The double burden of malnutrition among adolescents: analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries
The double burden of malnutrition among adolescents: analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries
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DOI：
10.1093/ajcn/nqy105
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发表时间：
2018-08-01
影响因子：
7.1
通讯作者：
Uauy-, Ricardo
中科院分区：
文献类型：
--
作者：
Caleyachetty, Rishi;Thomas, G. N.;Uauy-, Ricardo
背景资料：在经历营养转型的国家，成人和幼儿同时受到营养不足和营养过剩的影响。青春期是生长发育的关键时期。然而，营养不良的双重负担在多大程度上影响了中低收入国家（LMICs）的青少年，以及与营养不良双重负担相关的宏观背景因素尚不清楚。目的：目的是量化青少年营养不良双重负担的程度，并检查LMICs患病率估计异质性的潜在来源。设计：我们使用了2003年至2013年在57个LMIC进行的全球学校学生健康和学龄儿童健康行为调查的个人参与者数据，其中包括129，276名12-15岁的青少年。通过随机效应荟萃分析，按地区、性别分层计算总体发育迟缓、消瘦或两者兼而有之;超重或肥胖;以及并发发育迟缓和超重或肥胖的汇总估计值。在联合国儿童基金会儿童营养不良概念框架的指导下，我们使用生态线性回归模型来研究宏观层面背景因素之间的关联。（国内冲突、缺乏民主、国内生产总值、粮食不安全、城市化、调查年份）与发育迟缓、消瘦、超重和肥胖患病率的关系（95% CI：8.3%，12.2%），瘦型为5.5%（95% CI：4.3%，6.9%）。超重或肥胖的患病率为21.4%（95%CI：18.6%，24.2%）。在青少年营养不良的变异的38.4%和58.7%之间的解释宏观背景因素。同时发生发育迟缓和超重或肥胖的患病率为2.0%（95%CI：1.7%，2.5%）。为实现到2030年消除一切形式营养不良的可持续发展目标，需要针对具体情况实施和扩大针对营养不良双重负担的干预措施和政策。本试验在clinicaltrials.gov上注册为NCT 03346473。
Background: Adults and young children in countries experiencing the nutrition transition are known to be affected simultaneously by undernutrition and overnutrition. Adolescence is a critical period for growth and development. Yet, it is unknown to what extent this double burden of malnutrition affects adolescents in low- and middle-income countries (LMICs) and the macrolevel contextual factors associated with the double burden of malnutrition.Objective: The aim was to quantify the magnitude of the double burden of malnutrition among adolescents and to examine the potential sources of heterogeneity in prevalence estimates across LMICs.Design: We used individual-participant data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys conducted in 57 LMICs between 2003 and 2013, comprising 129,276 adolescents aged 12-15 y. Pooled estimates of stunting, thinness, or both; overweight or obesity; and concurrent stunting and overweight or obesity were calculated overall, by regions, and stratified by sex, with random-effects meta-analysis. Guided by UNICEF's conceptual framework for child malnutrition, we used ecological linear regression models to examine the association between macrolevel contextual factors (internal conflict, lack of democracy, gross domestic product, food insecurity, urbanization, and survey year) and stunting, thinness, and overweight and obesity prevalence, respectively.Results: The prevalence of stunting was 10.2% (95% CI: 8.3%, 12.2%) and of thinness was 5.5% (95% CI: 4.3%, 6.9%). The prevalence of overweight or obesity was 21.4% (95% CI: 18.6%, 24.2%). Between 38.4% and 58.7% of the variance in adolescent malnutrition was explained by macrolevel contextual factors. The prevalence of concurrent stunting and overweight or obesity was 2.0% (95% CI: 1.7%, 2.5%).Conclusions: The double burden of malnutrition among adolescents in LMICs is common. Context-sensitive implementation and scale-up of interventions and policies for the double burden of malnutrition are needed to achieve the Sustainable Development Goal to end malnutrition in all of its forms by 2030. This trial was registered at clinicaltrials.gov as NCT03346473.