Emory University, Laney Graduate School, Nutrition and Health Sciences Program, Atlanta, GA, USA.
Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA.
J Nutr. 2020 Jun 1;150(6):1554-1565. doi: 10.1093/jn/nxaa076.
In low-resource settings, urbanization may contribute to the individual-level double burden of malnutrition (DBM), whereby under- and overnutrition co-occur within the same individuals.
We described DBM prevalence among Malawian women by urban-rural residence, examined whether urban residence was associated with DBM, and assessed whether DBM prevalence was greater than the prevalence expected by chance given population levels of under- and overnutrition, which would suggest DBM is a distinct phenomenon associated with specific factors.
We analyzed nationally representative data of 723 nonpregnant women aged 15-49 y from the 2015-2016 Malawi Micronutrient Survey. DBM was defined as co-occurring overweight or obesity (OWOB) and ≥1 micronutrient deficiency or anemia. We used Poisson regression models to examine the association between urban residence and DBM and its components. The Rao-Scott modified chi-square test compared the observed and expected DBM prevalence.
Nationally, 10.8% (95% CI: 7.0, 14.5) of women had co-occurring OWOB and any micronutrient deficiency and 3.4% (95% CI: 1.3, 5.5) had co-occurring OWOB and anemia. The prevalence of co-occurring OWOB and any micronutrient deficiency was 2 times higher among urban women than rural women [urban 32.6 (24.1, 41.2) compared with rural 8.6 (5.2, 11.9), adjusted prevalence ratio: 2.0 (1.1, 3.5)]. Co-occurring OWOB and anemia prevalence did not significantly differ by residence [urban 6.9 (0.6, 13.2) compared with rural 3.0 (0.8, 5.3)]. There were no statistically significant differences in observed and expected prevalence estimates of DBM.
This analysis shows that co-occurring OWOB and any micronutrient deficiency was higher among women in urban Malawi compared with rural areas. However, our finding that co-occurring OWOB and any micronutrient deficiency or anemia may be due to chance suggests that there may not be common causes driving DBM in Malawian women. Thus, there may not be a need to design and target interventions specifically for women with DBM.
在资源匮乏的环境中，城市化可能会导致个体层面营养不良的双重负担（DBM），即同一人群中同时存在营养不足和营养过剩。
我们描述了马拉维女性按城乡居住情况的 DBM 流行情况，检验了城市居住是否与 DBM 相关，并评估了 DBM 的流行程度是否超过了人群中营养不足和营养过剩的预期流行程度，这表明 DBM 是一种与特定因素相关的独特现象。
我们分析了 2015-2016 年马拉维微量营养素调查中来自 723 名 15-49 岁非孕妇的全国代表性数据。DBM 定义为同时存在超重或肥胖（OWOB）和≥1 种微量营养素缺乏或贫血。我们使用泊松回归模型检验了城市居住与 DBM 及其组成部分之间的关联。Rao-Scott 修正卡方检验比较了观察到的和预期的 DBM 流行率。
全国范围内，10.8%（95%CI：7.0，14.5）的女性同时存在 OWOB 和任何一种微量营养素缺乏，3.4%（95%CI：1.3，5.5）的女性同时存在 OWOB 和贫血。城市女性同时存在 OWOB 和任何一种微量营养素缺乏的流行率是农村女性的 2 倍[城市 32.6（24.1，41.2），农村 8.6（5.2，11.9），调整后的流行率比：2.0（1.1，3.5）]。城乡居民的 OWOB 和贫血同时存在的流行率没有显著差异[城市 6.9（0.6，13.2），农村 3.0（0.8，5.3）]。DBM 的观察到和预期流行率估计没有统计学差异。
本分析表明，与农村地区相比，马拉维城市女性同时存在 OWOB 和任何一种微量营养素缺乏的情况更为普遍。然而，我们发现 OWOB 和任何一种微量营养素缺乏或贫血同时存在可能是偶然的，这表明导致马拉维女性 DBM 的原因可能并不相同。因此，可能没有必要专门为患有 DBM 的女性设计和实施干预措施。
