Health Economics and Nutrition: Over- and Under- nutrition

In this issue, the proceedings of a meeting on globalnutritional problems are presented. They deal with severalproblems that long were thought to be mutually exclusive:under-nutrition and over-nutrition. The first wasconsidered to be a problem related to poverty which mayresult in inadequate intake of energy and/or micronutrientsand strenuous labor. Chronic noncommunicablediseases were associated with affluence and related over-consumptionof food and sedentary lifestyles. The papersin this issue show that this is no longer a useful distinction.In fact, in many circumstances, especially in low andmiddle-income countries, people have access to energy-dense but, at the same time, nutrient-poor foods.There is an increasing trend in developing countries,where the demographic and socioeconomic transitionimposes more constraints on dealing with the doubleburden of infectious and noninfectious diseases as well asmalnutrition in a poor environment, characterized by ill-healthsystems. It is predicted that, by 2020, noncommunicablediseases will cause seven out of every ten deathsin developing countries. Among noncommunicable diseases,special attention is devoted to cardiovascular disease,diabetes, cancer and chronic pulmonary disease.The burden of these conditions affects countries worldwidebut with a growing trend in developing countries.Preventative strategies must take into account the growingtrend of risk factors correlated to these diseases. Inparallel, despite the success of vaccination programs forpolio and some childhood diseases, other diseases likeAIDS, tuberculosis, malaria and dengue are still out ofcontrol in many regions of the world. In addition, preventingand combating micronutrient deficiencies is ofgreat importance.A life course approach to combating under- and over-nutritionis essential. This is illustrated by the paper byKC et al. that focuses on gestational diabetes and macrosomia.Many noncommunicable diseases have their originsin utero. Intrauterine growth retardation resulting inlow-birth-weight babies as well as macrosomia (highbirth weight) are associated with an increased risk of obesity,type 2 diabetes and cardiovascular disease in the offspring.The paper by Seidell and Halberstadt shows thatobesity is an increasing problem in children around theworld. Similarly, the paper by Bailey et al. shows that theglobal problem of micronutrient deficiencies starts earlyin life with lifelong consequences.Both under- and over-nutrition greatly contribute tothe global burden of disease with severe global economicconsequences. These do not only relate to the direct costsassociated with the medical consequences of malnutritionbut also to the indirect costs of reduced productivityof those affected. The paper by Detzel and Wieser in thisissue illustrates that combatting iron deficiency by foodfortification can be cost-effective.