Double Burden of Malnutrition and Double Duty Actions

Nutrition is defined as the total of the processes referred to as the taking in and the utilization of food substances for growth, repair, and maintenance. It involves ingestion, digestion, absorption, and assimilation. Nutrition science is the study of nutrients in food, how the body uses nutrients, and the relationship between diet, health, and disease.¹

The words nutrition and nutrients cannot be used interchangeably, but they are closely related. Nutrients are stored by the body in various forms and drawn upon when the food intake is not sufficient. Specifically, nutrients are chemical compounds that are needed for growth and metabolism. They must be supplied in the diets as they cannot be synthesized in the body. Macronutrients and micronutrients are two primary categories to describe the nutrient needs of animals. Macronutrients are the protein, fat, and carbohydrates that the body needs in large amounts to provide energy for us, as well as maintain the body’s structure and systems. Micronutrients, including vitamins and minerals, are only needed in milligram or microgram quantities but are essential for the support of metabolism and maintenance of health.¹

Malnutrition is a serious condition that happens when the diet does not contain the right amount of nutrients, including inadequate intake of one or more nutrients, excessive intake of one or more nutrients, or an imbalance in the intake of nutrients. It presents in three forms, including undernutrition, overnutrition (obesity and diet related noncommunicable diseases such as heart disease and diabetes), and micronutrient deficiencies. 

The double nutritional burden is the coexistence of undernutrition alongside overweight or obesity which is a major driver of other diet-related NCDs such as diabetes and stroke. This is prevalent in both developed and developing countries.² Undernutrition can often be accompanied by micronutrient deficiencies, and equally, those with obesity may also be micronutrient deficient. The double nutritional burden can occur not only in the same populations but also in individuals through the life course at different stages within the various countries, cities, and communities who may be experiencing different types of malnutrition. This double burden poses a huge challenge to national policy, health policy, and resource allocation. 

While the double burden of malnutrition may pose a significant public health challenge for nutrition³, related sectors, and actors, they also present an important opportunity for integrated action. Programs and policies that aim to address the malnutrition burden through double-duty evidence-based actions are likely to be both successful and cost-effective³. Double-duty actions include interventions, programs, and policies that have the potential to simultaneously reduce the risk of both undernutrition (including wasting, standing, micronutrient deficiency) and overweight, obesity, or diet-related NCDs, including type 2 diabetes, cardiovascular disease, and some forms of cancer.⁴ 

The type of action, and its effectiveness, will vary between and within countries. Designing for double duty is not an approach of “one size fits all” but a method of crafting nutrition actions that are appropriate to the individual setting. For example, in the global nutrition report⁵, India has a higher prevalence of stunting and wasting as compared to Australia; however, Australia has higher incidences of overweight than India. Therefore, the double duty should be designed for different situations to tackle specific nutrition problems.

References 

1 Academy of Medical Royal Colleges. Relationship between nutrition, diet and malnutrition; 2010. 

2 Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3–21. 

3 Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, et al. The double burden of malnutrition: aetiological pathways and consequences for health. Lancet. 2020;395(10217):75–88. 

4 Hawkes C, Ruel MT, Salm L, Sinclair B, Branca F. Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms. Lancet. 2020;395(10218):142–55. 

5 2020 Global Nutrition Report: action on equity to end malnutrition. Bristol: Development Initiatives. Available from: https://globalnutritionreport.org/documents/566/2020_Global_Nutrition_Report_2hrssKo.pdfy