The Vicious Cycle of Mal and Mall Nutrition
Authors: Aman Jaiswal*, Ajay Kumar, Deepak Kumar Koli, Swati Sagar
Division of Microbiology, ICAR-Indian Agricultural Research Institute, New Delhi (India) 110 012


Introduction:

Around 52 million children are suffering from muscle wasting, 17 million even have severe wasting and 155 million have stunted growth. On the other hand, about 41 million are facing obesity or overweight problem. Malnutrition affects developmental, economic and social aspects of a society/country to great extent (WHO factsheet). The primary focus of nutrition research in developing countries like India has been on the problem of undernutrition. Governmental as well as non-governmental organisations have started a large number of programmes and are working to reduce tirelessly day and night to address this problem. Although success has been achieved to a significant extent but a large section of population still suffers from problem of under nutrition. Increasing population growth, poverty are among major factors responsible for persistence of this problem. Various studies have been done extensively to know more about the undernutrition and various factors responsible for it. These studies have guided policy makers to design various programmes. A curious observation in the recent past has been the rise in cases of overnutrition (obesity and overweight) in developing countries. The overnutrition problems are often associated with increased risk for chronic heart diseases, diabetes and stroke (Jequier, 1997, WHO 2003).

In the first look it seems paradoxical; the co-existence of both over and undernutrition in same country, but when socio-economic changes are taken into consideration the picture becomes clearer. An interesting theory of nutritional transition explaining these effects was proposed by Popkin (1993) which explains the change in eating habits and levels of physical activity. The nutritional transition can be divided into three different stages namely the stage of receding famine, degenerative diseases stage and the stage of behavioural change. Receding famine involves a plant-based diet habit which lacks diversity and is based on food production at the household levels which tends to be labour intensive and thus involves a lot of physical activity. The transition towards an upper level involves an increased reliance on animal based food products, high fat consumption, increase in contribution of processed food towards diet and higher content of simple sugars in the food. This in turn is accompanied by reduced physical activity due to production and processing of food outside the household and immediate neighbourhood. The third stage of nutritional transition involves decrease in consumption of fast foods and saturated/trans fats. In this stage the physical activity increases to maintain good health instead of labour for agricultural production. Presently most of the population around globe is witnessing a transition from first to second stage. However, In the western developed countries a transition from second to third stage is the dominant trend.

Reasons behind DBMN in third world countries:


An interesting analysis done by Monterio et al., (2004) showed that the trend of malnutrition tuned on its own head in Brazil. Where In the year 1975 the ratio of overweight to underweight person was 1:2 but after 22 years there were about two overweight persons for every underweight individual. Similar trend has been observed in other developing countries like China and India. In case of India the urban population is witnessing an increase in incidences of overweight problem but the rural regions still are fighting with the problem of undernutrition (Ramachandran, 2006; Deaton and Dreze, 2009). In developing countries, rapid urbanisation is linked to diets with more fats, animal source foods and processed products and lower activity levels resulting in higher levels of obesity.

Levels of DBMN:

  • DBMN observed in the same population/community:
  • Low Socioeconomic status (SES) segments experience stunting and underweight whereas economically better off are experiencing overnutrition
  • In the same household/family
    • At-least one member is overweight and at-least one is underweight
  • Within an person/individual
    • Stunting and obesity


    Table 1

    Under nutrition

    Over nutrition

    Undernutrition is commonly seen in developing countries where people suffer from lack of nutrients such as; carbohydrates, proteins and fats

    Overnutrition occurs when an individual has an excessive consumption of food, far more than their dietary needs

    They have difficulty meeting their dietary needs and are underweight

    Overnutrition leads to heart disease, obesity and other dietary disorders



    Key terms:

    • Malnutrition: The deficiency, excess or imbalances in someone’s energy intake and/or nutrients
    • The coexistence of undernutrition (Mal) and overnutrition (Mall) is known as the dual burden or double burden of malnutrition (DBMN)
    • Over-nutrition is defined as
      • Overweight (body mass index [BMI] >25 kg/m2) or
      • Obesity (BMI ≥30 kg/m2)
    • BMI below 18.5 kg/m2 is considered as thin or underweight
      • Underweight: a child has low weight for age. Composite measure includes chronic and acute malnutrition (low weight-for-age)
      • Stunting : child short for their age as a result of chronic under nutrition during the most critical periods of growth and development in early life (low height-for-age)
      • Wasting : child’s weight is too low for their height as a result of acute under nutrition, can vary with the seasons. Reflects loss of muscle tissue and fat (low weight-for-height)
    Role of agricultural and nutritional research: As per the data by IAASTD the meat production around globe is estimated to increase by 120 percent in 2050 from the levels in 2000. As the meat based products are resource intensive and require high fertilizer input, the scenario is becoming dangerous day by day. Thus a lot of efforts need to be devoted to find alternatives to meat based products. Addressing the consumer acceptability issues in protein rich legumes like soybean can be a possible solution. Similar efforts need to be done in millet crops which are promising in the era of climate change and deserve special attention. Millets are also nutritionally superior to staple cereals and were grown at a large scale in the African and South Asian regions before the industrial revolution.

    References:

    1. Abdullah A. The Double Burden of Undernutrition and Overnutrition in Developing Countries: an Update. Current obesity reports 4(3): 337-349 (2015).
    2. Deaton, A and J Dreze (2009). Food and Nutrition in India: Facts and Interpretations, Economic and Political Weekly, 44 (7): 42-65.
    3. Mastorci F et al. Undernutrition and Over nutrition Burden for Diseases in Developing Countries: The Role of Oxidative Stress Biomarkers to Assess Disease Risk and Interventional Strategies. Antioxidants doi:10.3390/antiox6020041 (2017)
    4. Subramanian SV, Kawachi I, Smith GD. Income inequality and the double burden of underÔÇÉ and overnutrition in India. J Epidemiol Community Health. 61(9): 802-809 (2007).
    5. Jequier, E (1997). The Problem of Obesity and Its Management. Shetty and McPherson (ed), Diet, Nutrition and Chronic Disease: Lessons from Contrasting Worlds. John Wiley & Sons, London School of Hygiene & Tropical Medicine, Sixth Annual Public Health Forum.

    6. Popkin, B M (1993). Nutritional Patterns and Transitions. Population and Development Review, 19 (1):138-57.



    About Author / Additional Info:
    I am pursuing PhD in department of microbiology from Indian Agricultural Research Institute, New Delhi-110012