(Xinhua)
Updated: 2008-04-16 08:56

WASHINGTON -- There is a growing trend toward the paradoxical co-occurrence of under- and over-nutrition in rapidly developing economies such as India and China, which nutritional experts call the "double-burden," an expert of pediatric nutrition said.

Helped by a growing economy and government efforts to reduce poverty and improve nutrition, India and China have eliminated extreme poverty and hunger, greatly reduced undernutrition and the number of underweight children, Dr. Vinodini Reddy, an international expert of pediatric nutrition, told Xinhua in a recent interview.

However, "the improvement is not evenly distributed," said Reddy. The poor still face grave nutritional problems, especially in remote areas.

The height and weight of rural children are lower compared to their urban counterparts, reflecting inadequate diet and poor health care. Micronutrient deficiencies, particularly iron deficiency anemia is common among women and children.

While problems of undernutrition have not yet been fully eliminated in rural areas, over-nutrition and obesity associated with chronic diseases is emerging as a major public health problem in the urban population.

Increasing levels of income are associated with changes in dietary patterns and lifestyles with lower physical activity. Current diets in urban areas approximate the western diet, which is high in fat and low in fiber.

These changes coupled with reduced physical activity lead to obesity.

"Thus, fast developing countries such as China and India are facing the double burden of malnutrition -- on the one hand, there is undernutrition among the rural poor, and on the other, there is rising prevalence of obesity and chronic diseases among the urban population," said Reddy, who is a visiting professor at the Johns Hopkins University, and serves as nutrition consultant to various international agencies such as the WHO and the UNICEF.

While it is true that rapid economic development is associated with rapid escalation of obesity and chronic diseases as in developed nations, this is not inevitable, noted Reddy.

"Fortunately, chronic diseases and 80 percent of premature deaths can be prevented through appropriate intervention measures, " she said.

These include effective education programs, promoting healthy lifestyles, creating public awareness about health problems, exercise programs in schools and at work places, and distribution of health care resources according to the burden of diseases, with greater emphasis on prevention.

Efforts are on to reduce obesity in many other countries.

In the United States, interventions range from state legislation regarding school physical education requirements and nutrition standards for beverages and foods sold in schools, to new school-board policies and community initiatives to expand bike lanes and improve recreational facilities.

The best example is Norway, where a decade of intensive education programs has brought about a significant change in diet with a significant reduction in fat content. This is associated with a reduction in cardiovascular disease mortality.

Governments "can and should" support programs to fortify food staples with key nutrients. In fact, such programs are in operation in many developing countries, said Reddy.

Supplementary feeding programs are widely implemented to fill the existing gap in the energy and nutrient intakes of preschool children. Nutrient supplementation and fortification of foods are the major strategies to control micronutrient deficiencies.

"However, if no action is taken, the consequences are dire," Reddy warned.

According to the Global Alliance for Improved Nutrition, it is estimated that by the year 2015, non-communicable diseases associated with over-nutrition will surpass undernutrition as the leading causes of death in low-income communities.