Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Canada.
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
PLoS One. 2020 Feb 3;15(2):e0228592. doi: 10.1371/journal.pone.0228592. eCollection 2020.
BACKGROUND: The coexistence of undernutrition (thinness) and overnutrition (overweight/obesity) among children and adolescents is a public health concern in low-middle-income countries. Accurate prevalence estimates of thinness and overweight/obesity among children and adolescents are unavailable in many low-middle-income countries due to lack of data. Here we describe the prevalences and examine correlates of objectively measured weight status among urban and rural schoolchildren in Mozambique. METHODS: A cross-sectional study design was applied to recruit 9-11-year-old schoolchildren (n = 683) from 17 urban and rural primary schools in Mozambique. Body mass index (BMI) was computed from objectively measured height and weight and participants' weight categories were determined using the World Health Organization cut-points. Actigraph GT3X + accelerometers were worn 24 hours per day for 7 days to assess movement behaviours. Multilevel multivariable modelling was conducted to estimate odds ratios and confidence intervals. RESULTS: Combined prevalence of overweight/obesity (11.4%) was significantly higher among urban participants compared to rural participants (5.7%; χ2 = 7.1; p = 0.008). Conversely, thinness was more prevalent among rural (6.3%) compared to urban (4.2%) participants. Passive school commute, not meeting daily moderate- to vigorous-intensity physical activity (MVPA) guidelines, and maternal BMI >25 kg/m2 were associated with overweight/obesity while possessing one or more functional cars at home, maternal BMI >25 kg/m2 and being an older participant were associated with thinness in the present sample. The proportion of total variance in the prevalences of obesity and/or thinness occurring at the school level was 8.7% and 8.3%, respectively. CONCLUSION: Prevalences of thinness, overweight/obesity and other key variables differ between urban and rural schoolchildren in Mozambique. MVPA, active transport and mother's BMI are important modifiable correlates of weight status among Mozambican schoolchildren. Results from this study demonstrate important differences between urban and rural schoolchildren that should not be ignored when designing interventions to manage malnutrition, formulating public health strategies, and interpreting findings.
背景：中低收入国家儿童和青少年营养不良（消瘦）与营养过剩（超重/肥胖）并存是一个公共卫生问题。由于缺乏数据，许多中低收入国家无法获得儿童和青少年消瘦和超重/肥胖的准确患病率估计。在这里，我们描述了莫桑比克城市和农村学龄儿童的客观测量体重状况的流行率，并检查了其相关因素。
方法：采用横断面研究设计，从莫桑比克 17 所城市和农村小学招募了 9-11 岁的学龄儿童（n=683）。从客观测量的身高和体重计算体重指数（BMI），并使用世界卫生组织的切点确定参与者的体重类别。Actigraph GT3X+加速度计每天佩戴 24 小时，持续 7 天，以评估运动行为。采用多水平多变量模型估计优势比和置信区间。
结果：超重/肥胖的综合患病率（11.4%）在城市参与者中明显高于农村参与者（5.7%；χ2=7.1；p=0.008）。相反，消瘦在农村参与者（6.3%）中比城市参与者（4.2%）更为普遍。被动上学交通方式、未达到每日中等到剧烈强度体力活动（MVPA）指南、母亲 BMI>25kg/m2与超重/肥胖有关，而家中拥有一辆或多辆功能车、母亲 BMI>25kg/m2 和参与者年龄较大与本研究样本中的消瘦有关。在学校层面上，肥胖和/或消瘦患病率的总方差比例分别为 8.7%和 8.3%。
结论：莫桑比克城市和农村学龄儿童的消瘦、超重/肥胖和其他关键变量的患病率存在差异。MVPA、主动交通和母亲的 BMI 是莫桑比克学龄儿童体重状况的重要可改变相关因素。本研究的结果表明，城市和农村学龄儿童之间存在重要差异，在设计管理营养不良的干预措施、制定公共卫生策略和解释研究结果时，不应忽视这些差异。
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