Institute for Social Science Research, University of Queensland, 80 Meiers Road, Indooroopilly, QLD, 4068, Australia.
ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, QLD, Australia.
Eur J Clin Nutr. 2021 Feb;75(2):385-391. doi: 10.1038/s41430-020-00726-z. Epub 2020 Sep 2.
Many developing countries currently face a double burden of malnutrition (DBM) at the household level, defined by the World Health Organization, as when a mother may be overweight or anemic, and a child or grandparent is underweight, in the same household. For the present study, we defined it as the coexistence of overweight or obesity in the mother, and at least one child under the age of 5 undernourished, within the same household. Although underweight has long been considered a major issue in South and Southeast Asia, overweight and obesity have also been identified as a growing problem. The main aim of this study was to assess the DBM at the household level and its major determinants in South and Southeast Asia.
We used population-representative cross-sectional data from the Demographic and Health Survey, conducted between 2007 and 2017, for eight South and Southeast Asian countries: Bangladesh, India, Nepal, Pakistan, Myanmar, Timor, Maldives, and Cambodia. Multivariate logistic regression was performed to identify the sociodemographic factors associated with DBM.
A total of 798,961 households were included in this study. The pooled prevalence of overweight or obesity for the mother and stunted child was 10.0% (95% CI: 8.0.0-12.0), for OBM and wasted child, it was 7.0% (95% confidence interval (CI): 6.0-8.0), and for overweight or obese mother (OBM) and underweight child, it was 7.0% (95% CI: 6.0-8.0). The prevalence of any of these DBM coexistences was 12.0% (95% CI: 10.0-13.0) in all households. Statistically significant positive associations (p < 0.05) were found for each of these coexistences, and a higher age of the mother, mothers with a lower education, the richest household quintile, and households with more than four members.
It is imperative that "double duty" action policies are developed that tackle the DBM, rather than targeting undernutrition or overnutrition separately. The findings from this study suggest that the promotion of education for women may aid in tackling the double burden on a household level.
许多发展中国家目前面临着家庭层面的双重营养不良负担（DBM），世界卫生组织将其定义为母亲可能超重或贫血，而同一家庭中的孩子或祖父母体重不足。在本研究中，我们将其定义为母亲超重或肥胖，以及同一家庭中至少有一名 5 岁以下儿童营养不良。尽管体重不足长期以来一直被认为是南亚和东南亚的一个主要问题，但超重和肥胖也已被确定为一个日益严重的问题。本研究的主要目的是评估南亚和东南亚家庭层面的 DBM 及其主要决定因素。
我们使用了 2007 年至 2017 年期间进行的人口代表性横断面数据，来自南亚和东南亚的 8 个国家：孟加拉国、印度、尼泊尔、巴基斯坦、缅甸、东帝汶、马尔代夫和柬埔寨。采用多变量逻辑回归分析方法确定与 DBM 相关的社会人口因素。
本研究共纳入 798961 户家庭。母亲超重或肥胖和发育迟缓儿童的总患病率为 10.0%（95%置信区间：8.0.0-12.0），母亲超重或肥胖和消瘦儿童的患病率为 7.0%（95%置信区间：6.0-8.0），母亲超重或肥胖（OBM）和儿童体重不足的患病率为 7.0%（95%置信区间：6.0-8.0）。所有家庭中这些 DBM 共存的患病率为 12.0%（95%置信区间：10.0-13.0）。这些共存关系中的每一种都存在统计学显著的正相关（p<0.05），且与母亲年龄较大、母亲教育程度较低、最富裕的家庭五分位数以及家庭人口超过四人有关。
制定“双重职责”行动政策迫在眉睫，这些政策应同时解决 DBM 问题，而不是分别针对营养不良或营养过剩问题。本研究的结果表明，促进妇女教育可能有助于解决家庭层面的双重负担。
