Socio-economic differences in height and body mass index of children and adults living in urban areas of Karachi, Pakistan

Abstract

Objective: To study the socio-economic differences in height and body mass index (BMI) in urban areas of Karachi. Design: A comparative study was undertaken to compare the heights and BMIs of adults and children belonging to three distinctively different income groups living in urban areas of Karachi. Setting: Data was collected from families living in small, medium and large houses located in the authorised urban residential areas of Karachi. Subjects: A total of 600 families, 200 from each income group, were included in the study. Anthropometric measurements of 1296 females and 1197 males of different ages were taken. Methods: All the housewives were interviewed to collect socio-demographic information. Height and weight of all the available family members were measured. In order to determine the socio-economic difference in height status, the mean height in cm of adults was compared. For children (2 ± 17 y) means of height-for-age Z-scores determined on the basis of NCHS reference values were compared. For studying the weight status the BMI of all the respondents was calculated and they were grouped into categories of under-, normal or overweight according to the NCHS recommended cut-off points. For adult men and women BMI values`18.5 kgam 2 indicated underweight and b 25 kgam 2 indicated overweight. Among children, those having BMI values below the 5th percentile of the NHANES III reference values were categorised as underweight and those above the 95th percentile were termed overweight. Results: Height status improved with income level among adults and children of both sexes. Among males the difference in weight status was signi®cant only among 2 to 18-y-olds (P`0.05 in each case). The rate of overweight among 2 to 18-y-old males was signi®cantly higher (P 0.004) at the middle-income level (15%) as compared to low or high income. The rate of underweight was signi®cantly higher (P 0.025) at the low-income level among 2 to 18-y-old males (31%, 21% and 22% at low-, middle-and high-income levels, respectively). Among females, rates of underweight were not signi®cantly different at any age. Rates of overweight increased signi®cantly (P 0.048) with income level among 41 to 60-y-old women (38%, 53% and 60% at low-, middleand high-income levels, respectively). Conclusion: Chronic undernutrition as indicated by de®cit in height decreased with increasing income level. Socio-economic differences in weight status were not uniform among various age ± sex groups. The in¯uence of increasing af¯uence is likely to be seen both in the form of increased obesity among older females and underweight among children. Differing patterns of association between income and weight status among male and female children need to studied further with more accurate birth records, so as to further clarify the situation. In terms of prevention of nutrition-related disorders both problems of under-and over-nutrition need to be addressed. Sponsorship: Financial support for this project was provided by ISFE, Switzerland.

Epidemiology of undernutrition in adults in Dhaka slum households, Bangladesh

“…Other studies have found that BMI was worse in low-income households (Pryer, 1990;Nube et al, 1998;Sarlio-Lahteenkorva and Lahelma, 1999;Delpeuch et al, 2000;Hakeem, 2001). Households where the head of household's occupational group was casual wage worker (unskilled) or dependent self-employed had the worse BMI compared with other occupational groups.…”

“…Earlier work by Pryer (1993) indicated that BMI was associated with livelihood groups, where the poorest groups (female-headed households and casual unskilled labour) had the lowest BMI for men and women, compared with the richest groups (traders and landlords) who had the highest BMI for men and women. Several studies have demonstrated that BMI is associated with low income (Pryer, 1990;Nube et al, 1998;Sarlio-Lahteenkorva and Lahelma, 1999;Delpeuch et al, 2000;Hakeem, 2001), low assets (Pryer, 1990(Pryer, , 1993, expenditure (Pryer, 1990;Nube et al, 1998), years of schooling (Sen, 1991), quality of housing and access to services (Nube et al, 1998), occupational groups (Pryer, 1993) and loans (Pryer, 1990;2003).…”

The effect of economic status on height, insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations in healthy Turkish children

“…In the same population, boys had lower height SDSs than girls in shantytown schools (Ulukanligil and Seyrek, 2004b). Similarly, in Pakistani children the rate of underweight was significantly higher in low income level among children and adolescents in males, but not in females (Hakeem, 2001). Lack of significant difference in growth of girls from different ESs could be because of sexual dimorphism in metabolic adaptation during shortage of nutrients.…”

“…A secular trend towards higher final height and earlier pubertal maturation is seen in countries with favorable socioeconomic development. Height of healthy children of the same age and ethnic origin is influenced by the socioeconomic factors (Gross et al, 1990;Peck and Lundberg, 1995;Hakeem, 2001;Ulukanligil and Seyrek, 2004a). However, malnutrition, diarrhea and parasitic infestations are mostly responsible for the different heights observed among different socioeconomic groups in the previous studies from developing countries (Gross et al, 1990;Ulukanligil and Seyrek, 2004a).…”

“…On the other hand, obesity leads to lower GH but high to normal IGF-I levels in children (Loche et al, 1987;Argente et al, 1997;Falorni et al, 1997;Saitoh et al, 1998). In developing countries, malnutrition is more common in children from lower socioeconomic levels and the obesity is more common in children from higher socioeconomic levels (Gross et al, 1990;Peck and Lundberg, 1995;Nebigil et al, 1997;Hakeem, 2001;Ulukanligil and Seyrek, 2004a). However, it is unknown whether socioeconomic status per se (after exclusion of children with malnutrition) affects IGF-I levels of children in a country of favorable development.…”