Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis

Wen Peng; Yuhan Mu; Yang Hu; Bin Li; Jayanthi Raman; Zhixian Sui

doi:10.2991/jegh.k.191117.002

Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis

J Epidemiol Glob Health. 2020 Mar;10(1):16-27. doi: 10.2991/jegh.k.191117.002.

Authors

Wen Peng¹, Yuhan Mu¹, Yang Hu¹, Bin Li¹, Jayanthi Raman², Zhixian Sui^{3

4}

Affiliations

¹ Department of Public Health, Medical School, Qinghai University, Qinghai, China.
² Clinical Psychology, Australian College of Applied Psychology, Sydney, NSW 2000, Australia.
³ School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2052, Australia.
⁴ The BMI Clinic, Double Bay, NSW 2028, Australia.

Abstract

Background: Double Burden of Malnutrition (DBM)-the coexistence of undernutrition along with overnutrition-is a significant public health issue in the Asia-Pacific region. The scope of the DBM in this region is largely unknown. This review aims to determine the prevalence of under- and overnutrition as major DBM components and to investigate whether there has been a shift from under- to overnutrition in the Asia-Pacific region.

Methods: Online databases including PubMed and Web of Science were searched for original studies on DBM prevalence in the Asia-Pacific region; particularly, those published from January 2008 to December 2018 were screened for eligibility. We collected data on indicators of under- and overnutrition on the population level and adapted the ratio of prevalence of overweight/obesity versus prevalence of underweight as the main outcome indicator. Pooled prevalence estimates of DBM and the ratio of overnutrition versus undernutrition were generated using R (3.4.0).

Results: In total, 33 studies were included in this review. Pooled analysis demonstrated that DBM was generally presented among countries/areas in the Asia-Pacific region except in high-income countries (HICs). Overall, the prevalence of undernutrition was 8.8% (95% CI 7.3-10.6%) while overnutrition among the same population reached 23.0% (95% CI 20.3-26.0%). Countries in the Oceania region or HICs reported low level of undernutrition (less than 3%). All subgroup analysis (geolocation, income level, sex, age) reported pooled prevalence of overweight/obesity as more than 18%. Overall, the whole region and all subgroups were more likely to experience a higher prevalence of overnutrition than undernutrition, except that low- and lower-middle-income countries (L-MICs) had similar prevalence for over- and undernutrition.

Conclusion: DBM in the Asia-Pacific region is alarmingly high and is titled toward overnutrition. As a result, future interventions/policy targeting to maintain a healthy weight for the population should not just focus on prevention and treatment toward one direction.

Keywords: Asia-Pacific; Double burden; malnutrition; overnutrition; undernutrition.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Asia / epidemiology
Developing Countries / statistics & numerical data*
Humans
Malnutrition / epidemiology*
Overnutrition / epidemiology*
Pacific Islands / epidemiology
Prevalence