Demographic, Socio-economic and Lifestyle Determinants of Under- and Over-nutrition among Bangladeshi Adult Population: Results from a Large Cross-Sectional Study.

Bangladesh is currently going through a nutritional transition with rapid increase in overnutrition while undernutrition is still remaining prevalent. Nevertheless, population-based data on demographic, socio-economic and lifestyle factors associated with underweight and overweight among adult population is scarce. Employing a nationwide cross-sectional survey, we collected anthropometric, demographic, socio-economic, lifestyle and dietary information from 12,180 adults aged ≥35 years. Body Mass Index (BMI) was calculated using standard formula and categorized into underweight (<18.50), normal weight (18.50-22.99), and overweight (≥23.00). Multivariable multinomial logistic regression was performed to identify factors associated with underweight and overweight. Overall, prevalence of underweight and overweight was 18.1% (95% CI: 17.5-18.8) and 33.7% (95% CI: 32.9-34.6), respectively. All the demographic, socio-economic, dietary and lifestyle factors showed significant association with nutritional status in bivariate analysis. In adjusted analysis, factors showing significant positive association with underweight included female gender (ARRR-1.38, 95% CI: 1.11-1.71), older age [compared to 35-39 years age group, ARRR (95% CI) for ≥ 70 years is 2.32 (1.89-2.86), for 60-69 years is 1.62 (1.36-1.93), for 50-59 years 1.34 (1.13-1.58) and for 40-49 years 1.05 (0.87-1.15)] and smoking habit (ARRR-1.32, 95% CI: 1.14-1.52) while factors showing significant inverse association with underweight included higher household wealth [compared to lowest wealth quintile, ARRR (95% CI) for highest quintile is 0.68 (0.55-0.84), for second highest quintile 0.77 (0.65-0.91), for middle quintile 0.81 (0.69-0.94) and for second lowest quintile 0.89 (0.77-1.03)], urban residence (ARRR-0.66, 95% CI: 0.66-0.90), and more frequent meat/fish and fruits consumption (ARRR-0.76, 95% CI: 0.65-0.90). On the other hand, factors significantly associated with increased risk of overweight included female gender (ARRR-1.35, 95% CI: 1.12-1.63), higher household wealth [compared to lowest wealth quintile, ARRR (95% CI) for highest quintile is 2.27 (1.93-2.68), for second highest quintile 1.67 (1.44-1.94), for middle quintile 1.26 (1.10-1.46) and for second lowest quintile 1.07 (0.93-1.24), excess food availability [compared to food shortage, ARRR (95% CI) for excess food in the household is 1.29 (1.12-1.47) and for no shortage/no excess is 1.23 (1.09-1.38) and more frequent fruits consumption [compared to no fruits, ARRR (95% CI) for 5-7 days per week consumption is 1.61 (1.41-1.83) and for 3-4 days per week is 1.28 (1.16-1.41) and factors significantly associated with decreased risk of overweight included older age [compared to 35-39 years age group, ARRR (95% CI) for ≥ 70 years is 0.77 (0.64-0.93), for 60-69 years is 0.82 (0.71-0.94), for 50-59 years 0.91 (0.80-1.04) and for 40-49 years 1.01 (0.89-1.15)] and smoking (ARRR-0.76, 95% CI: 0.68-0.86). Both underweight and overweight are prevalent in Bangladeshi adult population. Several demographic, socio-economic, dietary and lifestyle factors are associated with underweight and overweight in Bangladesh. Population level impact of these factors should be examined to design suitable public health and nutrition interventions to address this dual challenge.