Double burden of malnutrition in persons with obesity
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Double burden of malnutrition in persons with obesity Rocco Barazzoni 1 & Gianluca Gortan Cappellari 1
# The Author(s) 2020
Abstract A paradoxical double challenge has emerged in the last decades with respect to nutrition and nutrition-related clinical conditions. Hunger-related undernutrition continues to represent an unacceptable burden, although its prevalence has been encouragingly reduced worldwide. On the other hand, the prevalence of overweight and obesity, defined as fat excess accumulation with negative impact on individual health, has dramatically increased due to increasingly pervasive obesogenic lifestyle changes. Undernutrition and obesity may coexist in world regions, Countries and even smaller communities and households, being referred to as double burden of malnutrition. It is however important to point out that fat accumulation and obesity may also induce additional nutritional derangements in affected individuals, both directly through metabolic and body composition changes and indirectly through acute and chronic diseases with negative impact on nutritional status. In the current narrative review, associations between fat accumulation in obesity and malnutrition features as well as their known causes will be reviewed and summarized. These include risk of loss of skeletal muscle mass and function (sarcopenia) that may allow for malnutrition diagnosis also in overweight and obese individuals, thereby introducing a new clinically relevant perspective to the obesityrelated double burden of malnutrition concept. Keywords Obesity . Sarcopenia . Sarcopenic obesity . Malnutrition
1 Undernutrition and obesity: the double burden Undernutrition due to lack of sufficient food intake, both in terms of calorie and specific micronutrient supply, has been the main survival challenge for humans throughout evolution [1, 2]. Natural disasters, wars and famine have periodically limited food availability in various parts of the world, with substantial consequences on nutritional status and health, and ultimately limited survival. Although these challenges are unfortunately far from being eliminated, their global burden has been slowly reduced in recent decades by economic, technological and social progress. On the other hand, and perhaps not surprisingly, the same profound socialeconomic changes have led to a substantial increase in the prevalence of obesity, as defined by increased adiposity with negative impact on patient health that is commonly diagnosed by body mass index (BMI) above 30 kg/m2 [3–5].
* Rocco Barazzoni [email protected] 1
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
Indeed profound lifestyle changes with sedentary habits and high-calorie dietary intake causing positive energy balance may often combine with genetic predisposition, from evolutionary pressure selecting thrifty genes and phenotypes that favor energy intake and fat accumulation over energy dissipation at any given level of food availability [6, 7, 3, 4]. Combined overweight (BMI > 25 k
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