Urbanization and the Double Burden: Trends and Inequalities in Under- and Over-nutrition by Residence and Wealth Among 1.22 Million Indian Children, Women and Men over 10 Years (P10-078-19)

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ObjectivesWe examined trends and inequities in the double burden of malnutrition among girls, boys, women and men by residence and wealth between 2006 and 2016 in India where 590 million individuals are expected to live in cities by 2030. MethodsTwo rounds of National Family Health Survey data collected in 2006 and 2016 (n = 276,000 children 0–59 mo; 768,000 women 15–49y; and 178,000 men 15–54y) were used. Residence was categorized as rural (RUR), urban non-slum (U-NS) and urban slum (U-SL). Multivariate regression analyses were used to examine differences and changes over time in outcomes by residential group and gender. A socioeconomic status (SES) index was created for each residential area and inequalities were assessed using concentration and slope indices. ResultsChildren in different residential areas were born with similar height-for-age Z-scores, but growth faltering during the first two years of life was most rapid among children in RUR areas, followed by U-SL and U-NS areas. Boys and girls were equally likely to be stunted (48% in 2006 to 38% in 2016) or overweight (7–8% at both times). SES gaps were large for undernutrition, small for overnutrition, and did not change greatly in the past decade.Among adults, underweight prevalence decreased equally across residential areas (4–5%) to reach 20% on average in both men and women. Overweight prevalence increased more rapidly among those living in RUR areas (7–9%) compared to U-SL (4–6%) and U-NS (1–3%) areas, and also reached ∼20%. The SES gap for underweight was narrower in 2016 than in 2006, mainly due to improvements among the poor in all residential areas. Overweight prevalence increased in all SES quintiles in RUR and U-SL areas and increased among the poor in U-NS areas. ConclusionsThe double burden of malnutrition is now a reality among adults in India. Although undernutrition has been reduced in both rural and urban areas over the past decade, the rate of increase in overweight was much larger in rural compared to urban areas; and more so in slums compared to non-slum areas. A further examination of changing living conditions, food environments, and physical activity levels is needed to identify and address the causes for these rapid changes in nutrition outcomes. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by IFPRI.