Health consequences of malnutrition and its triple burden in Ecuador
In our first blog post, the paradoxical co-existence of undernutrition and overweight has been introduced, as well as the notion that this might not be as paradoxical as it seems. In this second post, I will be talking about the health consequences of this double burden of malnutrition, using Ecuador as a context.
Micronutrient deficiency: two sides of the same coin
As Ecuador is in the middle of the nutritional transition, the increase in overweight and obesity (OW/OB) is swifter than the decline in undernutrition. On top of that, both OW/OB and undernutrition have been linked to micronutrient deficiency, like zinc, iodine, or vitamin deficiency. This is because of the prevailing food pattern high in carbohydrates, like excessive rice intake, which can lead to both OW/OB and micronutrient deficiency. Besides, the nutritional transition leads to the consumption of more innutritious food, and being chronically undernourished is in itself a cause of micronutrient deficiency. So, micronutrient deficiency occurs on both ends of the spectra and can result in anemia, mental development disorders, and general loss of potential. In Ecuador, micronutrient deficiency is a double burden occurring at the household level, with 15% of OW/OB mothers having a child with micronutrient deficiency and anemia, and up to 10% of OW/OB people also suffer from these deficiencies.
Communicable diseases
These micronutrient deficiencies can lead to an impaired immune function, making people more prone to infectious disease and often worsening the course of an infection. This comes on top of an already existing pro-inflammatory state both undernourished and OW/OB people have. In addition, OW/OB in itself is an independent risk factor for likewise worse outcomes in terms of infections, as has become evident in the current COVID-19 pandemic. In Ecuador, 15% of under 5-mortality is caused by lower respiratory tract infections and diarrheal disease. In both cases, about 70% is attributable to child malnutrition. Through this, the double burden of malnutrition becomes a triple burden when communicable diseases are taken into account.
Non-communicable diseases
Besides communicable diseases, a triple burden can also be derived from non-communicable diseases (NCDs) and malnutrition. As stated in our first post, OW/OB has been a known risk factor for associated diseases like diabetes and cardiovascular disease. OW/OB is rising in Ecuador, with a current prevalence of 70%. This is driven by the nutritional transition, its risk factors, and to some extent the prevalence of undernutrition in children which increases the risk of NCDs and OW/OB later in life. In Ecuador, approximately 72% of all deaths are due to non-communicable diseases. Of this, 40% is directly associated with OW/OB, not taking the worse outcomes of other diseases into account. This mortality often comes prior to extensive disease burden, which comes on top of the still existing high burden of communicable diseases as is seen in other low and middle countries as well, like malaria and tuberculosis.
Future perspective
Concluding, it can be stated that the double burden of malnutrition poses an extra disease burden for both communicable and non-communicable diseases in Ecuador, just like in other South American countries. At the current rate, it is predicted that 30% and 20% of females and males, respectively, will have obesity by 2025. This is associated with a higher burden of NCDs, which is already rising due to ageing populations, tobacco smoking, and physical inactivity. Rising rates of OW/OB will amplify this trend, which will put a strain on the Ecuadorian health system when insufficient action is taken. The situation of undernourishment, though decreasing in severity, will still contribute to this strain as well. Moreover, the COVID-19 pandemic has shown how a general state of health can affect a body’s response and resilience to infectious diseases. As more newly emerging pathogens and pandemics are expected in the future, the need for healthy populations is emphasized, which includes well-nourished people and tackling both ends of the spectrum of malnutrition. How the Ecuadorian government has already responded to the issue and what should still ensue, will be discussed in an upcoming post highlighting the general situation of the double burden of malnutrition in Ecuador.
