title: The double burden of undernutrition and excess body weight in Ecuador.
abstract: BACKGROUND
  Ecuador's current nutrition policies have not taken adequate notice of the double burden of malnutrition and continue to focus on stunting and to a lesser extent on overweight, without addressing the simultaneous presence of undernutrition, micronutrient deficiencies, and overweight or obesity (OW/OB).
  
  
  OBJECTIVE
  The aim of this article was to describe the prevalence and distribution of undernutrition (stunting, anemia, and zinc deficiency), overweight, and obesity in Ecuador to explore the evolving double burden of malnutrition at the national, household, and individual levels and to discuss whether current public health policies are addressing the double burden.
  
  
  METHODS
  Data from the 2012 Ecuadorian National Health and Nutrition Survey (ENSANUT-ECU) was used to estimate the dual burden of malnutrition at the national, household, and individual levels in children <5 y old, school-aged children, and women of reproductive age.
  
  
  RESULTS
  In 13.1% of households, mothers with excess body weight coexist with a stunted child <5 y old. Moreover, among households with overweight or obese mothers, 12.6% have an anemic child and 14% have a zinc-deficient child. At the individual levels, the coexistence of OW/OB and stunting, anemia, or zinc deficiency was found in 2.8%, 0.7%, and 8.4% of school-aged children, respectively. In addition, 8.9% and 32.6% of women aged 12-49 y have excess body weight and anemia or zinc deficiency, respectively.
  
  
  CONCLUSIONS
  This article shows the coexistence of high rates of undernutrition and OW/OB at the individual, household, and national levels in Ecuador. Although integrated approaches to address the emerging double burden are required, public health policies to date have not responded adequately.
authors.affiliation: From the Ministerio de Salud Pública del Ecuador, Quito, Ecuador (WBF, KMS-J, MJR-L, and PB), and the Health and Nutrition Research Institute, University of San Francisco de Quito, Quito, Ecuador (WFW).
authors.forename: Wilma B
authors.initials: WB
authors.lastname: Freire
authors.affiliation: From the Ministerio de Salud Pública del Ecuador, Quito, Ecuador (WBF, KMS-J, MJR-L, and PB), and the Health and Nutrition Research Institute, University of San Francisco de Quito, Quito, Ecuador (WFW).
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Silva-Jaramillo
authors.affiliation: From the Ministerio de Salud Pública del Ecuador, Quito, Ecuador (WBF, KMS-J, MJR-L, and PB), and the Health and Nutrition Research Institute, University of San Francisco de Quito, Quito, Ecuador (WFW).
authors.forename: María J
authors.initials: MJ
authors.lastname: Ramírez-Luzuriaga
authors.affiliation: From the Ministerio de Salud Pública del Ecuador, Quito, Ecuador (WBF, KMS-J, MJR-L, and PB), and the Health and Nutrition Research Institute, University of San Francisco de Quito, Quito, Ecuador (WFW).
authors.forename: Philippe
authors.initials: P
authors.lastname: Belmont
authors.affiliation: From the Ministerio de Salud Pública del Ecuador, Quito, Ecuador (WBF, KMS-J, MJR-L, and PB), and the Health and Nutrition Research Institute, University of San Francisco de Quito, Quito, Ecuador (WFW).
authors.forename: William F
authors.initials: WF
authors.lastname: Waters
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004484:Ecuador; D005191:Family Characteristics; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D011634:Public Health; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D018977:Micronutrients
keywords: Ecuador; double burden; epidemiological transition; malnutrition; obesity; overweight; undernutrition