Obsesity, undernutrition and the double burden of disease in the Free State

Abstract

Introduction: Stunting in childhood predisposes to obesity, increasing the risk for chronic diseases of lifestyle in adulthood (i.e. the double burden of disease). Objectives: To gain insight into the eating patterns and anthropometric nutritional status of children (<7 years) and adults (25 to 64 years) in the rural- and urban Free State. Methods: Dietary intake was measured in 60 rural- and 116 urban children; and 553 rural- and 419 urban adults using 24- hour recall and food frequency questionnaires. Anthropometric data was measured using WHO guidelines. Results: Mean energy intake was 4254 kJ for rural children younger than two years (56,9% carbohydrates; 17,2% protein; 25,7% fat) and 3292kJ for urban children younger than two years (64,2% carbohydrates; 19,5% protein; 20,1% fat). The percentage of energy from carbohydrates and protein were within prudent dietary guidelines (carbohydrates (CHO): 45-65%; protein: 5-20%), while the percentage energy from fat was lower than the recommended 30-40%. Mean energy intake for rural children older than two years was 5581kJ (57,5% carbohydrates; 16,9% protein; 28,7% fat) and 4220kJ for urban children (65,5% carbohydrates; 17,9% protein; 20,3% fat). As in the younger children, the percentage of energy from carbohydrates and protein were within prudent dietary guidelines (CHO: 45-65%; protein: 10-30%; fat: 25-35%) except for fat intake which was lower than recommended among urban participants. The average energy intake for all men was 8040 kJ (61% carbohydrates; 17,8% protein; and 24,3% fat) and for all women in the current study was 7243 kJ (61,7% carbohydrates; 17,3% protein and 24,5% fat). Macronutirent distributions were thus within prudent guidelines (CHO: 45-65%; protein: 10-35%; fat: 20-35%). The energy intake was below the estimated energy requirements (EER) range of 10143 kJ for sedentary men and 7947 kJ for sedentary women. More than half (65,6%) of rural females and two-thirds (66,2%) of urban females were overweight or obese (bodymass- index (BMI) >25kg/m2). Fewer men were overweight or obese (23,3% rural men and 16% urban men). A significantly larger percentage of urban than rural men (urban: 61,0%; rural: 43,6%) had a normal BMI (18,5 to 24,9 kg/m2) (p=0.007). A third (33,1%) of rural men and 23% of urban men were underweight (BMI <18,5kg/m2). Mean BMI for men was within the normal range at 20 kg/m2. For women mean BMI fell in the overweight range at 28 kg/m2. Significantly more urban than rural men had a normal waist circumference (<94 cm) (p=0.002) and similarly, significantly more urban (32%) than rural women (24,4%) had a normal waist circumference (<80 cm) (p=0.03). Significantly more rural than urban men had a waist circumference >94 cm (p=0.01), placing them at risk for developing chronic diseases of lifestyle (CDLs). About one-fifth (17,8%) of rural and 19,4% of urban women were at risk (>80 cm). Significantly more rural women (57,9%) were at high risk of developing CDLs (>88cm) than urban women (48,6%) (p=0.02). Median waist circumference for rural women was 92 cm (high risk) and for urban women 87cm (at risk). The median waist circumference for rural men was 78,5 cm (normal) and for urban men 76 cm (normal). Rural children were more often underweight (weight-for-age <-2 standard deviations (SD))(rural: 31,7%; urban: 17,3%) than urban children. In contrast to what was expected, urban children were more often stunted (height-forage <-2SD) than rural children (rural: 38,4%; urban: 44,0%). Prevalence of wasting (weight-for-height <-2SD) was similar in rural and urban children (rural: 11,9%; urban: 10,1%). A double burden of undernutrition in children and overweight in caretakers was confirmed in this sample, with 63,2% of stunted- and 66,7% of underweight rural children and 71,9% of stunted- and 66,7% of underweight children in urban areas living with an overweight/obese caregiver. Conclusion: A double burden of disease and nutrition transition were confirmed in both rural- and urban communities.