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

Cut Novianti Rachmi,Kingsley Emwinyore Agho,Mu Li,Louise Alison Baur

doi:10.1017/s1368980016000926

Cut Novianti Rachmi, Kingsley Emwinyore Agho + Show 2 more

Open Access

https://doi.org/10.1017/s1368980016000926

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Abstract

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. 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 +1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors. Thirteen out of twenty-seven provinces in Indonesia. Children (n 4101) from four waves of the Indonesian Family Life Survey (1993-2007). 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). 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.

Highlights

From years 1993 to 2000, there were more people living in rural areas, but by year 2007 more families were living in urban areas
Children whose fathers had a healthy BMI, whose mothers and fathers were of short stature, whose mothers had a check-up during pregnancy, who were breast-fed for ≥6 months or who lived in rural areas had a higher prevalence of concurrent stunting and overweight
We show that concurrent stunting and overweight occurs in the 2·0–4·9 year age group in Indonesian children, and is more likely in the 2·0–2·9 year age group, in children who were breast-fed for longer than 6 months, who lived in rural areas or whose mothers had short stature

Summary

Methods

Data collection Data were from the first four waves of the Indonesian Family Life Survey (IFLS) in the years 1993, 1997, 2000 and 2007(18). Inclusion criteria Inclusion criteria were children aged 2·0–4·9 years who had complete records for child information (height, weight, age and sex) and matching parental-, householdand community-level data. We double-checked the backward elimination by including all community, child, parental and household variables, and only the variables with P < 0·05 were retained in the final model (i.e. child’s age group, age of weaning, maternal height and housing area). The unadjusted odd ratios for factors associated with stunting and overweight were examined using GLLAMM (generalised linear latent and mixed models)(29) This was followed by multivariable analyses after controlling for community-, child-, parental- and household-level factors. In the multivariable analysis models, a manual stepwise backward elimination process was used to identify factors that were significantly associated with the study outcome using a 5 % significance level.

Results

Discussion

Conclusion