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The 'double burden of malnutrition' is a global health challenge that increasingly affects populations in both low‐ and middle‐income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet‐related non‐communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context‐specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re‐evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio‐economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions. [ABSTRACT FROM AUTHOR]

Although widely used, there is little information concerning the efficacy of corn-soy blend (CSB) supplementation in the treatment of moderate underweight in African children. Lipid-based nutrient supplements (LNS), which have proven to be beneficial treatment for severely wasted children, could offer benefits to less severely affected individuals. We conducted a clinical randomized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children. A total of 182 underweight [weight-for-age Z-score (WAZ) < -2] 6- to 15-mo-old children were randomized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB, providing 1189 and 921 kJ, respectively, or no supplementation (control). The primary outcome was weight change; secondary outcomes included changes in anthropometric indices, hemoglobin levels, and morbidity. The body weight increases (mean [+ or -] SD) did not differ and were 620 [+ or -] 470, 510 [+ or -] 350, and 470 [+ or -] 350 g in the LNS, CSB, and control groups, respectively (P = 0.11). Compared with controls, infants and children in the LNS group gained more weight (mean (95% CI) = 150 g (0-300 g); P = 0.05] and had a greater increase in WAZ [0.33 (-0.02-0.65); P = 0.04]. Weight and WAZ changes did not differ between the control and CSB groups. In exploratory stratified analysis, the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [250 g (60-430 g; P = 0.01]. Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ. J. Nutr. 140: 2008-2013, 2010. doi: 10.3945/jn.110.122499.

Poor complementary feeding practices are associated with stunting and growth faltering throughout the developing world. The objective was to compare the effect of using peanut-/soy-based fortified spread (FS) and corn porridge fortified with fish powder (FP) as complementary foods on growth in rural Malawian children. A total of 240 children were enrolled at the age of 6 mo and randomized to receive FS or FP. Both complementary foods provided 836 kJ/d from 6 to 9 me of age and 1254 kJ/d from 9 to 18 mo of age. Children were followed monthly for anthropometry and fortnightly for the symptoms of fever, cough, or diarrhea until they were 18 mo old. Zn and Se status were assessed at 6 and 12 mo. The primary outcomes were the rates of weight and length gain from 6-12 mo and from 12-18 mo. Children who received FS gained 110 g more (95% Cl 220 to 10) from 6-12 me of age than children receiving FP. Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age, nor did statural growth from 6 to 12 mo or 12 to 18 mo. A total of 23% of all children were Zn deficient at 6 mo of age and this increased to 37% at 12 mo of age. Neither FS nor FP was associated with significantly improved Zn status. FS was associated with better weight gain from 6-12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world.

This study proposes a method for computing the distributions of mortality risk attributable to malnutrition among children of developing countries. Population distributions of nutritional status were adjusted with a normal curve and the relation between mortality and nutritional status was fitted with a linear logistic model after controlling for age. The attributable risk for mortality could therefore be computed at any threshold of low nutritional status. The method was applied in Niakhar, Senegal, where a comprehensive study of the relation between nutritional status and mortality was conducted in 1983-1984 on ~5000 children, 6-59 mo of age. The anthropometric indicators used were Z-scores of weight-for-age, weight-for -height, height-for-age, head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age, and subscapular skinfold-for-age, plus arm circumference, body mass index, and 2 composite indicators. Population attributable fraction varied according to indicators selected and ranged from 31% (head circumference) to 65% (arm circumference). The 2 composite indicators summarizing the whole nutritional status provided the same value for the population attributable fraction (59 and 60%, respectively). Classic thresholds of mild, moderate, and severe malnutrition are presented, as well as the bivariate distribution of wasting and stunting. Whatever the indicator used, mortality attributable risks appeared evenly distributed along the scale of low nutritional status. Our findings question the value of using classic thresh-olds of mild, moderate, and severe malnutrition (developed by clinicians for practical purposes) for nutritional epidemiology.

Objective: to predict, for French women, the impact of a cost constraint on the food choices required to provide a nutritionally adequate diet. Design: Isocaloric daily diets fulfilling both palatability and nutritional constraints were modeled in linear programming, using different cost constraint levels. For each modeled diet, total departure from an observed French population's average food group pattern ('mean observed diet') was minimized. Results: To achieve the nutritional recommendations without a cost constraint, the modeled diet provided more energy from fish, fresh fruits and green vegetables and less energy from animal fats and cheese than the 'mean observed diet.' Introducing and strengthening a cost constraint decreased the energy provided by meat, fresh vegetables, fresh fruits, vegetable fat, and yogurts and increased the energy from processed meat, eggs, offal, and milk. For the lowest cost diet (ie, 3.18 [euro]/d), marked changes from the 'mean observed diet' were required, including a marked reduction in the amount of energy from fresh fruits (-85%) and green vegetables (-70%), and an increase in the amount of energy from nuts, dried fruits, roots, legumes, and fruit juices. Implications: Nutrition education for low-income French women must emphasize these affordable food choices. Key Words: linear programming, nutrient recommendations, diet cost, food selection, women, nutrition education, economic constraints.

Objectives. We examined the association between diet quality and estimated diet costs. Methods. Freely chosen diets of 837 French adults were assessed by a dietary history method. Mean national food prices for 57 foods were used to estimate diet costs. Results. Diets high in fat, sugar, and grains were associated with lower diet costs after adjustment for energy intakes, gender, and age. For most levels of energy intake, each additional 100 g of fats and sweets was associated with a 0.05-0.40 [euro] per day reduction in diet costs. In contrast, each additional 100 g of fruit and vegetables was associated with a 0.18-0.29 [euro] per day increase in diet costs. Conclusions. Diets high in fats and sweets represent a low-cost option to the consumer, whereas the recommended 'prudent' diets cost more.

Effective food-based dietary guidelines (FBDGs) are required to combat micronutrient deficiencies. This study aimed to develop a rigorous approach for designing population-specific FBDGs. A 4-phase approach based on linear programming analysis was used to design, test, and refine the FBDGs. This was illustrated for Malawian children. In phase I, the objective function minimized the difference in the energy contributed by different food groups between modeled and observed diets for 16 observed diet types, while preferentially selecting foods most often consumed. Constraints ensured nutrient adequacy and diet palatability. In phase II, the meal/snack patterns of the phase I modeled diets were examined to develop season-specific FBDGs. In phase III, the robustness of these FBDGs, for ensuring a nutritionally adequate diet, was tested. The objective function, in this analysis, minimized selected nutrient levels in the modeled diets (i.e., chose the 'worst-case scenario'), while respecting the FBDGs, palatability, and energy constraints. The FBDGs were refined in phase IV. In the Malawian example used to illustrate our approach, the FBDGs promoted daily consumption of maize flour, small dry fish ([greater than or equal to] 20 g), leaf relish, and 2-3 snacks. The last mentioned included mangoes, in the food-shortage season, and pumpkin in the food-plenty season. In addition, legume relish was recommended in the food-shortage season. The approach presented here can be used to design and then test the robustness of FBDGs for meeting nutrient recommendations. J. Nutr. 134: 951-957, 2004. KEY WORDS: * linear programming * food-based dietary guidelines * recommendations * children * Africa * Malawi

Economic constraints may contribute to the unhealthy food choices observed among low socioeconomic groups in industrialized countries. The objective of the present study was to predict the food choices a rational individual would make to reduce his or her food budget, while retaining a diet as close as possible to the average population diet. Isoenergetic diets were modeled by linear programming. To ensure these diets were consistent with habitual food consumption patterns, departure from the average French diet was minimized and constraints that limited portion size and the amount of energy from food groups were introduced into the models. A cost constraint was introduced and progressively strengthened to assess the effect of cost on the selection of foods by the program. Strengthening the cost constraint reduced the proportion of energy contributed by fruits and vegetables, meat and dairy products and increased the proportion from cereals, sweets and added fats, a pattern similar to that observed among low socioeconomic groups. This decreased the nutritional quality of modeled diets, notably the lowest cost linear programming diets had lower vitamin C and [beta]-carotene densities than the mean French adult diet (i.e., KEY WORDS: * linear programming * nutrient * diet cost * food selection * adults

Goat's milk appears similar to cow's milk in enhancing weight gain in the treatment of malnourished children. Thirty malnourished children between one and five years old in Madagascar, Africa, were randomly assigned to treatment with either cow's milk or goat's milk. Both milks were supplemented with vegetable oil, sugar, vitamins and minerals. Goat's milk is cheaper than cow's milk in Madagascar. Children treated with goat's milk gained an average of 8.5 grams per kilogram of body weight per day compared with the 7.8 grams per kilogram per day gained by those treated with cow's milk. The average intake of 157 milliliters of milk per kilogram per day was the same for both groups., Objective. This paper compares the effects of goat&apos;s milk and cow&apos;s milk on weight gain and fat absorption, in children with overt malnutrition. Methods. Thirty hospitalized malnourished children aged from 1 to 5 years were included in a randomized double-blind trial. The children were fed either goat or cow&apos;s milk with a randomized will defined composition, added with vegetable oil, sugar, vitamins and minerals o achieve 1 000 kcal/liter. Children were offered 100 kcal/kg on the first day, with a regular daily increase in energy intake thereafter that reached 200 kcal/kg per day on the tenth day. Results. Both groups of children had the same degree of malnutrition on inclusion. The mean weight-for-height Z score was -1.7 in both groups. One death with candidiasis occurred in the goat&apos;s milk group. Weight gain was similar in both groups: 8.5 g/kg/day (SE = 1.37) with goat&apos;s milk and 7.8 (SE = 1.9) with cow&apos;s milk. There was no significant difference in HEM intake: 157 ml/kg/day (SE = 4), vs 162 (SE = 4) for goat and cow&apos;s milk, respectively. Fat absorption coefficients on the 15th day of treatment were also similar in both groups. Conclusion. These results suggest that goat&apos;s milk has a nutritional value similar to that of cow&apos;s milk and could be used as an alternative to cow&apos;s milk for rehabilitating undernourished children. Pediatrics 1994;94:65-69; malnutrition, goat&apos;s milk, cow&apos;s milk, randomized double-blind trial.

The treatment of malnourished children among refugees formed the subject of a meeting in Paris, conducted by Medicins Sans Frontiere with Epicentre and the Institut National de la Sante de la Recherche Medicale, on May 4-5, 1993. The need to adopt the sophisticated treatment procedures envolved in metabolic wards of research units to refugee camps such as those in Somalia, Angola and South Sudan in Africa prompted the meeting.