Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.

Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality

47 visualizaciones

Publicado el

Barry Popkin
POLICY SEMINAR
Virtual Event - The New Nutrition Reality: Time to Recognize and Tackle the Double Burden of Malnutrition!
DEC 1, 2020 - 09:30 AM TO 11:15 AM EST

  • Sé el primero en comentar

  • Sé el primero en recomendar esto

Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality

  1. 1. Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality Barry Popkin W. R. Kenan, Jr. Distinguished University Professor Department of Nutrition Gillings School of Global Public Health School of Medicine Department of Economics The University of North Carolina at Chapel Hill THE W RLD IS FAT Based on a paper with Camila Corvalan and Laurence Grummer-Strawn
  2. 2. Figure 1. The global double burden of malnutrition in low- and middle-income countries based on 1990s and 2010s weight and height data* (using UNICEF, WHO, World Bank, and NCD-RisC estimates, supplemented with selected DHS and other country direct measures) DBM at 40% overweight prevalence DBM at 30% overweight prevalence DBM at 20% overweight prevalence No double burden High-income countries 1a. 1990s double burden countries according to weight/height data 1b. 2010s double burden countries according to weight/height data * Double burden of malnutrition (DBM) = at least 1 child, adolescent, or adult in household with severe levels of wasting/stunting/thinness and 1 with overweight/obesity (shown at 20%, 30%, or 40% overweight prevalence)
  3. 3. Figure 2. Countries with high double burden of malnutrition* in 1990s and 2010s, by time period and GDP/capita (PPP) quartile** 3 5 10 4 14 8 5 1 0 4 8 12 16 20 Qtl 1 Qtl 2 Qtl 3 Qtl 4 2b. DBM at 30% adult overweight prevalence 12 15 13 5 19 13 7 1 0 4 8 12 16 20 Qtl 1 Qtl 2 Qtl 3 Qtl 4 2c. DBM at 20% adult overweight prevalence 1 2 8 4 1 3 2 1 0 4 8 12 16 20 Qtl 1 Qtl 2 Qtl 3 Qtl 4 Numberofcountries 2a. DBM at 40% adult overweight prevalence * Double burden of malnutrition (DBM) = at least 1 child, adolescent, or adult in household with severe levels of wasting/stunting/thinness and 1 with overweight/obesity (shown at 20%, 30%, or 40% adult overweight prevalence); countries only included here if they had DBM data available for both time periods (1990s and 2010s) ** Quartile (Qtl) 1 is lowest-wealth, Qtl 4 is highest-wealth Data sources: Based on UNICEF, WHO, World Bank, and NCD-RisC estimates supplemented with selected DHS and other country direct measures for the 1990’s 1990s 2010s
  4. 4. 1 2 1 13 6 3 11 5 4 -1 -1 -7 -3 -2 -3 -8 -3 -4 -7 -10 -4 [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] [CELLRANGE] -15 -10 -5 0 5 10 15 DBM at 20% adult overweight prevalence Ended DBM Became DBM Number of countries Figure 3. Number of countries that changed double burden of malnutrition* status from 1990s to 2010s, by GDP/capita (PPP) quartile * Double burden of malnutrition (DBM) = at least 1 child, adolescent, or adult in household with severe levels of wasting/stunting/thinness and 1 with overweight/obesity (shown at 20%, 30%, or 40% adult overweight prevalence); countries only included here if they had DBM data available for both time periods (1990s and 2010s) ** Quartile (Qtl) 1 is lowest-wealth, Qtl 4 is highest-wealth Data sources: Based on UNICEF, WHO, World Bank, and NCD-RisC estimates supplemented with selected DHS and other country direct measures for the 1990’s DBM at 30% adult overweight prevalence DBM at 40% adult overweight prevalence
  5. 5. Senegal Gabon Liberia Namibia Lesotho Niger Mali Chad Nigeria Malawi Zimbabwe Ethiopia Comoros Madagascar Cote d'Ivoire Guinea Burkina Faso Tanzania Ghana Mozambique Rwanda Kenya Congo, Rep. Zambia Togo Uganda Cameroon Congo, Dem. Rep. Sierra Leone India Bangladesh Nepal Egypt Jordan Morocco Honduras Colombia Brazil Dominican Republic Bolivia Guatemala Peru Mexico Haiti Nicaragua Kazakhstan Kyrgyz Republic Turkey Armenia China Indonesia Vietnam Cambodia East Asia & Pacific Europe & Central Asia Latin America & the Caribbean Middle East & North Africa South Asia Sub-Saharan Africa * Positive difference indicates higher annualized growth in overweight/obesity prevalence for the lowest-wealth quartile. ** Countries presented here had earliest-to-latest-year data spanning 15 or more years, latest-year data after 2010, and a population greater than ≈15 million (with the exception of Jordan and Kyrgyz Republic, which both had smaller populations but were included for regional representation). The data presented is from years spanning 1988 to 2016, but exact years vary by country. The span of earliest-to-latest years collected ranges from 15 years to 24 years. All data are from the Demographic and Health Surveys (DHS, https://dhsprogram.com/) with the exceptions of China (China Health and Nutrition Survey), Indonesia (Indonesian Family Life Survey), Mexico (Mexico National Survey of Health and Nutrition), Brazil (Brazil National Health Survey), and Vietnam (Vietnam Living Standards Survey). Figure 5. The shifting burden of overweight/obesity from higher- to lower-wealth populations in sample countries** Annualized difference in growth rate of overweight/obese prevalence for lowest-wealth minus highest-wealth groups* between first and last survey waves in selected countries**
  6. 6. Changes in overweight/obesity over time: equity considerations The shifting burden of overweight and obesity from higher-wealth to lower-wealth populations in sample countries Faster in wealthiest quintile Faster in poorest quintile Faster in wealthiest quintile Faster in poorest quintile
  7. 7. Global and National Dynamics underlying the major shifts in the Double Burden of Malnutrition • Economic growth – Reduced wasting, stunting, thinness – Reduced physical activity – Increased purchasing power • Food marketing and access • Shifts in control of the food supply • Urbanization • Women’s employment Rapid increase in Ultra- processed foods
  8. 8. • Technological shifts in the workplace, home, leisure and transportation have reduced physical activity greatly but we can not go back in time so need to focus much more on the diet drivers. • Economic growth and increased purchasing power reduce malnutrition • The global food system makes ultra-processed food and other less nutritious food cheaper and more accessible. We are finding this in all regions. Underlying factors include urbanization, increased of- farm employment for men and women, especially, • Effective policies that address the challenges of the DBM across the lifecycle are urgently needed Why we are seeing these increases in overweight status
  9. 9. • In LMIC’s, undernutrition is declining while overweight is increasing — both at about the same rate for SSA and overweight faster increase for many. • However, stunting was highly prevalent, so increases in overweight (20% or more in all countries) are leading to high DBM levels. • Of 126 LMICs, 38% face a DBM prevalence that we define as very high or severe. • The DBM is shifting toward countries in the poorest income quartile, particularly in South and Southeast Asia and sub-Saharan Africa Key Messages on DBM
  10. 10. • First both undernutrition and obesity are associated with significant reductions in immune function and greatly increased susceptibility to Covid. • A recent metanalysis highlights this for COVID-19 (Popkin et al, Obesity Reviews 2020, http://dx.doi.org/10.1111/obr.13128 PMCID: PMC7461480). • Globally, large decreases in physical activity both because of Covid control and also economic stress’s reduction of active employment and production, • In most regions, we are seeing rapid increases in consumption of both ultra-processed food and less-nutritious, cheaper food from vendors, stalls, and home cooking. In a select few countries we are seeing increased healthy eating among the poor. We have surveys from a number of low and middle income countries during Covid. • The result will be both increased overweight and undernutrition. Only documented weight increases are in high income countries. The COVID-19 pandemic has likely greatly exacerbated the DBM

×