Global Burden of Double Malnutrition: Has Anyone Seen It?

2000

The possibility that underweight and overweight coexist within households and understanding such an occurrence have not been studied sufficiently. In fact, underweight and overweight are thought of as resulting from very different environmental, behavioral and individual risk factors. This study identified households in which overweight and underweight coexist and explored household-level associations such as urban residence and income. Using three large national surveys from Brazil, China and Russia, the prevalence of such households ranged from 8% in China and Russia to 11% in Brazil. Even more important from the public health perspective is the finding that these under/over households accounted for a high proportion of all households with an underweight member in China (23%), Brazil (45%), and Russia (58%). The prevalence of the underweight/overweight household was highest in the urban environment in all three countries. There was no clear pattern in the prevalence of the underweight/overweight household type by income. Multivariable logistic regression was used to test the significance of the association of household type with urban residence and income while controlling for household size and household demographics by gender. Further analysis was done to consider the age relationships within the underweight/overweight pair. The underweight child coexisting with an overweight nonelderly adult was the predominant pair combination in all three countries. These findings illustrate the need for public health programs that are able to address underweight and overweight simultaneously.

The possibility that underweight and overweight coexist within households and understanding such an occurrence have not been studied sufficiently. In fact, underweight and overweight are thought of as resulting from very different environmental, behavioral and individual risk factors. This study identified households in which overweight and underweight coexist and explored household-level associations such as urban residence and income. Using three large national surveys from Brazil, China and Russia, the prevalence of such households ranged from 8% in China and Russia to 11% in Brazil. Even more important from the public health perspective is the finding that these under/over households accounted for a high proportion of all households with an underweight member in China (23%), Brazil (45%), and Russia (58%). The prevalence of the underweight/overweight household was highest in the urban environment in all three countries. There was no clear pattern in the prevalence of the underweight/overweight household type by income. Multivariable logistic regression was used to test the significance of the association of household type with urban residence and income while controlling for household size and household demographics by gender. Further analysis was done to consider the age relationships within the underweight/overweight pair. The underweight child coexisting with an overweight nonelderly adult was the predominant pair combination in all three countries. These findings illustrate the need for public health programs that are able to address underweight and overweight simultaneously.

2016

Chapter 1 Introduction Chapter 2 Trends in overweight by educational level in 33 low-and middle-income countries: The role of parity, age at first birth and breastfeeding Chapter 3 Trends in overweight among women differ by occupational class: Results from 33 low and middle income countries in the period 1992-2009 Chapter 4 Socio-demographic and birth characteristics influence the duration of breastfeeding in Colombia: results from the 2010 demographic and health survey Chapter 5 The impact of a conditional cash transfer programme on determinants of child health: evidence from Colombia Chapter 6 Conditional cash transfers and the double burden of malnutrition among children in Colombia: a quasiexperimental study Chapter 7 Discussion Summary Dankwoord/ acknowledgment Curriculum vitae List of publications PhD Portfolio On the other hand, many governments from low-and middle-income countries have turned to cash transfer programmes (conditional and unconditional) to improve child health and wellbeing and to reduce poverty 52-55. Beneficiary families receive predictable amounts of money in the form of pensions, child benefits or regular household grants. The cash transfer programmes arose in response to the deep economic recessions seen in the Latin American region in the 1990s 56, 57. In conditional cash transfers (CCT) programmes, families receive the benefits if they fulfil some pre-specified conditions 54, 56-59. The first nationwide CCT programme was called "Progresa" (now Prospera) and began in Mexico in 1997. It served as an example for other countries 60 (Figure 1.2). Currently, every country in Latin America has a CCT, while in some African and Asian nations both conditional and unconditional cash transfer programmes have also been implemented 55, 61, 62. Studies worldwide have demonstrated large impacts of CCT programmes on child education, health and nutritional outcomes 53, 54, 58, 59, 63-65. For example, CCT programmes have been linked with the reduction in childhood morbidity and mortality 54, 66. Likewise, evidence also suggests that CCT programmes improve the quality of diet by increasing household fruit and vegetable consumption 67-69. Yet, some evidence suggests that cash transfers may also increase intake of unhealthy foods associated with chronic diseases 70, 71 , contributing to rising trends in BMI. For example, a study among adults in Colombia concluded that CCT's had increased the risk of obesity among mothers 72 likewise, evidence from Mexico's Prospera suggests that CCT's may increase the consumption of fruits and vegetables, but also lead to excess energy consumption 34. Concerns have thus been raised that providing cash to poor families may have unintended negative consequences on nutrition, increasing the risk of overweight and obesity. Research questions The following specific research questions were formulated: 1. How have socioeconomic differences in overweight and obesity changed over the last decades among women of childbearing age in low-and middle-income countries? 2. What is the contribution of reproductive variables (e.g., parity, age at first birth, breastfeeding) to socioeconomic inequalities in overweight and obesity in lowand middle-income countries? 3. Do recently adopted poverty reduction policies, namely conditional cash transfer programmes, influence determinants of child health and children's nutritional status? table 1.1 Overview of data sources Study Population Data collection period Selected countries Follow-up Demography Health Surveys (DHS) Women in childbearing age from 33 low-and middle-income countries Early 1990s until 2009

American Journal of Clinical Nutrition

Background: It is generally believed that overweight is less prevalent than undernutrition in the developing world, particularly in rural areas, and that it is concentrated in higher socioeconomic status (SES) groups. Objective: The purpose of this study was to examine patterns of adult female overweight and underweight in the developing world by using categories of urban or rural status and SES strata. Design: Body mass index (BMI; in kg/m 2 ) data collected in 36 countries from 1992 to 2000 by nationally representative crosssectional surveys of women aged 20 -49 y (n ҃ 148 579) were classified as indicating underweight (BMI 18.5) and overweight (BMI ͧ 25). Associations between the nutritional status of urban and rural women and each country's per capita gross national income (GNI) and level of urbanization were explored in the overall sample and among different SES groups. Results: Overweight exceeded underweight in well over half of the countries: the median ratio of overweight to underweight was 5.8 in urban and 2.1 in rural areas. Countries with high GNIs and high levels of urbanization had not only high absolute prevalences of overweight but also small urban-rural differences in overweight and very high ratios of overweight to underweight. In the moredeveloped countries, overweight among low-SES women was high in both rural (38%) and urban (51%) settings. Even many poor countries, countries in which underweight persists as a significant problem, had fairly high prevalences of rural overweight. Conclusions: In most developing economies, prevalences of overweight in young women residing in both urban and rural areas are higher than those in underweight women, especially in countries at higher levels of socioeconomic development. Research is needed to assess male and child overweight to understand the dynamics facing these groups as well.

Studies in health technology and informatics, 2019

Although some studies have shown that obesity and other non-communicable diseases are more common in more disadvantaged areas, no publications to date have examined the interaction of obesity with urban and rural disadvantage in lower-income countries. This study analyzed the rates of obesity and underweight in disadvantaged urban women and disadvantaged rural women in 31 lower-income countries, and calculated the age-adjusted odds ratios of urban vs. rural obesity and underweight. The odds of obesity were significantly (p<0.05) higher for urban populations in 16 of the 31 countries and in all aggregated regions; the evidence that underweight is also associated more with urban populations was mixed. Because obesity is a rapidly-growing threat to the public health and financial strength of lower-income countries, and urban disadvantage is associated with more obesity than rural disadvantage, policymakers should work to understand, predict, and prevent obesity in urban populations ...

The Journal of nutrition, 2000

The possibility that underweight and overweight coexist within households and understanding such an occurrence have not been studied sufficiently. In fact, underweight and overweight are thought of as resulting from very different environmental, behavioral and individual risk factors. This study identified households in which overweight and underweight coexist and explored household-level associations such as urban residence and income. Using three large national surveys from Brazil, China and Russia, the prevalence of such households ranged from 8% in China and Russia to 11% in Brazil. Even more important from the public health perspective is the finding that these under/over households accounted for a high proportion of all households with an underweight member in China (23%), Brazil (45%), and Russia (58%). The prevalence of the underweight/overweight household was highest in the urban environment in all three countries. There was no clear pattern in the prevalence of the underwe...

International journal of obesity (2005), 2012

Overweight prevalence has increased globally; however, current time trends of overweight prevalence by social class in lower income countries have not been fully explored. We used repeated cross-sectional, nationally representative data from the Demographic and Health Surveys on women aged 18-49 years with young children (n=421,689) in 39 lower-income countries. We present overweight (body mass index ≥ 25 kg m⁻²) prevalence at each survey wave, prevalence difference and prevalence growth rate for each country over time, separately by wealth quintile and educational attainment. We present the correlation between nation wealth and differential overweight prevalence growth by wealth and education. In the majority of countries, the highest wealth and education groups still have the highest prevalence of overweight and obesity. However, in a substantial number of countries (14% when wealth is used as the indicator of socioeconomic status and 28% for education) the estimated increases in ...

International Journal of Obesity

Objective To analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs). Methods Using the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI

American Journal of Epidemiology, 2011

TheScientificWorldJournal, 2014

Obesity is a significant public health concern affecting more than half a billion people worldwide. Obesity rise is not only limited to developed countries, but to developing nations as well. This paper aims to compare the mean body mass index trends in the World Health Organisation- (WHO-) categorised regions since 1980 to 2008 and secondly to appraise how socioeconomic disparities can lead to differences in obesity and physical activity level across developing nations. Taking into account past and current BMI trends, it is anticipated that obesity will continue to take a significant ascent, as observed by the sharp increase from 1999 to 2008. Gender differences in BMI will continue to be as apparent, that is, women showing a higher BMI trend than men. In the coming years, the maximum mean BMI in more developed countries might be exceeded by those in less developed ones. Rather than focusing on obesity at the individual level, the immediate environment of the obese individual to br...