The Double Burden of Malnutrition: A Systematic Review of Operational Definitions.
Ontology highlight
ABSTRACT: Background
Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions.Objectives
To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment.Methods
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.Results
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).Conclusions
Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.
SUBMITTER: Davis JN
PROVIDER: S-EPMC7456307 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
Publications
The Double Burden of Malnutrition: A Systematic Review of Operational Definitions.
Davis Jennie N JN Oaks Brietta M BM Engle-Stone Reina R
Current developments in nutrition 20200721 9
<h4>Background</h4>Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions.<h4>Objectives</h4>To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment.<h4>Methods</h4>Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e. ...[more]
Similar Datasets
Project description:BackgroundResearchers use different definitions to identify children with asthma in epidemiological surveys. We conducted a systematic review to describe the definitions used in epidemiologic studies for wheeze and asthma in the paediatric population, aimed to inform the development of a uniform definition of paediatric asthma for future epidemiological research.MethodsWe systematically searched terms to identify asthma and/or wheeze among children aged <13 years and published between 1995-2020 across seven databases (MEDLINE, EMBASE, PsycINFO, Global Health, AMED, LILACS and CINAHL). PRISMA guidelines were followed for this review.ResultsWe extracted a total of 11 886 records, where 190 met our eligibility criteria and included in the analysis. Among the included studies, 62.1% (n = 118/190) used the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires, predominantly in developing countries (80%, n = 64/80). 'Wheeze' was reported in five categories, subdivided by 14 different definitions. "Current wheeze", defined as caregivers report of wheezing sounds from the chest of the child in the past 12 months and "Wheeze ever", defined as caregivers' report of wheezing or whistling in the chest of the child at any previous time, were the most common wheeze category reported in 129 and 95 studies, respectively. Asthma was reported in nine categories using 53 definitions. The most common asthma category was "Asthma ever", which was reported in 89 studies, based on caregiver statement that the child had asthma in the past.ConclusionDefinitions of wheeze and asthma for children used in surveys are primarily based on parent-reported clinical features. Studies from developing countries more frequently used the ISAAC definitions to report childhood asthma and wheeze compared to the studies from developed counties. The use of a uniform asthma definition will aid the interpretation of research findings globally.
| S-EPMC8285759 | biostudies-literature
Project description:BackgroundDouble 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.MethodsOnline 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).ResultsIn 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.ConclusionDBM 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.
| S-EPMC7310807 | biostudies-literature
Project description:Migrants and refugees living in high income countries (HICs) have an increased risk of developing non-communicable diseases (NCDs) due to malnutrition at different stages over their life course. This systematic review aims to examine the double burden of malnutrition (DBM) among migrants and refugees in developed countries. This review was informed by the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Eligible studies were peer-reviewed observational studies that focused on the DBM in refugee or migrant populations; and were written in English with full texts available and accessible. A combination of keywords was used to search 8 electronic bibliographic databases including Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, ProQuest, Scopus, PubMed, and web of science. There is a paucity of research into the DBM among migrants and refugees residing in HICs. Of a total of 2344 articles retrieved from eight databases, 5 studies met the inclusion criteria. All included studies showed the co-existence of some form of undernutrition and overnutrition within the same population. Overnutrition (overweight and obesity) in the studied populations ranged from 11.1% to 42% while undernutrition (stunting, wasting and underweight) ranged from 0.3% to 17%. Standard measures for anthropometry as determined by World Health Organization (WHO) were used for data collection in all included studies. A piloted form informed by the Cochrane Public Health Group Data Extraction and Assessment Template was used in the extraction of data from retrieved studies. Quality assessment of included studies was performed using the study assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and showed that all studies were of fair quality. Interventions that simultaneously target more than one form of malnutrition especially amongst migrant and refugee populations must be implemented for policy solutions to be effective. This review has been registered by the PROSPERO international prospective registry for systematic reviews, reference CRD42020192416.
| S-EPMC9387835 | biostudies-literature
Project description:BackgroundAs adolescence is a transition period from childhood to adulthood malnutrition occurring at this age resonates through generations. Although there were many individual studies in Ethiopia about different form of malnutrition among adolescent, their results are inconclusive indicating the need for generating a pooled estimate of adolescent nutritional status and associated factors. This review and meta-analyses aimed at estimating the pooled prevalence of different forms of malnutrition and associated factors among adolescents in Ethiopia.Method and materialsWe searched data bases from Pub Med, Cochrane Library, Health Inter Network Access to Research Initiative (HINARI), Science Direct and search engines; Google and Google Scholar and other sources; Reference of References and expert contact which were used to select the studies. Joanna Briggs Institute (JBI) quality appraisal tool was applied to identify eligible studies. STATA/SE V.14 was used to analyze the data. Effect size with 95% Confidence Interval (CI) and heterogeneity were estimated. Heterogeneity of studies was quantified with I2 statistic >50% used as an indicator of heterogeneity. Potential publication bias was assessed using Funnel plots and Egger's regression test. Trim and fill analysis was also performed. The presences of a statistical association between independent and dependent variables were declared at P <0.05. The PROSPERO registration number for the review is CRD42020159734.ResultsThe pooled prevalence of overweight/obesity, stunting and thinness were 10.63% (95% CI: 8.86, 12.40), 20.06% (95% CI: 15.61, 24.51) and 21.68% (95% CI: 9.56, 33.81), respectively. Being female (OR: 2.02, CI: 1.22-3.34), low dietary diversity score (OR: 2.26 CI: 1.28-3.99) and high physical activity (OR: 0.36, 95%CI: 0.14-0.88) were significantly associated with adolescent overweight/obesity. Urban residence (OR: 0.82, 95%CI: 0.68-0.99), protected drinking water source (OR: 0.50, CI: 0.27-0.90) and having family size<5 people (OR: 0.54, CI: 0.44-0.66) were independent predictors of adolescent stunting. Early adolescent age (10-14 years) (OR: 2.38, CI: 1.70-3.34), protected water source for drinking (OR: 0.36, CI: 0.21-0.61), low wealth index (OR: 1.80, CI: 1.01-3.19) and family size <5 people (OR: 0.50, CI: 0.28-0.89) were significantly (P < 0.05) associated with adolescent thinness.ConclusionThe prevalence of overweight/obesity, stunting and thinness are high in Ethiopian adolescents indicating the upcoming challenge of double burden of malnutrition. The results imply the presence of double burden of malnutrition among adolescents which heralds the need for programmatic and policy response in terms of addressing modifiable risk factors including: dietary practices, physical activity, water source and economic status of these adolescents.
| S-EPMC10096189 | biostudies-literature
Project description:Despite the widespread use of the expression "physical activity pattern" (PAP), there apparently is no general consensus regarding its definition. This systematic review aimed to examine available research focussing on (1) definitions of PAP, (2) instruments/techniques used to describe PAP, (3) statistical approaches used to analyse PAP, and (4) implications of PAP on children's health. A systematic review of the available literature was done to identify studies published up to October 2019, and 76 studies were eligible. None of the studies presented a formal definition of PAP; a wide range of instruments were used to investigate children's PAP, and most of the revised studies did not explicitly present a formal statistical model to define PAP. Twenty-four papers purported to examine associations between PAP and health indicators. The review highlights no consensus on a clear PAP definition whatever the instrument used to capture it, and we did not find any agreement regarding how best to analyse PAP. We suggest that PAP should be used when targeting the investigation of similarities/dissimilarities, as well as stabilities and/or changes in children's PA at an intra-personal level. In sum, PAP should be used to best describe individual streams of behaviours, and not exclusively PA levels/intensities.
| S-EPMC7459930 | biostudies-literature
Project description:BackgroundLow- to middle-income countries (LMICs) are believed to be characterized by the coexistence of underweight and overweight. It has also been posited that such coexistence is appearing among the low socioeconomic status (SES) groups.MethodsWe conducted a cross-sectional analysis of nationally representative samples of 451,321 women aged 20-49 years drawn from 57 Demographic and Health Surveys conducted between 1994 and 2008. Body Mass Index (BMI in kg/m²), was used to define underweight and overweight following conventional cut-points. Covariates included age, household wealth, education, and residence. We estimated multinomial multilevel models to assess the extent to which underweight (BMI<18.5 kg/m²) and overweight (BM I≥ 25.0 kg/m²) correlate at the country-level, and at the neighborhood-level within each country.ResultsIn age-adjusted models, there was a strong negative correlation between likelihood of being underweight and overweight at country- (r = -0.79, p<0.001), and at the neighborhood-level within countries (r = -0.51, P<0.001). Negative correlations ranging from -0.11 to -0.90 were observed in 46 of the 57 countries at the neighborhood-level and 29/57 were statistically significant (p ≤ 0.05). Similar negative correlations were observed in analyses restricted to low SES groups. Finally, the negative correlations across countries, and within-countries, appeared to be stable over time in a sub-set of 36 countries.ConclusionThe explicitly negative correlations between prevalence of underweight and overweight at the country-level and at neighborhood-level suggest that the hypothesized coexistence of underweight and overweight has not yet occurred in a substantial manner in a majority of LMICs.
| S-EPMC3182195 | biostudies-literature
Project description:BackgroundChildren living in refugee camps in South Asian countries suffer from undernutrition. However, the emerging prevalence of double burden of malnutrition could potentially cause a crisis in the healthcare of the refugee population. Double burden increases the risk for co-morbidities, poor functional health, and increased risk for premature death among these children. The study aims to assess the prevalence of malnutrition among refugee children in South Asia.MethodsThis systematic review and meta-analysis followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using CoCoPop mnemonic approach. We searched JSTOR, Scopus, PubMed, Web of Science, and MEDLINE databases for studies on the prevalence of malnutrition in refugee children from 1984 to August 2024 with restricted English language. The screening of research articles was undertaken using COVIDENCE 2.0 software. The JBI checklist was used to assess the methodological quality of the included articles. The meta analysis was carried out using MedCalc 22.018 software. The gray literature was manually searched from the reputed organizations focusing on refugee children and was narratively analyzed for malnutrition statistics. Furthermore, the corroboration of primary research articles and gray literature was conducted for comprehensive understanding.ResultsThe review included 10 full-text research articles, all with cross-sectional study design and 11 gray literatures. The 10 studies covered a total of 4,274 participants with 3,536 urban and 738 rural refugee children aged between 0 and 19 years [refugee children (n = 8) and refugee adolescents (n = 2)]. The sample size of the included studies varied between 58 and 1,087 and mostly from Bangladesh. The prevalence of stunting ranged from 3.9-75.4% in the included studies [pooled prevalence: 31.8% (95% CI: 18.6-46.6%)]; wasting between 0.3-24.3% [pooled prevalence:10.1% (95% CI: 4.6-17.3)]; underweight between 4.4-65% [pooled prevalence: 19.1% (95% CI: 10.8-29.2%)]; and overweight between 3 and 24% [pooled prevalence: 6.5% (95% CI: 2.6-12.1%)]. Time trend analysis of the prevalence of malnutrition showed a decreasing trend in underweight, an increasing trend for stunting and wasting, and overweight including a rising prevalence of dual burden of under-and overnutrition.DiscussionThe study indicates a high prevalence of undernutrition and a rising prevalence of overnutrition -the Asian paradox of the double burden of malnutrition in refugee children living in South Asia. The coexisting double burden of malnutrition among refugee children calls for comprehensive programs and policies for the prevention and management of the double burden of malnutrition.
| S-EPMC11847640 | biostudies-literature
Project description:IntroductionCurrently, the double burden of malnutrition (DBM) is an emerging public health problem due to the inevitable consequences of nutritional transition. An increasing number of studies have reported the DBM in Ethiopian populations. However, organised and summarised national evidence is not yet available. Therefore, the main aim and research question of this scoping review is to map the national evidence on the DBM in the last decades in Ethiopia.MethodsThis scoping review will be mapping the national evidence on the DBM in different population groups of Ethiopia including all ages and both sexes from 1 January 2021 to 30 September 2021. The Joanna Briggs Institute Reviewer's Manual will be used as the methodology of review for this review. The search strategy will be conducted using electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar, and grey literature sources and reference lists of key studies to identify studies appropriate for inclusion in the review. Two independent reviewers will be screened independently with all abstracts and full-text studies for inclusion. Data will be abstracted into tables and logically organised according to the items addressed in the specific research questions.Ethics and disseminationThe data will be used from publicly available secondary sources. Therefore, no ethical review and approval will be required for this review. Dissemination of results will be sought through peer-reviewed publications, conference presentations and stakeholder meetings. Regarding registration, this review protocol is registered on the figshare website on 28 February 2021, with the DOI number https://doiorg/106084/m9figshare14131874.
| S-EPMC8578986 | biostudies-literature
Project description:BackgroundCommon, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability among research and quality improvement efforts, to ensure findings are generalizable, and can be pooled to establish best practices.Research questionCan we establish operational definitions for key elements related to pediatric ventilator liberation using a combination of detailed literature review and consensus-based approaches?Study design and methodsA panel of 26 international experts in pediatric ventilator liberation, two methodologists, and two librarians conducted systematic reviews on eight topic areas related to pediatric ventilator liberation. Through a series of virtual meetings, we established draft definitions that were voted upon using an anonymous web-based process. Definitions were revised by incorporating extracted data gathered during the systematic review and discussed in another consensus meeting. A second round of voting was conducted to confirm the final definitions.ResultsIn eight topic areas identified by the experts, 16 preliminary definitions were established. Based on initial discussion and the first round of voting, modifications were suggested for 11 of the 16 definitions. There was significant variability in how these items were defined in the literature reviewed. The final round of voting achieved ≥ 80% agreement for all 16 definitions in the following areas: what constitutes respiratory support (invasive mechanical ventilation and noninvasive respiratory support), liberation and failed attempts to liberate from invasive mechanical ventilation, liberation from respiratory support, duration of noninvasive respiratory support, total duration of invasive mechanical ventilation, spontaneous breathing trials, extubation readiness testing, 28 ventilator-free days, and planned vs rescue use of post-extubation noninvasive respiratory support.InterpretationWe propose that these consensus-based definitions for elements of pediatric ventilator liberation, informed by evidence, be used for future quality improvement initiatives and research studies to improve generalizability and facilitate comparison.
| S-EPMC10206507 | biostudies-literature
Project description:Malnutrition has historically been researched and addressed within two distinct silos, focusing either on undernutrition, food insecurity, and micronutrient deficiencies, or on overweight, obesity, and dietary excess. However, through rapid global nutrition transition, an increasing proportion of individuals are exposed to different forms of malnutrition during the life course and have the double burden of malnutrition (DBM) directly. Long-lasting effects of malnutrition in early life can be attributed to interconnected biological pathways, involving imbalance of the gut microbiome, inflammation, metabolic dysregulation, and impaired insulin signalling. Life-course exposure to early undernutrition followed by later overweight increases the risk of non-communicable disease, by imposing a high metabolic load on a depleted capacity for homoeostasis, and in women increases the risk of childbirth complications. These life-course trajectories are shaped both by societal driving factors-ie, rapidly changing diets, norms of eating, and physical activity patterns-and by broader ecological factors such as pathogen burden and extrinsic mortality risk. Mitigation of the DBM will require major societal shifts regarding nutrition and public health, to implement comprehensive change that is sustained over decades, and scaled up into the entire global food system.
| S-EPMC7613491 | biostudies-literature