Concurrence of stunting and overweight/obesity among children: Evidence from Ethiopia

Abstract

Background Nutrition transition in many low- and middle-income countries (LMICs) has led to shift in childhood nutritional outcomes from a predominance of undernutrition to a double burden of under- and overnutrition. Yet, policies that address undernutrition often times do not include overnutrition nor do policies on overweight, obesity reflect the challenges of undernutrition. It is therefore crucial to assess the prevalence and determinants of concurrence stunting and overweight/obesity to better inform nutrition programs in Ethiopia and beyond. Methods We analyzed anthropometric, sociodemographic and dietary data of children under five years of age from 2016 Ethiopian Demographic and Health Survey (EDHS). A total of 8,714 children were included in the current study. Concurrence of stunting and overweight/obesity (CSO) prevalence was estimated by basic, underlying and immediate factors. To identify factors associated with CSO, we conducted hierarchical logistic regression analyses. Results The overall prevalence of CSO was 1.99% (95% CI, 1.57–2.53). The odds of CSO was significantly higher in children in agrarian region compared to their counter parts in the pastoralist region (AOR = 1.51). Other significant factors included; not having improved toilet facility (AOR = 1.94), being younger than 12 months (AOR = 4.22), not having history of infection (AOR = 1.83) and not having taken deworming tablet within the previous six months (AOR = 1.49). Conclusion Our study provided evidence on the co-existence of stunting and overweight/obesity among infants and young children in Ethiopia. Therefore, identifying children at risk of growth flattering and excess weight gain provides nutrition policies and programs in Ethiopia and beyond with an opportunity of earlier interventions through improving sanitation, dietary quality by targeting children under five years of age and those living in Agrarian regions of Ethiopia.

A Review of the Prevalence, Trends, and Determinants of Coexisting Forms of Malnutrition

“…Globally, around 1.7% of children below 5 years of age were affected with coexistence of stunting with overweight/obesity (40) . The prevalence of coexistence of stunting with overweight/obesity among children under 5 years old was 2% in Ethiopia (27) , 1% in India (35), 7.5% in Indonesia (28) , 1% in Kenya (32) ; between 5-10% in Mexico (26) ; 2-3% in Uruguay (36) , and 0.4%-18% in China (34,45,46) . According to the 2019 Global Nutrition Report, the global prevalence of coexistence of wasting with stunting among children below 5 years of age was 3.5% (40) .…”

“…Further De nitions and Terminologies for representing coexisting forms of malnutrition: Several terminologies were used to describe the presence of more than one form of malnutrition. These include concurrent existence of malnutrition (12,(26)(27)(28)(29) , coexisting forms of malnutrition (30,31) , short and plump syndrome (32) , decompensated chronic undernutrition (33) paradox (34) and dual/double burden of malnutrition (DBM) (32,35,36) . The term DBM was used to describe individuals who were simultaneously suffering from undernutrition and overnutrition, for example, the coexistence of stunting with overweight/obesity or overnutrition with micronutrient de ciencies (i.e., the coexistence of overweight/obesity with anaemia) (37,38) .…”

“…In another study, it was observed that the odds of coexistence of stunting with overweight/obesity in children aged three to ve years was signi cantly higher (OR: 1.4, 95% CI: 1.0 to 1.8), compared to young children aged under two year (26) . The odds of coexistence of stunting with overweight/obesity was 4.22 (2.22 to 8.05) times higher in children aged below one year, compared with children aged 48 to 59 months (27) . However, a study conducted in Indonesia reported a more prevalent coexistence of stunting with overweight/obesity in young school-aged children (6 to 9 years) than in older children aged (10 to 12 years) (27,28) .…”

“…The odds of coexistence of stunting with overweight/obesity was 4.22 (2.22 to 8.05) times higher in children aged below one year, compared with children aged 48 to 59 months (27) . However, a study conducted in Indonesia reported a more prevalent coexistence of stunting with overweight/obesity in young school-aged children (6 to 9 years) than in older children aged (10 to 12 years) (27,28) . Overall, the coexistence of wasting with stunting is more common among young children, but con icting associations between the coexistence of stunting with overweight/obesity and child age was observed.…”

“…coexistence of underweight with stunting, coexistence of underweight with wasting, and coexistence of underweight with wasting and stunting both, and they did not nd a signi cant association of coexisting forms of undernutrition with child age (42) . The problems relating to undernutrition appear to diminish with increasing age, while the probability of coexistence of stunting with overweight/obesity or coexistence of overweight/obesity with micronutrient de ciency rises (27,30,36,44,49) . In contrast, Zhang, et al, (2016) reported that every year of increasing age signi cantly reduced the odds of coexistence of stunting with overweight/obesity by 0.74 (95% CI: 0.71 to 0.77) (34) .…”