Abstract
BackgroundLow- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa.MethodsA cross-sectional growth survey was conducted involving 3511 children and adolescents 1-20 years, selected through stratified random sampling from a previously enumerated population living in Agincourt sub-district, Mpumalanga Province, South Africa. Anthropometric measurements including height, weight and waist circumference were taken using standard procedures. Tanner pubertal assessment was conducted among adolescents 9-20 years. Growth z-scores were generated using 2006 WHO standards for children up to five years and 1977 NCHS/WHO reference for older children. Overweight and obesity for those <18 years were determined using International Obesity Task Force BMI cut-offs, while adult cut-offs of BMI ≥ 25 and ≥ 30 kg/m2 for overweight and obesity respectively were used for those ≥ 18 years. Waist circumference cut-offs of ≥ 94 cm for males and ≥ 80 cm for females and waist-to-height ratio of 0.5 for both sexes were used to determine metabolic disease risk in adolescents.ResultsAbout one in five children aged 1-4 years was stunted; one in three of those aged one year. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was substantial among adolescent girls, increasing with age and reaching approximately 20-25% in late adolescence. Central obesity was prevalent among adolescent girls, increasing with sexual maturation and reaching a peak of 35% at Tanner Stage 5, indicating increased risk for metabolic disease.ConclusionsThe study highlights that in transitional societies, early stunting and adolescent obesity may co-exist in the same socio-geographic population. It is likely that this profile relates to changes in nutrition and diet, but variation in factors such as infectious disease burden and physical activity patterns, as well as social influences, need to be investigated. As obesity and adult short stature are risk factors for metabolic syndrome and Type 2 diabetes, this combination of early stunting and adolescent obesity may be an explosive combination.
Highlights
Low- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases
The aim of this study is to investigate the prevalence of stunting and overweight/obesity by age and sex and to estimate the risk for metabolic disease in a group of children and adolesents aged 1-20 years randomly selected from a health and socio-demographic surveillance site in Agincourt, rural South Africa
Non-participation was due to failure to present for measurements after giving consent (9%), refusal to consent (1%), absence due to being in boarding school (8%), out-migration from study area (3%), and being away for other reasons (3%)
Summary
Low- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. Understanding the prevalence and patterns of undernutrition, stunting, the emergence of overweight/obesity in children and adolescents, and the concomitant risk for metabolic disease, is of criticial importance for public health policy. A nutrition transition, often accompanied by changes in physical activity levels, is being experienced in LMICs. Nutrition transition refers to changes in diet composition from traditional diets that are primarily derived from plant-based food sources low in fat and high in fibre, to more “Western” diets that are high energy dense and low in fibre. Nutrition transition refers to changes in diet composition from traditional diets that are primarily derived from plant-based food sources low in fat and high in fibre, to more “Western” diets that are high energy dense and low in fibre This transition is driven by rapid economic transition, urbanisation, globalisation, technological and social changes [4,5]. Increased intake of animal source foods and edible oils have been documented in less urbanised urban areas and more urbanised rural areas [6]
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