{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:52:34Z","timestamp":1791615154724,"version":"4.3.4"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T00:00:00Z","timestamp":1645488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Low- and middle-income countries (LMICs) suffered the most from nutritional deficiencies (NDs). Although decades of efforts have reduced it, little is known about the changing trajectory of ND burden in LMICs. By extracting data of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we calculated indicators of incidence and disability-adjusted life years (DALYs) to measure the burden of NDs and its main subcategories in LMICs, including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, dietary iron deficiency, and other nutritional deficiencies by sex, age and spatial patterns. In LMICs, ND incidence still increased in the age group 15+ born before 2005, especially in males. The effort of reducing the DALYs of NDs has generated a strong decline in per age group. In the main subcategories of NDs, protein-energy malnutrition incidence in males age 45+ born before 1970 still increased. Despite vitamin A deficiency incidence and dietary iron deficiency, DALYs strongly experienced decreases over three decades while still remaining at the heaviest level in 2019, especially in females and children under 5 years. The top largest tendency estimates occurred in Mali\u2019 females and Bhutan\u2019 males. Zimbabwe was the only country with increased DALYs rate tendency in both sexes.<\/jats:p>","DOI":"10.3390\/nu14050931","type":"journal-article","created":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T22:34:30Z","timestamp":1645569270000},"page":"931","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Evolving Patterns of Nutritional Deficiencies Burden in Low- and Middle-Income Countries: Findings from the 2019 Global Burden of Disease Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Jingjing","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinye","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Wang","sequence":"additional","affiliation":[{"name":"The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghua","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengchao","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyuan","family":"Han","sequence":"additional","affiliation":[{"name":"Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linghan","family":"Shan","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libo","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2873-5266","authenticated-orcid":false,"given":"Qunhong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150086, China"},{"name":"Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150086, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,22]]},"reference":[{"key":"ref_1","unstructured":"FAO, IFAD, UNICEF, WFP, and WHO (2020). The State of Food Security and Nutrition in the World 2020, Food and Agricultural Organization of the UN. Available online: http:\/\/www.fao.org\/3\/ca9692en\/online\/ca9692en.html#chapter-forward."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e528","DOI":"10.1016\/S2214-109X(15)00039-X","article-title":"Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: A pooled analysis of population-based surveys","volume":"3","author":"Stevens","year":"2015","journal-title":"Lancet Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1159\/000371618","article-title":"The Epidemiology of Global Micronutrient Deficiencies","volume":"66","author":"Bailey","year":"2015","journal-title":"Ann. Nutr. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Workie, S.B., Abebe, Y.G., Gelaye, A.A., and Mekonen, T.C. (2017). Assessing the status of iodine deficiency disorder (IDD) and associated factors in Wolaita and Dawro Zones School Adolescents, southern Ethiopia. BMC Res. Notes, 10.","DOI":"10.1186\/s13104-017-2480-5"},{"key":"ref_5","unstructured":"World Bank (2006). Repositioning Nutrition as Central to Development\u2014A Strategy for Large Scale Action, The World Bank."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"264","DOI":"10.2174\/1871530317666170921142055","article-title":"Diet Bioactive Compounds: Implications for Oxidative Stress and Inflammation in the Vascular System","volume":"17","author":"Gabriele","year":"2017","journal-title":"Endocr. Metab. Immune Disord. Drug Targets"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"376","DOI":"10.5694\/j.1326-5377.1995.tb124635.x","article-title":"Nutritional disorders in the elderly","volume":"163","author":"Wahlqvist","year":"1995","journal-title":"Med. J. Aust."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1038\/sj.ejcn.1602178","article-title":"Nutritional deficiency in general practice: A systematic review","volume":"59","year":"2005","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_9","first-page":"43","article-title":"Exploring the biological contributions to human health: Does sex matter? The Institute of Medicine answers \u201cyes\u201d","volume":"10","author":"Wizemann","year":"2001","journal-title":"J. Womens Health Gend. Based Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"433","DOI":"10.2105\/AJPH.94.3.433","article-title":"The Burden of Disease from Undernutrition and Overnutrition in Countries Undergoing Rapid Nutrition Transition: A View from Brazil","volume":"94","author":"Monteiro","year":"2004","journal-title":"Am. J. Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1016\/S0140-6736(20)30750-9","article-title":"Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Collaborators","year":"2020","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Diseases","year":"2020","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/S0140-6736(16)30388-9","article-title":"Guidelines for accurate and transparent health estimates reporting: The GATHER statement","volume":"388","author":"Stevens","year":"2016","journal-title":"Lancet"},{"key":"ref_14","unstructured":"World Bank (2022, January 06). New Country Classifications by Income Level: 2019\u20132020. Available online: https:\/\/blogs.worldbank.org\/opendata\/new-country-classifications-income-level-2019-2020."},{"key":"ref_15","unstructured":"Ahmad, O.B., Boschi-Pinto, C., Lopez, A.D., Murray, C.J., and Inoue, M. (2001). Age Standardization of Rates: A New WHO Standard, World Health Organization. Available online: https:\/\/www.who.int\/healthinfo\/paper31.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e374","DOI":"10.1016\/S2468-2667(18)30114-2","article-title":"Premature mortality projections in the USA through 2030: A modelling study","volume":"3","author":"Best","year":"2018","journal-title":"Lancet Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2013","journal-title":"Stat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Beal, T., Massiot, E., Arsenault, J.E., Smith, M.R., and Hijmans, R.J. (2017). Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175554"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1111\/j.1753-6405.2010.00504.x","article-title":"The increasing cost of healthy food","volume":"34","author":"Harrison","year":"2010","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"153S","DOI":"10.3945\/jn.109.110767","article-title":"High Food Prices and the Global Financial Crisis Have Reduced Access to Nutritious Food and Worsened Nutritional Status and Health","volume":"140","author":"Brinkman","year":"2010","journal-title":"J. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Smil, V. (2000). Feeding the World\u2014A Challenge for the Twenty-First Century, The MIT Press.","DOI":"10.7551\/mitpress\/2977.001.0001"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.actatropica.2019.03.012","article-title":"Food-borne and water-borne diseases under climate change in low- and middle-income countries: Further efforts needed for reducing environmental health exposure risks","volume":"194","year":"2019","journal-title":"Acta Trop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1136\/bmj.284.6323.1161","article-title":"Smoking habits and inflammatory bowel disease: Effect on nutrition","volume":"284","author":"Harries","year":"1982","journal-title":"Br. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Suter, P.M. (2012). Alcohol: Its Role in Nutrition and Health, Academic Press.","DOI":"10.1002\/9781119946045.ch55"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1093\/jn\/135.4.933","article-title":"Women\u2019s voices, women\u2019s choices: The challenge of nutrition and HIV\/AIDS","volume":"135","author":"Piwoz","year":"2005","journal-title":"J. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"633S","DOI":"10.3945\/ajcn.110.008227","article-title":"Executive summary: Biomarkers of nutrition for development (BOND): Building a consensus","volume":"94","author":"Raiten","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_27","unstructured":"Corish, C.A., and Bardon, L.A. (2018, January 12\u201318). Malnutrition in older adults: Screening and determinants. Proceedings of the Nutrition Society, London, UK."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Archer, E., Hand, G.A., and Blair, S.N. (2013). Validity of U.S. Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971\u20132010. PLoS ONE, 8.","DOI":"10.1371\/annotation\/c313df3a-52bd-4cbe-af14-6676480d1a43"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3252","DOI":"10.3390\/nu7053252","article-title":"Determination of zinc status in humans: Which indicator should we use?","volume":"7","author":"Wieringa","year":"2015","journal-title":"Nutrients"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1093\/ageing\/27.4.527","article-title":"Undereating and undernutrition in old age: Integrating bio-psychosocial aspects","volume":"27","author":"Clarke","year":"1998","journal-title":"Age Ageing"},{"key":"ref_31","first-page":"429","article-title":"Aging and Gastrointestinal Physiology","volume":"15","author":"Blechman","year":"1999","journal-title":"Gastroenterology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/BF02412647","article-title":"Overview of geriatric nutrition","volume":"5","author":"Curran","year":"1990","journal-title":"Dysphagia"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"134","DOI":"10.2165\/00002512-199608020-00007","article-title":"Anorexia in older persons: Epidemiology and optimal treatment","volume":"8","author":"Morley","year":"1996","journal-title":"Drugs Aging"},{"key":"ref_34","unstructured":"Tukey, J.W. (1977). Exploratory Data Analysis, Addison-Wesley."},{"key":"ref_35","unstructured":"World Health Organization (2011). Vitamin a Supplementation in Infants 1\u20135 Months of Age, World Health Organization."},{"key":"ref_36","unstructured":"World Health Organization (2011). Vitamin a Supplementation in Infants and Children 6\u201359 Months of Age, World Health Organization."},{"key":"ref_37","unstructured":"World Health Organization (2012). Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition Annex 2, WHO. A65\/11."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S193","DOI":"10.1177\/0379572115595889","article-title":"An economic optimization model for improving the efficiency of vitamin A interventions: An application to young children in Cameroon","volume":"36","author":"Vosti","year":"2015","journal-title":"Food Nutr. Bull."},{"key":"ref_39","unstructured":"GBD 2017 DALYs and HALE Collaborators (2018). Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392, 1859\u20131922."},{"key":"ref_40","unstructured":"GBD 2017 Causes of Death Collaborators (2018). Global, regional, and national age\u2013sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392, 1736\u20131788."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/5\/931\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:25:02Z","timestamp":1760135102000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/5\/931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,22]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["nu14050931"],"URL":"https:\/\/doi.org\/10.3390\/nu14050931","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,22]]}}}