The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children

Abstract

BackgroundLow- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa.MethodsA cross-sectional growth survey was conducted involving 3511 children and adolescents 1-20 years, selected through stratified random sampling from a previously enumerated population living in Agincourt sub-district, Mpumalanga Province, South Africa. Anthropometric measurements including height, weight and waist circumference were taken using standard procedures. Tanner pubertal assessment was conducted among adolescents 9-20 years. Growth z-scores were generated using 2006 WHO standards for children up to five years and 1977 NCHS/WHO reference for older children. Overweight and obesity for those <18 years were determined using International Obesity Task Force BMI cut-offs, while adult cut-offs of BMI ≥ 25 and ≥ 30 kg/m2 for overweight and obesity respectively were used for those ≥ 18 years. Waist circumference cut-offs of ≥ 94 cm for males and ≥ 80 cm for females and waist-to-height ratio of 0.5 for both sexes were used to determine metabolic disease risk in adolescents.ResultsAbout one in five children aged 1-4 years was stunted; one in three of those aged one year. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was substantial among adolescent girls, increasing with age and reaching approximately 20-25% in late adolescence. Central obesity was prevalent among adolescent girls, increasing with sexual maturation and reaching a peak of 35% at Tanner Stage 5, indicating increased risk for metabolic disease.ConclusionsThe study highlights that in transitional societies, early stunting and adolescent obesity may co-exist in the same socio-geographic population. It is likely that this profile relates to changes in nutrition and diet, but variation in factors such as infectious disease burden and physical activity patterns, as well as social influences, need to be investigated. As obesity and adult short stature are risk factors for metabolic syndrome and Type 2 diabetes, this combination of early stunting and adolescent obesity may be an explosive combination.

Overweight, stunting, and concurrent overweight and stunting observed over 3 years in Vietnamese children

“…Regarding concurrent undernutrition and overnutrition in Vietnam, the prevalence we found is comparable to other low- and middle-income countries [11,12]. Between 1945 and 1975, Vietnam experienced a long period of food shortage due to war, which was followed by post-war consequences, resulting in a high prevalence of underweight and stunting.…”

Phenotypic consequences in black South African Fanconi anemia patients homozygous for a founder mutation

“…Compared with a cohort of healthy black South African children as published by Kimani-Murage et al, 12 patients with FA were found to be significantly underweight (weight for age z-score <−2) and stunted (height for age z-score <−2) for age ( Table 1).…”

“…Weight for age z-scores could only be calculated in children younger than the age of 10 years as the World Health Organization calculators do not allow for a calculation in those older than 10 years of age. The z-scores were used to compare the growth measurements of the study group with a cohort of healthy (cohort of rural South African children presumed not to have significant chronic illness or disease) black South African children as published by Kimani-Murage et al 12 The frequency of individuals with weight for age and height for age z-scores <−2 in the two groups was compared using Fisher's exact test. The frequency of each described physical phenotypic parameter was calculated.…”

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“…Africa is at an early stage of epidemiological transition from communicable to chronic, non-communicable diseases (NCD) (Oladapo et. al., 2010;Kimani-Murage et. al., 2010).…”