Associação entre déficit de estatura e sobrepeso em crianças de países de renda baixa e média: avaliando a dupla carga de má nutrição no nível individual e populacional

Abstract

Introduction: The double burden of malnutrition has been described at the individual level, when the same person presents short stature concomitantly with overweight; at household level, when stunting and overweight affect different individuals (often when children present undernutrition and their mothers being overweight); and at the population level, when there are high prevalences of both stunting and overweight in the same population. Low and middle-income countries (LMICs) are suggested to be the most affected by the double burden of malnutrition, as they still struggle with high levels of undernutrition and are increasingly dealing with problems related to overweight and its related diseases. Objective: To assess the relationship between stunting and overweight prevalences and to describe the frequency of the double burden of malnutrition at population level - both national and wealth quintile levels – and at individual level and comparing to what would be expected by chance. Methods: The present analyses are based on Demographic and Health Surveys and Multiple Indicators Clusters Surveys conducted in 93 LMICs since 2005. Stunting and overweight were defined according to WHO classification. Correlations between the prevalence of stunting and overweight were tested using Spearman coefficients. Countries were considered presenting the double burden at population level when stunting >20% and overweight >10%. The expected number of countries presenting this outcome was calculated by the percentage of countries with high stunting prevalence multiplied by the percentage of countries with high overweight. The same approach was also used to assess the double burden within countries’ wealth quintiles. The prevalence of double burden of malnutrition at individual level was compared with the one expected by chance, assuming independent of stunting and overweight are conditions. The observed prevalence was considered higher than expected when its 95% CI lower limit was higher than the 95% CI upper limit of the expected prevalence. Results: There was a moderate inverse correlation between stunting and overweight prevalence at global level (r= -0.44; p<0.001). Nine countries presented double burden of malnutrition at population level, while the expected number only by chance would be 14. The number of countries presenting double burden of malnutrition at population level was lower than the expected one, at national and wealth quintile levels. The high prevalence of stunting and overweight at population level usually varied according to wealth quintiles, except by Syria, Egypt and Iraq. The proportion of children with both stunting and overweight ranged from 0.2% in Kosovo (2013) to 12.4% in Syria (2006). A total of 38 countries (40.9%) presented the observed prevalence higher than the expected one. Conclusion: The double burden of malnutrition at population level seems not to be as significant as expected in terms of number of countries affected and a clear distribution pattern by wealth quintiles was not identified. There is a considerable proportion of countries presenting the double burden at individual level, however, its magnitude is still relatively low.