Jonathan Wells POLICY SEMINAR Virtual Event - The New Nutrition Reality: Time to Recognize and Tackle the Double Burden of Malnutrition! DEC 1, 2020 - 09:30 AM TO 11:15 AM EST

1. The double burden of malnutrition: etiological
pathways and consequences for health
J Wells, A-L Sawaya, R Wibaek, M Mwangome, M Poullas, CS Yajnik, A Demaio
Lancet 2020; 395(10217):75-88.
Series leads
Barry Popkin
Corinna Hawkes
Rachel Nugent
Series organisers
Francesco Branca
Alessandro Demaio
Richard Horton
Tamara Lucas
Funding for the preparation of the Series was provided by WHO,
through a grant from the Bill & Melinda Gates Foundation

2. The double burden: epidemiology
Speed of nutrition transition
Country-level Community-level Household level

3. Speed of nutrition transition
Country-level Community-level Household level Individual level
The double burden: biology

4. Intergenerational effects
Cycle of
undernutrition
Maternal
undernutrition
Child
undernutrition
Cycle of
overweight
Maternal
overweight
Child
overweight

5. Cycle of
undernutrition
Cycle of
overweight
Maternal
undernutrition
Maternal
overweight
Child
undernutrition
Child
overweightRapid
nutrition
transition
Disease
Intergenerational effects

6. The double burden and disease
Bhargava et al., New Engl J Med 2004
Odds Ratio
adult Diabetes
or Glucose
intolerance
New Delhi cohort

7. Biological pathways in the double
burden of malnutrition
Exposure to
malnutrition
in early life
Cellular health
Epigenetic changes in
gene expression
Maturation of the
gut microbiome
Organ size, structure
and function
Undernutrition
Overweight

8. Shape
consequences
of exposure
to malnutrition
in later life
Biological pathways in the double
burden of malnutrition
Cellular health
Epigenetic changes in
gene expression
Maturation of the
gut microbiome
Organ size, structure
and function
Obesity

9. The double burden and disease

10. Nutrition transition in Pune, India

11. Nutrition transition in Pune, India

12. Nutrition transition in Pune, India

13. Stunting, obesity and childbirth

14. Double burden and risk of C-section
Normal BMI
Short stature
Obesity
Short stature
Overweight
Short stature

15. Double burden and breast-feeding
Healthy growth and development
Undernutrition
Obesity
Diabetes

16. Malnutrition in early life
Gender inequality
Commercial determinants of health
Unhealthy diets
Driving factors

17. COVID-19 and lockdowns
Lockdowns
Psychosocial stress
Household income
Family contact
Support for infant feeding
Access to green space
Physical activity
Excess weight gain
Challenges establishing
breast-feeding
Early cessation of
breast-feeding
Commercial determinants
of health
Vulnerable groups

18. Conclusions
Food systems and interventions