The Double Burden of Malnutrition: A Systematic Review of Operational Definitions

• Published in: Current developments in nutrition Vol. 4; no. 9; p. nzaa127
• Main Authors: Davis, Jennie N, Oaks, Brietta M, Engle-Stone, Reina
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2020; Oxford University Press
• Subjects: anemia; assessment; double burden; literature review; malnutrition; micronutrient deficiency; noncommunicable disease; obesity; REVIEW; stunting; CMRF; MN; NCHS; double burden; literature review; stunting; anemia; micronutrient deficiency; DBM; NCD; assessment; malnutrition; MetS; TWU; LMIC; IOTF; OW/OB; noncommunicable disease; obesity
• ISSN: 2475-2991; 2475-2991
• DOI: 10.1093/cdn/nzaa127

Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions. To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment. Following a structured search of peer-reviewed articles with terms describing “overnutrition” [e.g., overweight/obesity (OW/OB)] and “undernutrition” (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles. We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73). Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities. A systematic review identifying operational definitions of the double burden of malnutrition, measuring their frequency of use, and recommending assessment considerations, including a framework for building operational definitions.