13 January 2021
Published online 22 April 2020
Communities in Sudan, Iran and Iraq are among the most vulnerable in the Middle East to the co-occurrence of over- and under-nutrition.
High rates of childhood wasting persist in many low- and middle-income countries, while overweight estimates among young children are increasing, according to a large-scale collaborative study published in Nature Medicine.
Current public health nutrition programmes designed to address under-nutrition may unwittingly exacerbate childhood obesity, which is why “determining the double burden of malnutrition at the population level is crucial for the design of effective interventions,” says Damaris Kinyoki of the Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
The study analysed and mapped estimates of under-nutrition, characterised primarily by wasting, and over-nutrition, manifested by overweight and obesity, in children under the age of five across 105 low- and middle-income countries between 2000 and 2017.
The Middle East witnessed a rise in the overall prevalence of overweight children from 13.9% in 2000 to 16% in 2017, with the highest in Egypt (28.6%) and Iraq (26.2%). The prevalence of wasting in the region decreased from 9.7% in 2000 to 7.7% in 2017, with the highest in Yemen (15.7%), Sudan (14.2%) and Syria (11.4%).
“The most progress in reducing wasting was evident in Sudan, Palestine and Iraq,” says Kinyoki. She points out, though, that a double burden of malnutrition has emerged in several communities in Sudan, Iran and Iraq.
On a global scale, areas most affected by a double burden of malnutrition were found to be in Indonesia, Thailand, south-eastern China, Botswana, Cameroon and central Nigeria.
More than half of all low- and middle-income countries, which have collectively demonstrated reductions in wasting from 8.4% to 6.4% between 2000 and 2017, are not on course to meet the World Health Organization's Global Nutrition Target of less than 5% by 2025.
What makes subnational-level estimates so valuable is that they provide a clear assessment for policymakers to implement targeted interventions and to direct resources accordingly.
“It is important to understand the factors underpinning the trends leading to double burden of malnutrition in order to design nutrition programmes that target wasting without incurring high rates of childhood overweight,” says Kinyoki.
LBD Double Burden of Malnutrition Collaborators. Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017. Nat. Med. https://doi.org/10.1038/s41591-020-0807-6 (2020).