Table 1

Summary of determinants of the double burden and their key features (adapted from WHO ‘The double burden of malnutrition: policy brief’15)

DeterminantThis determinant relates toExample interventions to address this determinant
  • Changes in the expression of genes

  • Changes that affect the body’s regulation of energy

  • Prevention of intrauterine growth restriction15

Early-life nutrition
  • Period from conception to early childhood (often called the first 1000 days)

  • Pregnant and lactating women; children under 2 (24 months)

  • Fetal development and infancy

  • Promotion of exclusive breastfeeding in the first 6 months4

Lifestyle factors
  • Unhealthy behaviours, both automatic and learnt

  • Food habits

  • Counselling of mothers on contents of an appropriate healthy diet26

Food access, portion sizes and cost
  • Quality and quantity of available food

  • Meal portions

  • Price of nutritious food such as fresh produce

  • School food/meal programmes4

Socioeconomic disadvantage, inequality and poverty
  • Poverty

  • Household’s ability to afford nutrient-rich food

  • Establishment of well-managed microfinance institutions27

Urbanisation, urban design and the built environment
  • Water and sanitation infrastructure

  • Opportunity for physical activity

  • Source of food (eg, smallholder and home-grown food vs store bought)

  • Urban-agriculture programmes and direct farm-consumer marketing4

Food systems
  • Food/agricultural production

  • Homogenisation of diets

  • Food environment (eg, what is on the market)

  • Minimising postharvest losses among smallholder farmers21