title: Maternal and child undernutrition and overweight in low-income and middle-income countries.
abstract: Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate--including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding--is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.
authors.affiliation: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: rblack@jhsph.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Universidade Federal de Pelotas, Pelotas, Rio Grande do Sol, Brazil.
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.affiliation: The University of the West Indies, Tropical Medicine Research Institute, Mona Campus, Kingston, Jamaica.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Walker
authors.affiliation: The Aga Khan University and Medical Center, Department of Pediatrics, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: World Health Organization, Department of Nutrition for Health and Development, Geneva, Switzerland.
authors.forename: Mercedes
authors.initials: M
authors.lastname: de Onis
authors.affiliation: Imperial College of London, St Mary's Campus, School of Public Health, MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, London, UK.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Institute of Child Health, University College London, London, UK; The University of the West Indies, Mona, Jamaica.
authors.forename: Sally
authors.initials: S
authors.lastname: Grantham-McGregor
authors.affiliation: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Martorell
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Uauy
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology; D001361:Avitaminosis / Q000453:epidemiology; D015992:Body Mass Index; D002118:Calcium / Q000172:deficiency; D002648:Child; D002675:Child, Preschool; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D014943:Global Health; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007239:Infections / Q000453:epidemiology; D007455:Iodine / Q000172:deficiency; D000090463:Iron Deficiencies; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D015995:Prevalence; D011624:Pteroylpolyglutamic Acids / Q000172:deficiency; D012307:Risk Factors; D012423:Rural Health; D012959:Socioeconomic Factors; D014504:Urban Health; D055815:Young Adult; D015032:Zinc / Q000172:deficiency
chemical_list: D011624:Pteroylpolyglutamic Acids; D007455:Iodine; D015032:Zinc; D002118:Calcium