Double burden of malnutrition at household level: A comparative study among Bangladesh, Nepal, Pakistan, and Myanmar

Abstract Objectives Northern coastal Ecuador has seen rapid market integration since the initiation of a road system in the late 1990 s connecting the region to the Andean mountains. We previously demonstrated that, between 2003 and 2013, living in a relatively remote (less accessible) community was protective against stunting in children under five. Our objectives were to characterize trends in BMI among rural adults over the same period, and to examine the co-occurrence of adult overweight or obesity (OB/OW) and child stunting. Methods Adult anthropometry was collected through a series of case-control studies repeated over a decade across thirty communities (N = 2053). Anthropometry was measured for all children under five in every community (N = 4170). Logistic and mixed-effect Poisson models, weighted to account for the case-control sampling design, were used to estimate the prevalence of OW/OB over time, to examine individual- and household-level risk factors associated with adult OW/OB, and to examine the co-occurrence of adult OW/OB and under-five stunting within households. Results Among men, OW/OB increased over time (35.0% in 2003 to 52.9% by 2013) and was most common in the least remote versus the most remote communities (46.2% versus 26.9% across the study period). Among women, OW/OB was more prevalent (65.4%), but was not associated with community remoteness and did not increase over time. At the community level, the prevalence of under-five stunting was correlated with the prevalence of OW/OB among men (Spearman's ρ = 0.56, P = 0.002) but not women (Spearman's ρ = 0.16, P = 0.404). However, the presence of a stunted child under five within the household was not associated with adult OW/OB (odds ratio 0.87, P = 0.151). Conclusions Changes in food environments and livelihoods due to the presence of roads may have driven increasing OW/OB among men over the study period. The positive association between adult male OW/OB and child stunting at the community level, but not at the household level, suggests that strategies to address the double burden of malnutrition that target the community (e.g., the food environment) are more likely to be effective than interventions targeted to households alone. Funding Sources This project was supported by the National Institutes of Health [R01-AI050038].

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Patterns and determinants of the double burden of malnutrition at the household level in South and Southeast Asia

European Journal of Clinical Nutrition ◽

10.1038/s41430-020-00726-z ◽

2020 ◽

Author(s):

Tuhin Biswas ◽

Nick Townsend ◽

R. J. Soares Magalhaes ◽

Mehedi Hasan ◽

Abdullah Mamun

Keyword(s):

Southeast Asia ◽

Double Burden ◽

Household Level ◽

South And Southeast Asia ◽

Double Burden Of Malnutrition

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Various forms of double burden of malnutrition problems exist in rural Kenya

BMC Public Health ◽

10.1186/s12889-019-7882-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Andrea Fongar ◽

Theda Gödecke ◽

Matin Qaim

Keyword(s):

Developing Countries ◽

Rural Areas ◽

Micronutrient Deficiency ◽

Double Burden ◽

Household Level ◽

Individual Level ◽

Child Undernutrition ◽

Rural Kenya ◽

Double Burden Of Malnutrition ◽

The Individual

Abstract Background The coexistence of overweight/obesity and undernutrition is often referred to as the double burden of malnutrition (DB). DB was shown to exist in many developing countries, especially in urban areas. Much less is known about DB in rural areas of developing countries. Also, the exact definition of DB varies between studies, making comparison difficult. The objective of this study is to analyse DB problems in rural Kenya, using and comparing different DB definitions and measurement approaches. Methods Food intake and anthropometric data were collected from 874 male and female adults and 184 children (< 5 years) through a cross-section survey in rural areas of Western Kenya. DB at the individual level is defined as a person suffering simultaneously from overweight/obesity and micronutrient deficiency or stunting. DB at the household level is defined as an overweight/obese adult and an undernourished child living in the same household, using underweight, stunting, wasting, and micronutrient deficiency as indicators of child undernutrition. Results DB at the individual level is found in 19% of the adults, but only in 1% of the children. DB at the household level is relatively low (1–3%) when using wasting or underweight as indicators of child undernutrition, but much higher (13–17%) when using stunting or micronutrient deficiency as indicators. Conclusion Various forms of DB problems exist in rural Kenya at household and individual levels. Prevalence rates depend on how exactly DB is defined and measured. The rise of overweight and obesity, even in rural areas, and their coexistence with different forms of undernutrition are challenges for food and nutrition policies.

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Socioeconomic status and the double burden of malnutrition in Cambodia between 2000 to 2014: overweight mothers and stunted children

Public Health Nutrition ◽

10.1017/s1368980021000689 ◽

2021 ◽

pp. 1-26

Author(s):

Michelle K. Nakphong ◽

Hiram Beltrán-Sánchez

Keyword(s):

Socioeconomic Status ◽

Maternal Employment ◽

Household Survey ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Double Burden ◽

Household Level ◽

Child Stunting ◽

Double Burden Of Malnutrition ◽

The Impact

ABSTRACT Objective: The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socioeconomic factors associated with this household-level double burden over time. Design: We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socioeconomic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 vs. 2010-2014. We hypothesized that SES would be a primary factor associated with this phenomenon. Participants: We included 14,988 children under age 5, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1,572 children with overweight mothers. Setting: Nationally-representative household survey across all regions. Results: SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: aOR=2.53, 95%CI: 1.25, 5.13; 2010-2014: aOR=2.61, 95%CI: 1.43, 4.77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. Conclusions: Socioeconomic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.

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Household Levels of Double Burden of Malnutrition in Low–Middle-income Countries: A Review

Journal of the Anthropological Survey of India ◽

10.1177/2277436x211043628 ◽

2021 ◽

pp. 2277436X2110436

Author(s):

A. Bose ◽

N. Mondal ◽

J. Sen

Keyword(s):

Infant Health ◽

Health Conditions ◽

Double Burden ◽

Middle Income ◽

Household Level ◽

Middle Income Countries ◽

Under Nutrition ◽

Low Middle Income Countries ◽

Wide Range ◽

Double Burden Of Malnutrition

Malnutrition is characterised by both over-nutrition and under-nutrition. Over-nutrition is defined as excessive intake of energy and/or macronutrients. Both over-nutrition and under-nutrition are associated with a wide range of detrimental health conditions. Under-nutrition can contribute to high mortality, morbidity and poor infant health conditions; lead to delayed physical and mental development among children; and cause poor physical productivity and reproductive outcomes among adults. Over-nutrition remains the main risk factor for non-communicable diseases such as hypertension, cardiovascular diseases, type 2 diabetes and certain types of cancers. The world has witnessed a global obesity epidemic with levels rising at alarming rates in the low-middle-income countries. The higher prevalence of obesity is often accompanied by under-nutrition, and these two health issues coexist at household levels. This is termed as ‘Double Burden of Malnutrition’. The objectives of the present article are to account for the evidences, causes and risk factors of household level of double burden of malnutrition in the low-middle-income countries.

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Household-level double burden of malnutrition in Ethiopia: a comparison of Addis Ababa and the rural district of Kersa

Public Health Nutrition ◽

10.1017/s1368980021003700 ◽

2021 ◽

pp. 1-15

Author(s):

Lilia Bliznashka ◽

Mia M Blakstad ◽

Yemane Berhane ◽

Amare W Tadesse ◽

Nega Assefa ◽

...

Keyword(s):

Associated Factors ◽

Addis Ababa ◽

Rural Households ◽

Demographic Factors ◽

Household Wealth ◽

Housing Quality ◽

Rural Setting ◽

Double Burden ◽

Household Level ◽

Double Burden Of Malnutrition

Abstract Objective: To examine the prevalence of and factors associated with different forms of household-level double burden of malnutrition (DBM) in Ethiopia. Design: We defined DBM using anthropometric measures for adult overweight (BMI ≥ 25 kg/m2), child stunting (height-for-age Z-score <-2 sd) and overweight (weight-for-height Z-score ≥2 sd). We considered sixteen biological, environmental, behavioural and socio-demographic factors. Their association with DBM forms was assessed using generalised linear models. Setting: We used data from two cross-sectional studies in an urban (Addis Ababa, January–February 2018), and rural setting (Kersa District, June–September 2019). Participants: Five hundred ninety-two urban and 862 rural households with an adult man, adult woman and child <5 years. Results: In Addis Ababa, overweight adult and stunted child was the most prevalent DBM form (9 % (95 % CI 7, 12)). Duration of residence in Addis Ababa (adjusted OR (aOR) 1·03 (95 % CI 1·00, 1·06)), Orthodox Christianity (aOR 1·97 (95 % CI 1·01, 3·85)) and household size (aOR 1·24 (95 % CI 1·01, 1·54)) were associated factors. In Kersa, concurrent child overweight and stunting was the most prevalent DBM form (11 % (95 % CI 9, 14)). Housing quality (aOR 0·33 (95 % CI 0·20, 0·53)), household wealth (aOR 1·92 (95 % CI 1·18, 3·11) and sanitation (aOR 2·08 (95 % CI 1·07, 4·04)) were associated factors. After adjusting for multiple comparisons, only housing quality remained a significant factor. Conclusions: DBM prevalence was low among urban and rural Ethiopian households. Environmental, socio-economic and demographic factors emerged as potential associated factors. However, we observed no common associated factors among urban and rural households.

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The Double Burden of Malnutrition in East Asia and the Pacific

10.1596/26102 ◽

2016 ◽

Cited By ~ 2

Author(s):

Roger Shrimpton ◽

Nkosinathi Vusizihlobo Mbuya ◽

Anne Marie Provo

Keyword(s):

East Asia ◽

Double Burden ◽

The Pacific ◽

Double Burden Of Malnutrition

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