Diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries

OBJECTIVE: To examine the possibility of diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries. METHODS: A modified version of the Japanese Diagnostic Tool was used. Data on 194 countries were analyzed, including data from the United Nations International Children’s Fund, World Health Organization and World Bank. After conducting a Box–Cox transformation, deviation values were calculated. The degree to which the values deviated relative to a deviation cutoff value of 50 was assessed. Focusing on countries with low- and middle-income economic levels, we examined the utility of this tool to show characteristic nutritional problems in each country. RESULTS: The deviation values had normal, distorted, bimodal, or trimodal distributions. In the lower-middle-income countries, almost all countries had values ranging from 40 to 60 for education and water environments (urban and rural), and the differences were minimal. However, different causes of noncommunicable disease-related deaths were considered, and the primary cause appeared to be related to lifestyle factors, particularly alcohol consumption and tobacco smoking. In comparison, the deviation values related to death among low-income countries also appeared to be related to differences in education and sanitation in urban and rural areas. CONCLUSION: The study results can help to determine the status of nutritional inequalities and plan country-specific strategies to reduce the double burden of malnutrition.