Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa

Factors associated with stunting in healthy children aged 5 years and less living in Bangui (RCA)

Stunting remains a major public health concern worldwide. Although its global prevalence is slowly decreasing, the actual number of affected children is still rising in Sub-Saharan Africa. In the Central African Republic (CAR), about one third of all children below the age of five are stunted. Stunting is correlated with many long-term consequences, including poor cognitive development and a higher rate of morbidity and mortality, making stunting a major contributor to poverty. In CAR, little is known about the factors that contribute to stunting. This study aimed at analysing, in a cross-sectional study, the main factors associated with stunting in a group of 414 children recruited between December 2011 and November 2013, aged five years or less and living in Bangui. For all children, demographic, socio-economic and anthropometric data were recorded and asymptomatic enteropathogen carriage was assessed in stool samples using classical microbiological assays. The study group had a mean age of 14.2±10 months. Fifty-eight percent (292/414) were boys, and 36 percent (148/414) exhibited stunted growth. Of the stunted children, 51% (75/148) showed a moderate delay in linear growth for their age group [height-for-age z-score (HAZ) between -2 and -3 SD] while 49% (73/148) presented a severe delay (HAZ < -3). Factors significantly associated with stunting included gender (aOR: 1.67; 95% CI: 1.07; 2.62 for boys compared to girls) and age (aOR of 3.98 (95% CI: 2.45; 6.46) for toddlers and aOR 4.42 (95% CI: 2.36; 8.28) for children compared to infants). Most importantly, we identified being overweight [weight-for-height z-score (WHZ) > 2 SD; aOR: 3.21; 95% CI: 1.50; 6.90 of overweight compared to normal weight] as also being significantly associated with stunting. This is the first study showing that even in the poorest countries of the world there is an association of stunting with being overweight.

Maternal employment and childhood overweight in low- and middle-income countries

OBJECTIVE

To investigate the association between maternal employment and childhood overweight in low- and middle-income countries (LMIC). Design/Setting We utilized cross-sectional data from forty-five Demographic and Health Surveys from 2010 to 2016 (n 268 763). Mothers were categorized as formally employed, informally employed or non-employed. We used country-specific logistic regression models to investigate the association between maternal employment and childhood overweight (BMI Z-score>2) and assessed heterogeneity in the association by maternal education with the inclusion of an interaction term. We used meta-analysis to pool the associations across countries. Sensitivity analyses included modelling BMI Z-score and normal weight (weight-for-age Z-score≥-2 to <2) as outcomes.

SUBJECTS

Participants included children 0-5 years old and their mothers (aged 18-49 years).

RESULTS

In most countries, neither formal nor informal employment was associated with childhood overweight. However, children of employed mothers, compared with children of non-employed mothers, had higher BMI Z-score and higher odds of normal weight. In countries where the association varied by education, children of formally employed women with high education, compared with children of non-employed women with high education, had higher odds of overweight (pooled OR=1·2; 95 % CI 1·0, 1·4).

CONCLUSIONS

We find no clear association between employment and child overweight. However, maternal employment is associated with a modestly higher BMI Z-score and normal weight, suggesting that employment is currently associated with beneficial effects on children's weight status in most LMIC.

Double burden or double counting of child malnutrition? The methodological and theoretical implications of stuntingoverweight in low and middle income countries

BACKGROUND

There is increasing concern at research and policy levels about the double burden of child malnutrition (DBCM)-with stunting and overweight found across different groups of children. Despite some case studies suggesting that stunting and overweight can occur concurrently in children, here known as 'stuntingoverweight', and major drives to reduce all forms of malnutrition in low and middle income countries (LMICs), stuntingoverweight is continually overlooked. This research evidences the prevalence of stuntingoverweight across LMICs, exploring the theoretical and methodological implications of failing to acknowledge this form of malnutrition.

METHODS

Prevalence estimates of stuntingoverweight are constructed from 79 LMICs with nationally representative anthropometric survey data. Stunting and overweight estimates are amended to exclude stuntedoverweight children. These estimates are compared with those published in the Joint Child Malnutrition Estimates (JMEs)-evidencing overestimation and double counting of stuntedoverweight children.

RESULTS

Children can be concurrently stunted and overweight. Stuntedoverweight children are found in all LMICs, from 0.3% to 11.7% of under-fives and are included in both stunting and overweight rates. Analysed together, this leads to double counting of stuntedoverweight children. This artificial inflation of stunting and overweight rates can give a false impression of a DBCM, obscuring the true diversity of malnutrition present. Over 10 million children are stuntedoverweight in the world.

CONCLUSIONS

Stuntingoverweight is a newly recognised, understudied phenomenon. Affected children are included in both stunting and overweight prevalence estimates, introducing unobserved heterogeneity to both individual-level and population-level research and double counting to population-level research. Overlooking stuntedoverweight children has great implications for methodology, theory, policies, programmes and the health of affected children.

Determinants of overweight with concurrent stunting among Ghanaian children

Background

Malnutrition (undernutrition and overnutrition) is a major public health problem in Ghana –affecting growth and development of individuals and the nation. Stunting and overweight are of particular interest, as recent national surveys show a rising trend of overnutrition and stubbornly high burden of stunting among Ghanaian children. There are currently no data on the simultaneous occurrence of overweight and stunting within individuals in Ghana. This paper presents the burden, the individual-level, and contextual determinants of overweight with concurrent stunting among Ghanaian children.

Methods

This study analyzed data set of the fourth round of the Ghana Multiple Indicator Cluster Survey (MICS4). Bivariate analyses were used to describe selected characteristics of survey respondents and their children. Hierarchical modelling approach facilitated identification of significant distal, intermediate and proximal factors/determinants of concurrent stunting and overweight. Both crude and adjusted prevalence ratios via a multivariable Poison regression model with their corresponding 95% Confidence Intervals (CI) are reported. Variables with p ≤ 0.25 at the bivariate level were included in the multivariable analysis. An alpha value of 5% was used to indicate significance.

Results

Of 7550 cases (children) analyzed, the prevalence of stunting was 27.5%; underweight was 17.3%; and wasting was 7.7%. The prevalence of overweight and concurrent overweight and stunting were respectively 2.4% and 1.2%. Children who belonged to the fourth wealth quintile, were more likely to be overweight and concurrently stunted as against children belonging to the poorest quintile (aPR = 1.010; 95% CI, 1.003–1.017). Compared to religious (Christians/Muslim/Traditionalist) household heads, children whose household heads did not belong to any religion had 2 times the rates of the Overweight with concurrent stunting (PR = 2.024; 95% CI, 1.016–4.034). Children with mothers aged 20–34 and 35–49 had an increased though insignificant prevalence ratio of association (aPR = 1.001; 95% CI, 0.994–1.005) and (aPR = 1.001; 95% CI, 0.998–1.012) respectively.

Conclusion

This analysis determined the prevalence of concurrent stunting and overweight among Ghanaian children to be 1.2%. Four contextual variables (breastfeeding status, religion, geographic region, and wealth index quintile) were associated with overweight with concurrent stunting. We conclude that, only contextual factors are predictive of DBM among children under five living in Ghana.

Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.

Patterns and Determinants of Double-Burden of Malnutrition among Rural Children: Evidence from China

Chinese children are facing dual burden of malnutrition—coexistence of under-and over-nutrition. Little systematic evidence exists for explaining the simultaneous presence of under-and over-nutrition. This study aims to explore underlying mechanisms of under-and over-nutrition among children in rural China. This study used a nationwide longitudinal dataset of children (N = 5,017) from 9 provinces across China, with four exclusively categories of nutritional outcomes including under-nutrition (stunting and underweight), over-nutrition (overweight only including obesity), paradox (stunted overweight), with normal nutrition as reference. Multinomial logit models (Level-1: occasions; Level-2: children; Level-3: villages) were fitted which corrected for non-independence of observations due to geographic clustering and repeated observations of individuals. A mixture of risk factors at the individual, household and neighbourhood levels predicted under-and over-nutrition among children in rural China. Improved socioeconomic status and living in more urbanised villages reduced the risk of stunted overweight among rural children in China. Young girls appeared to have higher risk of under-nutrition, and the risk decreased with age more markedly than for boys up to age 5. From age 5 onwards, boys tended to have higher risk of under-nutrition than girls. Girls aged around 12 and older were less likely to suffer from under-nutrition, while boys’ higher risk of under-nutrition persisted throughout adolescence. Children were less likely to suffer from over-nutrition compared to normal nutrition. Boys tended to have an even lower risk of over-nutrition than girls and the gender difference widened with age until adolescence. Our results have important policy implications that improving household economic status, in particular, maternal education and health insurance for children, and living environment are important to enhance rural children’s nutritional status in China. Investments in early years of childhood can be effective to reduce gender inequality in nutritional health in rural China.

Relationships between Wasting and Stunting and Their Concurrent Occurrence in Ghanaian Preschool Children

Objective. The main aim of the study was to assess the magnitude of concurrent wasting and stunting among Ghanaian preschool children. Secondly, we investigated the relationship between wasting and stunting as well as factors associated with these conditions. Methods. This paper is based on reanalysis of anthropometric and other relevant data which was collected in the 2014 Ghana Demographic and Health Survey. The data set consisted of 2,720 preschool children aged 0-59 months. We conducted three-step moderated hierarchical multiple regression analyses to determine independent predictors and moderators of height-for-age Z-score. Results. Nationally, the prevalence of concurrent wasting and stunting among children aged 0-59 months was low at 1.4% but it varied geographically with the Upper East Region having the highest prevalence of 3.2% (95% CI: 1.7-5.8). Children who had low weight-for-height Z-scores were at a higher risk of linear growth retardation (stunting) especially among children aged less than three years. A 1-unit increase in weight-for-height Z-score (WHZ) was associated with 0.07 standard units' increase in height-for-age Z-score (HAZ) [β = 0.071 (95% CI: 0.03, 0.15)]. Conclusions. The study results suggest that weight-for-height relates to linear growth but this relationship is moderated by age of child. Stunting and wasting share some common risk factors. Therefore, measures to prevent wasting may positively influence linear growth.

Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys

Objective

The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height.

Design

A secondary data analysis of children aged 2·0–4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children’s height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined ‘concurrent stunting and overweight’ as height-for-age Z-score <−2 and BMI Z-score >+1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors.

Setting

Thirteen out of twenty-seven provinces in Indonesia.

Subjects

Children (n 4101) from four waves of the Indonesian Family Life Survey (1993–2007).

Results

There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0–2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34–2·01).

Conclusions

Concurrent stunting and overweight occurs in Indonesian children aged 2·0–4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

OBJECTIVE

Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49.8%), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1.5 months of life among Guatemalan infants.

DESIGN

As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ <-2 using WHO growth standards.

SETTING

Eight rural, indigenous Mam-Mayan villages (n 200, 100% of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27% of Mayan indigenous origin), Guatemala.

SUBJECTS

Three hundred and six newborns with a median age of 19 d.

RESULTS

The median rural HAZ was -1.56 and prevalence of stunting was 38%; the respective urban values were -1.41 and 25%. Linear regression revealed no relationship between infant age and HAZ (r = 0.101, r(2) = 0.010, P = 0.077). Maternal height explained 3% of the variability in HAZ (r = 0.171, r(2) = 0.029, P = 0.003).

CONCLUSIONS

Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.

Maternal overweight/obesity characteristics and child anthropometric status in Jos, Nigeria

Objective:

This study is to determine the pattern of overweight and obesity and its relationship with childhood anthropometric status in Nigeria.

Materials and Methods:

This cross-sectional study was conducted in Jos, Nigeria. Interviewer administered questionnaire was used in data collection. Maternal and child anthropometric measurements were obtained using standard WHO methods. Child anthropometric Z scores were obtained from WHO Anthroplus while BMI of mothers were also determined. Totally, 262 mother-child pairs were recruited.

Results:

Mean maternal age and mean child age were 30.8 ± 6.3 yrs (15-47 yrs) and 22.3 ± 18.7 months (3-72 months). Prevalence of maternal underweight, overweight and obesity was 4.2% (11/262), 29.4% (77/262) and 25.9% (68/262), respectively. Child overweight/obesity was 5.4% (14/262), severe under-nutrition 5.7% (15/262). Mean maternal BMI was higher in the older, more educated and higher socioeconomic status (SES). Child mean birth-weight, weight-for-age Z-score and BMI-for-age Z-score (BAZ) were higher among mothers with BMI ≥ 25 kg/m². All large-for-age babies were in mothers with maternal BMI ≥ 25 kg/m². Childhood over-nutrition was more common in maternal BMI of ≥25 kg/m². Overall, BAZ was directly related with maternal BMI, maternal age and birth-weight, although it was inversely related with maternal BM I ≥ 25 kg/m².

Conclusion:

Higher BMI is seen in educated and higher SES mothers and this impact on childhood anthropometry.

Predictors of the risk of malnutrition among children under the age of 5 years in Somalia

OBJECTIVE

To investigate the predictors of wasting, stunting and low mid-upper arm circumference among children aged 6-59 months in Somalia using data from household cross-sectional surveys from 2007 to 2010 in order to help inform better targeting of nutritional interventions.

DESIGN

Cross-sectional nutritional assessment surveys using structured interviews were conducted among communities in Somalia each year from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6-59 months from households across three livelihood zones (pastoral, agro-pastoral and riverine). Predictors of three anthropometric measures, weight-for-height (wasting), height-for-age (stunting) and mid-upper arm circumference, were analysed using Bayesian binomial regression, controlling for both spatial and temporal dependence in the data.

SETTING

The study was conducted in randomly sampled villages, representative of three livelihood zones in Somalia.

SUBJECTS

Children between the ages of 6 and 59 months in Somalia.

RESULTS

The estimated national prevalence of wasting, stunting and low mid-upper arm circumference in children aged 6-59 months was 21 %, 31 % and 36 %, respectively. Although fever, diarrhoea, sex and age of the child, household size and access to foods were significant predictors of malnutrition, the strongest association was observed between all three indicators of malnutrition and the enhanced vegetation index. A 1-unit increase in enhanced vegetation index was associated with a 38 %, 49 % and 59 % reduction in wasting, stunting and low mid-upper arm circumference, respectively.

CONCLUSIONS

Infection and climatic variations are likely to be key drivers of malnutrition in Somalia. Better health data and close monitoring and forecasting of droughts may provide valuable information for nutritional intervention planning in Somalia.

Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey

BACKGROUND

Malnutrition is a prevalent public health concern in Ghana. While studies have identified factors that influence child malnutrition and related inequalities in Ghana, very little efforts have been made to decompose these inequalities across various household characteristics. This study examined the influence of socioeconomic factors on inequality in child malnutrition using a decomposition approach.

METHODS

The study employed cross section data from the 2011 Multiple Indicator Cluster Survey (MICS). Analysis was done at three levels: First, concentration curves were constructed to explore the nature of inequality in child malnutrition. Secondly, concentration indices were computed to quantify the magnitude of inequality. Thirdly, decomposition analysis was conducted to determine the role of mother's education and health insurance coverage in inequality of child malnutrition.

RESULTS

The concentration curves showed that there exists a pro-poor inequality in child malnutrition measured by stunting and wasting. The concentration indices of these measures indicated that the magnitude of inequality was higher and significant at 1 % for weight-for-age (WAZ) (-0.1641), relative to height-for-age (HAZ) (-0.1613). The decomposition analyses show that whilst mother's education contributed about 13 and 11 % to inequality in HAZ, it contributed about 18.9 and 11.8 % to inequality in WAZ for primary and secondary or above education attainments, respectively. Finally, health insurance contributed about 1.91 and 1.03 % to inequality in HAZ and WAZ, respectively.

CONCLUSION

The results suggest that there is the need to encourage critical policies directed towards improving female literacy in the country. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child malnutrition.

Tackling malnutrition: a systematic review of 15-year research evidence from INDEPTH health and demographic surveillance systems

Background

Nutrition is the intake of food in relation to the body's dietary needs. Malnutrition results from the intake of inadequate or excess food. This can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity.

Objective

To perform a systematic review to assess research conducted by the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) of health and demographic surveillance systems (HDSSs) over a 15-year period on malnutrition, its determinants, the effects of under and over nutrition, and intervention research on malnutrition in low- and middle-income countries (LMICs).

Methods

Relevant publication titles were uploaded onto the Zotero research tool from different databases (60% from PubMed). Using the keywords ‘nutrition’, ‘malnutrition’, ‘over and under nutrition’, we selected publications that were based only on data generated through the longitudinal HDSS platform. All titles and abstracts were screened to determine inclusion eligibility and full articles were independently assessed according to inclusion/exclusion criteria. For inclusion in this study, papers had to cover research on at least one of the following topics: the problem of malnutrition, its determinants, its effects, and intervention research on malnutrition. One hundred and forty eight papers were identified and reviewed, and 67 were selected for this study.

Results

The INDEPTH research identified rising levels of overweight and obesity, sometimes in the same settings as under-nutrition. Urbanisation appears to be protective against under-nutrition, but it heightens the risk of obesity. Appropriately timed breastfeeding interventions were protective against malnutrition.

Conclusions

Although INDEPTH has expanded the global knowledge base on nutrition, many questions remain unresolved. There is a need for more investment in nutrition research in LMICs in order to generate evidence to inform policies in these settings.

Has the prevalence of stunting in South African children changed in 40 years? A systematic review

BACKGROUND

In the last 20 years, South Africa has experienced political, economic, and demographic transitions accompanied by an epidemiological transition. Like several sub-Saharan countries, the South African population is facing both under-and over-nutrition, and nutrition and lifestyle related chronic disease while the burden of infectious disease remains high. It is critical to understand these trends overtime in order to highlights the pitfalls and successful measures initiatives taken in the efforts to tackle malnutrition. The objective of this systematic review is to investigate the changes in the prevalence of stunting, a chronic form of undernutrition, in South Africa over 40 years, and to derive lessons from the South African experience, a country in an advanced process of transition in sub-Saharan Africa.

METHODS

We undertook a systematic review of publications selected from PubMed, Science Direct and Scopus. We included studies and surveys published between 1970 and 2013 if they reported the prevalence of stunting (low height-for-age) in children under-6 years of age living in South Africa. We excluded studies conducted in health facility outpatients or hospital wards, or children with known chronic and acute infectious diseases. We extracted Date of data collection, study setting, ethnicity, age, sex, sample size, growth references/standards, diagnostic criteria for stunting and prevalence of stunting from each study.

RESULTS

Over the last decade, the national prevalence of stunting has decreased. However, between and within provincial, age and ethnic group disparities remain. Unlike other countries in sub-Saharan Africa, no sex or rural/urban differences were found in preschool children. However, the analysis of long-term trends and identification of vulnerable groups is complicated by the use of different growth references/standards and sampling methods.

CONCLUSION

Despite economic growth, political and social transitions, and national nutritional programs, stunting remains stubbornly persistent and prevalent in South Africa. A multi-sectoral and public health approach is needed to: (i) better monitor stunting over time, (ii) combat malnutrition during the first thousand days of life through continued efforts to improve maternal nutrition during pregnancy and infant feeding practices.

The challenges of underweight and overweight in South African children: are we winning or losing the battle? A systematic review

Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review available South Africa studies regarding the comprehensive summary of prevalence of underweight and overweight and evaluates government policies in addressing undernutrition and overnutrition in South African children and adolescents. We searched subject-specific electronic bibliographic databases of observational studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African boys and girls from birth to 20 years of age in studies published on or after 1990. A total of sixteen cross-sectional, three longitudinal studies and one report met the criteria for inclusion in this review. Descriptive data synthesis revealed the small number of longitudinal studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. In this review, 0.7%-66% of underweight was reported among children in rural areas compared to a 3.1%-32.4% of overweight in urban areas. All studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight were positively related with health-related physical activity and psychological health problems such as low activity, low fitness, low self-image and self-esteem. Numerous recommendations were made in the reviewed studies, however effective strategic programs in eradicating both underweight and overweight are minimal. It is evident from the reviewed studies that the burden of underweight and overweight are still a problem in South African children. The most highly affected by underweight are rural children, while children in urban areas in transition are faced with burden of overweight. There is little evidence to suggest that government strategic programs are effective in addressing underweight and overweight in South African children. Based on these findings, sustainable school-based feeding schemes and physical education programmes are needed for optimal benefits in children and adolescents.

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

OBJECTIVE

To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.

DESIGN

Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991-2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban-rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).

SETTING

Peru.

SUBJECTS

Children aged 0-59 months surveyed in 1991-92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007-08 (n 8232) and 2011 (n 8186).

RESULTS

Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991-2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).

CONCLUSIONS

The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Factors associated with stunting among children of age 24 to 59 months in Meskan district, Gurage Zone, South Ethiopia: a case-control study

Background

Stunting is one of the major causes of morbidity among under-five children Knowledge about risk factors of stunting is an important precondition for developing and strengthening nutritional intervention strategies. The purpose of this study was to assess factors associated with stunting among children of age 24 to 59 months in Meskan District of Gurage Zone, South Ethiopia.

Methods

Community based case-control study was conducted among children of age 24 to 59 months. A multistage sampling technique was used to select the study participants. Cases were stunted children while controls were not stunted children. A total of 121 cases and 121 controls were studied.. Data were analyzed using SPSS 16.0 statistical software.

Results

Children living in households with eight to ten [Adjusted Odds Ratio (AOR) = 4.44, 95% CI: 1.65, 11.95] and five to seven [AOR = 2.97, 95% CI: 1.41, 6.29] family members were more likely to be stunted than those living in households with two to four family members. Similarly, children living in households with three under-five children [AOR = 3.77, 95% CI: 1.33, 10.74] were more likely to develop stunting than those living in households with one under-five child. Children whose mothers worked as merchants [AOR = 4.03, 95% CI: 1.60, 10.17] were more likely to be stunted than children whose mothers worked as house wives. Children who breast fed for <2 years [AOR = 5.61, 95% CI: 1.49, 11.08] were more likely to be stunted than those who breast fed ≥2 years. Children who were exclusively breast fed for <6 months [AOR = 3.27, 95% CI: 1.21, 8.82]were more likely to develop stunting than children who were exclusively breast fed for the first 6 months. Children who bottle fed [AOR =3.30, 95% CI: 1.33, 8.17)] were more likely to be stunted than children who fed their complementary food using spoon/cup.

Conclusions

Family size, number of under-five children in the household, maternal occupation, duration of exclusive breastfeeding, duration breast feeding, and method of feeding complementary food were independently associated with stunting. Thus, public health intervention working on improving child nutrition should consider these determinants.

Determinants of Stunting and Overweight among Young Children and Adolescents in Sub-Saharan Africa

Background

Stunting and overweight are nutritional problems affecting most of sub-Saharan Africa. The region now has the world's highest rate of stunting among children (43%), while overweight and obesity are becoming a global epidemic, and Africa is not spared. The past two decades have seen a dramatic increase in obesity in sub-Saharan Africa.

Objective

The purpose of this systematic review is to explore the determinants of stunting and overweight in sub-Saharan Africa.

Methods

A literature search was conducted in PubMed using the key words stunting, overweight, obesity, Africa, sub-Saharan Africa, determinants, and prevalence. Limits were set to include articles published between 1990 and 2012. The systematic review resulted in 38 studies, and after selection based on title, content, and country of the study, 18 studies were eligible for this review. Data were analyzed by the chi-square test.

Results

The prevalence rates of stunting and over-weight were dependent on socioeconomic, demographic, and environmental factors. Many studies indicate that male children and those living in a rural setting are more likely to be stunted, whereas overweight among children depends more on age, household composition, occupation of the mother, and the mother's body mass index. Stunting occurred together with overweight among both boys and girls from 1 to 5 years of age. Stunting was more prevalent among boys than among girls. Indicators of socioeconomic status, such as mother's education, mother's occupation, and household income, were some of the determinants directly linked to stunting, whereas environmental factors, such as rural or urban setting and sanitation, influenced both stunting and overweight. Concurrent stunting and overweight is influenced by maternal and household factors, such as maternal height, age, and education, large household size, and lower socioeconomic status.

Conclusions

Although socioeconomic, demographic, and environmental factors were significant in determining stunting and overweight, other factors, such as nutrition and lifestyle, were important risk factors. Stunting in childhood is a risk factor that may result in overweight and obesity later in adolescence and adulthood, indicating the need to screen children below 1 year of age to identify stunting early in life. Promoting exclusive breastfeeding is reported to be important in preventing both stunting and overweight among children. More research is needed to explore the relationship between stunting and overweight and to explore policy guidelines to address the phenomenon.

Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review

BACKGROUND

In low- and middle-income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively.

OBJECTIVE

To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years of age.

METHODS

We reviewed literature since January 1, 1990, published in English, using the PubMed search terms nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. The findings were classified and described according to dual burden level (community, household, or individual).

RESULTS

Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the extent of the dual burden, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia due to shared underlying determinants or physiologic links.

CONCLUSIONS

The dual burden of malnutrition poses a threat to children's health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing over-nutrition through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity.

Parasitic Infections among Children under Five Years in Senegal: Prevalence and Effect on Anaemia and Nutritional Status

Although malaria is declining in many countries in Africa, malaria and anaemia remain frequent in children. This study was conducted to assess the relationship between malaria parasitaemia, intestinal worms, and anaemia, in children <5 years living in low transmission area in Senegal. A survey was carried out in 30 villages in the central part of Senegal. A two-level random cluster sampling technique was used to select study participant. Children <5 years were enrolled after informed consent. For each child, blood thick and smear tests were performed, haemoglobin concentration was measured with HemoCue, and stool samples were collected and examined using the Ritchie technique. A total of 736 children were recruited. Malaria parasite prevalence was 1.5% (0.7-2.6); anaemia was found in 53.4% (48.2-58.9), while intestinal parasites and stunting represented 26.2% (22.6-30.2) and 22% (18.6-25.5), respectively. In a logistic regression analysis, anaemia was significantly associated with malaria parasitaemia (aOR= 6.3 (1.5-53.5)) and stunting (aOR = 2 (1.2-3.1)); no association was found between intestinal parasites and anaemia. Malaria and anaemia remain closely associated even when malaria is declining. Scaling up antimalarial interventions may contribute to eliminate malaria and reduce the occurrence of anaemia among children.

Associação entre ganho de peso no primeiro ano de vida com excesso de peso e adiposidade abdominal na idade pré-escolar

OBJETIVO: Avaliar se a mudança no escore Z do índice de massa corpórea por idade >0,67 no primeiro ano de vida se associou ao excesso de peso na idade pré-escolar. MÉTODOS: Estudo de coorte aninhado a ensaio de campo randomizado realizado na cidade de São Leopoldo, no Rio Grande do Sul. Foram coletados dados de peso e estatura das crianças ao nascimento, dos seis aos oito meses e dos 12 aos 16 meses. Aos três e aos quatro anos, além destes dados aferiu-se a circunferência da cintura. Calculou-se o ganho de peso pela diferença no escore Z do índice de massa corpórea/idade dos 12 até os 16 meses em relação ao índice de massa corpórea/idade ao nascimento, adotando-se ponto de corte >0,67 para ganho de peso excessivo. A relação cintura/estatura foi realizada, considerando-se excesso de adiposidade central se valores >0,5. Utilizou-se a análise multivariada para o teste da associação entre os desfechos e as variáveis independentes. RESULTADOS: A prevalência do ganho de peso excessivo no primeiro ano de vida foi de 29,5% de um total de 338 crianças. Após ajuste para as variáveis sexo, grupo, peso ao nascer, tempo de aleitamento materno exclusivo e índice de massa corpórea da mãe, a mudança no escore Z >0,67 do nascimento até os 12 a 16 meses apresentou-se como fator de risco para o excesso de peso (RR 2,81; IC95% 1,53-5,16) e elevada relação cintura/altura na idade pré-escolar (RR 2,10; IC95% 1,19-3,72). CONCLUSÕES: O ganho de peso excessivo no primeiro ano de vida está associado ao excesso de peso e à elevada adiposidade abdominal na idade pré-escolar.

Prevalence of overweight, obesity and thinness in 9-10 year old children in Mauritius

Objective

To document the prevalence of overweight, obesity and thinness in 9–10 year old children in Mauritius.

Methods

412 boys and 429 girls aged 9–10 years from 23 primary schools were selected using stratified cluster random sampling. All data was cross-sectional and collected via anthropometry and self-administered questionnaire. Outcome measures were BMI (kg/m²), prevalence of overweight, obesity (International Obesity Task Force definitions) and thinness (low BMI for age). Linear and logistic regression analyses, accounting for clustering at the school level, were used to assess associations between gender, ethnicity, school location, and school's academic performance (average) to each outcome measure.

Results

The distribution of BMI was marginally skewed with a more pronounced positive tail in the girls. Median BMI was 15.6 kg/m² in boys and 15.4 kg/m² in girls, respectively. In boys, prevalence of overweight was 15.8% (95% CI: 12.6, 19.6), prevalence of obesity 4.9% (95% CI: 3.2, 7.4) and prevalence of thinness 12.4% (95% CI: 9.5, 15.9). Among girls, 18.9% (95% CI: 15.5, 22.9) were overweight, 5.1% (95% CI: 3.4, 7.7) were obese and 13.1% (95% CI: 10.2, 16.6) were thin. Urban children had a slightly higher mean BMI than rural children (0.5 kg/m², 95% CI: 0.01, 1.00) and were nearly twice as likely to be obese (6.7% vs. 4.0%; adjusted odds ratio 1.6; 95% CI: 0.9, 3.5). Creole children were less likely to be classified as thin compared to Indian children (adjusted odds ratio 0.3, 95% CI: 0.2, 0.6).

Conclusion

Mauritius is currently in the midst of nutritional transition with both a high prevalence of overweight and thinness in children aged 9–10 years. The coexistence of children representing opposite sides of the energy balance equation presents a unique challenge for policy and interventions. Further exploration is needed to understand the specific causes of the double burden of malnutrition and to make appropriate policy recommendations.

Is overweight in stunted preschool children in Cameroon related to reductions in fat oxidation, resting energy expenditure and physical activity?

BACKGROUND

Recent studies suggest that early modifications in metabolic pathways and behaviour, leading to energy conservation and reduced linear growth, could represent adaptations to nutritional constraints during foetal life and infancy. Impaired fat oxidation, low resting energy expenditure and reduced physical activity, resulting from these adaptations, could facilitate fat storage and development of overweight in growth-retarded children that consume more energy-dense food. This study aims at assessing whether: (1) dual-burden preschool children (simultaneously stunted and overweight) of Yaounde (Cameroon) have low birth-weight (indicator of foetal undernutrition) and reductions in fat oxidation, resting energy expenditure (REE) and physical activity, (2) fat oxidation, REE and physical activity are associated with foetal growth.

METHODOLOGY/PRINCIPAL FINDINGS

162 children (24-72 months) were considered: 22 stunted-overweight (SO), 40 stunted (S), 41 overweight (O), and 59 non stunted-non overweight (NSNO). Nutritional status and body composition were assessed using anthropometry and multifrequency bioimpedance analysis. Fasting respiratory quotient (RQ) and REE were measured by indirect calorimetry. Physical activity was determined using accelerometers, food questionnaires were used for diet assessment and birth-weight was noted. Mean RQs and REE (weight adjusted) did not differ between stunted children (SO and S) and non-stunted children (O and NSNO). SO and S children spent more time in sedentary activities than O children (p = 0.01 and p = 0.02, respectively) and less time in moderate-to-vigorous activities than NSNO children (p = 0.05 and p = 0.04, respectively). SO children's diet was less diverse (p = 0.01) with less animal products (p = 0.006). Multiple linear regressions model revealed that birth-weight is predictive of RQ (β = 0.237, p<0.01, R(2) = 0.08).

CONCLUSIONS/SIGNIFICANCE

This study showed that growth retardation in stunted-overweight children could be associated with postnatal nutritional deficiencies. Overweight in stunted children could be associated with reduced physical activity in the context of nutrition transition. High birth-weight was a predictor of reduced lipid oxidation, a risk factor of fat deposition.

Chronic malnutrition among overweight Hispanic children: understanding health disparities

Obesity may be masking other health problems such as height deficit, or stunting. Stunting may reflect the cumulative effect of chronic malnutrition especially in underserved immigrant communities. Exploratory analysis of a sample of children 2-19 years old from the 2007-2008 NHANES was used to assess the relationship between chronic malnutrition and overweight/obesity in Hispanic children. Overall, overweight/obesity prevalence was nearly 1 in 3 children and stunting prevalence was 3.1%. The prevalence of stunting varied significantly across race/ethnicity, with prevalence among Hispanics of 6.6%. Prevalence of stunting varied significantly by socio-economic characteristics within the Hispanic population. Our exploratory study showed differences in the prevalence of stunting across racial/ethnic groups and highlighted that overweight/obese Hispanic children have a higher prevalence of stunting compared with Non-Hispanic White overweight/obese children. More studies are needed to better understand the phenomenon and the implications for health inequities.

Birth weight, maternal body mass index, and early childhood growth: a prospective birth cohort study in China

BACKGROUND

The relations of birth weight and maternal body mass index (BMI) to overweight remain unresolved. We prospectively examined the relations of birth weight with various anthropometric measures at age 3 to 6 years, the effect of maternal BMI, and the patterns of these relations in an analysis using 9 birth weight categories.

METHODS

The subjects were 210 172 singleton infants born alive with a gestational age ≥ 28 weeks between October 1993 and December 1996; the subjects were followed up in 2000. Birth weight, maternal height and weight, and other relevant information were measured or collected prospectively. Overweight and underweight were defined by using National Center for Health Statistics/World Health Organization reference data. Logistic regression models were used to estimate relative risks. Analyses stratified by quartile of maternal BMI were performed to examine the effects of maternal BMI on the associations of birth weight with overweight and underweight.

RESULTS

Birth weight was linearly associated with height, weight, and BMI at age 3-6 years. Adjustment for maternal BMI did not alter this association. Birth weight was positively associated with overweight and negatively associated with underweight. The relation curves for both overweight and underweight resembled half of a flat parabolic curve. The associations for overweight and underweight were slightly stronger for the highest and lowest quartiles of maternal BMI, respectively.

CONCLUSIONS

Higher birth weight is associated with an increased risk for childhood overweight, and lower birth weight with an increased risk for underweight. The associations between birth weight and early childhood anthropometric growth measures could not explained by maternal BMI.

Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia

Background

The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia.

Methods

This cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden).

Results

Significant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1–2.0)].

Conclusion

In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia.

The economic and nutrition transition in Equatorial Guinea coincided with a double burden of over- and under nutrition

We assess trends in children's nutritional status in Equatorial Guinea, a country in socioeconomic transition. Nationally representative samples were conducted in 1997, at the start of the economic take off, and again in 2004. Children aged 0-60 months were included in the surveys (N=436, 552). Both surveys included a sociodemographic, dietary and health questionnaire, and anthropometric measurements from which height-for-age (HAZ); weight-for-age (WAZ) and weight-for-height (WHZ) Z-scores were calculated. Between 1997 and 2004, the prevalence of child overweight for all children increased from 21.8% to 31.7%, especially in urban areas (from 18.2% to 29.4%, p=0.01). Stunting prevalence among children >or=2 years old decreased (from 57.9% to 45.3%, p<0.02), but for all age groups remained very high (34.7% overall, 46.5% rural and 28.5% urban in 2004). The economic take off in Equatorial Guinea appeared to coincide with substantial increases in the prevalence of child overweight whereas the prevalence of stunting decreased even if it remained high. The results suggest that the country is undergoing a nutrition transition and acquiring the concomitant double burden of under and over nutrition.

Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors

Objective

To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors.

Design

Demographic Health Survey data, multistage stratified cluster sampling methodology.

Setting

Rural and urban areas of Kenya.

Subjects

A total of 1495 children between the ages of 3 and 5 years in Kenya.

Results

Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children.

Conclusions

The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

[Nutritional situation for mothers and children in South Africa]

BACKGROUND

Even 15 years after the downfall of the apartheid regime, there are significant inequalities regarding resources, welfare and social benefits among the people of South Africa. Poverty prevails and conditions are bad with respect to sanitation, health and living conditions; a situation which is likely to affect nutritional health. We have reviewed the nutritional status in South Africa.

MATERIAL AND METHODS

This article is based on literature retrieved from non-systematic reviews of the databases PubMed and High Wire Press, in addition to information from official documents and African journals. The author's recent field work in South Africa was also a source of information.

RESULTS

Nationwide surveys, as well as smaller studies have documented high rates of stunting, malnutrition and deficiency of micronutrients among South African children. Daily hunger is reported from more than half of South African households. There is also a rise in the number of overweight and obese children and mothers. HIV/aids is highly prevalent and often coexists with tuberculosis. Many of these patients have a poor nutritional status, which in turn reduces the effect of antiviral treatment.

INTERPRETATION

The high rate of malnutrition and HIV/aids among mothers and children in South Africa will delay improvement of general health in this population with generations.

Is migration status a determinant of urban nutrition insecurity? Empirical evidence from Mumbai city, India

From an economic perspective that understood it as a spillover of development, migration is now also the subject of socioeconomic investigation incorporating the problems of assimilation, relative deprivation and isolation. The corollary is an increased emphasis on economic and social understanding of migration and its consequences. This entails studying migration or migrants in terms of factors beyond income. Health outcome is important among these non-income factors but at the same time remains less studied. Although there have been a few influential studies on health issues as linked to migration status, the issue of malnutrition in this context continues to be under-researched. This paper explores, theoretically and empirically, migration status and malnutrition in Mumbai in India. An econometric analysis of Demographic and Health Survey data gives insight into the dynamics of child and maternal undernutrition as mediated by migration status in Mumbai.

Countries in transition: underweight to obesity non-stop?

The rise in childhood overweight and obesity in less developed countries and those with transitional economies is widely recorded. In many cases, this increase in overweight is occurring in societies where levels of under-nutrition remain high. Overweight particularly affects children in affluent families and urban families and is usually much less in rural areas. Changes such as the availability of more Western-style foods, the prevalence of snacking, a decline in physical activity, less sleep and the inactivity associated with watching television may all be contributing to the rise of overweight. The complications of overweight/obesity are already being seen in some affected children. Efforts to treat and prevent overweight in children are needed urgently if the appalling levels of overweight currently seen in the well established market economies of Europe and North America are to be avoided by less developed and transitional economies.

Seasonality, household food security, and nutritional status in Dinajpur, Bangladesh

BACKGROUND

The influence of seasonality on food security and nutritional status is widely accepted. However, research has typically focused on rural households and has not explored the specific mechanisms underlying seasonal effects.

OBJECTIVE

To investigate the role of seasonality in determining the food security and nutritional status of low-income urban households and to isolate specific pathways through which seasonality has its impact.

METHODS

Secondary panel data from CARE/IFPRI were utilized. Three rounds of data were collected from approximately 600 households in low-income areas of Dinajpur, Bangladesh, from 2002 through 2003, twice during the monsoon season and once in the dry season. Household-level surveys collected data on income and expenditure, employment, urban agriculture, health, and assets. Height and weight measurements were taken from children between the ages of 6 and 72 months. Paired t-tests and logistic fixed-effects modeling were then used to explore the role of seasonality.

RESULTS

The prevalence rates of food insecurity, wasting, and inadequate growth were all significantly higher during the monsoon season as compared with the dry season. Dietary diversity and lost work due to the weather were identified as specific pathways through which season affected household food security. However, mechanisms hypothesized to contribute to seasonal declines in nutritional status, such as child illness, were not found to be significant.

CONCLUSIONS

Season had a significant effect on both food security and nutritional status in Dinajpur, with households consistently worse off during the monsoon season. Initiatives to promote food market development, support employment during the hunger season, and prevent seasonal declines in nutritional status should be implemented.

Undernutrition in early life and body composition of adolescent males from a birth cohort study

The evidence for an association between poor nutrition in early life and subsequent obesity is inconclusive. In the present study, we investigated the associations between stunting, wasting and underweight at 2 and 4 years of age, and body composition in adolescence in male subjects studied since birth. The 1982 Pelotas Birth Cohort Study included all children born in maternity hospitals and living in the urban area of the city of Pelotas, Southern Brazil. All males born in 1982 were legally required to enlist in the army between January and April 2000. We were thus able to track 2250 subjects in 2000 (78.9% of the original cohort). Anthropometric measurements were collected in 1984 and 1986, and body composition was assessed in 2000. In the present analysis, we used as predictors the nutritional indices height-for-age, weight-for-height and weight-for-age presented in six categories. Outcomes included fat, lean and body mass indices and fat:lean mass ratio, derived from anthropometric and bioimpedance measurements. ANOVA and linear regression were used in the analyses to adjust for confounding. All predictors were positively associated with fat and body mass indices. Height-for-age Z score at age 2 or 4 years was not associated with lean mass index, but all other predictors were associated. Fat:lean mass ratio was associated only with weight-for-height Z score. Our results suggest that undernutrition is not a risk factor for overweight and obesity in our population and may partially protect against fatness in adolescence.

The social context of children's nutritional status in rural South Africa

AIM

To investigate the relationship between children's nutritional status and a series of measures capturing both the current status and the lifetime history of their connection with adult caregivers in the Agincourt sub-district of rural South Africa.

METHODS

Using data on a sample of 202 children from a recent ethnographic study of children's social connections and well-being, the authors (1) compare height for age and weight for age to an accepted international standard and (2) conduct bivariate analyses of the relationships between selected measures of social connection and extreme deviations below expected weight and expected height.

RESULTS

Fitted curves for weight for age and height for age fall between the 5th and 50th percentiles of CDC growth curves. Compromised nutrition, defined as being more than two standard deviations below expected height or weight, is associated with the death or non-co-residence of the mother, and with the absence of financial support from the father. The co-residence of maternal female kin as substitutes for the mother do not fully compensate for her absence.

CONCLUSIONS

The findings highlight the importance of parental living arrangements, parental financial support, birth order and the composition of sibling sets, and lifetime residential patterns in facilitating access to nutrition.

Association between insulin-like growth factor-1, insulin-like growth factor-binding protein-1 and leptin levels with nutritional status in 1–3-year-old children, residing in the central region of Limpopo Province, South Africa

The present study evaluated levels of growth factors and their associations with nutritional status with emphasis on stunting in children at 1 and 3 years of age. A follow-up study on a birth cohort (n 219) of children from villages in the central region of the Limpopo Province was undertaken. Of the original cohort, 156 and 162 could be traced and assessed at ages 1 and 3 years, respectively. Data collected included socio-demographic characteristics, anthropometric measurements, dietary intake and fasting blood (collected from 116 and 145 children at 1 and 3 years, respectively) for growth factor analysis (insulin-like growth factor (IGF)-1, IGF binding protein (BP)-1, IGFBP-3, leptin, glucose and insulin). At 1 year it was found that stunted children had lower leptin levels while their IGFBP-1 levels were higher than that in normal children. These differences were, however, not observed at 3 years. Furthermore at 1 year the biochemical parameters were more related to length measures whereas at 3 years the parameters were more associated with weight measures. The observed stunting in this group of children may be a result of chronic undernutrition resulting in long-term growth faltering which is already evident at 1 year. Thus the observed phenomenon might be an adaptive mechanism adopted by children's metabolic processes as they grow up in an environment with inadequate essential nutrients due to poor weaning practices and consumption of a diet of poor quality, resulting in them gaining more weight at the expense of linear growth.

Overweight with concurrent stunting in very young children from rural Mexico: prevalence and associated factors

OBJECTIVE

To document the prevalence of overweight or obesity concurrent with stunting in rural low-income Mexican children and to identify demographic and socio-economic characteristics that could help identify families at risk of having an overweight/obese and stunted young child in this population.

DESIGN

Cross-sectional analysis of the nutritional status of very young children, using primary data from a rural community-based survey conducted in 2003. Overweight, obesity and stunting were documented along with several maternal, household and community characteristics.

SETTING

Impoverished areas of rural Mexico.

SUBJECTS

Pre-school children (n=7555), aged 24-72 months.

RESULTS

The combined prevalence of overweight and obesity was equal to or greater than 20% in all children, as was the prevalence of stunting. The prevalence of concurrent overweight or obesity and stunting was approximately 5% in non-indigenous children, and over 10% in indigenous children 24-60 months. A multinomial logistic analysis revealed that the factors associated with coexisting stunting and overweight/obesity were lower socio-economic status (SES), lower maternal age, education, intelligence (vocabulary) and perceived social status, shorter maternal height, and larger household size. Among only stunted children, the risk of also being overweight or obese was associated with younger maternal age (relative risk ratios (RRR): 0.98, P=0.05), lower maternal perceived social status (RRR: 0.95, P<0.01) and maternal obesity (RRR: 2.93, P<0.0001) or overweight (RRR: 1.50, P=0.002).

CONCLUSIONS

These analyses highlight that concurrent overweight or obesity and stunting is an important public health issue in low-income areas of rural Mexico beginning in early childhood. Even within this impoverished population, children living in households with low relative SES are the most vulnerable.

SPONSORSHIP

Financial support for this research was provided by the National Institutes of Child Health and Human Development, the Fogarty International Center at NIH, the John D and Catherine T MacArthur Foundation 'Research Network on Socioeconomic Status and Health' and the Mexican Government.