Malnutrition among Children under Age Five in Panama: Results of the ENSPA 2019.

Background: Malnutrition has important short- and long-term consequences in children under age five. Malnutrition encompasses undernutrition, overnutrition, and the coexistence of both of them, known as the double burden of malnutrition (DBM). Objective: The aim of this study was to estimate the prevalence of undernutrition, overnutrition, and the DBM among these children at the national level and by living area in Panama. Methods: Data from the National Health Survey of Panama (ENSPA, Spanish acronym), a population-based, cross-sectional study carried out in 2019 were used. Stunting, wasting, overweight, and obesity were defined according to the cut-off points of the World Health Organization Growth Standards. Undernutrition was defined as being stunted only, wasted only or both; overnutrition was defined as being overweight only or obese only; and the DBM was defined as the co-occurence of stunting and overweight/obesity in the same child. Prevalence and general characteristics at the national level and by living area were weighted. Findings: The prevalence of undernutrition was 15.3% (95% confidence interval (CI) 13.4-17.3) at the national level and 36.6% (CI: 30.1-43.5) in indigenous areas. The prevalence of overnutrition was 10.2% (8.2-12.6) at the national level and 11.9% (CI: 8.5-16.3), 8.4% (CI: 6.5-10.7) and 8.7% (CI: 5.2-14.3) in urban, rural and indigenous areas, respectively. The DBM prevalence was 1.4% (CI: 1.0-2.1) at the national level and 2.7% (CI: 1.4-5.1) in indigenous areas. Conclusions: Undernutrition is still the most prevalent malnutrition condition in our country. Panama has the highest prevalence of overnutrition in Central America. The highest prevalence of undernutrition and DBM was found among children living in indigenous areas.

Inequality of opportunity in the double burden of malnutrition in Mexico.

This paper proposes a pseudo-birth-cohort approach to deal with a lack of longitudinal data to measure health inequities over time. Using Roemer's framework for inequality of opportunity, this study measures ex-ante and ex-post inequalities in malnutrition, a concept that spans both sides of the nutrition continuum. The total contribution of observed circumstances and the direct contribution of observed efforts to the variation of malnutrition are disentangled for people born between 1983 and 1988 in Mexico. Results indicate that inequality of opportunity has been persistent across this 30-year lifespan for that cohort. Some evidence suggests that a lack of opportunities has been transmitted from parents to children and that people's circumstances account for most of the explained variation in the double burden of malnutrition. However, stratifying the analysis by sex shows that efforts account for more of the explained variation of inequality of opportunity for women in their middle adulthood than for men in most of the outcomes analyzed.

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants.

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.

The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study.

BACKGROUND: The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population. METHODS: Nationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women-MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods-UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics' performances were compared using Wald's post-test. RESULTS: The mean GDQS for Brazilians was 14.5 (0-49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%). CONCLUSION: The GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.

Dynamics of the double burden of malnutrition in Guatemala: a secondary data analysis of the demographic and health surveys from 1998-2015.

OBJECTIVE: We estimated the prevalence and time trends of the double burden of malnutrition (DBM) in Guatemala and explored its occurrence based on socio-demographic factors. STUDY DESIGN: This was a secondary data analysis using information from four Demographic and Health Surveys covering the period 1998-2015. METHODS: The unit of analysis was the household within which information was gathered from women 18-49 years and their children, 6-59 months. The main outcome was the prevalence of any DBM in the household (co-existence of undernutrition and overnutrition in a woman, her children or both). We estimated the prevalence of any DBM by survey and analysed time trends. Stepwise logistic regression was used to explore the occurrence of DBM and socio-demographic factors. RESULTS: We analysed 39,749 households across all surveys. The prevalence of any DBM was 25.3% (95%CI: 22.1-28.7) in 1998-99, 23.8% (22.0-25.8) in 2002, 25.9% (24.3-27.5) in 2008-09 and 24.2% (22.9-25.5) in 2014-15, with no significant change over time (P = 0.782). Characteristics associated with lower odds of any DBM were rural residence, female-headed household, wealth and women's secondary education. Higher odds were seen for households with electricity, women >25y, indigenous and with >2 children. CONCLUSION: Our findings revealed that a quarter of Guatemala's households suffer from DBM, which has remained unchanged for 17 years. Interventions should prioritise urban areas, households of lower socio-economic status and those less educated. To increase awareness of policymakers of this pressing public health concern, further research on DBM could be strengthened by prospective study designs, integrating all household members and expanding the types of malnutrition.

High glycemia and resistin normalized in children with double burden of malnutrition: a cross-sectional study.

The coexistence of stunting and excess weight in the same individual is defined as a double burden of malnutrition (DBM) and is associated with noncommunicable diseases. In this study, we evaluated the impact of DBM on adipokine concentrations and metabolic profiles in children compared with weight excess alone. Children were allocated to the weight excess group (n = 23) (height-for-age (HAZ) > 0.0 and < 2.0 Z-score and body mass index-for-age (BMI/A) > 1.0 Z-score) or DBM (n = 22) group (HAZ < -1.0 Z-score (including mild stunting) and BMI/A > 1.0 Z-score). Lipid, glycemic profile, resistin, plasminogen activator inhibitor-1, leptin, and adiponectin concentrations were analyzed. Glycemia was significantly higher in the DBM group compared to the weight excess group (5.05 (4.76-5.31) mmol/L vs. 4.57 (4.35-4.81) mmol/L), although no differences were found in insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Adipokine concentrations did not differ between the groups. However, the DBM group showed higher resistin concentrations normalized by body fat mass than those of the weight excess group (1.44 (0.98-1.93) ng/mL vs. 0.76 (0.55-1.45) ng/mL). Insulin and HOMA-IR showed a negative correlation with adiponectin (r = -0.590 and -0.624, respectively, both p < 0.01). DBM was associated with increased glucose and resistin concentrations adjusted by fat mass compared to that associated with excess weight alone. Therefore, this association between mild stunting and weight excess has deleterious potential for long-term metabolic function, highlighting an additional precaution against weight gain in children, especially in those with stunting.

The double burden of malnutrition and environmental enteric dysfunction as potential factors affecting gut-derived melatonin in children under adverse environments.

Poor environmental conditions combined with continuous unhealthy and unsafe diets may substantially increase the risk of a vicious cycle of enteric infections (EED-environmental enteric dysfunction) and malnutrition (DBM-double burden of malnutrition) in children. Gut melatonin, mainly produced by the intestinal microbiota, can modulate the composition, variety, and dynamics of the microbiota itself and may affect and be affected by intestinal microbiota alterations due to DBM and EED.

Exploring the magnitude and drivers of the double burden of malnutrition at maternal and dyad levels in peri-urban Peru: A cross-sectional study of low-income mothers, infants and young children.

Multiple forms of malnutrition coexist in Peru, especially in peri-urban areas and poor households. We investigated the magnitude of, and the contribution of, dietary and socio-demographic factors to the double burden of malnutrition (DBM) at maternal (i.e., maternal overweight/obesity with anaemia) and dyad (i.e., maternal overweight/obesity with child anaemia) levels. A cross-sectional survey was conducted among low-income mother-child (6-23 months) dyads (n = 244) from peri-urban communities in Peru. Dietary clusters and the minimum dietary diversity score (MDD) were generated for mothers and infants, respectively. A composite indicator using the maternal dietary clusters and the MDD was created to relate to dyad level DBM. Two dietary clusters were found: (i) the 'high variety (i.e., animal-source foods, fruit and vegetables), high sugary foods/beverages' (cluster 1) and (ii) the 'high potato, low fruit and vegetables, low red meat' (cluster 2). DBM prevalence among mothers and dyads was 19.9% and 36.3%, respectively. Logistic regression analyses revealed that the only socio-demographic factor positively associated with maternal DBM was maternal age (aOR/5 years: 1.35 [1.07, 1.71]). Mothers belonging to diet cluster 1 were less likely to experience the DBM (aOR = 0.52 [0.26, 1.03]), although CIs straddled the null. Socio-demographic factors positively associated with dyad level DBM included maternal age (aOR/5 years: 1.41 [1.15, 1.73]), and having ≥ two children under 5 years (aOR = 2.44 [1.23, 4.84]). Diet was not associated with dyad-level DBM. Double-duty actions that tackle the DBM are needed given that one-third of dyads and a fifth of mothers had concurrent overweight/obesity and anaemia.

Dual burden of individual malnutrition in children 1-4 years: Findings from the Colombian nutritional health survey ENSIN 2015.

BACKGROUND: To date there are no studies with estimation of multiple types of double burden of individual malnutrition (DBIM) and evaluation of associated determinants. OBJECTIVE: To estimate the prevalence and social determinants associated with the double burden of individual malnutrition in children aged 1-4 years. METHODS: A cross-sectional study was conducted using data from Colombian nutritional heath survey ENSIN 2015. Global DBIM was analysed on the basis of excess weight and the presence of one or more micronutrient deficiencies (vitamin A, D, zinc, or iron) and/or stunting. Specific DBIM pairs were also analysed. Logistic regression was used to evaluate variables associated with DBIM. RESULTS: The sample consisted of 6807 children. The overall DBIM prevalence was 4%. The prevalence of DBIM in children affected by overweight or obesity was 75%. Male sex was associated with global DBIM (OR 2.19 (1.52-3.16) p = 0.000), indigenous children presented 6 times the DBIM due to stunting (OR 6.17 (1.67-22.7) p = 0.007). Children from the Atlantic (OR 3.95 (1.23-12.61) p = 0.021), central (OR 8.80 (2.38-32.49) p = 0.001) and Pacific (OR 4.19 (1.21-14.49) p = 0.024) regions, had a higher chance of DBIM due to iron deficiency. Children from east region (OR 3.03 (1.12-8.16) p = 0.029) and Bogotá city (OR 4.15 (1.65-12.32) p = 0.004) were associated with DBIM due to vitamin D deficiency. CONCLUSIONS: Children with overweight or obesity had a high likelihood of presenting micronutrients deficiencies or stunting. Ethnicity, male sex and country region of residence were variables associated with overall DBIM or specific DBIM.

Extreme Food Insecurity and Malnutrition in Haiti: Findings from a Population-Based Cohort in Port-au-Prince, Haiti.

Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population.

Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents.

BACKGROUND: Ultraprocessed products (UPPs) have been associated with unfavorable health outcomes; however, until now, they have not been associated with the coexistence of undernutrition and overnutrition, known as the double burden of malnutrition (DBM) at the individual level. METHODS: Cross-sectional analyses were performed on data collected from children and adolescents participating in the 2006 and 2016 Mexican National Health and Nutrition Surveys. The food and beverages reported in the food frequency questionnaire (SFFQ) were classified as UPPs as defined by the NOVA classification system. Associations of UPPs with anemia, excess weight, and the DBM were estimated with logistic regression models. A pseudo-panel was generated using the cohorts of children born from 1997 to 2001 to estimate the effect of the UPPs on anemia, excess weight, and the DBM. RESULTS: The consumption of UPPs (% energy) was higher in 2016 (children 30.1% and adolescents 28.3%) than in 2006 (children 27.3% and adolescents 23.0%) in both age-groups. The higher contribution of UPPs was positively associated with excess weight and the DBM in children's lower tertile of socioeconomic status (SES) and the DBM in higher tertile of SES in adolescents. The pseudo-panel analysis shows the positive association between UPPs and DBM in lower SES. CONCLUSIONS: These results provide evidence of the association between the consumption of UPPs and the DBM and excess weight in children and adolescents.

Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017.

BACKGROUND: Peru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children's growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration. METHODS: Using data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p]. RESULTS: In 1991-2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (- 1.0 vs - 1.2; p < 0.001) and WAZ (- 0.3 vs - 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration. CONCLUSIONS: Migration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.

Doble carga de malnutrición en prescolares, escolares y adolescentes bolivianos que viven a gran altura, municipio de La Paz / Double burden of malnutrition in Bolivian preschool, school age children and adolescents living at high altitudes, municipality of La Paz

INTRODUCCIÓN: la presencia simultánea del retraso del crecimiento y del exceso de peso en una persona representa una de las principales paradojas en la salud pública global y es de creciente preocupación en Bolivia, donde ambas condiciones en su conjunto no han sido abordadas y ocurren en un contexto de transición nutricional en el que se encuentra el país. OBJETIVO: describir la coexistencia de la doble carga de malnutrición a nivel individual en la población escolar (3-19 años) del municipio de La Paz. MÉTODOS: se realizó un estudio observacional de corte transversal analítico con datos antropométricos de 7.654 escolares pertenecientes al municipio de La Paz del año 2019. Se determinaron las prevalencias y los intervalos de confianza al 95% para emaciación, retraso en el crecimiento, sobrepeso, obesidad y sobrepeso + obesidad por sexo y grupo de edad. A nivel poblacional, la doble carga de malnutrición (DCM), se estimó en base a los umbrales de alta prevalencia sugeridos por organizaciones internacionales, a saber, prevalencias por encima del 20% y 10% para retraso en el crecimiento y sobrepeso, respectivamente. Para los análisis a nivel individual, la DCM se definió como la coexistencia de retraso en el crecimiento y sobrepeso + obesidad en los tres grupos de estudio y se comparó con su valor esperado, bajo el supuesto de distribuciones independientes de cada condición. RESULTADOS: a nivel poblacional, la prevalencia de emaciación para toda la muestra analizada fue de 3,7%, sin diferencias significativas por sexo. La prevalencia de retraso del crecimiento para el año 2019 no superó el 20% en todos los grupos de edad analizados. La prevalencia de sobrepeso fue mayor al 10% para el grupo de escolares y adolescentes. A nivel individual la doble carga de malnutrición se encontró en 2,8%, 1,9% y 2,9% en prescolares, escolares y adolescentes, respectivamente. Valores que se encontraron por debajo de lo esperado. CONCLUSIONES: las prevalencias de doble carga de malnutrición, retraso del crecimiento y sobrepeso + obesidad a nivel individual, fueron menores de lo esperado en los tres grupos de estudio, asumiendo distribuciones independientes de las dos condiciones. A pesar de ello, la coexistencia de la doble carga poblacional (municipio de La Paz) debe ser abordada en políticas y programas adecuados de salud pública(AU).

INTRODUCTION: the simultaneous presence of growth retardation and excess weight in a person represents one of the main paradoxes in global public health and is of growing concern in Bolivia, where both conditions as a whole have not been addressed and occur in a context of nutritional transition in which the country finds itself. OBJECTIVE: to describe the coexistence of the double burden of malnutrition at the individual level in the school population (3-19 years) of the municipality of La Paz. METHODS: an analytical cross-sectional observational study was carried out with anthropometric data from 7,654 schoolchildren belonging to the municipality of La Paz in 2019. The prevalences and 95% confidence intervals were determined for wasting, stunting, overweight, obesity and overweight+obesity, by sex and age group. At the population level, the double burden of malnutrition (DBM) was estimated based on thresholds of high prevalence suggested by international organizations, namely, prevalence above 20% and 10% for stunting and overweight, respectively. For individual level analyzes, DBm was defined as the coexistence of stunting and overweight + obesity in the three study groups and was compared with its expected value, under the assumption of independent distributions of each condition. RESULTS: at the population level, the prevalence of wasting for the entire sample analyzed was 3.7%, with no significant differences by sex. The prevalence of stunting for the year 2019 did not exceed 20% in all the age groups analyzed. The prevalence of overweight was higher than 10% for the group of schoolchildren and adolescents. At the individual level, the double burden of malnutrition was found in 2.8%, 1.9% and 2.9% in preschool, schoolchildren and adolescents, respectively. Values that turned out to be lower than expected. CONCLUSIONS: the prevalence of double burden, growth retardation and overweight and obesity at the individual level, were lower than expected in the three study groups, assuming independent distributions of the two conditions. Despite this, the coexistence of the double burden in the municipality of La Paz must be addressed in appropriate public health policies and programs(AU).

Food insecurity and the double burden of malnutrition in Colombian rural households.

OBJECTIVE: This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother. DESIGN: A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child. SETTING: Rural Colombia. PARTICIPANTS: Totally, 2·350 mother-child pairs living in the same household. RESULTS: Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)). CONCLUSIONS: Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.

The double burden of malnutrition in Peru: An update with a focus on social inequities.

BACKGROUND: The decrease in stunting in Peru is seen as a "success story" in the fight against malnutrition; however, the parallel increase in obesity has often been ignored. OBJECTIVE: To investigate trends in the double burden of malnutrition (i.e., the coexistence of stunting and overweight/obesity) in Peru compared with trends in household food expenditures by family socioeconomic status and urban/rural residency. METHODS: Using Peruvian nationally representative surveys, we analyzed stunting (children aged 0-5 y) and overweight/obesity (women aged 18-49 y) trends between 1992 and 2017, as well as trends in household energy consumption from healthy and unhealthy foods between 2001 and 2017 by education, income, participation in the Juntos cash-transfer program, and urban/rural residency. Joinpoint software was used for all trends analyses. RESULTS: Overall, stunting decreased and obesity increased among all social groups between 1992 and 2017. Inequities in stunting by income and urban/rural residency widened over time. From 1992 to 2017, urban stunting prevalence decreased at an average annual percent change (AAPC) of -4.5% (SE = 0.27%, P < 0.0001), whereas rural stunting prevalence decreased at a lower AAPC of -2.6% (SE = 0.30%, P < 0.0001). On the contrary, inequities in obesity narrowed as obesity prevalence among women from the extremely poor group and those living in rural areas increased at a faster rate than that of their counterparts. Rural obesity prevalence increased at an AAPC of 8.5% (SE = 1.14%, P < 0.0001), whereas urban obesity prevalence increased at an AAPC of 2.0% (SE = 0.25%, P < 0.0001). Increases in energy consumption from unhealthy foods were observed along with decreases in energy consumption from healthy foods in most social groups. CONCLUSION: The prevalence of stunting and obesity is high in Peru. The need for multisectoral interventions addressing both ends of the malnutrition spectrum, particularly among disadvantaged groups to avoid further widening of social inequities, is warranted.

Food addiction symptoms and metabolic changes in children and adolescents with the double burden of malnutrition.

The double burden of malnutrition (DBM) has been described in many low-/middle-income countries. We investigated food addiction, thyroid hormones, leptin, the lipid/glucose profile and body composition in DBM children/adolescents. Subjects were allocated into groups according to nutritional status: control (C, n 28), weight excess (WE, n 23) and DBM (WE plus mild stunting, n 22). Both the DBM and WE groups showed higher mean insulin concentrations than the control (DBM = 57·95 (95 % CI 47·88, 70·14) pmol/l, WE = 74·41 (95 % CI 61·72, 89·80) pmol/l, C = 40·03 (95 % CI 34·04, 47·83) pmol/l, P < 0·001). WE and DBM showed more food addiction symptoms than the control (3·11 (95 % CI 2·33, 3·89), 3·41 (95 % CI 2·61, 4·20) and 1·66 (95 % CI 0·95, 2·37)). In DBM individuals, addiction symptoms were correlated with higher body fat and higher insulin and leptin levels. These data provide preliminary evidence consistent with the suggestion that DBM individuals have a persistent desire to eat, but further studies are required to confirm these results in a larger study. These hormonal changes and high body fat contribute to the development of diabetes in long term.

Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers.

OBJECTIVE: To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN: We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING: Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS: Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS: We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS: Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.

Multiple burdens of malnutrition and relative remoteness in rural Ecuadorian communities.

OBJECTIVE: Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia. DESIGN: Adult anthropometry was collected through serial case-control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community. SETTING: Northern coastal Ecuador. PARTICIPANTS: Adults (n 1665) and children under 5 years of age (n 2618). RESULTS: From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness-OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age. CONCLUSIONS: The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.

Height Trajectory During Early Childhood Is Inversely Associated with Fat Mass in Later Childhood in Mexican Boys.

BACKGROUND: Childhood obesity continues to be a global health problem. Previous research suggests that linear growth retardation or stunting during early childhood increases the risk of obesity, but others have reported that rapid linear growth poses a greater concern than early nutritional status. OBJECTIVE: The objective of this study was to determine if growth trajectories are associated with body composition at age 8-10 y. METHODS: Study participants consisted of 255 girls and 281 boys who participated in a follow-up of the Prenatal Omega-3 Fatty Acid Supplementation and Child Growth and Development (POSGRAD) Study. Sex-specific latent height class (LHC) trajectories were derived from 11 measures of height from birth to 5 y of age and used to calculate 3 distinct growth classes for boys (low, intermediate, and high) and 2 distinct classes for girls (low and high). Body composition at age 8-10 y was estimated using bioelectrical impedance analysis. Multivariable linear regression analysis was used to determine the relationship between growth trajectory classes and fat mass (FM) and fat-free mass (FFM) in late childhood, controlling for confounding factors. RESULTS: In girls, there were no significant associations between LHC and FM or FFM. In boys, relative to the intermediate LHC, the low LHC had higher FM (ß = 0.69 kg; 95% CI: 0.26-1.11 kg) and the high LHC had lower FM (ß = -0.40 kg; 95% CI: -0.76 to -0.05 kg). Boys in the low LHC had significantly less FFM (ß = -0.69 kg; 95% CI: -1.11 to -0.26 kg), and boys in the high LHC had more FFM (ß = 0.40 kg; 95% CI: 0.05-0.76 kg) compared with the intermediate LHC. CONCLUSION: Gain in height among boys, but not girls, in early childhood was associated with lower adiposity in late childhood compared with children with a slower rate of growth. Clinical trial registration number: NCT00646360.

The double burden of malnutrition among youth: Trajectories and inequalities in four emerging economies.

As part of the nutritional transition, undernutrition is globally declining while changes brought by economic development have ushered in increases in overweight and its related economic costs and health consequences around the world. We examine trajectories in stunting and overweight from age one year to mid-adolescence and from mid-childhood to early adulthood among two cohorts from Ethiopia, India, Peru and Vietnam using data from the Young Lives study. We examine descriptive data and then model trajectories in stunting and overweight status over age. Group-based trajectory analysis with five ages of overweight and stunting for each country-cohort reveals (1) trajectories of catch-up growth for a subset of study children between the ages of 12 and 19 in the older cohort in Ethiopia (20.1% of the cohort), India (20.5%), Peru (16.9%), and Vietnam (14.0%); (2) trajectories of increasing probabilities of stunting as children age from 12 to 22 in the older cohort in India (22.2%) and Peru (30.7%); (3) trajectories of early (childhood) increases in overweight probabilities (younger cohort: India, 3.4%, Peru, 19.4%, and Vietnam, 8.1%), and of later (adolescence) increases in overweight probabilities (older cohort: Ethiopia, 0.5%, India, 6.3%, Peru, 40.9%, and Vietnam, 9.4%). Multinomial logit prediction of membership in trajectory categories reveals that higher wealth quartiles and maternal schooling are protective against high stunting probability trajectory group membership, but higher wealth and urban residence predict high overweight probability trajectory group membership. This evidence suggests a window of opportunity for interventions to reduce stunting and to avert overweight development in adolescence, in addition to the often-emphasized first 1000 days after conception. A life-course approach to policies and programs to target both undernutrition and overweight should be considered.