The double burden of malnutrition among adolescents: Analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries

Rishi Caleyachetty, G. N. Thomas, Andre P. Kengne, Justin B. Echouffo-Tcheugui, Samantha Schilsky, Juneida Khodabocus, Ricardo Uauy

Research output: Contribution to journalReview article

Abstract

Background: Adults and young children in countries experiencing the nutrition transition are known to be affected simultaneously by undernutrition and overnutrition. Adolescence is a critical period for growth and development. Yet, it is unknown to what extent this double burden of malnutrition affects adolescents in low- and middleincome countries (LMICs) and the macrolevel contextual factors associated with the double burden of malnutrition. Objective: The aim was to quantify the magnitude of the double burden of malnutrition among adolescents and to examine the potential sources of heterogeneity in prevalence estimates across LMICs. Design:We used individual-participant data from the Global School- Based Student Health and Health Behavior in School-Aged Children surveys conducted in 57 LMICs between 2003 and 2013, comprising 129,276 adolescents aged 12-15 y. Pooled estimates of stunting, thinness, or both; overweight or obesity; and concurrent stunting and overweight or obesity were calculated overall, by regions, and stratified by sex, with random-effects meta-analysis. Guided by UNICEF's conceptual framework for child malnutrition, we used ecological linear regression models to examine the association between macrolevel contextual factors (internal conflict, lack of democracy, gross domestic product, food insecurity, urbanization, and survey year) and stunting, thinness, and overweight and obesity prevalence, respectively. Results: The prevalence of stunting was 10.2% (95% CI: 8.3%, 12.2%) and of thinness was 5.5% (95% CI: 4.3%, 6.9%). The prevalence of overweight or obesity was 21.4% (95% CI: 18.6%, 24.2%). Between 38.4% and 58.7% of the variance in adolescent malnutrition was explained by macrolevel contextual factors. The prevalence of concurrent stunting and overweight or obesity was 2.0% (95% CI: 1.7%, 2.5%). Conclusions: The double burden of malnutrition among adolescents in LMICs is common. Context-sensitive implementation and scaleup of interventions and policies for the double burden of malnutrition are needed to achieve the Sustainable Development Goal to end malnutrition in all of its forms by 2030. This trial was registered at clinicaltrials.gov as NCT03346473.

Original languageEnglish (US)
Pages (from-to)414-424
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Volume108
Issue number2
DOIs
StatePublished - 2018

Keywords

  • Adolescent
  • Double burden
  • Malnutrition
  • Obese
  • Stunting
  • Thinness

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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