Double burden of malnutrition among children under 5 in poor areas of China

Yan, Zhuangzhi; Huang, Xiaona; Yang, Yuning; Liu, Xiaoli; Yang, Chenlu; Wang, Anqi; Zhou, Hong

doi:10.1371/journal.pone.0204142

Cited by 48 publications

(53 citation statements)

References 27 publications

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“…Other studies that have examined DBM among preschool children have predominantly used anthropometric indicators to define both over- and under-nutrition ( 31 , 32 ). At the population level, DBM is often characterized as coexistence of OWOB children or adults and stunted or underweight children ( 33 , 34 ); at the individual level, studies have reported the co-occurrence of OWOB and stunting among children ( 14 ). Other DBM analyses have used anemia as a measure of undernutrition ( 16 ), with the advantage that these data are widely available through Demographic and Health Surveys.…”

Section: Discussionmentioning

confidence: 99%

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

Engle‐Stone

Guo

Ismaily

et al. 2020

The American Journal of Clinical Nutrition

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Background Child overweight prevalence is increasing globally, but micronutrient deficiencies persist. Objectives We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting. Methods We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao–Scott chi-square test and examined predictors of DBM and its components with logistic regression. Results DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%–19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6–23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components. Conclusions Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

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Section: Discussionmentioning

confidence: 99%

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

Engle‐Stone

Guo

Ismaily

et al. 2020

The American Journal of Clinical Nutrition

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“…This is especially true in poor, rural, and ethnic minority areas in China. The prevalence of malnutrition was 19.2% among children under five years in poor areas of China in 2016 [21]. Over 65% of children aged 12–24 months suffered from vitamin D deficiency in 2003 [22].…”

Section: Introductionmentioning

confidence: 99%

Dietary Diversity among Preschoolers: A Cross-Sectional Study in Poor, Rural, and Ethnic Minority Areas of Central South China

Liu

et al. 2019

Nutrients

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The aim of this study was to document the dietary diversity status of preschool children in poor, rural, and ethnic minority areas of Central South China and examine its associated factors both at home and in preschools. A cross-sectional study including 1328 preschool children aged three or five years from two nationally designated poverty counties in Hunan Province was conducted. A dietary diversity score (DDS) was constructed to measure the dietary patterns based on the 24 h recall method. The mean DDS among the sample children was 5.77 (95% confidence interval: 5.70–5.83, range 1 to 9) with a standard deviation of 1.22. Both household characteristics (including the education level of the child’s primary caregiver and the nutritional knowledge of the caregiver) and preschool factors (including the nutritional knowledge of the child’s preschool principal and teachers, nutritional training to children, and the preschool kitchen manager) were positively associated with children’s DDS. The dietary diversity status of children in poor, rural, and ethnic minority areas of Central South China is much lower than that of their peers in other areas. Nutritional education should be provided to caregivers, preschool staff, and children to narrow the gap.

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“…The 2014 data of the Chinese National Survey on Students' Constitution and Health (CNSSCH) showed that the prevalence of undernutrition was 10.0% among Han students [2]. Undernutrition prevalence went up to 19.2% among children under five in the poor areas of China, according to the 2016 data from the United Nations International Children's Emergency Fund (UNICEF) and the National Health and Family Planning Commission of China (NHFPC) [3]. On the other hand, the prevalence of both adult and childhood obesity in China has sharply increased in recent years.…”

Section: Introductionmentioning

confidence: 99%

Nutrition Education Practices of Health Teachers from Shanghai K-12 Schools: The Current Status, Barriers and Willingness to Teach

Fan

Yuan

et al. 2019

IJERPH

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China is facing challenges in both undernutrition and overnutrition, resulting from unhealthy diets. Nutrition education early in life, especially in school settings, has been reported to be effective in addressing these challenges. However, little is known about how nutrition education is delivered in schools in China. This study aimed to investigate the current status of delivering nutrition education by health teachers in Shanghai and to determine the barriers and resources that influence the teachers' practices and their willingness to teach nutrition. In 2016-2017, a cross-sectional questionnaire survey was conducted on 904 health teachers from 823 K-12 schools in Shanghai, China. There were 722 (79.9%) teachers that had the experience of teaching nutrition, but only 137 (19.0% of 722) spent ≥1 h teaching nutrition courses in each school year. Only 18.6% of the teachers had received a formal education in nutrition in college. About 88.5% of teachers expressed their willingness to teach nutrition in the future. The three major reasons for never teaching nutrition were categorized as: nutrition being taught by other teachers (39.5%), willing to teach but lack of knowledge (37.9%), and the subject not being required by school administrators (31.3%). Teachers who spent more time or were more willing to teach nutrition courses were those who were female, from private schools, had a better background in receiving nutrition education, and were more concerned about nutrition. Our data show that nutrition education is at a formative stage in Shanghai, China.

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Double burden of malnutrition among children under 5 in poor areas of China

Cited by 48 publications

References 27 publications

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

Dietary Diversity among Preschoolers: A Cross-Sectional Study in Poor, Rural, and Ethnic Minority Areas of Central South China

Nutrition Education Practices of Health Teachers from Shanghai K-12 Schools: The Current Status, Barriers and Willingness to Teach

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