Health Economics and Nutrition: Over- and Under- nutrition

In this issue, the proceedings of a meeting on global nutritional problems are presented. They deal with several problems that long were thought to be mutually exclusive: undernutrition and overnutrition. The first was considered to be a problem related to poverty which may result in inadequate intake of energy and/or micronutrients and strenuous labor. Chronic noncommunicable diseases were associated with affluence and related overconsumption of food and sedentary lifestyles. The papers in this issue show that this is no longer a useful distinction. In fact, in many circumstances, especially in lowand middle-income countries, people have access to energy- dense but, at the same time, nutrient-poor foods. There is an increasing trend in developing countries, where the demographic and socioeconomic transition imposes more constraints on dealing with the double burden of infectious and noninfectious diseases as well as malnutrition in a poor environment, characterized by illhealth systems. It is predicted that, by 2020, noncommunicable diseases will cause seven out of every ten deaths in developing countries. Among noncommunicable diseases, special attention is devoted to cardiovascular disease, diabetes, cancer and chronic pulmonary disease. The burden of these conditions affects countries worldwide but with a growing trend in developing countries. Preventative strategies must take into account the growing trend of risk factors correlated to these diseases. In parallel, despite the success of vaccination programs for polio and some childhood diseases, other diseases like AIDS, tuberculosis, malaria and dengue are still out of control in many regions of the world. In addition, preventing and combatting micronutrient deficiencies is of great importance. A life course approach to combatting under- and overnutrition is essential. This is illustrated by the paper by KC et al. that focuses on gestational diabetes and macrosomia. Many noncommunicable diseases have their origins in utero. Intrauterine growth retardation resulting in low-birth-weight babies as well as macrosomia (high birth weight) are associated with an increased risk of obesity, type 2 diabetes and cardiovascular disease in the offspring. The paper by Seidell and Halberstadt shows that obesity is an increasing problem in children around the world. Similarly, the paper by Bailey et al. shows that the global problem of micronutrient deficiencies starts early in life with lifelong consequences. Both under- and overnutrition greatly contribute to the global burden of disease with severe global economic consequences. These do not only relate to the direct costs associated with the medical consequences of malnutrition but also to the indirect costs of reduced productivity of those affected. The paper by Detzel and Wieser in this issue illustrates that combatting iron deficiency by food fortification can be cost-effective.