The document discusses the double burden of malnutrition (DBM), where undernutrition and overweight/obesity coexist. It presents trends showing many low and middle income countries experiencing a nutrition transition due to diet changes from traditional plant-based foods to more processed foods high in fats and sugars. This transition is linked to a rise in overweight/obesity and nutrition-related non-communicable diseases (NCDs) while undernutrition persists, demonstrating the DBM. Indonesia is provided as a case study showing how rising incomes, changing diets and lifestyles have contributed to the DBM through data on calories and nutrition as well as the prevalence of undernutrition and NCD risk factors.

1. The double burden of malnutrition: a
rising tide in the region
Source: Heather Grieve and Asian Development Bank, 2007
Heather Grieve
Senior Nutrition Specialist
Australian Embassy Timor-Leste and the Office of his Excellency the President
of the Republic of Timor-Leste

2. • The situation where undernutrition (stunting, wasting, underweight and
micro nutrient deficiencies) co-exists with overweight and obesity
within the same country, population, household, or individual
• Many low middle income countries (LMIC) are experiencing early signs
of the DBM and others are more advanced
The double burden of malnutrition (DBM)

3. The traditional diet in LMICs was mostly plant based foods ,low in fats and
sugars. With increasing incomes a “nutrition transition” is occurring, in
which diets are higher in processed foods, high in fats and sugars .
The nutrition transition
‘Receding
famine’
‘Nutrition related
non-
communicable
disease’
‘Policy and
behaviour
change’
Many LMICs are in the ‘receding famine/’nutrition-related non-
communicable disease (NCDs) phase. The change in diet and
lifestyles is associated with an increase in the prevalence of
overweight, obesity and NCDs and in many countries :the
‘double burden of malnutrition’
Many high income countries are
in the policy/behaviour change
phase and are promoting healthy
food and physical activity and
health promoting environments
Source; Popkin et al (2001)

4. Trends in prevalence of malnutrition in children (<5 years):1990-2015
South East Asia
Source: WHO,2013
DBM trends in children (<5 years): South East Asia

5. Trends in prevalence of malnutrition in women of reproductive age (aged 20 -
49 years) 1990-2008 : Asia
DBM trends in women of reproductive age: South East Asia

6. Trends in prevalence of malnutrition in children (<5 years):1990-2015
Oceania (excluding Australia and New Zealand)
Source: WHO,2013
DBM trends in children (<5 years):Oceania

7. Trends in prevalence of malnutrition in women of reproductive age ( aged 20-
49 years):1990-2008
Oceania (excluding Australia and New Zealand)
DBM trends in women of reproductive age: Oceania

8. Indonesia –a classic example of the
nutrition transition and DBM in a low-
middle income country

9. 0
500
1000
1500
2000
2500
3000
3500
4000
2300
2350
2400
2450
2500
2550
2600
2650
2700
2750
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GDPpercapita
KCalperpersonperday
Kcal GDP/ capita
Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per
person per day (2002-2011)
Source: World Bank and FAOSTAT
The nutrition transition: Indonesia

10. 0
500
1000
1500
2000
2500
3000
1991 2001 2011
Kcalperdayperperson
Alcoholic beverages and stimulants Fruits, vegetables, pulses and treenuts
Animal products Sugar crops, sugar and sweeteners
Starchy Roots Oil crops and vegetable oils
Cereals - Excluding Beer
Changes in energy supply (Kcal per day per person)
Source :FAOSTAT
The nutrition transition: Indonesia

11. Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004:
SKRT; 2007: Riskesdas; 2010: Riskesdas;
Changes in the prevalence of malnutrition in children (< 5 years)
The double burden of malnutrition: Indonesia

12. Source: 1995: MICS;1997 CDC; 2000: NHSS;
2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;
Changes in the prevalence of malnutrition in women of reproductive age (aged 15-49 years)
The double burden of malnutrition: Indonesia

13. Source:WHO,2010
Estimated NCD risk factors (2008)
The double burden of malnutrition: Indonesia

14. 0
50
100
150
200
250
300
350
400
450
Men Women
Cardiovascular diseases and diabetes Cancers
Chronic respiratory disease Other
Source: WHO, 2011
Estimated age standardised NCD deaths per 100,000 people, Indonesia (2008)
In 2008 an estimated 582,000 men and 481,700 women died from NCD related
deaths
The double burden of malnutrition: Indonesia

15. Thank you !