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

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  1. Is there a need for improving quality of diabetes care and diabetes support among individuals with coexisting diabetes and severe mental illness?

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  2. How does diabetes impact everyday life and what are the diabetes support needs in people with diabetes and severe mental illness?

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  3. Body mass index trajectories in early childhood in relation to cardiometabolic risk profile and body composition at 5 years of age

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  4. Fat- and fat-free mass growth in infancy in relation to cardiometabolic risk profile and body composition at 5 years of age – the IABC study

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  • Jonathan C K Wells
  • Ana L. Sawaya
  • Rasmus Wibæk Christensen
  • Martha Mwangome
  • Marios Paullas
  • Chittaranjan S Yajnik
  • Alessandro R. Demaio
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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.
Original languageEnglish
JournalThe Lancet
Volume395
Issue number10217
Pages (from-to)75-88
Number of pages14
ISSN0140-6736
DOIs
Publication statusPublished - 4 Jan 2020

ID: 58653410