Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates

Abstract

Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates Diana Sagastume 1,2,* , Antonio Barrenechea-Pulache 3 , Andrea Ruiz-Alejos 2 , Katja Polman 1,4 , Lenka Be nov a 1 , Manuel Ramírez-Zea 5 , Jos e L Pe~ nalvo 2,6 1 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; 2 Global Health Institute, University of Antwerp, Wilrijk, Belgium; 3 Facultad de Medicina, Universidad Científica del Sur, Miraflores, Lima, Perú; 4 Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, Netherlands; 5 INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala; 6 National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain ABSTRACT Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of “adult with overweight and child with anemia” having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was “adult with overweight and child with stunting,” with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I 2 >90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755. Keywords: malnutrition, double burden of malnutrition, Latin America, the Caribbean, systematic review, meta-analysis, stunting, obesity