Double burden of malnutrition in developing countries as a global problem. Part 1. (literature review of research in Vietnam)
REVIEWS
Abstract
This series of three reviews of the current literature summarizes the causes, prevalence, consequences, and key approaches to prevention of malnutrition in Vietnam. It is widely recognized that developing countries have a combination of undernutrition in one part of the population and overweight and obesity in another. This situation is called the double burden of malnutrition, the prevalence of which varies from 5 to 30% in Southeast Asian countries. The first, introductory review presents the problem of underweight, overweight, obesity, and micronutrient deficiencies in the Pacific region and globally, and provides a brief overview of the health consequences of these conditions. It is reported that in Southeast Asia, 25% of children are underweight, and 11 to 30% are obese, depending on gender, age, and region of residence. The review also reveals the socioeconomic causes of the double burden of malnutrition in Vietnam. According to experts, this is due to rapid economic transformation and urbanization, which have led to a change in diet towards more caloric, micronutrient-poor processed foods, and have contributed to a sedentary lifestyle. An analysis of the literature shows that the health and social development policies pursued by the country's leadership have led to a reduction in poverty, nutritional deficiencies, maternal and infant malnutrition, a smoothing of the economic gap between the city and the village, an increase in food production and food security in general. However, this has led to an increase in the percentage of obesity and excess body weight due to the population's failure to adhere to the principles of healthy eating and physical activity.
References
Gillespie S., Harris J., Nisbett N., van den Bold M. Stories of change in nutrition from Africa and Asia: an introduction to a special series in Food Security. Food Secur. 2021;13(4):799–802.
Tan P.Y., Som S.V., Nguyen S.D., Tran D.T., Tran N.T., Tran V.K., Dye L. et al. The Role of Complementary Feeding Practices in Addressing the Double Burden of Malnutrition among Children Aged 6-23 Months: Insight from the Vietnamese General Nutrition Survey 2020. Nutrients. 2024a;16(19):3240.
Popkin B.M., Corvalan C., Grummer-Strawn L.M. Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet. 2020;395(10217):65–74.
Truong D.T.T., Tran T.H.T., Nguyen T.T.T., Tran V.H.T. Double burden of malnutrition in ethnic minority school-aged children living in mountainous areas of Vietnam and its association with nutritional behavior. Nutr Res Pract. 2022;16(5):658–672.
Mai T.M.T., Pham N.O., Tran T.M.H., Baker P., Gallegos D. et al. The double burden of malnutrition in Vietnamese school-aged children and adolescents: a rapid shift over a decade in Ho Chi Minh City. Eur J Clin Nutr. 2020b;74(10):1448–1456.
Yazawa A., Kawachi I., Shrestha R.M., Fukunaga A., Pham T.T.P. et al. Parental absence during childhood and weight status in adulthood among middle-aged community dwellers in rural Vietnam. Am J Hum Biol. 2023;35(3):e23827.
Gayer J., Smith G. Micronutrient fortification of food in Southeast Asia: recommendations from an expert workshop. Nutrients. 2015;7(1):646–658.
Nguyen T.T., Darnell A., Weissman A., Cashin J., Withers M. et al. National nutrition strategies that focus on maternal, infant, and young child nutrition in Southeast Asia do not consistently align with regional and international recommendations. Matern Child Nutr. 2020;16(Suppl 2):e12937.
Hawkes C., Ruel M.T., Salm L., Sinclair B., Branca F. Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms. Lancet. 2020;395(10218):142–155. Erratum in: Lancet. 2020;395(10221):338.
de Onis M., Blössner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. Int J Epidemiol. 2003;32(4):518–526.
Black R.E., Victora C.G., Walker S.P., Bhutta Z.A., Christian P., de Onis M. et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890): 427–451.
Mertens A., Benjamin-Chung J., Colford J.M.Jr., Coyle J. et al. Causes and consequences of child growth faltering in low-resource settings. Nature. 2023;621(7979):568–576.
Huynh G., Huynh Q.H.N., Nguyen N.H.T., Do Q.T., Khanh Tran V. Malnutrition among 6-59-Month-Old Children at District 2 Hospital, Ho Chi Minh City, Vietnam: Prevalence and Associated Factors. Biomed Res Int. 2019;2019:6921312.
Bhutta Z.A., Das J.K., Rizvi A., Gaffey M.F., Walker N., Horton S. et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-477.
Robinson J.A., Dinh P.T.T. High doses of a national preschool program are associated with the long-term mitigation of adverse outcomes in cognitive development and life satisfaction among children who experience early stunting: a multi-site longitudinal study in Vietnam. Front Public Health. 2023;11:1087349.
Azevedo F.M., de Morais N.S., Silva D.L.F., Candido A.C. et al. Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis. Front Public Health. 2023;11:1087955.
Gausman J., Kim R., Subramanian S.V. Stunting trajectories from post-infancy to adolescence in Ethiopia, India, Peru, and Vietnam. Matern Child Nutr. 2019;15(4):e12835.
Kang Y., Aguayo V.M., Campbell R.K., West K.P.Jr. Association between stunting and early childhood development among children aged 36–59 months in South Asia. Matern Child Nutr. 2018;14(Suppl 4):e12684.
de Onis M., Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12(Suppl 1):12–26.
Chyne D.A.L., Meshram I.I., Rajendran A., Kodali V., Getti N., Roy P., Kuhnlein H.V., Longvah T. Nutritional status, food insecurity, and biodiversity among the Khasi in Meghalaya, North-East India. Matern Child Nutr. 2017;13(Suppl 3):e12557.
Khadilkar A.V., Oza C., Kajale N., Pulungan A.B., Wacharasindhu S. et al. Local anthropometric parameters for assessing double burden of malnutrition in South Asian and Southeast Asian countries: a review and retrospective analysis. Lancet Reg Health Southeast Asia. 2024;28:100473.
Krishna A., Oh J., Lee J.K., Lee H.Y., Perkins J.M., Heo J., Ro Y.S., Subramanian S.V. Short-term and long-term associations between household wealth and physical growth: a cross-comparative analysis of children from four low- and middle-income countries. Glob Health Action. 2015;8:26523.
Campisi S.C., Cherian A.M., Bhutta Z.A. World Perspective on the Epidemiology of Stunting between 1990 and 2015. Horm Res Paediatr. 2017;88(1):70–78.
Benjamin-Chung J., Mertens A., Colford J.M.Jr., Hubbard A.E. et al. Early-childhood linear growth faltering in low- and middle-income countries. Nature. 2023;621(7979):550–557.
Vaivada T., Akseer N., Akseer S., Somaskandan A., Stefopulos M., Bhutta Z.A. Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline. Am J Clin Nutr. 2020;112(Suppl 2):777S–791S.
Walker S.P., Chang S.M., Wright A.S., Pinto R., Heckman J.J., Grantham-McGregor S.M. Cognitive, psychosocial, and behaviour gains at age 31 years from the Jamaica early childhood stimulation trial. J Child Psychol Psychiatry. 2022;63(6):626–635.
De Sanctis V., Soliman A., Alaaraj N., Ahmed S., Alyafei F., Hamed N. Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Biomed. 2021;92(1):e2021168.
Nguyen L.H., Tran B.X., Thi Nguyen H.L., Le H.T., Do H.T. et al. Socio-Economic Disparities in Attitude and Preference for Menu Labels among Vietnamese Restaurant Customers. Int J Environ Res Public Health. 2018;15(3):460.
Parikh P., Semba R., Manary M., Swaminathan S., Udomkesmalee E., Bos R., Poh B.K., Rojroongwasinkul N., Geurts J., Sekartini R., Nga T.T. Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries. Matern Child Nutr. 2022;18(1):e13264.
Norris S.A., Frongillo E.A., Black M.M., Dong Y., Fall C., Lampl M. et al. Nutrition in adolescent growth and development. Lancet. 2022;399(10320):172–184.
Georgiadis A., Benny L., Duc L.T., Galab S., Reddy P., Woldehanna T. Growth recovery and faltering through early adolescence in low- and middle-income countries: Determinants and implications for cognitive development. Soc Sci Med. 2017;179:81–90.
Deshpande A., Ramachandran R. Early childhood stunting and later life outcomes: A longitudinal analysis. Econ Hum Biol. 2022;44:101099.
Han X., Ding S., Lu J., Li Y. Global, regional, and national burdens of common micronutrient deficiencies from 1990 to 2019: A secondary trend analysis based on the Global Burden of Disease 2019 study. EClinicalMedicine. 2022;44:101299.
Kiani A.K., Dhuli K., Donato K., Aquilanti B., Velluti V. et al. Main nutritional deficiencies. J Prev Med Hyg. 2022;63(2 Suppl 3):E93–E101.
Munns C.F., Shaw N., Kiely M., Specker B.L., Thacher T.D., Ozono K. et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016;101(2):394–415.
Kumar S.B., Arnipalli S.R., Mehta P., Carrau S., Ziouzenkova O. Iron Deficiency Anemia: Efficacy and Limitations of Nutritional and Comprehensive Mitigation Strategies. Nutrients. 2022;14(14):2976.
Wieringa F.T., Dijkhuizen M.A., Berger J. Micronutrient deficiencies and their public health implications for South-East Asia. Curr Opin Clin Nutr Metab Care. 2019;22(6):479–482.
Roos N., Ponce M.C., Doak C.M., Dijkhuizen M., Polman K., Chamnan C. et al. Micronutrient status of populations and preventive nutrition interventions in South East Asia. Matern Child Health J. 2019;23(Suppl 1):29–45.
Crookston B.T., Dearden K.A., Alder S.C., Porucznik C.A., Stanford J.B., Merrill R.M., Dickerson T.T., Penny M.E. Impact of early and concurrent stunting on cognition. Matern Child Nutr. 2011;7(4):397–409.
Tham K.W., Abdul Ghani R., Cua S.C., Deerochanawong C., Fojas M. et al. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev. 2023;24(2):e13520.
NCD Risk Factor Collaboration (NCD-RisC). A century of trends in adult human height. Elife. 2016;5:e13410.
Naidu B.M., Mahmud S.Z., Ambak R., Sallehuddin S.M., Mutalip H.A., Saari R., Sahril N., Hamid H.A. Overweight among primary school-age children in Malaysia. Asia Pac J Clin Nutr. 2013;22(3):408–415.
Lipoeto N.I., Geok Lin K., Angeles-Agdeppa I. Food consumption patterns and nutrition transition in South-East Asia. Public Health Nutr. 2013;16(9):1637–1643.
Valenzuela P.L., Carrera-Bastos P., Castillo-García A., Lieberman D.E., Santos-Lozano A., Lucia A. Obesity and the risk of cardiometabolic diseases. Nat Rev Cardiol. 2023;20(7):475–494.
Piché M.E., Tchernof A., Després J.P. Obesity Phenotypes, Diabetes, and Cardiovascular Diseases. Circ Res. 2020;126(11):1477–1500.
Li M., Cui M., Li G., Liu Y., Xu Y., Eftekhar S.P., Ala M. The Pathophysiological Associations Between Obesity, NAFLD, and Atherosclerotic Cardiovascular Diseases. Horm Metab Res. 2024;56(10):683–696.
Tutor A.W., Lavie C.J., Kachur S., Milani R.V., Ventura H.O. Updates on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis. 2023;78:2–10.
Welsh A., Hammad M., Piña I.L., Kulinski J. Obesity and cardiovascular health. Eur J Prev Cardiol. 2024;31(8):1026–1035.
Bjork S., Jain D., Marliere M.H., Predescu S.A., Mokhlesi B. Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, and Pulmonary Hypertension: A State-of-the-Art Review. Sleep Med Clin. 2024;19(2):307–325.
Ruze R., Liu T., Zou X., Song J., Chen Y., Xu R., Yin X., Xu Q. Obesity and type 2 diabetes mellitus: connections in epidemiology, pathogenesis, and treatments. Front Endocrinol (Lausanne). 2023;14:1161521.
Chandrasekaran P., Weiskirchen R. The Role of Obesity in Type 2 Diabetes Mellitus-An Overview. Int J Mol Sci. 2024;25(3):1882.
Purdy J.C., Shatzel J.J. The hematologic consequences of obesity. Eur J Haematol. 2021;106(3):306–319.
Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy Wound Manage. 2006;52(6):34–36.
Ayazi S., Hagen J.A., Chan L.S., DeMeester S.R., Lin M.W. et al. Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg. 2009;13(8):1440–1447.
Camilleri M., Malhi H., Acosta A. Gastrointestinal Complications of Obesity. Gastroenterology. 2017;152(7):1656–1670.
Geerts A., Onghena L., Lefere S. Liver health and the interplay between obesity, alcohol and bariatric surgery. Acta Gastroenterol Belg. 2023;86(2):313–317.
Ameratunga D., Gebeh A., Amoako A. Obesity and male infertility. Best Pract Res Clin Obstet Gynaecol. 2023;90:102393.
Ennab F., Atiomo W. Obesity and female infertility. Best Pract Res Clin Obstet Gynaecol. 2023;89:102336.
Rabijewski M. Male-specific consequences of obesity — functional hypogonadism and fertility disorders. Endokrynol Pol. 2023;74(5):480–489.
Opoku A.A., Abushama M., Konje J.C. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol. 2023;88:102348.
Gkastaris K., Goulis D.G., Potoupnis M., Anastasilakis A.D., Kapetanos G. Obesity, osteoporosis and bone metabolism. J Musculoskelet Neuronal Interact. 2020;20(3):372–381.
Piñar-Gutierrez A., García-Fontana C., García-Fontana B., Muñoz-Torres M. Obesity and Bone Health: A Complex Relationship. Int J Mol Sci. 2022;23(15):8303.
Tukker A., Visscher T.L., Picavet H.S. Overweight and health problems of the lower extremities: osteoarthritis, pain and disability. Public Health Nutr. 2009;12(3):359–368.
O'Brien P.D., Hinder L.M., Callaghan B.C., Feldman E.L. Neurological consequences of obesity. Lancet Neurol. 2017;16(6):465–477.
Milaneschi Y., Simmons W.K., van Rossum E.F.C., Penninx B.W. Depression and obesity: evidence of shared biological mechanisms. Mol Psychiatry. 2019;24(1):18–33.
Dakanalis A., Mentzelou M., Papadopoulou S.K., Papandreou D. et al. The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence. Nutrients. 2023;15(5):1173.
Rao W.W., Zong Q.Q., Zhang J.W., An F.R., Jackson T., Ungvari G.S. et al. Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis. J Affect Disord. 2020;267:78–85.
Sobczak K., Leoniuk K. Attitudes of Medical Professionals Towards Discrimination of Patients with Obesity. Risk Manag Healthc Policy. 2021;14:4169–4175.
Nutter S., Eggerichs L.A., Nagpal T.S., Ramos Salas X., Chin Chea C. et al. Changing the global obesity narrative to recognize and reduce weight stigma: A position statement from the World Obesity Federation. Obes Rev. 2024;25(1):e13642.
Ayyavoo A. Gynecomastia. Indian J Pediatr. 2023;90(10):1013–1017.
Konttinen H. Emotional eating and obesity in adults: the role of depression, sleep and genes. Proc Nutr Soc. 2020;79(3):283–289.
Otelea M.R., Nartea R., Popescu F.G., Covaleov A., Mitoiu B.I., Nica A.S. The Pathological Links between Adiposity and the Carpal Tunnel Syndrome. Curr Issues Mol Biol. 2022;44(6):2646–2663.
Jahromi S.R., Martami F., Morad Soltani K., Togha M. Migraine and obesity: what is the real direction of their association? Expert Rev Neurother. 2023;23(1):75–84.
Chai N.C., Scher A.I., Moghekar A., Bond D.S., Peterlin B.L. Obesity and headache: part I--a systematic review of the epidemiology of obesity and headache. Headache. 2014;54(2):219–234.
Wyszomirski K., Walędziak M., Różańska-Walędziak A. Obesity, Bariatric Surgery and Obstructive Sleep Apnea-A Narrative Literature Review. Medicina (Kaunas). 2023;59(7):1266.
Lee J.H., Cho J. Sleep and Obesity. Sleep Med Clin. 2022;17(1):111–116.
Orozco González B.N., Rodriguez Plascencia N., Palma Zapata J.A. et al. Obesity hypoventilation syndrome, literature review. Sleep Adv. 2024;5(1):zpae033.
Vucenik I., Stains J.P. Obesity and cancer risk: evidence, mechanisms, and recommendations. Ann N Y Acad Sci. 2012;1271(1):37–43.
Mili N., Paschou S.A., Goulis D.G., Dimopoulos M.A., Lambrinoudaki I., Psaltopoulou T. Obesity, metabolic syndrome, and cancer: pathophysiological and therapeutic associations. Endocrine. 2021;74(3):478–497.
Karra P., Winn M., Pauleck S., Bulsiewicz-Jacobsen A., Peterson L. et al. Metabolic dysfunction and obesity-related cancer: Beyond obesity and metabolic syndrome. Obesity (Silver Spring). 2022;30(7):1323–1334.
Belladelli F., Montorsi F., Martini A. Metabolic syndrome, obesity and cancer risk. Curr Opin Urol. 2022;32(6):594–597.
Nguyen T.T., Hoang M.V. Non-communicable diseases, food and nutrition in Vietnam from 1975 to 2015: the burden and national response. Asia Pac J Clin Nutr. 2018;27(1):19–28.
Quoc P.S., Charles M.A., Cuong N.H., Lieu L.H., Tuan N.A., Thomas M., Balkau B., Simon D. Blood glucose distribution and prevalence of diabetes in Hanoi (Vietnam). Am J Epidemiol. 1994;139(7):713–22.
Binh T.Q., Phuong P.T., Nhung B.T., Thoang D.D., Lien H.T., Thanh D.V. Association of the common FTO-rs9939609 polymorphism with type 2 diabetes, independent of obesity-related traits in a Vietnamese population. Gene. 2013;513(1):31–35.
Duc Son L.N., Kusama K., Hung N.T., Loan T.T., Chuyen N.V., Kunii D., Sakai T., Yamamoto S. Prevalence and risk factors for diabetes in Ho Chi Minh City, Vietnam. Diabet Med. 2004;21(4):371–376.
Ta M.T., Nguyen K.T., Nguyen N.D., Campbell L.V., Nguyen T.V. Identification of undiagnosed type 2 diabetes by systolic blood pressure and waist-to-hip ratio. Diabetologia. 2010;53(10):2139–2146.
Nguyen N.T., Nguyen T.N., Nguyen K.M., Tran H.P.N., Huynh K.L.A., Hoang S.V. Prevalence and impact of metabolic syndrome on in-hospital outcomes in patients with acute myocardial infarction: A perspective from a developing country. Medicine (Baltimore). 2023;102(45):e35924.
Shaw J.E., Sicree R.A., Zimmet P.Z. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.
General Statistics Office. Population growth rate by province, 2005–2023. Available at: https://www.nso.gov.vn/en/px-web/?pxid=E0220&theme (accessed: 16.09.2025).
Mondon C., Tan P.Y., Chan C.L., Tran T.N., Gong Y.Y. Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review. BMC Public Health. 2024;24(1):960.
Devereux S., Béné C., Hoddinott J. Conceptualising COVID-19's impacts on household food security. Food Secur. 2020;12(4):769–772.
Vu K., Vuong N.D.T., Vu-Thanh T.A., Nguyen A.N. Income shock and food insecurity prediction Vietnam under the pandemic. World Dev. 2022;153:105838.
Nguyen N.T.T., Nguyen L.H., Nguyen T.T., Vu L.G., Vu T.M.T. et al. Preference and willingness to pay for reproductive health services among adults in Urban-Rural transition settings of a developing country: evidence from a cross-sectional study in a rural district of Hanoi, Vietnam. BMC Health Serv Res. 2023;23(1):1196.
Thang N.M., Popkin B.M. Patterns of food consumption in Vietnam: effects on socioeconomic groups during an era of economic growth. Eur J Clin Nutr. 2004;58(1):145–153.
Khan N.C., Ninh N.X., Van Nhien N., Khoi H.H., West C.E., Hautvast J.G. Sub clinical vitamin A deficiency and anemia among Vietnamese children less than five years of age. Asia Pac J Clin Nutr. 2007a;16(1):152–157.
Thang N.M., Popkin B. Child malnutrition in Vietnam and its transition in an era of economic growth. J Hum Nutr Diet. 2003;16(4): 233–244.
Tan X., Tan P.Y., Som S.V., Nguyen S.D., Tran D.T., Tran N.T. et al. Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020. Lancet Reg Health West Pac. 2024;50:101164.
Harris J., Nguyen P.H., Tran L.M., Huynh P.N. Nutrition transition in Vietnam: Changing food supply, food prices, household expenditure, diet and nutrition outcomes. Food Secur. 2020;12:1141–1155.
Kien V.D., Lee H.Y., Nam Y.S., Oh J., Giang K.B., Van Minh H. Trends in socioeconomic inequalities in child malnutrition in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000-2011. Glob Health Action. 2016;9:29263.
General Statistical Office (2001) Vietnam 1975–2000. Hanoi: Statistical Publishing House.
Dinh P.H., To T.H., Vuong T.H., Höjer B., Persson L.A. Maternal factors influencing the occurrence of low birthweight in northern Vietnam. Ann Trop Paediatr. 1996;16(4):327–333.
Tran T.K., Nguyen C.T., Nguyen H.D., Eriksson B., Bondjers G., Gottvall K., Ascher H., Petzold M. Urban — rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam. BMC Health Serv Res. 2011;11:120.
Hung H.V., Jampaklay A., Chamratrithirong A., Soonthorndhada K. Do Rural-Urban Migrants Have Higher Fertility than Urban Non-Migrants in Vietnam? Journal of Population and Social Studies. 2009;18(1):23–48.
Feng Y., Tuan T.D., Shi J., Li Z., Maimaitiming M., Jin Y., Zheng Z. Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020. BMJ Glob Health. 2024;9(3):e014739.
This work is licensed under a Creative Commons Attribution 4.0 International License.
