Background

Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs.

Methods

We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before–after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131).

Findings

We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity.

Interpretation

There is considerable scope to repurpose existing nutrition interventions to reduce the growing burden of the DBM in LMICs. In settings undergoing rapid nutrition transition, specific policy attention is required to ensure that food-based or supplement-based MCH programmes do not unintentionally increase maternal or child overweight. Consistent reporting of undernutrition and overnutrition outcomes in all nutrition interventions is essential to expand the evidence base to identify and promote interventions maximising benefits and minimising harms on the DBM.

Funding

President's Scholarship (Imperial College London) and National Institute for Health and Care Research.

Translations

For the Portuguese, Spanish and French translations of the abstract see Supplementary Materials section.

中文翻译：

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针对低收入和中等收入国家营养不良和营养敏感的干预措施对营养不良双重负担的影响：系统评价

背景

正在经历营养转型的低收入和中等收入国家（LMIC）面临着日益严重的营养不良（DBM）双重负担。世卫组织敦促查明营养干预措施的风险和机遇，以减轻 DBM，但缺乏有力的证据。本综述总结了特定营养和营养敏感干预措施对中低收入国家营养不足和营养过剩的影响。

方法

我们检索了 4 个主要数据库和灰色文献，查找 2000 年 1 月 1 日至 2023 年 8 月 14 日期间英语、法语、葡萄牙语和西班牙语的出版物。符合条件的研究评估了针对营养不足和营养过剩的特定营养或营养敏感干预措施，采用了稳健的方法研究设计（个体随机、整群随机和非随机试验；中断时间序列；前后对照；以及前瞻性队列研究）。研究经过叙述性综合，并使用计票将其分类为 DBM 有利于、潜在 DBM 有益、DBM 中立、潜在 DBM 有害和 DBM 有害。此评论已在 PROSPERO 注册 (CRD42022320131)。

发现

我们确定了 26 项研究，评估了 20 项特定营养（妇幼健康 [MCH] 和学校计划）和 6 项营养敏感（有条件现金转移和其他社会政策）干预措施。八项提供食品或营养补充剂的妇幼保健干预措施中有七项表明可能存在 DBM 有害影响，与孕产妇或儿童超重增加有关。大多数以行为改变为目标的学校项目和 MCH 干预措施被认为可能对 DBM 有益。两项有条件现金转移的研究表明 DBM 对儿童有有益的影响，而一项研究则表明对母亲超重有潜在的有害影响。一项关于计划生育服务的研究和一项关于教育改革的研究揭示了可能对肥胖产生长期有害影响。

解释

现有的营养干预措施还有很大的空间可以重新调整用途，以减轻中低收入国家 DBM 日益增长的负担。在经历快速营养转型的环境中，需要特别关注政策，以确保以食品或补充剂为基础的妇幼保健计划不会无意中增加孕产妇或儿童超重。所有营养干预措施中对营养不足和营养过剩结果的一致报告对于扩大证据基础以识别和促进干预措施至关重要，从而最大限度地提高 DBM 的效益并最大限度地减少其危害。

资金

总统奖学金（伦敦帝国学院）和国家健康与护理研究所。

翻译

有关摘要的葡萄牙语、西班牙语和法语翻译，请参阅补充材料部分。