The association between stunting and overweight in Latin American and Caribbean preschool children

Excess weight and thinness over two decades (1996-2015) and spatial distribution in children from Jujuy, Argentina

Background

The increase of excess weight around the world is progressive and sustained in children. This is the most prevalent form of malnutrition in this population and they represent the major public health problem in developed and developing countries. The aim of this study was to analyze the magnitude of change in thinness and excess weight prevalence in 4–7 years-old schoolchildren from Jujuy (Argentina), between 1996 and 2015 and to examine the association according to sex and school location.

Methods

Cross-sectional study. Data was obtained from databases of School Health programs and it is representative of the city school population. For the analysis, 31,014 schoolchildren between 4 and 7 years old were evaluated, 20,224 from the first period (1996–2001) and 10,790 from the second (2010–2015). The city was partitioned in three different areas determined by the rivers that cross it. Nutritional status was determined by BMI for age with the criteria suggested by the International Obesity Task Force. The percentage of malnutrition change between periods was calculated and a binomial regression model was adjusted.

Results

Between periods, a significant (p-value< 0.0001) increase in the prevalence of overweight from 15.1% (CI 14.6–15.6%) to 18.1% (CI 17.4–18.8%) and obesity from 5% (CI 4.7–5.3) to 10.7% (CI 10.1–11.3%), and a decrease of thinness prevalence from 6.3% (CI 6.0–6.7%) to 4.7% (CI 4.3–5.1%) were observed. The percentage of change in the prevalence of obesity was very high in all areas and in both sexes (103.5% girls; 125.6% in boys), being higher in the south for girls (122.4%) and in the north for boys (158.8%). Besides, being a boy was inversely associated with the presence of excess weight and, as the age increases, the presence of obesity does it too. By analyzing the effect of the school location, the south and north zones had an inverse association with the presence of obesity. The period has a direct association with the presence of excess weight.

Conclusion

The study contributes with valuable information on the magnitude of the increase in obesity in schoolchildren and suggests a possible correlation with sex and spatial distribution in the capital city of Jujuy.

Socio-demographic patterning of the individual-level double burden of malnutrition in a rural population in South India: a cross-sectional study

BACKGROUND

The double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India.

METHODS

We undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes.

RESULTS

Prevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70).

CONCLUSION

This study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.

Extended composite index of anthropometric failure in Argentinean preschool and school children

OBJECTIVE

The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces.

DESIGN

ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess.

SETTING

Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina).

PARTICIPANTS

10 879 children of both sexes aged between 3 and 13·99.

RESULTS

ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight.

CONCLUSIONS

The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.

Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS)

This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, socioeconomic, and nutritional status. A multicenter household population-based cross-sectional survey was conducted with 9218 individuals (age range 15–65 years). Sociodemographic and anthropometric data were collected. Dietary intake was measured using two non-consecutive 24-h recalls and diet quality and diversity were assessed. In the whole sample, scores were observed from 63.0% ± 9.3% to total DQS, 65.0% ± 13.6% to healthy dietary items and 60.2% ± 13.6% to unhealthy items, and 5.6 ± 1.1 out of 9 points to DDS. Women presented lower DDS compared to men (5.5 ± 1.1 vs. 5.6 ± 1.1, p < 0.001). Healthy DQS was higher as the socio-economic level increased, and unhealthy DQS was the opposite (p < 0.05). Total DQS was significantly lower only at the low socio-economic level (p < 0.05). Chile and Venezuela showed the lowest healthy (62.2 ± 15.2 and 61.9 ± 11.7, p < 0.05) and total DQS (61.4 ± 10.3, 61.2 ± 8.7, p < 0.05). No effects were observed when considering the age and anthropometric measurements. Promoting consumption of a diverse and high-quality diet is an essential challenge to accomplish.

Small-area estimates of stunting. Mexico 2010: Based on a hierarchical Bayesian estimator

The Sustainable Development Goal (SDG) 2.2 proposes ending stunting and wasting in children under five years of age by 2025. In Mexico, progress in the reduction of stunting has slowed in the 21st century. One of the challenges in tackling stunting is that it has become more concentrated in certain areas, but there are no data detailing its precise location. This paper produces the first small-area estimates of stunting for the Mexican municipalities by applying a hierarchical Bayesian estimator using data from a nationally representative survey (ENSANUT 2012, in Spanish) and the sample of the National Housing and Population Census 2010. The findings suggest the existence of large within-state differences in the prevalence of stunting and that this phenomenon is highly spatially clustered. The paper also illustrates the value of the small-area stunting estimates by performing a spatial analysis on the relationship between stunting and food insecurity at the municipal level.

The Association of Handgrip Strength and Mortality: What Does It Tell Us and What Can We Do With It?

The relationship between grip strength and mortality is often used to underscore the importance of resistance exercise in physical activity guidelines. However, grip strength does not appear to appreciably change following traditional resistance training. Thus, grip strength could be considered reflective of strength independent of resistance exercise. If true, grip strength is not necessarily informing us of the importance of resistance exercise as an adult, but potentially highlighting inherent differences between individuals who are stronger at "baseline" compared to their weaker counterpart. The purpose of this article is to discuss: (1) potential factors that may influence grip strength and (2) hypothesize strategies that may be able to influence grip strength and ultimately attain a higher baseline level of strength. Although there appears to be a limited ability to augment grip strength as an adult, there may be critical periods during growth/development during which individuals can establish a higher baseline. Establishing a high baseline of strength earlier in life may have long-term implications related to mortality and disease.

Perceptions of Body Size in Mothers and Their Young Children in the Galapagos Islands

Introduction Little specific information has been published about the health of people who live in the Galapagos Islands. As part of determining the status of the nutrition transition that may be occurring in the islands mothers of young children in the Galapagos perceptions of their child's body size and therefore health status was evaluated along with actual body size. Methods This paper presents data collected as part of a pilot study that used a mixed methods approach to identify and describe health and nutrition issues for mother-child pairs on Isla Isabela in Galapagos, Ecuador. It includes participant anthropometric assessment and self-perception of body size using silhouettes for themselves and one of their children along with open-ended questions to elicit further understanding of body size perceptions. Twenty mothers of children greater than 6 months of age but less than 6 years of age were interviewed. Results The women preferred a smaller body size for themselves but a larger body size for their children. Findings of different body size combinations between mothers and children in the same household demonstrated that the island is undergoing or may be post the nutrition transition. Discussion This dual burden of body weights (especially overweight or obese mothers) in the same household with underweight, normal and overweight or obese children and the potential nutrition related chronic disease burden in the future will require more educational resources and innovative health services than are currently available for the people of the Galapagos.

Prevalence and differentials of overweight and obesity in preschool children in Sub-Saharan Africa

OBJECTIVE

To determine the prevalence and differentials of overweight/obesity (body mass index (BMI)-for-age z-score >2) in preschool children in Sub-Saharan Africa (SSA).

DESIGN

Cross-sectional study.

SETTING

The study was conducted on the basis of the data of 26 Demographic and Health Surveys carried out in SSA since 2010.

PARTICIPANTS

The records of 155,726 children aged 0-59 months were included in the analysis.

PRIMARY OUTCOME

Overweight/obesity.

RESULTS

The prevalence of overweight/obesity was 6.8% (95% CI 6.7% to 6.9%). Among the countries represented, higher figures were reported in Sierra Leone (16.9%), Comoros (15.9%) and Malawi (14.5%), whereas lower prevalence was found in Ethiopia (3.0%), Togo (2.6) and Senegal (2.0%). In 11 of the countries, overweight/obesity was more prevalent than wasting. It is estimated that in the whole subcontinent, 10.7 million children were affected by the problem. The prevalence of overweight/obesity was slightly higher in boys than in girls. Overweight/obesity was three times more frequent in stunted children than in normal children. The risk also significantly increased with increasing maternal BMI and birth weight and decreased with increasing maternal age, maternal education, child's age and number of siblings. On the other hand, no significant association was observed with national gross domestic product per capita, place of residence (urban-rural) and household wealth index.

CONCLUSION

Childhood overweight/obesity has become a sizeable problem in the subcontinent.

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

OBJECTIVE

To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.

DESIGN

Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991-2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban-rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).

SETTING

Peru.

SUBJECTS

Children aged 0-59 months surveyed in 1991-92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007-08 (n 8232) and 2011 (n 8186).

RESULTS

Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991-2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).

CONCLUSIONS

The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Glucose metabolism in adult survivors of severe acute malnutrition

CONTEXT AND OBJECTIVES

The clinical syndromes of severe acute malnutrition may have early life origins because children with marasmus have lower birth weight than those with kwashiorkor. We hypothesized that resultant metabolic effects may persist into adulthood. We investigated whether marasmus survivors (MS) are more insulin resistant and glucose intolerant than kwashiorkor survivors (KS).

RESEARCH DESIGN AND SETTING

This was a case-control study in Jamaican adults.

SUBJECTS

We performed oral glucose tolerance tests on 191 adults (aged 17-50 y; 52% male; body mass index 24.2 ± 5.5 kg/m(2)). There were 43 MS; 38 KS; 70 age-, sex-, and body mass index-matched community controls; and 40 age- and birth weight-matched controls.

MEASUREMENTS

We measured insulin sensitivity with the whole-body insulin sensitivity index, and β-cell function with the insulinogenic index and the oral disposition index.

RESULTS

Fasting glucose was comparable across groups, but glucose intolerance was significantly more common in MS (19%) than in KS (3%), community controls (11%), and birth weight-matched controls (10%). The whole-body insulin sensitivity index was lower in MS than KS (P = .06) but similar between MS and controls. The insulinogenic index and oral disposition index were lower in MS compared with all three groups (P < .01).

CONCLUSIONS

Marasmus survivors tend to be less insulin sensitive, but have significantly lower insulin secretion and are more glucose intolerant compared with kwashiorkor survivors and controls. This suggests that poor nutrition in early life causes β-cell dysfunction, which may predispose to the development of diabetes.

Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review

BACKGROUND

In low- and middle-income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively.

OBJECTIVE

To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years of age.

METHODS

We reviewed literature since January 1, 1990, published in English, using the PubMed search terms nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. The findings were classified and described according to dual burden level (community, household, or individual).

RESULTS

Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the extent of the dual burden, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia due to shared underlying determinants or physiologic links.

CONCLUSIONS

The dual burden of malnutrition poses a threat to children's health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing over-nutrition through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity.

Stunting, adiposity, and the individual-level "dual burden" among urban lowland and rural highland Peruvian children

Background

The causes of the “dual burden” of stunting and obesity remain unclear, and its existence at the individual level varies between populations. We investigate whether the individual dual burden differentially affects low socioeconomic status Peruvian children from contrasting environments (urban lowlands and rural highlands), and whether tibia length can discount the possible autocorrelation between adiposity proxies and height due to height measurement error.

Methods

Stature, tibia length, weight, and waist circumference were measured in children aged 3–8.5 years (n = 201). Height and body mass index (BMI) z scores were calculated using international reference data. Age-sex-specific centile curves were also calculated for height, BMI, and tibia length. Adiposity proxies (BMI z score, waist circumference-height ratio (WCHtR)) were regressed on height and also on tibia length z scores.

Results

Regression model interaction terms between site (highland vs. lowland) and height indicate that relationships between adiposity and linear growth measures differed significantly between samples (P < 0.001). Height was positively associated with BMI among urban lowland children, and more weakly with WCHtR. Among rural highland children, height was negatively associated with WCHtR but unrelated to BMI. Similar results using tibia length rather than stature indicate that stature measurement error was not a major concern.

Conclusions

Lowland and rural highland children differ in their patterns of stunting, BMI, and WCHtR. These contrasts likely reflect environmental differences and overall environmental stress exposure. Tibia length or knee height can be used to assess the influence of measurement error in height on the relationship between stature and BMI or WCHtR.

School-based programs aimed at the prevention and treatment of obesity: evidence-based interventions for youth in Latin America

BACKGROUND

Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be gathered from such interventions.

METHODS

We performed a systematic review of papers published between 1965 and December 2010. Interventions were considered eligible if they had a school-based component, were done in Latin America, evaluated an obesity related outcome (body mass index [BMI], weight, %body fat, waist circumference, BMI z-score), and compared youth exposed vs not exposed.

RESULTS

Ten studies were identified as having a school-based component. Most interventions had a sample of normal and overweight children. The most successful interventions focused on prevention rather than treatment, had longer follow-ups, a multidisciplinary team, and fewer limitations in execution. Three prevention and 2 treatment interventions found sufficient improvements in obesity-related outcomes.

CONCLUSIONS

We found sufficient evidence to recommend school-based interventions to prevent obesity among youth in Latin America. Evidence-based interventions in the school setting should be promoted as an important component for integrated programs, policies, and monitoring frameworks designed to reverse the childhood obesity in the region.

Stunting, overweight and child development impairment go hand in hand as key problems of early infancy: Uruguayan case

BACKGROUND

Stunting, overweight and child development impairment are key problems affecting early infancy and have short and long-term consequences on academic performance, social competence and adult health. The aim of this paper is to identify linkages and factors that may simultaneously contribute to these problems.

STUDY DESIGN

A cross sectional study.

SUBJECTS

2,046 children under 5 years in Canelones, Uruguay.

OUTCOME MEASURES

For simultaneous assessment of the relationship between stunting, overweight and child development impairment we used multiple logistic regression analyses. We included children, household, maternal and paternal variables as confounder factors. To give the strength of association we performed odds ratios (OR). A significant OR was defined as upper and lower 95% confidence limits not containing the value of one. Significance level was <0.05.

RESULTS

Low birthweight was a risk for stunting OR: 3.2 (1.8-5.6) and for reduced head circumference growth OR: 3.9 (1.9-8.0); infants with reduced head circumference had an increased chance of delayed psychomotor development OR: 2.4 (1.17-5.07) and of being stunted OR: 3.2 (1.7-6.3); stunted infants had almost three times risk of being overweight OR: 2.7 (1.8-4.1). Maternal stature <160 cm, low BMI, low education and poverty were also predictor for stunting. Obese mother, maternal stature >160 cm and maternal smoking increased chance of overweight. Some maternal behaviors, such as mother not used to singing songs and maternal smoking increased the likelihood of delaying psychomotor development.

CONCLUSIONS

The close linkages between stunting, being overweight and child development impairment suggest they should be targeted together: they coexist in the same infants and predict each other.

Chronic malnutrition among overweight Hispanic children: understanding health disparities

Obesity may be masking other health problems such as height deficit, or stunting. Stunting may reflect the cumulative effect of chronic malnutrition especially in underserved immigrant communities. Exploratory analysis of a sample of children 2-19 years old from the 2007-2008 NHANES was used to assess the relationship between chronic malnutrition and overweight/obesity in Hispanic children. Overall, overweight/obesity prevalence was nearly 1 in 3 children and stunting prevalence was 3.1%. The prevalence of stunting varied significantly across race/ethnicity, with prevalence among Hispanics of 6.6%. Prevalence of stunting varied significantly by socio-economic characteristics within the Hispanic population. Our exploratory study showed differences in the prevalence of stunting across racial/ethnic groups and highlighted that overweight/obese Hispanic children have a higher prevalence of stunting compared with Non-Hispanic White overweight/obese children. More studies are needed to better understand the phenomenon and the implications for health inequities.

Global nutrition transition and the pandemic of obesity in developing countries

Decades ago, discussion of an impending global pandemic of obesity was thought of as heresy. But in the 1970s, diets began to shift towards increased reliance upon processed foods, increased away-from-home food intake, and increased use of edible oils and sugar-sweetened beverages. Reductions in physical activity and increases in sedentary behavior began to be seen as well. The negative effects of these changes began to be recognized in the early 1990s, primarily in low- and middle-income populations, but they did not become clearly acknowledged until diabetes, hypertension, and obesity began to dominate the globe. Now, rapid increases in the rates of obesity and overweight are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels. Concurrent rapid shifts in diet and activity are well documented as well. An array of large-scale programmatic and policy measures are being explored in a few countries; however, few countries are engaged in serious efforts to prevent the serious dietary challenges being faced.

How can the Developmental Origins of Health and Disease (DOHaD) hypothesis contribute to improving health in developing countries?

The relevance of nutrition during pregnancy and early infancy in defining short-term health and survival has been well established. However, the Developmental Origins of Health and Disease (DOHaD) paradigm provides a framework to assess the effect of early nutrition and growth on long-term health. This body of literature shows that early nutrition has significant consequences on later health and well-being. In this article, we briefly present the main consequences of malnutrition that affect human growth and development and consider how the DOHaD paradigm, with its evolutionary implications, might contribute to better addressing the challenge of improving nutrition. We examine how this paradigm is particularly appropriate in understanding the health and nutrition transition in countries that face the double burden of nutrition-related diseases (acute malnutrition coexisting with obesity and other chronic diseases). We focus on stunting (low height-for-age) to examine the short- as well as long-term consequences of early malnutrition with a life-course, transgenerational, and multidisciplinary perspective. We present current global and regional prevalence of stunting and discuss the need to reposition maternal and infant nutrition not only in health and nutrition intervention programs but also in consideration of the emerging research questions that should be resolved to better orient program and policy decisions.

Negative Impact on Calorie Intake Associated with the 2006–08 Food Price Crisis in Latin America

Background

From 2006 to 2008, there were sharp increases in the prices of major food commodities globally, including maize, rice, and wheat. Few studies have contributed empirical evidence of the nutritional impacts of this food price crisis.

Objective

To assess changes in energy intake in response to food price shocks and in relation to calorie adequacy levels in seven Latin American countries.

Methods

Data were drawn from nationally representative household budget surveys. The quadratic almost ideal demand system (QUAIDS) model characterized change patterns in consumption for six food groups and one nonfood group under two scenarios: actual change in food prices by country, and standardized 10% increase in prices across all countries. Energy intakes before and after the crisis were determined once calories were assigned to food items from the ProPAN and US Department of Agriculture food composition databases.

Results

Energy intakes were reduced by 8.0% (range, 0.95% to 15.1%) from precrisis levels across all countries. Ecuador and Panama were the worst affected, followed by Haiti and Nicaragua. There was a consistent, direct relationship between wealth quintile and change in energy intake. Rural areas were affected to the same extent as or a greater extent than urban areas. High positive increases in calorie consumption were found in the richest wealth quintile, exceeding 10% of previous levels in five countries.

Conclusions

Policies and programs targeting the poorest households in both rural and urban areas may be needed to offset the energy deficits associated with food price increases. More research is needed on the effect of food prices and micronutrient nutrition.

Micronutrient and anthropometric status indicators are associated with physical fitness in Colombian schoolchildren

Poor physical fitness is associated with increased health-related risks in children. The association of nutritional status indicators and physical fitness in children residing in developing countries is not well characterised. We conducted a cross-sectional study among 1945 children of age 5-12 years in Bogotá, Colombia, to assess whether anthropometric and micronutrient status indicators were associated with performance in the shuttle run and standing long jump tests. Stunted children scored significantly lower in the run (0·4 s; P = 0·0002) and jump (6 cm; boys only; P = 0·003) tests than non-stunted children, after adjustment for age and other factors. Children who were thin, overweight or obese ran slower than normal-weight children (P < 0·01). Lower jump scores were associated with overweight or obesity and greater arm fat area in boys only (P < 0·0001). Girls with low ferritin concentrations ran 0·6 s slower than girls with normal ferritin concentrations (P = 0·02). Erythrocyte folate concentrations were linearly related to higher run (P < 0·0001) and long jump scores (P = 0·0001). Boys with marginal or low vitamin B12 status had 4 cm lower long jump scores than children with normal status (P = 0·01). Suboptimal anthropometric and micronutrient status are related to poorer performance in fitness tests. The effects of improving nutritional status on physical fitness of children warrant investigation.

Prevalence of overweight, obesity and underweight among 5-year-old children in Saint Lucia by three methods of classification and a comparison with historical rates

BACKGROUND

The study aimed to determine if child obesity rates have risen in the Caribbean nation of Saint Lucia, as found globally, and whether under-nutrition coexists, as in other developing nations. The average adult in Saint Lucia is overweight, thus considerable child obesity might be expected, but there are no current data.

METHODS

Heights and weights were obtained from a sample (n= 425) of the 2001 birth cohort of Saint Lucian children measured during the nation-wide 2006/2007 Prior to School Entry Five-Year Assessment. Prevalence of overweight, obesity and underweight were estimated by Centers for Disease Control (CDC), Cole et al. and new World Health Organization (WHO) methods. Previously reported 1976 estimates, including children ≤60 months of age only, based on National Centre for Health Statistics curves, were adjusted to new WHO equivalents using an algorithm developed by Yang and de Onis, and compared with rates in our subsample of children ≤60 months of age (n= 99).

RESULTS

Regardless of classification method, overweight and obesity rates were high: 14.4% and 9.2% (WHO); 11.3% and 12.0% (CDC); and 9.9% and 7.1% (Cole et al.), respectively. Underweight estimates also varied: 4.7% (WHO); 11.3% (CDC) and 6.6% (Cole et al.). Obesity in our young subsample (15.2%; WHO) was more than 3 times the adjusted 1976 rate (4.3%).

CONCLUSIONS

Obesity among Saint Lucian pre-schoolers has tripled in 30 years. Our findings also suggest that this country, like many undergoing a 'nutrition transition', faces the dual challenge of over-nutrition and under-nutrition. Routine monitoring of overweight and underweight is needed in Saint Lucia, as is the implementation and evaluation of programmes to address these problems.

Double burden of nutritional disorders in young Iranian children: findings of a nationwide screening survey

OBJECTIVE

To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry.

DESIGN

Cross-sectional nationwide survey.

SETTING

Mandatory national screening programme before entrance to elementary school in 2008 in Iran.

SUBJECTS

All Iranian children entering public and private elementary schools.

RESULTS

The study population comprised 862,433 children (48.4% girls, 77.2% urban resident). Overall, 6.5% of children had short stature, 19.1% were underweight, 12.8% were overweight and 3.4% were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces.

CONCLUSIONS

The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children's growth.

Umbilical waist-to-height ratio and trunk fat mass index (DXA) as markers of central adiposity and insulin resistance in Argentinean children with a family history of metabolic syndrome

Central adiposity is increasing in childhood. To find a simple index of central fatness that accurately predicts insulin resistance we studied 55 obese children and 53 siblings, aged 6-16 years. We recorded the family metabolic score, calculated clinical and DXA-derived fat distribution indexes and HOMA-IR. Umbilical waist-to-height ratio (W-to-Ht) had the best combination of ROC area (0.99, IC95: 0.93 to 1.0), Youden's index (0.976), coefficient of variation (4.9) and correlation with HOMA-IR (r = 0.58, p < 0.0001); it also correlated (p < 0.001) with BMI (r = 0.95) and DXA-trunk fat mass index (r = 0.93). It was the best predictor of insulin resistance in a multiple regression model (p < 0.0001). Odds ratios for insulin resistance were 9.33 when the family score was >10 (p < 0.01) and 14.35 when umbilical W-to-Ht was >0.54 (p < 0.0001). Umbilical W-to-Ht, a simple marker of central adiposity, strongly relates to children's DXA-trunk fat mass index and insulin resistance.

Provision of a school snack is associated with vitamin B-12 status, linear growth, and morbidity in children from Bogota, Colombia

In 2004, Bogotá's Secretary of Education (SED) initiated a snack program in public primary schools. A midmorning food ration was provided free of charge to children to supplement 30 and 50% of their daily requirements of energy and iron, respectively. The purpose of this study, an observational investigation of 3202 children ages 5-12 y, was to examine whether the snack program improved children's nutritional and health status. We measured micronutrient levels (plasma ferritin and vitamin B-12, and erythrocyte folate), anthropometry, and reported morbidity during the first semester of the 2006 school year. After adjusting for socioeconomic status and other school interventions, children at schools receiving the snack (n = 1803) had greater increases in plasma vitamin B-12 (42 pmol/L; P < 0.0001) from baseline to 3 mo of follow-up than children at schools not receiving the snack (n = 1399). They also experienced a smaller decrease in height-for-age Z-scores than children who did not receive the snack (P = 0.001). Provision of the SED snack was associated with significantly fewer reported days with morbidity symptoms (e.g. cough with fever, diarrhea with vomiting), 44% fewer doctor visits (P = 0.02), and 23% fewer days of school absenteeism (P = 0.03). The snack was not related to ferritin or folate levels. In conclusion, provision of a school-administered snack was related to improved vitamin B-12 status and linear growth and decreased reported morbidity. Although provision of the snack was not related to BMI changes over a 4-mo period, snack components such as candy and sugar-sweetened beverages should be replaced with healthier options, as the rates of child overweight in Colombia are not negligible.

Impact of growth patterns and early diet on obesity and cardiovascular risk factors in young children from developing countries

Non-communicable chronic diseases are now a worldwide epidemic. Diet and physical activity throughout life are among its main determinants. In countries undergoing the early stages of the nutrition transition weight gain from birth to 2 years of life is related to lean mass gain, while ponderal gain after age 2 years is related to adiposity and later diabetes and CVD risk. Evidence from developing countries undergoing the more advanced stages of the nutrition transition is limited. The early growth patterns of a cohort of Chilean children born in 2002 with normal birth weight who at 4 years had a high prevalence of obesity and CVD risk factors have been assessed. Results indicate that BMI gain in early life, particularly from 6 months to 24 months, is positively associated with adiposity and CVD risk status at 4 years. These results together with existing evidence suggest that actions to prevent obesity and nutrition-related chronic diseases in developing countries should start early in life, possibly after 6 months of age. This approach should consider assessing the effect of mode of feeding and the amount and type of energy fed, as well as the resulting growth patterns. The challenge for researchers addressing the nutrition transition is to define the optimal nutrition in early life, considering not only the short- and long-term health consequences but also taking into account the stage of the nutritional transition for the given population of interest. The latter will probably require redefining optimal postnatal growth based on the context of maternal size and fetal growth.

Overweight is more prevalent than stunting and is associated with socioeconomic status, maternal obesity, and a snacking dietary pattern in school children from Bogota, Colombia

The objectives of this study were to estimate the prevalence of overweight in school-aged children from Bogotá, Colombia and to examine its associations with sociodemographic characteristics, dietary patterns, and indicators of physical activity. We measured height and weight in 3075 children between 5 and 12 y of age who attended public primary schools in 2006 and we obtained information on maternal sociodemographic and anthropometric characteristics. The survey was representative of children from low and middle socioeconomic backgrounds. The prevalences of child overweight (including obesity) and obesity according to the International Obesity Task Force criteria were 11.1 and 1.8%, respectively. The prevalence of stunting was 9.8%. In multivariate analysis, child overweight was positively associated with indicators of higher socioeconomic status (SES), including low maternal parity and ownership of household assets. The prevalence of overweight was 3.6 times greater in children whose mothers were obese compared with children whose mothers had an adequate BMI (adjusted prevalence ratio = 3.61; 95% CI = 2.64, 4.93). Child overweight was positively associated with adherence to a "snacking" dietary pattern (P-trend = 0.06) and to frequent intake of hamburgers or hot dogs (adjusted prevalence ratio for at least once per week vs. never = 1.93; 95% CI = 1.03, 3.62), independent of total energy intake and other potential confounders. Time spent viewing television or playing outside the household were not significantly related to the prevalence of child overweight. In conclusion, child overweight in Bogotá is more common than stunting and is associated with higher SES, maternal obesity, and a snacking dietary pattern.

Nutrition, child growth, and chronic disease prevention

Countries undergoing the nutrition transition are experiencing a progressive increase in obesity and nutrition-related chronic diseases (NRCDs). In transitional countries, stunting (shortness for age) and micronutrient deficiencies (iron, vitamin A, and zinc) in children coexist with obesity and NRCDs originating the double burden of nutritional disease. The causal web for obesity and NRCDs is complex and multifaceted; changes in diet and physical activity of the population are likely the main concurrent determinant factors. However, recent evidence suggests that specific patterns of prenatal and postnatal growth are also potential contributors. Evidence indicates that intervention strategies to prevent malnutrition should emphasize improvements in linear growth in the first 2-3 years of life rather than aim at gaining weight. Avoiding excessive weight gain relative to height gain (BMI) is especially relevant after the first 2 years of life. Routine assessment of child growth based on the new World Health Organization (WHO) standard, defining energy needs based on the recent Food and Agricultural Organization (FAO)/WHO norms, and providing critical micronutrients to support lean mass growth are critical to prevent obesity and NRCDs starting early in the life course. These actions should contribute in the prevention and control of obesity in childhood and thus help prevent NRCDs in future generations of adults.

Nature and strength of epidemiological evidence for origins of childhood and adulthood obesity in the first year of life

Increased interest in early life origins of chronic disease, a concept often referred to as programming, has resulted in several studies investigating the origins of childhood or adulthood obesity during infancy. Rapid infancy weight gain as a risk factor and breastfeeding as a protective factor for later obesity have been most thoroughly studied. The association between rapid infancy weight gain and later obesity is supported by several observational studies, but not by the two, relatively small, randomized trials. This association is strong, suggests a dose-response effect and has biological plausibility, but is not consistent between study designs. Rapid infancy weight gain as a risk factor for later obesity has been experimentally reproduced in animal models, but not in humans. The protective effect of breastfeeding on obesity is also supported by several observational studies, but randomized trials are not available. Considering the potential for residual confounding factors, current evidence is insufficient to demonstrate origins of obesity during infancy or to change public health recommendations, but the potential for obesity prevention during infancy is promising.