The double burden of malnutrition: aetiological pathways and consequences for health

Wells, Jonathan C; Sawaya, Ana Lydia; Wibaek, Rasmus; Mwangome, Martha; Poullas, Marios S; Yajnik, Chittaranjan S; Demaio, Alessandro

doi:10.1016/s0140-6736(19)32472-9

Cited by 993Birth, Development, and HealthChild Nutrition and Water AccessObesity, Physical Activity, Diet

The double burden of malnutrition: aetiological pathways and consequences for health

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Wells, Jonathan C, Sawaya, Ana Lydia, Wibaek, Rasmus, Mwangome, Martha, Poullas, Marios S, Yajnik, Chittaranjan S, Demaio, Alessandro·2020·The Lancet

DOI 10.1016/s0140-6736(19)32472-9PMC PMC7613491

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Abstract

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.

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Height and weight are affected by the quantity and quality of nutrition, energy expenditure, and some infections.
“Height and weight are affected by the quantity and quality of nutrition, energy expenditure, and some infections.19,20”
From Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults (2024) · cites this paper as [19]
The paper’s “An evolutionary perspective” section (page unavailable) links dietary energy availability and diet composition to growth and weight gain; its Conclusion says infectious disease constrains linear growth. The “Intergenerational emergence of the DBM” section discusses energy sparing and fuel metabolism in relation to weight gain, but the available text does not clearly establish energy expenditure as a determinant of both height and weight. (LLM, conf=0.81)
Experimental — accuracy not yet measured
In some countries, equitable economic and agricultural policies and food programmes have improved the quality of nutrition, especially for the poor, resulting in gains in height, whereas elsewhere weight gain occurred without substantial height gain, leading to increasing obesity.
“In some countries, equitable economic and agricultural policies and food programmes have improved the quality of nutrition, especially for the poor,33–36 resulting in gains in height, whereas elsewhere weight gain occurred without substantial height gain, leading to increasing obesity.4,11,19,37”
From Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults (2024) · cites this paper as [19]
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Authors: Wells, J. C., Sawaya, A. L., Wibaek, R., Mwangome, M., Poullas, M. S., Yajnik, C. S., & Demaio, A.
Affiliations: University College London (GB)
Universidade Federal de São Paulo (BR)
Kenya Medical Research Institute (KE)
Corresponding author: Wells, Jonathan C
ORCID: Wells, Jonathan C
Sawaya, Ana Lydia
Mwangome, Martha
Poullas, Marios S
Yajnik, Chittaranjan S
Venue: The Lancet
Publisher: Elsevier BV
Published: 2020-01
Volume: 395
Issue: 10217
Pages: 75-88
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(19)32472-9
PMC: PMC7613491
OpenAlex: W2994880111
Cited by: 993
References: 142
Citations by year: 2026: 193 · 2025: 160 · 2024: 146 · 2023: 151 · 2022: 131 · 2021: 126 · 2020: 81 · 2019: 4
FWCI: 18.07
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: Bill and Melinda Gates Foundation
World Health Organization
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords: double burden of malnutrition, malnutrition, overweight, obesity, nutrition transition, gut microbiota, inflammation, metabolic dysfunction, insulin signaling, non-communicable diseases, maternal health, life course exposure, food insecurity, micronutrient deficiency, public health policy
MeSH terms: Gastrointestinal Microbiome, Female, Humans, Indonesia, Male, Nutritional Status, Obesity, Exercise, Prevalence, Age of Onset, Africa South of the Sahara, Malnutrition, Overweight, Metabolic Networks and Pathways

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The double burden of malnutrition: aetiological pathways and consequences for health

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