Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

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ABSTRACT

Background

Child overweight prevalence is increasing globally, but micronutrient deficiencies persist.

Objectives

We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting.

Methods

We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao–Scott chi-square test and examined predictors of DBM and its components with logistic regression.

Results

DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%–19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6–23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components.

Conclusions

Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

Keywords:

double burden of malnutrition
preschool children
anemia
overweight/obesity
micronutrients

Abbreviations used:

AGP
α-1-acid glycoprotein
BAZ
BMI-for-age z score
BRINDA
Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia
CRP
C-reactive protein
DBM
double burden of malnutrition
DBM-Anemia
double burden of malnutrition, defined using anemia as the indicator of undernutrition
DBM-MDI
double burden of malnutrition, defined using micronutrient deficiency as the indicator of undernutrition
MDI
Micronutrient Deficiency Index
NCD
noncommunicable disease
OWOB
overweight or obesity
RBCF
red blood cell folate
SES
socioeconomic status
WHZ
weight-for-height z score
25(OH)D
25-hydroxyvitamin D.

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Supported by the Bill & Melinda Gates Foundation, CDC, Eunice Kennedy Shriver National Institute of Child Health and Human Development, HarvestPlus, and the United States Agency for International Development.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Supplemental Tables 1–10 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/.

Data described in the article, code book, and analytic code will be made available upon request pending approval from the BRINDA steering committee and country representatives.

Publication costs for this supplement were defrayed in part by the payment of page charges by the Bill & Melinda Gates Foundation. The Guest Editor for this supplement was Daniel Roth, who has no relevant disclosures. The Supplement Coordinators for the supplement publication were Parminder S Suchdev and Melissa F Young, Emory University, Atlanta, GA 30322, USA. Supplement Coordinator disclosure: PSS receives salary support from the CDC; MFY: no conflicts to disclose. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board of The American Journal of Clinical Nutrition.