Introduction to the double burden of undernutrition and excess weight in Latin America

The satellite symposium titled “The Double Burden of Undernutrition and Obesity in Latin America: Where Do We Stand and Where Do We Go?” was presented at the International Union of Nutritional Science (IUNS) 20th International Congress of Nutrition, “Joining Cultures through Nutrition,” held in Granada, Spain, 15–20 September 2013, and hosted by the Spanish Society of Nutrition (SEN). The symposium, chaired by Juan Rivera [National Institute of Public Health, Mexico (INSP)] and Eduardo Atalah (University of Chile, Santiago, Chile), aimed at documenting the coexistence of undernutrition and obesity at the individual, household, and country levels and the degree to which nutrition programs and policies take into account the double burden within their scope and objectives in 11 Latin American countries. The participants presented results from Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Guatemala, Mexico, Peru, Uruguay, and Venezuela; 7 of them completed a final manuscript describing their country’s situation (1–7). The participation of the investigators was cosponsored by DSM Nutritional Products, the IUNS 20th International Congress of Nutrition, and the authors’ own institutions. The publication of the articles was funded by the Division of Social Protection and Health of the Inter-American Development Bank, Washington, DC. The prevalence of stunting and of overweight and obesity (OW/OB) in children ,5 y as well as the prevalence of OW/OB in women are shown in Table 1. Chile has the lowest prevalence of stunting (w1.9%), lower in fact than in the WHO standards (2.3%), whereas Guatemala has the highest prevalence (48%) followed by Ecuador (25.3%). Colombia, Mexico, and Uruguay have prevalences ranging between 10% and 14%, and Brazil has a prevalence of w7%. Prevalences of excess body weight .7% in children ,5 y are found in Chile, Uruguay, Mexico, Ecuador, and Brazil, whereas prevalences in Guatemala and Colombia are lower. The prevalence of OW/OB in women for different age subgroups ranged between 40.6% and 84.1%. The highest prevalences were found in Mexico and the lowest in Colombia and Guatemala. Statistics are not provided for Chile, but other publications report a high prevalence of OW/OB in women (8, 9). The double burden of malnutrition was estimated by each country following a common framework (10) provided by the symposium coordinators. The percentage of households with a stunted child and an overweight or obese mother, referred to as the prevalence of the double burden at household level, is shown in Table 2. Prevalence estimates ranged from 20% in Guatemala to 13.1% in Ecuador, 8.4% in Mexico, 6.3% in Uruguay, 5.1% in Colombia and 2.7% in Brazil. To assess if the coexistence or joint prevalence of the 2 conditions was solely the result of the independent occurrence of each one of them, we compared the observed prevalence of the double burden with the expected prevalence under the assumption that the 2 conditions are uncorrelated. In 5 of 6 countries (Brazil, Colombia, Ecuador, Guatemala, and Mexico), the observed double burden prevalence was significantly lower than the expected value, indicating lower risk of stunting in children ,5 y or of overweight or obesity in women in households in which the other condition was present. In Uruguay, the observed and expected values were not significantly different. In all cases, differences between observed and expected prevalences were small. The prevalence of the double burden of overweight and anemia (or zinc deficiency in Ecuador) at the individual level in preschoolor school-aged children ranged from as low as 1.2% in Brazil to 8.4% in Ecuadorian children ,5 y (Table 2). In 3 of 5 countries with available information, prevalences were lower than expected (P , 0.05) under the assumption of independent occurrence of the 2 conditions; in Brazil, the observed and expected values were not significantly different (P . 0.05), whereas in Ecuador the observed prevalence was higher than expected (P , 0.05). However, as was the case at the household level, all differences were small. The prevalence of the double burden of overweight and anemia at the individual level in women ranged from 3.4% to 13.6% (Table 2). Brazil presented the highest prevalence (13.6%) followed by Guatemala (11.7%). Other countries had prevalences between 3.4% and 8.9%. In 2 of 5 countries, observed prevalence rates were lower than expected (P , 0.05); in one (Mexico) the observed prevalence was higher than expected (P , 0.05); and in 2, observed and expected prevalence rates were not signifi-