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There is growing recognition of the emergence of a "double burden" of malnutrition with under- and overnutrition occurring simultaneously among different population groups in developing countries. This phenomenon is not limited to upper-income developing countries, but is occurring across the globe in countries with very different cultures and dietary customs. There is accumulating evidence that when economic conditions improve, obesity and diet-related non-communicable diseases may escalate in countries with high levels of undernutrition. There is also evidence to indicate that undernutrition in utero and early childhood may predispose individuals to greater susceptibility to some chronic diseases.

Historically the menu of programmes to address nutrition problems in developing countries has focused primarily on reducing undernutrition and has met with varying degrees of success. There are only a handful of programmes, mainly in high-income countries, which have had some success in reducing the burgeoning growth of overweight, obesity and associated non-communicable diseases. It is now being understood that more aggressive strategies are needed and that attention to both under- and overnutrition should be incorporated into nutrition action plans and programmes.

This publication is the result of a multi-country effort to assess the extent of the double burden of malnutrition in six case study countries and identify programmes currently in place or needed to prevent and manage nutritional problems. The work represents ongoing efforts by FAO to document changes in diet and monitor population-level nutritional status and the prevalence of diet-related non-communicable diseases.

The case studies presented in this publication were prepared using existing secondary data in China, Egypt, India, Mexico, the Philippines and South Africa. Collaborating institutes include the Chinese Center for Disease Control and Prevention, the National Nutrition Institute, Egypt, the Nutrition Foundation of India, the National Institute of Public Health, Mexico, the Food and Nutrition Research Institute, the Philippines and the Medical Research Council, South Africa. The project was supported financially by the FAO-Norway Partnership Programme.

For many of those involved in preparing the case studies, this was a valuable opportunity to reassess priority nutrition problems and review programmes in place to address the problems. Some of the case study countries were already systematically monitoring patterns of dietary intake, nutritional status and risk factors related to non-communicable diseases, while others acknowledged a need to improve monitoring efforts. Most recognized the need to intensify efforts to prevent and manage overweight and obesity and disease processes associated with overnutrition, while maintaining efforts to eliminate undernutrition and micronutrient deficiencies.

Kraisid Tontisirin
Nutrition and Consumer Protection Division


Special thanks go to all of the authors whose papers appear in this publication. Particular acknowledgement is due to Dr Osman Galal, School of Public Health, University of California Los Angeles for his considerable assistance and contribution to the Egypt case study. We would also like to thank Terri Ballard, Ruth Charrondiere and Cristina Lopriore, Food and Agriculture Organization; Pirjo Pietinen, Department of Nutrition, National Public Health Institute, Finland; Dr David Sanders and Thandi Puoane, School of Public Health, University of the Western Cape and Dr Veronica Tuffrey, Centre for Public Health Nutrition, University of Westminster for their assistance in reviewing one or more of the papers in this publication.

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