Seedat Faheem, Tollman Stephen M, Twine Wayne, Cappola Anne R, Wade Alisha N
Division of Endocrinology and Metabolism, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa.
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
BMC Nutr. 2024 Jun 10;10(1):84. doi: 10.1186/s40795-024-00890-6.
Double malnutrition (co-existing overnutrition and undernutrition) is increasingly prevalent in sub-Saharan Africa due to rapid epidemiological and nutritional transitions. In this region, studies of double malnutrition have largely been conducted at country and household level, with individual-level studies primarily limited to children and women of reproductive age. We investigated the prevalence and determinants of individual-level double malnutrition in middle-aged and older adults who constitute an increasing proportion of the sub-Saharan African population.
250 individuals aged 40-70 years (50% women) and resident in the Agincourt Health and socio-Demographic Surveillance System in rural Mpumalanga province, South Africa, were randomly selected. Double malnutrition was defined as overweight/obesity and anaemia only, overweight/obesity and iodine insufficiency, or overweight/obesity and any micronutrient deficiency (anaemia and/or iodine insufficiency). The Chi-squared goodness of fit test was used to compare the expected and observed numbers of individuals with the type of double malnutrition. Logistic regression was used to investigate determinants of each type of double malnutrition.
Double malnutrition was present in 22-36% of participants, depending on the definition used. All types of double malnutrition were more common in women than in men (overweight/obesity and anaemia: 34% vs. 10.2%, p < 0.01; overweight/obesity and iodine insufficiency: 32% vs. 12.2%, p < 0.01 and overweight/obesity and any micronutrient deficiency: 50.5% vs. 20.4%, p < 0.01). There were no differences between the overall expected and observed numbers of individuals with combinations of overweight and micronutrient deficiencies [overweight/obesity and anaemia (p = 0.28), overweight/obesity and iodine insufficiency (p = 0.27) or overweight/obesity and any micronutrient deficiency (p = 0.99)]. In models adjusted for socio-demographic factors, HIV and antiretroviral drug status, and food security or dietary diversity, men were 84-85% less likely than women to have overweight/obesity and anaemia, 65% less likely to have overweight/obesity and iodine insufficiency and 74% less likely to have overweight/obesity and any micronutrient deficiency.
Individual-level double malnutrition is prevalent in middle-aged and older adults in a rural sub-Saharan African community. Interventions to improve nutrition in similar settings should target individuals throughout the life course and a focus on women may be warranted.
由于快速的流行病学和营养转变，双重营养不良（即同时存在营养过剩和营养不足）在撒哈拉以南非洲地区日益普遍。在该地区，对双重营养不良的研究主要在国家和家庭层面进行，个体层面的研究主要局限于儿童和育龄妇女。我们调查了在撒哈拉以南非洲人口中占比日益增加的中年及老年人个体层面双重营养不良的患病率及其决定因素。
随机选取了250名年龄在40 - 70岁之间（50%为女性）、居住在南非姆普马兰加省农村阿金库尔健康与社会人口监测系统地区的居民。双重营养不良被定义为仅超重/肥胖与贫血、超重/肥胖与碘缺乏，或超重/肥胖与任何微量营养素缺乏（贫血和/或碘缺乏）。采用卡方拟合优度检验来比较双重营养不良类型的预期个体数和观察个体数。使用逻辑回归分析来研究每种双重营养不良类型的决定因素。
根据所使用的定义，22% - 36%的参与者存在双重营养不良。所有类型的双重营养不良在女性中比在男性中更常见（超重/肥胖与贫血：34%对10.2%，p < 0.01；超重/肥胖与碘缺乏：32%对12.2%，p < 0.01；超重/肥胖与任何微量营养素缺乏：50.5%对20.4%，p < 0.01）。超重与微量营养素缺乏组合的个体总体预期数和观察数之间没有差异[超重/肥胖与贫血（p = 0.28）、超重/肥胖与碘缺乏（p = 0.27）或超重/肥胖与任何微量营养素缺乏（p = 0.99）]。在对社会人口因素、艾滋病毒和抗逆转录病毒药物状态以及粮食安全或饮食多样性进行调整的模型中，男性患超重/肥胖与贫血的可能性比女性低84% - 85%，患超重/肥胖与碘缺乏的可能性低65%，患超重/肥胖与任何微量营养素缺乏的可能性低74%。
在撒哈拉以南非洲农村社区的中年及老年人中，个体层面的双重营养不良很普遍。在类似环境中改善营养的干预措施应针对整个生命历程中的个体，可能有必要重点关注女性。
