Child-level double burden of malnutrition in the MENA and LAC regions: Prevalence and social determinants.

Khalil El Asmar,Hala Ghattas,Moubadda Assi,Zeina Jamaluddine,Yubraj Acharya,Andrew D. Jones

doi:10.1111/mcn.12923

Abstract

Although the prevalence of obesity has rapidly increased in the low‐ and middle‐income countries of the Middle East and North Africa (MENA) and Latin America and the Caribbean (LAC) regions, child undernutrition remains a public‐health challenge. We examined region‐specific sociodemographic determinants of this double burden of malnutrition, specifically, the co‐occurrence of child stunting and overweight, using Demographic and Health Survey and Multiple Indicator Cluster Survey data (2003–2016) from 11 countries in the MENA (n = 118,585) and 13 countries in the LAC (n = 77,824) regions. We used multiple logistic regressions to model region‐specific associations of maternal education and household wealth with child nutritional outcomes (6–59 months). The prevalence of stunting, overweight, and their co‐occurrence was 24%, 10%, and 4.3% in children in the MENA region, respectively, and 19%, 5%, and 0.5% in children in the LAC region, respectively. In both regions, higher maternal education and household wealth were significantly associated with lower odds of stunting and higher odds of overweight. As compared with the poorest wealth quintiles, decreased odds of co‐occurring stunting and overweight were observed among children from the second, third, and fourth wealth quintiles in the LAC region. In the MENA region, this association was only statistically significant for the second wealth quintile. In both regions, double burden was not statistically significantly associated with maternal education. The social patterning of co‐occurring stunting and overweight in children varied across the two regions, indicating potential differences in the underlying aetiology of the double burden across regions and stages of the nutrition transition.

Highlights

A global nutrition transition is under way, characterized by a rapid shift in diet composition and behavioural trends towards increased intakes of foods high in energy in the form of saturated fats and sugars and decreased intakes of nutrient‐ and fibre‐rich foods
Whereas household‐level double burden, has been defined as the coexistence of undernutrition in children and overweight in adults within the same household (Black et al, 2013; Gubert, Spaniol, Segall‐Corrêa, & Pérez‐Escamilla, 2017; Jones, Acharya, & Galway, 2016; Wojcicki, 2014). Both population‐level and household level double burdens have been relatively well documented in the Latin America and the Caribbean (LAC) region, with findings highlighting that stunting, anaemia and overweight are prevalent in women and children in these countries (Atalah, Amigo, & Bustos, 2014; Conde & Monteiro, 2014; Freire, Silva‐ Jaramillo, Ramírez‐Luzuriaga, Belmont, & Waters, 2014; Gubert et al, 2017; Kroker‐Lobos, Pedroza‐Tobías, Pedraza, & Rivera, 2014; Ramirez‐Zea, Kroker‐Lobos, Close‐Fernandez, & Kanter, 2014; Rivera et al, 2014; Sarmiento et al, 2014; Severi & Moratorio, 2014)
The prevalence of stunting in the Middle East and North Africa (MENA) region varied from 7.4% in Palestine to 49.1% in Yemen and in the LAC region from 5.7% in Paraguay to 48.2% in Guatemala

Summary

Introduction

A global nutrition transition is under way, characterized by a rapid shift in diet composition and behavioural trends towards increased intakes of foods high in energy in the form of saturated fats and sugars and decreased intakes of nutrient‐ and fibre‐rich foods Whereas household‐level double burden, has been defined as the coexistence of undernutrition in children and overweight in adults within the same household (Black et al, 2013; Gubert, Spaniol, Segall‐Corrêa, & Pérez‐Escamilla, 2017; Jones, Acharya, & Galway, 2016; Wojcicki, 2014) Both population‐level and household level double burdens have been relatively well documented in the LAC region, with findings highlighting that stunting, anaemia and overweight are prevalent in women and children in these countries (Atalah, Amigo, & Bustos, 2014; Conde & Monteiro, 2014; Freire, Silva‐ Jaramillo, Ramírez‐Luzuriaga, Belmont, & Waters, 2014; Gubert et al, 2017; Kroker‐Lobos, Pedroza‐Tobías, Pedraza, & Rivera, 2014; Ramirez‐Zea, Kroker‐Lobos, Close‐Fernandez, & Kanter, 2014; Rivera et al, 2014; Sarmiento et al, 2014; Severi & Moratorio, 2014). One analysis found height‐for‐age z score (HAZ) to be correlated with body mass index‐for‐age z score among children under the age of 5 (El Taguri et al, 2009), few studies have described double burdens in the MENA region

Results

Discussion

Conclusion