Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa.
Front Public Health. 2022 Sep 23;10:948090. doi: 10.3389/fpubh.2022.948090. eCollection 2022.
Childhood stunting remains a global public health problem. Many stunted children live in the same household as overweight or obese adults (the so-called double burden of malnutrition), evidence that quality as well as quantity of food is important. In recent years, food security measurement has shifted away from anthropometry (e.g., stunting) to experiential measures (e.g., self-reported hunger). However, given the continued problem of stunting, it is important that national surveys identify malnutrition.
To examine the associations between a variety of food security indicators, including dietary diversity, with adult, child (0-4 years) (5-9 years) and adolescent (10-17 years) anthropometry. To estimate the prevalence of double burden households.
The study utilized cross-sectional data from the South African National Income Dynamics Survey NIDS (2008). We examined the associations between five food security indicators and anthropometry outcomes. The indicators were adult and child hunger in the household, self-reported household food sufficiency, food expenditure>60% of monthly expenditure and household dietary diversity. Multinomial and logistic regression models were employed to examine the associations with adult BMI categories and children's stunting and BMI.
The prevalence of stunting was 18.4% and the prevalence of wasting and overweight was 6.8 and 10.4%, respectively. Children <5 and adolescents with medium dietary diversity were significantly more likely to be stunted than children with high dietary diversity. Among children <5, child hunger and medium dietary diversity were significantly associated with wasting. None of the food security indicators were associated with stunting in children aged 5-9. Among stunted children, 70.2% lived with an overweight or obese adult. Among adults, increased dietary diversity increased the risk of overweight and obesity.
Dietary diversity can be used as a proxy for poor nutritional status among children <5 years and adolescents but the relationship between dietary diversity and adult obesity is more complex. Given the double burden of malnutrition in many low- and middle-income countries, indicators of dietary quality remain important. These tools can be further refined to include an extra category for processed foods. Given the relative simplicity to collect this data, national surveys would be improved by its inclusion.
儿童发育迟缓仍是全球公共卫生问题。许多发育迟缓的儿童与超重或肥胖成年人生活在同一家庭（所谓的营养不良双重负担），这表明食物的质量和数量都很重要。近年来，粮食安全的衡量标准已从人体测量学（例如发育迟缓）转向经验性衡量标准（例如自我报告的饥饿感）。但是，鉴于发育迟缓问题的持续存在，国家调查确定营养不良问题仍然很重要。
研究各种粮食安全指标（包括饮食多样性）与成人、儿童（0-4 岁）、（5-9 岁）和青少年（10-17 岁）人体测量结果之间的关联。估计存在双重负担家庭的比例。
本研究利用了南非国家收入动态调查（NIDS）（2008 年）的横断面数据。我们研究了五个粮食安全指标与人体测量结果之间的关联。这些指标是家庭中的成人和儿童饥饿感、自我报告的家庭粮食充足情况、食物支出占月支出的 60%以上以及家庭饮食多样性。使用多项和逻辑回归模型来研究与成人 BMI 类别和儿童发育迟缓及 BMI 的关联。
发育迟缓的患病率为 18.4%，消瘦和超重的患病率分别为 6.8%和 10.4%。与饮食多样性高的儿童相比，<5 岁儿童和青少年中饮食多样性中等的儿童更有可能发育迟缓。在<5 岁儿童中，儿童饥饿和中等饮食多样性与消瘦显著相关。在 5-9 岁儿童中，没有任何粮食安全指标与发育迟缓有关。在发育迟缓的儿童中，70.2%的儿童与超重或肥胖的成年人生活在一起。在成年人中，饮食多样性的增加增加了超重和肥胖的风险。
饮食多样性可作为<5 岁和青少年营养状况不佳的替代指标，但饮食多样性与成人肥胖之间的关系更为复杂。鉴于许多低收入和中等收入国家存在营养不良的双重负担，饮食质量指标仍然很重要。这些工具可以进一步细化，以包括加工食品的额外类别。鉴于收集此类数据相对简单，因此将其纳入国家调查将有所改进。
