The Double Burden of Malnutrition

What is hunger?

Hunger is undernourishment

What was a very strong maternal predictor of child stunting and why? Who found this and where?

Maternal education - Abuya et al (2012) - slums of Nairobi

Overall, what would Mohsena et al (2010) recommend were the best predictors of child's nutritional status?

Maternal education!! and possession score

What did Mohsena et al. find about prediction of undernutrition? What year?

Maternal education/possession score provided greater discrimination of undernutrition than poverty index, 2010

What does maternal overweight and obesity contribute to? According to who?

Maternal morbidity and infant mortality, Black et al (2013)

Who did Pomeroy et al look at (2014)?

Peruvian urban lowland and rural highland children

What is the most common type of 'hidden hunger'?

Poor iron status in women

Who does iodine deficiency affect the most?

Populations that consume foods grown on soils depleted in iodine due to erosion

Who found evidence that stunted children have altered body composition and fat distribution predisposing to excess adiposity and abdominal fat distribution?

Hoffman et al (2007)

Which is greater, maternal overweight or underweight? Says who?

Overweight, Black et al (2013)

Who found that stunted individuals experience metabolic effects as adults that preferentially store energy as fat?

(Florêncio et al., 2004)

Who called the double burden 'short and plump syndrome'?

(Martorel et al., 1987)

How many people are overweight?

1.5 billion (2008)

How many people worldwide are anaemic, what proportion of preschool children have it, and what proportion of maternal deaths does it contribute to?

2.0 billion, 40%, 20%

How many people are living on less than $2 a day (in poverty)?

2.2 billion

When were the MDGs created and when are they meant to be achieved by? Who by?

2000, 2015. Multiple global health agencies and stakeholders

How many Vietnamese School children did Le Nguyen find were underweight and stunted?

22.2% underweight, 15.6% stunted

How many preschool children have Vitamin A deficiency?

250 million

What percentage of child deaths were associated with undernutrition in 2011? Says who?

45% - Black et al (2013)

How many are obese?

500 million (2008)

How many countries are iodine deficient?

54

What is the most severe level of household food insecurity?

A hungry child, which is recognised by their parents - social intervention recommended

What did Levine et al. find about sugar and fat? What year?

Adaptive powerful sources of neurobiological reward 2003

What is the 'urban advantage' and does it apply in sub-saharan Africa?

Advantage of generally better health, resources and education in urban environments. Not really, as slum settings mean that malnutrition has become more of a problem in urban areas.

What did Mohsena et al (2010) use to analyse Bangladeshi undernutrition along with socioeconomic status?

Bangladesh demographic health survey, 2004

Why is it a big deal that women are overrepresented among the poor?

Because women are the main providers of food, education and healthcare for children in the world (Tanumihardjo et al, 2007)

What child factors affect stunting? Who found this and where?

Birth height and gender - Abuya et al. (2013)

What are the two different definitions for stunting? Does this make a big difference?

CDC - below the 5th percentile of height for age (classifies more individuals as stunted) WHO - below -2 z scores of height for age In well nourished populations, differences are often negligible, however, in transitioning populations, the difference can be large (Varela-Silva et al. (2012)

What is the 'double burden of malnutrition'?

Coexistence of undernutrition (mainly stunting) and over nutrition (overweight and obesity), in the same population or group, the same household or family, or the same person (Valera-Silva, 2012)

What does maternal undernutrition do, according to who?

Contributes to foetal growth restriction, increases neonatal deaths, increases stunting by age 2, Black et al (2013)

Is low BMI increasing or declining? Is it still high anywhere? Says who?

Declining, still high in Asia and Africa, says Black et al (2013)

Determinants of obesity and non-communicable diseases in developing countries?

Developmental transition, nutritional transition, diet and lifestyle changes, migration, urbanisation, inequalities, undernutrition, globalisation

What causes stunting?

Disease, manual labour, endocrine stuff

What happens during developmental transition?

Epidemiological transition, demographic transition, nutrition transition

What is malnutrition associated with (5 things)?

Impaired cognitive development, poor educational achievement and low economic productivity (Victora et al, 2008) and ill health and mortality in the short term

What did Drewnowski and Spector find about over nutrition? What year?

In the US, over nutrition is more of a widespread problem amongst individuals in (relative) poverty, due to agricultural and technological advances that have made energy-dense foods more accessible and cheaper - 2004

How can you define poverty?

Individual's or family's income and resources are so inadequate as to preclude them from having a standard of living considered acceptable in the society in which they live. A condition that can disadvantage individuals through unemployment, low income, poor housing, inadequate health care and barriers to lifelong learning, culture, sport and recreation, as well as experiencing exclusion and possible denial of fundamental rights.

Why is it hard to tell in low SES societies?

Isolation of causal factors, education or poverty?

Who studied the double burden of undernutrition and over nutrition in Vietnam, and in what year?

Le Nguyen et al (2013)

What maternal factors affect stunting? Who found this and where?

Marital status, parity, pregnancy intentions, health-seeking behaviour and maternal level. - Abuya et al. (2013)

What did Houck et al find re: market integration? What year? Where?

Market integration is a major factor influencing cultural change, which has affected epidemiological and nutritional transitions. 2013. Ecuador compared with US

What about middle income countries?

Middle income countries have further suggested that burdens of overweight and obesity are shifted to groups of lower socioeconomic status (Monteiro et al., 2002)

What is the definition of food insecurity?

No adequate physical, social or economic access to sufficient, safe and nutritious food that meets dietary needs and food preferences for an active, healthy life - Tanumihardjo et al (2007)

What is 'hidden hunger'?

No overt clinical signs of undernutrition but subclinical nutrient deficiency - Tanumiharjo et al (2007)

What can prenatal/postnatal metabolic conditions do to an infant?

Prenatal/postnatal metabolic conditions can cause metabolic imprinting of the neuroendocrine pathways involved in energy homeostasis in the developing foetus, causing a vicious cycle

What is the difference between relative and absolute poverty?

Relative poverty = a standard that compares individuals with the society in which they live. An income-related example is X% of the average UK yearly income. Absolute poverty is a universal standard - less than $2 a day.

What is malnutrition?

Results from a diet in which nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals. It may be undernutrition or over nutrition.

Since when has stunting decreased? Where is it still high? Says who?

Since the 1980s. Still hight in South Asia and Sub-Saharan Africa - Black et al. (2013)

What did Steyn find about stunting? Where? What year?

Steyn found that stunting = an increased risk for being overweight, and that the determinants for stunting and overweight were similar, including housing type, type of toilet in home, fuel used for cooking, refrigerator or stove presence, tv presence, education of caregiver, maternal education level - South Africa, 2005

What did Black et al find? What year?

Suboptimum breastfeeding increases risk of mortality in first 2 years of life.

What did Pomeroy et al find? What year?

That rural highland and urban lowland Peruvian children had different patterns of stunting, due to different environmental stressors. 2014

Le Nguyen et al (2013) measured height, weight, mid-upper arm circumference, waist circumference, hip circumference, and dietary intake by 24 hour recall questionnaire. Why are recall questionnaires fundamentally shite?

WHO can recall what they ate all day?