scholarly journals Strengthened Data Systems to Mitigate the Double Burden of Malnutrition: The Role of Stable Isotope Technique-Derived Nutrition Indicators

2019 ◽  
Vol 75 (2) ◽  
pp. 119-122
Author(s):  
Victor O. Owino ◽  
Theodora Mouratidou
Keyword(s):  
Body Composition ◽  
Stable Isotope ◽  
Metabolic Response ◽  
Data Availability ◽  
Noncommunicable Diseases ◽  
Surveillance Systems ◽  
Data Systems ◽  
Population Surveys ◽  
Double Burden ◽  
Double Burden Of Malnutrition

Indicators reflecting the double burden of malnutrition are rarely measured in nutrition surveys and are needed to strengthen national data systems. Indicators such as body composition reflect both metabolic response to undernutrition and obesity risk and nutrition-related noncommunicable diseases. Stable isotope techniques (SITs) provide accurate data on body composition, exclusive breastfeeding and vitamin A status that are otherwise problematic with routine methods. Integration of SIT-derived nutrition indicators in data systems could improve the design and evaluation of programmes focused on obesity prevention, food fortification and infant and young child feeding practices. The Working Group at the symposium considered “how SIT-derived nutrition indicators may be integrated into surveillance systems to strengthen data availability and capacity at national and regional levels”. Practical considerations for the use of SITs include cost, sample size, rigorous training and logistics. It was concluded that SITs are best suited, at present, for use in sub-samples of population surveys and for validating tools that can be scaled-up more easily in population surveys. In the long term, SITs could be applied to larger surveys following potential innovations in more affordable, hand-held devices for analysis of stable isotope enrichment in the field and simpler specimen collection protocols.

scholarly journals The Impact of Dietary Protein in Complementary Foods on Infant Growth and Body Composition in a Population Facing the Double Burden of Malnutrition: Protocol for a Multicenter, Prospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Kulnipa Kittisakmontri ◽  
Julie Lanigan ◽  
Jonathan C K Wells ◽  
Mary Fewtrell
Keyword(s):  
Amino Acids ◽  
Growth Hormone ◽  
Body Composition ◽  
Protein Intake ◽  
Complementary Feeding ◽  
Iron Status ◽  
Plasma Amino Acids ◽  
Double Burden ◽  
Protein Sources ◽  
Double Burden Of Malnutrition

BACKGROUND Protein is an essential macronutrient with an important role during complementary feeding. Low protein intake contributes to undernutrition while high intake, especially from animal sources, may increase obesity risk. However, the influences of different protein sources (dairy, meat, and plants) on growth, and underlying mechanisms for these effects, are poorly understood. Animal-sourced foods provide both high-quality protein and iron and are recommended to improve iron status. However, it is unclear whether current dietary recommendations are adequate to support healthy growth and optimize iron status. These issues are of particular concern in countries facing the double burden of malnutrition, the coexistence of all forms of malnutrition. More evidence is needed to develop appropriate recommendations for these countries. OBJECTIVE This study will investigate associations between protein intake during complementary feeding and growth, body composition, and iron status of infants in Thailand, a country facing the double burden of malnutrition. The study will also explore how different protein sources influence growth via the growth hormone—insulin-like growth factor I (IGF-1) axis and plasma amino acids. METHODS A multicenter cohort study will be conducted in Chiang Mai, Thailand, in 150 healthy term infants aged 4-6 months with birth weight ≥2500 g. Demographic data, dietary intake, and anthropometry will be collected at 6, 9, and 12 months. Dietary intake will be assessed using 24-hour dietary recalls, 3-day food records, and food frequency questionnaires. Blood samples for iron status, growth hormone, IGF-1, insulin-like growth factor-binding protein III (IGFBP-3), and plasma amino acids and urine samples for body composition analysis using stable isotope dilution will be obtained at 12 months. RESULTS The recruitment of study participants and data collection was undertaken from June 2018 to May 2019. Data and laboratory analyses are ongoing and are expected to be completed by December 2020. A total of 150 participants were enrolled, and 146 completed the study. We hypothesized that protein intake from animal-sourced foods in recommended quantities could support normal weight and length gain and lower the risk of undernutrition associated with similar amounts of plant-based protein. However, higher protein intake, especially from milk protein, may be linked to increased body fat via plasma amino acids and the growth hormone-IGF axis. CONCLUSIONS The results of this study will provide data on current complementary feeding practices, focusing on protein and iron intake in Thai infants. This information, combined with data on associations with infant growth and iron status, will help inform complementary feeding recommendations for this population and may be found relevant to other settings experiencing the double burden of malnutrition. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18112

scholarly journals Regional Overview on the Double Burden of Malnutrition and Examples of Program and Policy Responses: Latin America and the Caribbean

2019 ◽  
Vol 75 (2) ◽  
pp. 139-143
Author(s):  
Ruben Grajeda ◽  
Trevor Hassell ◽  
Kimberly Ashby-Mitchell ◽  
Ricardo Uauy ◽  
Eduardo Nilson
Keyword(s):  
Latin America ◽  
Motor Development ◽  
Child Protection ◽  
Health Agency ◽  
Premature Death ◽  
School Nutrition ◽  
Noncommunicable Diseases ◽  
Double Burden ◽  
Double Burden Of Malnutrition ◽  
The Caribbean

Background: Hunger, food insecurity, stunting, anemia, overweight, and noncommunicable diseases (NCDs) may coexist in the same person, household, and community in Latin America and the Caribbean (LAC). The double burden of malnutrition (DBM) is an important cause of disability and premature death, which could be addressed with comprehensive policies such as the Plan of Action for the Prevention of Obesity in Children and Adolescents. This paper summarizes the main policies and actions aimed to prevent undernutrition and obesity. Summary: Several countries are implementing the Plan of Action, Caribbean Public Health Agency is actively supporting Ministries of Health, Education, and Sport to develop school nutrition policies and strategies to create health-promoting environments at school and in their surrounding communities. Chile is implementing the comprehensive child protection system “Chile Crece Contigo” that integrates health, social development, and educational activities to optimize growth and childhood cognitive-motor development. Brazil is implementing policies and plans to commit to international targets regarding food and nutrition security, NCDs and their risk factors. Key Messages: The DBM exists in the Americas and contributes to disability and premature death. The Region is making progress implementing policies and actions addressing the DBM. However, stronger political will and leadership are needed to enact legislation and policies that create and support enabling ­environments.

scholarly journals Using Body Composition Assessment to Evaluate the Double Burden of Malnutrition

2019 ◽  
Vol 75 (2) ◽  
pp. 103-108 ◽  
Author(s):  
Jonathan C.K. Wells
Keyword(s):  
Body Composition ◽  
Early Life ◽  
Noncommunicable Disease ◽  
Body Composition Assessment ◽  
Double Burden ◽  
Poor Growth ◽  
Middle Income ◽  
Child Undernutrition ◽  
Double Burden Of Malnutrition ◽  
The Individual

Background: Populations in low- and middle-income countries are increasingly experiencing a double burden of malnutrition (DBM), incorporating both persistent levels of child undernutrition and rising prevalence of overweight/obesity at later ages. A growing number of individuals experience both components of the DBM through the life-course, thereby accumulating high susceptibility to noncommunicable disease (NCD). Summary: Measurements of body composition may prove valuable for assessing NCD risk at the level of the individual. The capacity-load model provides a simple conceptual framework for integrating data on different components of body composition to predict NCD risk. Poor growth in early life, indexed by becoming wasted or stunted, constrains the development of lean mass components such as muscle and organ mass, each of which contribute to the metabolic capacity for homeostasis. Catch-up weight gain in early life, or the development of excess weight from childhood onwards, is associated with elevated adiposity, especially abdominal adiposity, which challenges cardio-metabolic homeostasis and elevates NCD risk. Key Messages: A variety of techniques are now available for the measurement of body composition, helping research the association of the DBM with NCD risk. Reference charts allow raw data to be converted to age- and sex-specific z-scores, aiding interpretation.

scholarly journals Regional Overview on the Double Burden of Malnutrition and Examples of Program and Policy Responses: African Region

2019 ◽  
Vol 75 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Adelheid W. Onyango ◽  
Juddy Jean-Baptiste ◽  
Betty Samburu ◽  
Tshimi Lynn Moeng Mahlangu
Keyword(s):  
Age Groups ◽  
Health Sector ◽  
Lifestyle Changes ◽  
Sub Saharan Africa ◽  
World Health ◽  
Noncommunicable Diseases ◽  
African Region ◽  
Double Burden ◽  
Double Burden Of Malnutrition ◽  
Sub Saharan

Sub-Saharan Africa is experiencing the double burden of malnutrition (DBM) with high levels of undernutrition and a growing burden of overweight/obesity and diet-related noncommunicable diseases (NCDs). Undernourishment in sub-Saharan Africa increased between 2010 and 2016. Although the prevalence of chronic undernutrition is decreasing, the number of stunted children under 5 years of age is increasing due to population growth. Meanwhile, overweight/obesity is increasing in all age groups, with girls and women being more affected than boys and men. It is increasingly recognized that the drivers of the DBM originate outside the health sector and operate across national and regional boundaries. Largely unregulated marketing of cheap processed foods and nonalcoholic beverages as well as lifestyle changes are driving consumption of unhealthy diets in the African region. Progress toward the goal of ending hunger and malnutrition by 2030 requires intensified efforts to reduce undernutrition and focused action on the reduction of obesity and diet-related NCDs. The World Health Organization is developing a strategic plan to guide governments and development partners in tackling all forms of malnutrition through strengthened policies, improved service delivery, and better use of data. It is only through coordinated and complementary efforts that strides can be made to reduce the DBM.

scholarly journals The Impact of Dietary Protein in Complementary Foods on Infant Growth and Body Composition in a Population Facing the Double Burden of Malnutrition: Protocol for a Multicenter, Prospective Cohort Study

10.2196/18112 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e18112
Author(s):  
Kulnipa Kittisakmontri ◽  
Julie Lanigan ◽  
Jonathan C K Wells ◽  
Mary Fewtrell
Keyword(s):  
Amino Acids ◽  
Growth Hormone ◽  
Body Composition ◽  
Protein Intake ◽  
Complementary Feeding ◽  
Iron Status ◽  
Plasma Amino Acids ◽  
Double Burden ◽  
Protein Sources ◽  
Double Burden Of Malnutrition

Background Protein is an essential macronutrient with an important role during complementary feeding. Low protein intake contributes to undernutrition while high intake, especially from animal sources, may increase obesity risk. However, the influences of different protein sources (dairy, meat, and plants) on growth, and underlying mechanisms for these effects, are poorly understood. Animal-sourced foods provide both high-quality protein and iron and are recommended to improve iron status. However, it is unclear whether current dietary recommendations are adequate to support healthy growth and optimize iron status. These issues are of particular concern in countries facing the double burden of malnutrition, the coexistence of all forms of malnutrition. More evidence is needed to develop appropriate recommendations for these countries. Objective This study will investigate associations between protein intake during complementary feeding and growth, body composition, and iron status of infants in Thailand, a country facing the double burden of malnutrition. The study will also explore how different protein sources influence growth via the growth hormone—insulin-like growth factor I (IGF-1) axis and plasma amino acids. Methods A multicenter cohort study will be conducted in Chiang Mai, Thailand, in 150 healthy term infants aged 4-6 months with birth weight ≥2500 g. Demographic data, dietary intake, and anthropometry will be collected at 6, 9, and 12 months. Dietary intake will be assessed using 24-hour dietary recalls, 3-day food records, and food frequency questionnaires. Blood samples for iron status, growth hormone, IGF-1, insulin-like growth factor-binding protein III (IGFBP-3), and plasma amino acids and urine samples for body composition analysis using stable isotope dilution will be obtained at 12 months. Results The recruitment of study participants and data collection was undertaken from June 2018 to May 2019. Data and laboratory analyses are ongoing and are expected to be completed by December 2020. A total of 150 participants were enrolled, and 146 completed the study. We hypothesized that protein intake from animal-sourced foods in recommended quantities could support normal weight and length gain and lower the risk of undernutrition associated with similar amounts of plant-based protein. However, higher protein intake, especially from milk protein, may be linked to increased body fat via plasma amino acids and the growth hormone-IGF axis. Conclusions The results of this study will provide data on current complementary feeding practices, focusing on protein and iron intake in Thai infants. This information, combined with data on associations with infant growth and iron status, will help inform complementary feeding recommendations for this population and may be found relevant to other settings experiencing the double burden of malnutrition. International Registered Report Identifier (IRRID) DERR1-10.2196/18112

scholarly journals The Double Burden of Malnutrition: Research Agenda for Reversing Global Trends

2019 ◽  
Vol 75 (2) ◽  
pp. 149-152
Author(s):  
Daniel Hoffman
Keyword(s):  
Research Methods ◽  
Data Systems ◽  
Double Burden ◽  
Public And Private ◽  
Global Trends ◽  
Double Burden Of Malnutrition ◽  
New Research ◽  
Lower Income Countries ◽  
Collaborative Efforts ◽  
Research And Policy

The double burden of malnutrition (DBM) is becoming more prevalent throughout the world, but most alarming is the fact that it is also prevalent in lower-income countries, those with limited research and policy funding. To that end, a number of research gaps have been identified related to the biology, research methodologies/data systems, and programs and policies that could be improved to best address the DBM across the globe, especially in diverse settings with limited resources. Clearly, understanding the biology of the DBM is fundamental to developing policies, but research needs to become more interdisciplinary and communicate better with policymakers. At the same time, research methods need to become more innovative, and data systems must advance to accommodate new research methods and approaches. Filling these gaps will allow for broad and effective policies to be implemented through both public and private groups, an area that could be leveraged through transparent public-private engagement and programs. Without novel and integrated approaches to research, efforts to reverse the DBM will be limited. Therefore, the time has come for truly cooperative and collaborative efforts on all fronts to work together and promote the health of future generations across the globe.

The Double Burden of Malnutrition in East Asia and the Pacific

10.1596/26102 ◽  
2016 ◽  
Author(s):  
Roger Shrimpton ◽  
Nkosinathi Vusizihlobo Mbuya ◽  
Anne Marie Provo
Keyword(s):  
East Asia ◽  
Double Burden ◽  
The Pacific ◽  
Double Burden Of Malnutrition
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