Research suggests macro-level factors are to blame for malnutrition

A study led by Dr Rishi Caleyachetty, Assistant Professor at the Warwick Medical School, suggests that macro-level factors are to blame for the double burden of malnutrition among adolescents in low- and middle- income countries (LMIC). Research has found that macro-level factors including war, lack of democracy, urbanisation, food insecurity and economic growth contribute to this shockingly common issue found in developing countries.

The double burden of malnutrition refers to a coexistence of undernutrition and obesity and being overweight, and diet-related non-communicable diseases such as Type 2 diabetes. Adolescence is a period of critical growth and development with greater nutritional demands thereby putting individuals at a greater risk of malnutrition. The study, published in the American journal of Clinical Nutrition (AJCN) has found that macro-level factors contribute to increasing this risk.

Double burden of malnutrition refers to a coexistence of undernutrition and obesity and overweight and diet-related non-communicable diseases such as Type-2 diabetes

Researchers used data from surveys conducted by the Centre for Disease Control and Prevention and the World Health Organisation in 57 LMICs and linked the nutritional data to international databases including the World Bank and the Food and Agriculture Organisation (FAO). The objective of the study was to quantify the magnitude of the double burden of malnutrition among adolescents in LMICs and explain their variance across the countries.

Firstly, it was found that 10.2% of the adolescents were stunted, which is associated with impaired cognitive development and school achievement, reduced economic productivity, and poor reproductive health in females. This indicates that the double burden not only is exacerbated by the macro-level factors but it also consequently reduces the economic developments of the countries. Secondly, it was found that 5.5% of the adolescents among the 57 LMICs were affected by thinness which can lead to delayed maturation and poor muscle growth. Additionally, more than a fifth, a 21.4%, of the adolescents were overweight or obese which contributes to an early onset of chronic diseases, including Type 2 diabetes and hypertension, and mortality in adult life.

The double burden not only is exacerbated by the macro-level factors but it also consequently reduces the economic developments of the countries

Between 38.4% – 58.7% of the variance in adolescent malnutrition was explained by macro-level contextual factors, therefore, researchers are now calling on governments and NGOs to identify context-specific issues. The paper acknowledges that it is an important challenge for governments to decide how to allocate their limited resources to counteract this wide-spread public health issue. Researchers, however, argue that without any consideration of the context, interventions and programs for adolescent malnutrition in LMICs may fail or underperform. It has been proposed that double-duty actions, including interventions, programs and policies, have the potential to reduce the risk or burden of obesity and thinness.

Dr Caleyachetty added that “the majority of adolescents live in LMICs but the global health community has largely neglected the health needs of this population” and further encouraged the global health community to adapt their traditional responses so that optimal interventions for adolescents can be provided.