Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology

Patterns and determinants of the double burden of malnutrition at the household level in South and Southeast Asia

European Journal of Clinical Nutrition volume 75, pages 385–391 (2021)Cite this article

Subjects

Abstract

Objectives

Many developing countries currently face a double burden of malnutrition (DBM) at the household level, defined by the World Health Organization, as when a mother may be overweight or anemic, and a child or grandparent is underweight, in the same household. For the present study, we defined it as the coexistence of overweight or obesity in the mother, and at least one child under the age of 5 undernourished, within the same household. Although underweight has long been considered a major issue in South and Southeast Asia, overweight and obesity have also been identified as a growing problem. The main aim of this study was to assess the DBM at the household level and its major determinants in South and Southeast Asia.

Methods

We used population-representative cross-sectional data from the Demographic and Health Survey, conducted between 2007 and 2017, for eight South and Southeast Asian countries: Bangladesh, India, Nepal, Pakistan, Myanmar, Timor, Maldives, and Cambodia. Multivariate logistic regression was performed to identify the sociodemographic factors associated with DBM.

Results

A total of 798,961 households were included in this study. The pooled prevalence of overweight or obesity for the mother and stunted child was 10.0% (95% CI: 8.0.0–12.0), for OBM and wasted child, it was 7.0% (95% confidence interval (CI): 6.0–8.0), and for overweight or obese mother (OBM) and underweight child, it was 7.0% (95% CI: 6.0–8.0). The prevalence of any of these DBM coexistences was 12.0% (95% CI: 10.0–13.0) in all households. Statistically significant positive associations (p < 0.05) were found for each of these coexistences, and a higher age of the mother, mothers with a lower education, the richest household quintile, and households with more than four members.

Conclusion

It is imperative that “double duty” action policies are developed that tackle the DBM, rather than targeting undernutrition or overnutrition separately. The findings from this study suggest that the promotion of education for women may aid in tackling the double burden on a household level.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Prevalence of household-level double burden of malnutrition among mother–child pair in South and Southeast Asian countries.

Similar content being viewed by others

References

  1. Hoque ME, Hasan MT, Rahman M, Long KZ, Al Mamun A. Double burden of underweight and overweight among Bangladeshi adults differs between men and women: evidence from a nationally representative survey. JPHN. 2017;20:2183–91.

    Google Scholar 

  2. Doak CM, Adair LS, Monteiro C, Popkin BM. Overweight and underweight coexist within households in Brazil, China and Russia. J Nutr. 2000;130:2965–71.

    Article  CAS  Google Scholar 

  3. Hanandita W, Tampubolon G. The double burden of malnutrition in Indonesia: social determinants and geographical variations. SSM-Popul Health. 2015;1:16–25.

    Article  Google Scholar 

  4. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. 2013;382:427–51.

    Article  Google Scholar 

  5. Bloom D, Cafiero E, Jané-Llopis E, Abrahams-Gessel S, Bloom L, Fathima S, et al. The global economic burden of noncommunicable diseases. Geneva: Program on the Global Demography of Aging; 2012.

  6. Robert KW, Parris TM, Leiserowitz AA. What is sustainable development? Goals, Indicators, Values, and Practice. 2005;47:8–21.

  7. Dieffenbach SD. Are stunted child/overweight mother pairs a distinct entity or a statistical artifact? Demographic and Health Surveys, 1991–2009. Stein: Emory University; 2012.

  8. NIPORT M, Macro O. Bangladesh demographic and health survey 2004. Dhaka: National Institute of Population Research and Training, Mitra and Associates, and ORC Macro; 2005.

    Google Scholar 

  9. NIPORT M. Bangladesh demographic and health survey BDHS 2014: key indicators. Dhaka and Calverton, Maryland: National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International; 2014.

    Google Scholar 

  10. Biswas T, Uddin MJ, Al Mamun A, Pervin S, Garnett SP. Increasing prevalence of overweight and obesity in Bangladeshi women of reproductive age: findings from 2004 to 2014. PloS ONE. 2017;12:e0181080.

    Article  Google Scholar 

  11. Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393:791–846.

    Article  Google Scholar 

  12. Perez-Escamilla R, Bermudez O, Buccini GS, Kumanyika S, Lutter CK, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018;361:k2252.

    Article  Google Scholar 

  13. Das S, Shah MF, Islam MS, Biswas T, Mahfuz M, Ahmed T. Prevalence and sociodemographic determinants of household-level double burden of malnutrition in Bangladesh. JPHN. 2019;22:1425–32.

  14. Jehn M, Brewis AJE, Biology H. Paradoxical malnutrition in mother–child pairs: untangling the phenomenon of over- and under-nutrition in underdeveloped economies. Econ Hum Biol. 2009;7:28–35.

  15. Oddo VM, Rah JH, Semba RD, Sun K, Akhter N, Sari M, et al. Predictors of maternal and child double burden of malnutrition in rural Indonesia and Bangladesh. The Am J Clin Nutr. 2012;95:951–8.

  16. Schott W, Aurino E, Penny ME, Behrman JR. The double burden of malnutrition among youth: trajectories and inequalities in four emerging economies. Econ Hum Biol. 2019;34:80–91.

    Article  Google Scholar 

  17. Kimani-Murage EW, Muthuri SK, Oti SO, Mutua MK, van de Vijver S, Kyobutungi C. Evidence of a double burden of malnutrition in urban poor settings in Nairobi, Kenya. PloS ONE. 2015;10:e0129943.

    Article  Google Scholar 

  18. Kosaka S, Umezaki M. A systematic review of the prevalence and predictors of the double burden of malnutrition within households. Br J Nutr. 2017;117:1118–27.

    Article  CAS  Google Scholar 

  19. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157.

    Article  Google Scholar 

  20. Pi-Sunyer X. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults-the evidence report. Obes Res. 1998;6:51S–210S.

    Article  Google Scholar 

  21. Biswas T, Islam MS, Linton N, Rawal LB. Socio-economic inequality of chronic non-communicable diseases in Bangladesh. PloS ONE. 2016;11:e0167140.

    Article  Google Scholar 

  22. Hasan MT, Soares Magalhaes RJ, Williams GM, Mamun AAJM. The role of maternal education in the 15‐year trajectory of malnutrition in children under 5 years of age in Bangladesh. 2016;12:929–39.

  23. Jehn M, Brewis A. Paradoxical malnutrition in mother–child pairs: untangling the phenomenon of over-and under-nutrition in underdeveloped economies. Econ Hum Biol. 2009;7:28–35.

    Article  Google Scholar 

  24. Sekiyama M, Jiang HW, Gunawan B, Dewanti L, Honda R, Shimizu-Furusawa H, et al. Double burden of malnutrition in rural West Java: household-level analysis for father-child and mother-child pairs and the association with dietary intake. Nutrients. 2015;7:8376–91.

  25. Wong C, Zalilah M, Chua E, Norhasmah S, Chin Y, Nur’Asyura AS. Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia. BMC Public Health. 2015;15:680.

  26. Biswas T, Townsend N, Magalhaes RS, Islam MS, Hasan MM, Mamun A. Current progress and future directions in the double burden of malnutrition among women in South and Southeast Asian countries. Curr Dev Nutr. 2019;3:nzz026.

  27. World Health Organization. Double-duty actions for nutrition: policy brief. Geneva: World Health Organization; 2017.

Download references

Acknowledgements

We thank the MEASURE DHS Data Archive, ICF International, for providing access to the South and Southeast Asian Demographic and Health Surveys data.

Author information

Authors and Affiliations

  1. Institute for Social Science Research, University of Queensland, 80 Meiers Road, Indooroopilly, QLD, 4068, Australia

    Tuhin Biswas, Mehedi Hasan & Abdullah Mamun

  2. ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, QLD, Australia

    Tuhin Biswas, Mehedi Hasan & Abdullah Mamun

  3. Department for Health, University of Bath, Bath, BA2 7AY, UK

    Nick Townsend

  4. UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia

    R. J. Soares Magalhaes

  5. Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia

    R. J. Soares Magalhaes

Authors
  1. Tuhin Biswas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nick Townsend
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. J. Soares Magalhaes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehedi Hasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abdullah Mamun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tuhin Biswas.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Biswas, T., Townsend, N., Magalhaes, R.J.S. et al. Patterns and determinants of the double burden of malnutrition at the household level in South and Southeast Asia. Eur J Clin Nutr 75, 385–391 (2021). https://doi.org/10.1038/s41430-020-00726-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-020-00726-z

This article is cited by

Search

Advanced search

Quick links