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The Double Burden of Malnutrition in Six Case Study Countries 1

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The Double Burden of Malnutrition in Six Case Study Countries 1 FAO The double burden FOOD AND NUTRITION of malnutrition PAPER Case studies from six developing countries 84 FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS Rome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ª'"0 iii CONTENTS Foreword v Acroynms vii Assessment of the double burden of malnutrition in six case study countries 1 The double burden of malnutrition in China, 1989 to 2000 21 Assessment of dietary changes and their health implications 43 in countries facing the double burden of malnutrition: Egypt, 1980 to 2005 The double burden of malnutrition in India 99 Food consumption, food expenditure, anthropometric status and 161 nutrition-related diseases in Mexico Dietary changes and their health implications in the Philippines 205 Dietary changes and the health transition in South Africa: 259 implications for health policy Trends towards overweight in lower- and middle-income countries: 305 some causes and economic policy options Workshop recommendations 327 v Foreword There is growing recognition of the emergence of a “double burden” of malnutrition with under- and overnutrition occurring simultaneously among different population groups in developing countries. This phenomenon is not limited to upper-income developing countries, but is occurring across the globe in countries with very different cultures and dietary customs. There is accumulating evidence that when economic conditions improve, obesity and diet- related non-communicable diseases may escalate in countries with high levels of undernutrition. There is also evidence to indicate that undernutrition in utero and early childhood may predispose individuals to greater susceptibility to some chronic diseases. Historically the menu of programmes to address nutrition problems in developing countries has focused primarily on reducing undernutrition and has met with varying degrees of success. There are only a handful of programmes, mainly in high-income countries, which have had some success in reducing the burgeoning growth of overweight, obesity and associated non- communicable diseases. It is now being understood that more aggressive strategies are needed and that attention to both under- and overnutrition should be incorporated into nutrition action plans and programmes. This publication is the result of a multi-country effort to assess the extent of the double burden of malnutrition in six case study countries and identify programmes currently in place or needed to prevent and manage nutritional problems. The work represents ongoing efforts by FAO to document changes in diet and monitor population-level nutritional status and the prevalence of diet-related non-communicable diseases. The case studies presented in this publication were prepared using existing secondary data in China, Egypt, India, Mexico, the Philippines and South Africa. Collaborating institutes include the Chinese Center for Disease Control and Prevention, the National Nutrition Institute, Egypt, the Nutrition Foundation of India, the National Institute of Public Health, Mexico, the Food and Nutrition Research Institute, the Philippines and the Medical Research Council, South Africa. The project was supported financially by the FAO-Norway Partnership Programme. For many of those involved in preparing the case studies, this was a valuable opportunity to reassess priority nutrition problems and review programmes in place to address the problems. Some of the case study countries were already systematically monitoring patterns of dietary intake, nutritional status and risk factors related to non-communicable diseases, while others acknowledged a need to improve monitoring efforts. Most recognized the need to intensify efforts to prevent and manage overweight and obesity and disease processes associated with overnutrition, while maintaining efforts to eliminate undernutrition and micronutrient deficiencies. Kraisid Tontisirin Director Nutrition and Consumer Protection Division vi Aknowledgements Special thanks go to all of the authors whose papers appear in this publication. Particular acknowledgement is due to Dr Osman Galal, School of Public Health, University of California Los Angeles for his considerable assistance and contribution to the Egypt case study. We would also like to thank Terri Ballard, Ruth Charrondiere and Cristina Lopriore, Food and Agriculture Organization; Pirjo Pietinen, Department of Nutrition, National Public Health Institute, Finland; Dr David Sanders and Thandi Puoane, School of Public Health, University of the Western Cape and Dr Veronica Tuffrey, Centre for Public Health Nutrition, University of Westminster for their assistance in reviewing one or more of the papers in this publication. vii Acronyms 24HDR 24-hour dietary recall AE adult equivalent AIS acquired immune deficiency syndrome ARC Agriculture Research Centre (Egypt) ASR age-standardized incidence rate ASSA Actuarial Society of South Africa BHS barangay health station (the Philippines) BMD bone mass density BMI body mass index BP blood pressure CAPMAS Central Agency for Public Mobilization and Statistics (Egypt) CED chronic energy deficiency CHD coronary heart diseases CHNS China Economic, Population, Nutrition and Health Survey CU consumption unit CVD cardiovascular disease DALY disability-adjusted life year DES dietary energy supply DLHS District-Level Household Survey (India) DR-NCD diet-related non-communicable disease DWCD Department of Women and Child Development (China) EDHS Egypt Demographic and Health Survey viii EHDR Egypt Human Development Report EMR East Mediterranean Region FAO Food and Agriculture Organization of the United Nations FBG fasting blood glucose FCT Food Composition Table (the Philippines) FHSIS Field Health Service Information System (the Philippines) FNRI-DOST Food and Nutrition Research Institute, Department of Science and Technology (the Philippines) FTRI Food Technology Research Institute (Egypt) GDP gross domestic product GDI gender development index GNP gross national product HCV hepatitis C virus HDI human development index HES Health Examination Survey (Egypt) HIV/AIDS human immunodeficiency virus/acquired immunodeficiency syndrome HPE Health Profile of Egypt HSRC Human Sciences Research Council (South Africa) IARC International Agency for Research on Cancer ICCIDD International Council for Control of Iodine Deficiency Disorders ICD International Classification of Diseases ICMR Indian Council of Medical Research ICN International Conference on Nutrition (Rome, December 1992, FAO and WHO) ix IDA iron-deficiency anaemia IDD iodine deficiency disorder IFPRI International Food Policy Research Institute IGT impaired glucose tolerance IIPS International Institute of Population Sciences INEGI National Institute of Informatics, Statistics and Geography (Mexico) INP India Nutrition Profile ISCC inter-sectoral coordinating committee/council IUGR intrauterine growth retardation LAC Latin America and the Caribbean (region) LBW low birth weight LPE Lipid Profile among Egyptians MCDS Mexican Chronic Diseases Survey MDG Millennium Development Goal MECC Middle East Cancer Consortium MHIES Mexican Household Income and Expenditure Survey MHS Mexican Health Survey MISS Mexican Institute of Social Security MNE multinational enterprise MNS Mexican Nutrition Survey MOHP Ministry of Health and Population (Egypt) MPCE monthly per capita expenditure MTPPAN Medium-Term Philippine Plan of Action for Nutrition x NAP National Agricultural Policy (India) NCD non-communicable disease NCHS National Center for Health Statistics NCI National Cancer Institute (Egypt) NCPR National Cancer Registry Programme (India) NFCS National Food Consumption Survey (South Africa) NFHS National Family Health Survey (India) NFI Nutrition Foundation of India NGO non-governmental organization NHP National Hypertension Project (Egypt) NIN National Institute of Nutrition (India) NNC National Nutrition Council (the Philippines) NNI National Nutrition Institute (Egypt) NNMB National Nutrition Monitoring Board (India) NNS National Nutrition Survey (China, the Philippines) NPNL non-pregnant, non-lactating NSSO National Sample Survey Organization (India) OECD Organisation for Economic Co-operation and Development PA physical activity PAHO Pan-American Health Organization PBMI percentile body mass index for age PDS public distribution system PEM protein-calorie malnutrition xi PHS Philippine Health Statistics PPP purchasing power parity PPY percentage points a year RDA recommended dietary allowance RENI recommended energy and nutrient intake RGI Registrar General of India RHU rural health unit (the Philippines) RNI recommended nutrient intake SADHS South African Demographic and Health
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