data from adolescents aged 12–19 years (n = 7380) from the National Survey of Health and Nutrition (ENSANUT-2006). Principal component analysis was used to derivate the DPs. Associations between DP and nutritional status were determined by prevalence ratio (PR). Four DPs were identified: nontraditional and breakfast-type, Western, plant-based, and protein-rich. The prevalence of overweight and obesity was higher in adolescents who scored high on the Western pattern (PR: 1.15, 95% CI: 1.08–1.21) or on the plant-based pattern (PR: 1.09, 95% CI: 1.03–1.17). The Western pattern was positively associated with anemia in girls (PR: 1.18, 95% CI: 1.03–1.35), while the nontraditional and breakfast-type pattern was inversely associated with anemia in adolescents aged 12–15 years (PR: 0.87, 95% CI: 0.76–0.99) and in girls (PR: 0.84, 95% CI: 0.75–0.97). The Western and plant-based patterns were simultaneously associated with overweight–obesity and at least one indicator of undernutrition. In the context of the double burden of malnutrition, dietary advice must consider malnutrition in all its forms. Full article
(This article belongs to the Special Issue The Double Burden of Malnutrition)
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Review

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14 pages, 410 KiB  
Review
Actions Targeting the Double Burden of Malnutrition: A Scoping Review
by Sonia Menon and José L. Peñalvo
Nutrients 2020, 12(1), 81; https://doi.org/10.3390/nu12010081 - 27 Dec 2019
Cited by 32 | Viewed by 6958
Abstract
Background: In many developing countries, nutritional and epidemiological transitions are contributing to continuous undernutrition and escalating overnutrition, resulting in coexisting forms of malnutrition often referred as the “double burden of malnutrition” (DBM). This complex phenomenon constitutes an unprecedented challenge to global public health [...] Read more.
Background: In many developing countries, nutritional and epidemiological transitions are contributing to continuous undernutrition and escalating overnutrition, resulting in coexisting forms of malnutrition often referred as the “double burden of malnutrition” (DBM). This complex phenomenon constitutes an unprecedented challenge to global public health and has been prioritized by international health organizations, prompting governments to swift action. Specifically, five years ago the World Health Organization (WHO) proposed a roadmap to tackle the DBM though so-called “double-duty actions”. The objective of this review was to synthesize the literature on interventions which address the DBM. Methods: We developed a scoping review to identify interventions addressing the DBM. We searched PUBMED for papers reporting interventions until December 2019. Articles examining interventions, government policies, or tools at the individual, household, or community level to address the DBM were included. Results: Seven articles met the inclusion criteria. Three were from sub-Saharan Africa, one was from Southeast Asia, and one was from Central America. Two were modelling studies, with one covering 24 low-income countries and the other focusing on Ghana. Conclusion: Notwithstanding the pressing issue of the DBM, there is a paucity of studies examining double-duty actions despite the attention that it has garnered within the global nutrition community. Whilst nutrient deficiencies may be curbed by poverty reduction measures, for obesity prevention nutrition, education and promotion of physical activity, along with the encouragement of local food production, may be instrumental. Full article
(This article belongs to the Special Issue The Double Burden of Malnutrition)
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