The double burden of malnutrition: aetiological pathways and consequences for health

By Jonathan Wells, A. Sawaya, R. Wibaek, Martha K Mwangome, Marios Poullas, C. Yajnik, A. Demaio. The Lancet, 2019

728 citations recorded by the source corpus.

Malnutrition has historically been researched and addressed within two distinct silos, focusing either on undernutrition, food insecurity, and micronutrient deficiencies, or on overweight, obesity, and dietary excess. However, through rapid global nutrition transition, an increasing proportion of individuals are exposed to different forms of malnutrition during the life course and have the double burden of malnutrition (DBM) directly. Long-lasting effects of malnutrition in early life can be attributed to interconnected biological pathways, involving imbalance of the gut microbiome, inflammation, metabolic dysregulation, and impaired insulin signalling. Lifecourse exposure to early undernutrition followed by later overweight increases the risk of non-communicable disease, by imposing a high metabolic load on a depleted capacity for homoeostasis, and in women increases the risk of childbirth complications. These life-course trajectories are shaped both by societal driving factors—ie, rapidly changing diets, norms of eating, and physical activity patterns—and by broader ecological factors such as pathogen burden and extrinsic mortality risk. Mitigation of the DBM will require major societal shifts regarding nutrition and public health, to implement comprehensive change that is sustained over decades, and scaled up into the entire global food system.

Subfields: Nutrition and Dietetics, Pediatrics, Perinatology and Child Health, Public Health, Environmental and Occupational Health

View Paper: https://www.semanticscholar.org/paper/28656c2ddff85ef45d87edc56235c27333a45f8d

Citations in the corpus

• Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults (2024, neutral): “19,20 For decades before the COVID-19 pandemic, higher incomes allowed more spending on food, especially in poor countries and households where a large share of income is spent on food.”
• Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021 (2025, neutral): “…pattern of life-course exposure to the double burden of malnutrition triggers a metabolic capacity–load mismatch, which aggravates the risk of NCDs. 59 Furthermore, obesity exacerbates individuals’ susceptibility to infectious diseases and increases the risk of associated metabolic complications.”