Undernutrition among adult Bengalees of Dearah, Hooghly District, West Bengal, India: Relationship with educational status and food habit

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A cross-sectional study of 1203 adult (> 18 years of age) Bengalees of Dearah, Hooghly District, West Bengal, India, was undertaken to evaluate the prevalence of undernutrition and the relationship of educational level and food habit with undernutrition. Height and weight were measured and body mass index (BMI) computed following the standard equation. A BMI < 18.5 kg/m2 was classified as undernutrition or chronic energy deficiency (CED) as per World Health Organization (WHO) recommendations. The public health problem of low BMI in this population was classified according to the WHO criteria. Educational status was coded as: no formal education, 1-8 years of schooling and > 8 years of schooling. Food habit was recorded as vegetarian or non-vegetarian. The mean ages of males and females were (39.6 +/- 15.0 years) and (39.6 +/- 15.0 years), respectively. There were significant (p < 0.001) sex differences in mean height and weight; both sexes had a similar BMI. The overall (sex combined) prevalence of undernutrition was 27.7%. The frequency of undernutrition was significantly (p < 0.001) higher among females (31.7%) compared to males (23.6%). According to the WHO classification of low BMI, the prevalence of CED was high (20-39%) indicating a serious situation. There existed a significant (p < 0.001) relationship between the level of formal education and nutritional status. Overall, the frequencies of CED (43.5%) were much higher than overweight (7.0%) among subjects with no formal education. The frequencies of CED and overweight among subjects with 1-8 years of formal education were 25.7% and 9.7%, respectively. Similarly, significantly (p < 0.001) higher rates of CED were found among subjects with no formal education in both sexes (males = 39.5%; females = 45.6%) compared to the presence of overweight (males = 1.8%; females = 9.8%). Sex-combined frequency of undernutrition was significantly (p < 0.001) higher among vegetarians (48.3%) compared with non-vegetarians (25.5%). The respective frequencies of overweight were 1.7% and 12.8%. This significant (p < 0.001) trend existed in both sexes with 46.9% male and 49.3% female vegetarians having CED. The corresponding figures for overweight among vegetarians were 0.0% and 2.9%, respectively. The rates of CED were significantly (p < 0.001) lower among non-vegetarians (males = 21.5%; females = 29.6%). Non-vegetarians had significantly higher rates of overweight in both males (8.7%) and females (16.9%). Multiple regression analysis revealed that both educational status as well as food habit had significant effect on BMI in both sexes. In general, the educational status had a stronger impact (males: t = 6.356, females: t = 5.017) than food habit (males: t = 3.373; females: t = 2.763) on BMI. This significant impact remained even after controlling for the effect of age. In conclusion, this study demonstrated that adult Bengalees of Dearah were under serious nutritional stress indicating a public health problem. In addition, a strong inverse relationship existed between educational level and CED. Moreover, vegetarianism was significantly associated with CED. Urgent public health measures are required, particularly among females, to reduce the high prevalence of CED in this population. Similar studies should be conducted in other parts of West Bengal before any general conclusions can be inferred about the relationship between educational status, food habit and CED in the state.