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The Double Burden of Malnutrition GCHB 6780 Roger Shrimpton John Mason Lisa Saldanha

The Double Burden of Malnutrition GCHB 6780 Roger Shrimpton John Mason Lisa Saldanha. 23 January 2012 Class 3 : Consequences of DBM. Content. Review of readings Transitions Consequences of undernutrition Consequences of overnutrition Conclusions. Transitions.

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The Double Burden of Malnutrition GCHB 6780 Roger Shrimpton John Mason Lisa Saldanha

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  1. The Double Burden of MalnutritionGCHB 6780Roger ShrimptonJohn MasonLisa Saldanha 23 January 2012 Class 3 : Consequences of DBM

  2. Content • Review of readings • Transitions • Consequences of undernutrition • Consequences of overnutrition • Conclusions

  3. Transitions MOST POPULATION GROWTH IS IN URBAN POPULATIONS OF DEVELOPING COUNTRIES 3

  4. Transitions

  5. Transitions

  6. Transitions

  7. Transitions Source WHO 2011

  8. Consequences of undernutrition Source: WHO 2009

  9. Consequences of undernutrition THIS Death Source: James et al 2000 (modified)

  10. Consequences of undernutrition Cognitive function is benefitted across the life course, and optimal birth weight is above the mean Cognitive Function score(relative to 3-3.5kg) Birth weight (kg) OPTIMAL WEIGHT Years of age Richards, M. Et al. 2001 Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study. BMJ. 322:199-203

  11. The consequences of undernutrition Season of birth and adult mortality 3 Gambian villages Harvest season Hungry season Source: Moore, S.E., et al. 1997. Season of birth predicts mortality in rural Gambia. Nature 388: 434

  12. Consequences of undernutrition Coronary heart disease death rates according to birth weight in in men and women born between 1911 and 1930, Hertfordshire, UK. Godfrey, K.M. and Barker, D.J.P. 2000. Fetal Nutrition and adult disease. Am J Clin Nutr 71(suppl):1344S-52S

  13. Consequences of undernutrition Source: Sichieri et al 2000

  14. Consequences of undernutrition • Approximately a half of the economic growth achieved by the United Kingdom between 1790 and 1980, has been attributed to better nutrition (Fogel 1994) • Studies in developing countries suggest that the costs of child undernutrition alone exceed 3 percent of the GDP (Horton 1999). Which makes the annual costs for all the countries in Sub-Saharan Africa around US$10 billion. • Micronutrient “malnutrition” alone is estimated to cost 5% of GDP in South Asia (World Bank 1994), • No real estimate of the cost of the DBM across the life course

  15. Consequences of malnutrition Over half (12/19) of leading risk factors for death are nutrition related (50% over 50% under) Source WHO 2011

  16. Consequences of overnutrition Most NCD deaths occur in low and middle income countries Source WHO 2011

  17. Consequences of overnutrition Source WHO 2011

  18. Consequences of overnutrition Metabolic syndrome Source WHO 2011

  19. Consequences of overnutrition The metabolic syndrome (abdominal obesity, dyslipidaemia, high blood pressure, impaired glucose tolerance) increases the risk of developing cardiovascular diseases by x2, and type 2 diabetes by x3. Source: Potenza et al 2009

  20. Consequences of overnutrition Source: Potenza et al 2009

  21. Consequences of overnutrition Source: Potenza et al 2009

  22. Overweight (BMI>25) and underweight (BMI<18.5) in men and women over 45 years of age in Indonesian Family Life Surveys (%)

  23. Causes of DBM: Biological environment Hypertension* among adults in the Indonesia Family Life Surveys in 2007 % * Systolic >=140 or diastolic >=90

  24. Consequences of overnutrition Costs of the metabolic syndrome: • In US overweight and obesity costs estimated at $147 billion or 9.1% of health care expenditures (Hodgson 2001) • The total cost of diabetes in the United States in 2007 estimated at $218 billion (ADA 2008) • Direct and indirect costs of CVD in USA estimated at US$368 billion in 2004 (AHA 2003) • Costs of treating CVD in South Africa was 25% of health care spending and 2-3% of GDP. (Pestana et al 2006) • WEF estimates NCDs will cost more than US$ 30 trillion globally over the next 20 years, representing 48% of global GDP in 2010

  25. Rates and Hazard Ratios of Cardiovascular Disease Death by Body Mass Index and Cardiorespiratory Fitness Level in a cohort of men with diabetes (Source Church T et al 2005.)

  26. Conclusions • There are many transitions involved in the nutrition transition that is causing the double burden of malnutrition: epidemiological, demographic, rural to urban, economic, food, and anthropometric • The consequences of the DBM are enormous. • Early life undernutrition causes a large proportion of young children to die • In survivors lifelong capacity to study ,to carry out physical work, and to resist disease are all impaired. • Costs of undernutrition to the nation are at least 5% of GDP • Later in the life course, half of the most important risk factors for non-communicable diseases (NCDs) diet and nutrition related • The metabolic syndrome, of which abdominal obesity and type 2 diabetes play a central role, caused two thirds of the CVD burden. • The costs of the metabolic syndrome and/or CVD are already consuming upwards of 10% of health budgets and at least 5% of GDP in most more developed countries and will rapidly do the same in LMICs

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