Topical Area: Policy, Global Nutrition
Objectives : The double burden of malnutrition (DBM) has received increased attention in research and policy arenas, with wide variation in how DBM is defined. We aimed to systematically identify current operational definitions for DBM (e.g., the coexistence of overnutrition and undernutrition) used in research and evaluate their frequency of use and implications for nutrition surveillance and programs.
We conducted a structured search for peer-reviewed articles published up to July 2017, using terms describing overnutrition (e.g., overweight, obesity) and undernutrition (e.g., stunting, anemia) in PubMed and Scopus. Additional references were added through snowball searches and online searches for gray literature. We included studies that reported DBM prevalence, including those with primary or secondary data analyses (see Figure 1). Screening of abstracts and full texts for inclusion was conducted in duplicate, with discrepancies resolved by discussion and consensus. Information extracted included the level of DBM assessment (population, household, or individual), measures of overnutrition and undernutrition (BMI, waist circumference, micronutrient status, etc.), and stated definitions of DBM.
We identified 1920 titles and abstracts for screening through the structured search, and added an additional 66 papers and reports. Of these, 500 full-texts were reviewed and 239 were eligible for data extraction. Frequently-occurring DBM definitions included the coexistence of: 1) overweight/obesity and underweight within a population (e.g., entire country or region); 2) adult overweight/obesity and child stunting within a population or household; and 3) overweight/obesity and anemia or iron deficiency within an individual. DBM was most frequently measured at the population level, followed by the individual and household levels.
The most common operational definitions of DBM relied on population-level analyses of anthropometric indicators, with many studies leveraging existing data, such as national health surveys. Further research exploring DBM definitions in relation to key health outcomes and country priorities may help select indicators that best inform public health program and policy development.
Funding Sources : This work was supported by the USDA National Institute of Food and Agriculture Hatch Project.