New study lists war, lack of democracy and urbanisation among factors to blame
A new study from the University of Warwick blames macro-level factors for the double burden of malnutrition among adolescents in developing countries including India.
The double burden of malnutrition refers to the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases such as type 2 diabetes.
The authors have examined studies of almost 130,000 adolescents and also found that a fifth are overweight or obese and more than 10 per cent had stunted growth due to double malnutrition and two per cent were classed as both stunted and overweight
The study The double burden of malnutrition among adolescents: analysis of data from the Global School‐Based Student Health and Health Behaviour in School‐Aged Children Surveys in 57 low‐income and middle‐income countries suggests that factors including war, lack of democracy, food insecurity, urbanisation and economic growth are to blame.
The study was published in the American Journal of Clinical Nutrition (AJCN) and was led by Dr Rishi Caleyachetty, Assistant Professor, Warwick Medical School.
His team found that the burden of double malnutrition is shockingly common and the researchers are now calling on governments and NGOs to identify context-specific issues and design and implement policies and interventions to reduce adolescent malnutrition accordingly.
The study set out to quantify the magnitude of the double burden of malnutrition among adolescents and explain the varying burden of adolescent malnutrition across low- and middle-income countries (LMICs).
Adolescence is a period for growth and development, with higher nutritional demands placing adolescents at greater risk of malnutrition.
They used data from the Centers for Disease Control and Prevention/World Health Organisation (WHO) Global School-Based Student Health Survey and WHO Health Behaviour in School-Aged Children surveys done in 57 LMICs between 2003-2013, comprising 129,276 adolescents aged 12-15 years. They examined the burden of stunting, thinness, overweight or obesity, and concurrent stunting and overweight or obesity. They then linked nutritional data to international databases including the World Bank, Center for Systemic Peace, Uppsala Conflict Data Program, and the Food and Agriculture Organization (FAO).
They found that across the 57 LMICs, 10.2% of the adolescents were stunted and 5.5% were thin. The prevalence of overweight or obesity was much higher at more than a fifth of the adolescents (21.4%). The prevalence of concurrent stunting and overweight or obesity was 2.0%. Between 38.4%-58.7% of the variance in adolescent malnutrition was explained by macro-level contextual factors.
Dr Caleyachetty said: “The majority of adolescents live in LMICs but the global health community has largely neglected the health needs of this population. At the population level, macro-level contextual factors such as war, lack of democracy, food insecurity, urbanisation and economic growth partly explain the variation in the double burden of malnutrition among adolescents across LMICs.
“The global health community will have to adapt their traditional response to the double burden of malnutrition in order to provide optimal interventions for adolescents.”
List of countries
| African Region |
| Algeria |
| Benin |
| Ghana |
| Mauritania |
| Republic of Mauritius |
| Sudan |
| Swaziland |
| Uganda |
| Americas Region |
| Argentina |
| Belize |
| Bolivia |
| British Virgin Islands |
| Chile |
| Costa Rica |
| Dominica |
| Guatemala |
| Guyana |
| Honduras |
| Jamaica |
| Peru |
| St. Kitts & Nevis |
| Suriname |
| Uruguay |
| Eastern Mediterranean Region |
| Djibouti |
| Egypt |
| Iraq |
| Jordan |
| Lebanon |
| Libya |
| Morocco |
| Pakistan |
| Palestine |
| Syria |
| Yemen |
| European Region |
| Bulgaria |
| Macedonia |
| Romania |
| Russia |
| Turkey |
| Ukraine |
| South-East Asia Region |
| India |
| Indonesia |
| Malaysia |
| Myanmar |
| Sri Lanka |
| Thailand |
| Western Pacific Region |
| China |
| Cook Islands |
| Fiji |
| Kiribati |
| Nauru |
| Niue |
| Philippines |
| Samoa |
| Solomon Islands |
| Tonga |
| Vanuatu |
Thinness was defined as BMI-for-age <2 standard deviations (SDs) below the WHO Growth Reference median.
The double burden of malnutrition among adolescents: analysis of data from the Global School-Based Student Health and Health Behaviour in School-Aged Children Surveys in 57 low-income and middle-income countries published in the American Journal of Clinical Nutrition (AJCN)
Authors:
Rishi Caleyachetty: Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, UK; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
GN Thomas; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
Andre P Kengne: South African Medical Research Council and University of Cape Town, Cape Town, South Africa; The George Institute for Global Health, Sydney, Australia
Justin B Echouffo-Tcheugui: Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Samantha Schilsky: George Washington University School of Medicine and Health Sciences, Washington DC, USA
Juneida Khodabocus: University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
Ricardo Uauy: University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK;: Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile; Division of Pediatrics, School of Medicine, Catholic University of Chile, Santiago, Chile;: London School of Hygiene and Tropical Medicine, London, United Kingdom