Table 1

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

Determinant	This determinant relates to	Example interventions to address this determinant
Epigenetics	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