期刊论文详细信息
BMC Public Health
The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries
Jason R Randall2  David Teye Doku1  Hesham El-Sayed3  Taru Manyanga2 
[1] Department of Population and Health, University of Cape Coast, Cape Coast, Ghana;Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada;Department of Pediatrics, Faculty of Medicine, Suez Canal University, Suez, Egypt
关键词: Prevalence and risk factors;    Obesity;    Overweight;    Underweight;   
Others  :  1128149
DOI  :  10.1186/1471-2458-14-887
 received in 2013-09-08, accepted in 2014-08-15,  发布年份 2014
PDF
【 摘 要 】

Background

The burden caused by the coexistence of obesity and underweight in Low and Middle Income Countries is a challenge to public health. While prevalence of underweight among youth has been well documented in these countries, overweight, obesity and their associated risk factors are not well understood unlike in high income countries.

Methods

Cross-sectional data from the Global School-based Student Health Survey (GSHS) conducted in seven African countries were used for this study. The survey used a clustered design to obtain a representative sample (n = 23496) from randomly selected schools. 53.6% of the sample was male, and participants ranged in age from 11-17 years old. Body Mass Index (BMI) was calculated using age and sex adjusted self-reported heights and weights. Classification of weight status was based on the 2007 World Health Organization growth charts (BMI-for-age and sex). Multivariable Logistic Regression reporting Odds Ratios was used to assess potential risk factors on BMI, adjusting for age, sex, and country. Statistical analyses were performed with Stata with an alpha of 0.05 and reporting 95% confidence intervals.

Results

Unadjusted rates of being underweight varied from 12.6% (Egypt) to 31.9% (Djibouti), while being overweight ranged from 8.7% (Ghana) to 31.4% (Egypt). Obesity rates ranged from 0.6% (Benin) to 9.3% (Egypt). Females had a higher overweight prevalence for every age group in five of the countries, exceptions being Egypt and Malawi. Overall, being overweight was more prevalent among younger (≤12) adolescents and decreased with age. Males had a higher prevalence of being underweight than females for every country. There was a tendency for the prevalence of being underweight to increase starting in the early teens and decrease between ages 15 and 16. Most of the potential risk factors captured by the GSHS were not significantly associated with weight status.

Conclusions

The prevalence of both overweight and underweight was relatively high, demonstrating the existence of the double burden of malnutrition among adolescents in developing countries. Several factors were not associated with weight status suggesting the need to explore other potential risk factors for overweight and underweight, including genetic factors and socioeconomic status.

【 授权许可】

   
2014 Manyanga et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150222113007387.pdf 542KB PDF download
Figure 3. 56KB Image download
Figure 2. 60KB Image download
Figure 1. 57KB Image download
【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】
  • [1]Ho TF, Yip WC, Tay JS, Rajan U: Social class distribution of obese Chinese children. J Singapore Paediatr Soc 1991, 33(1–2):55-58.
  • [2]Ji CY, Cheng TO: Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol 2008, 131(1):1-8.
  • [3]Ben-Sefer E, Ben-Natan M, Ehrenfeld M: Childhood obesity: current literature, policy and implications for practice. Int Nurs Rev 2009, 56(2):166-173.
  • [4]Grijalva-Eternod CS, Wells JC, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C, Meziani C, Wilkinson C, Spiegel P, Seal AJ: The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees. PLoS Med 2012, 9(10):e1001320.
  • [5]Mindru DE, Moraru E: Risk factors and their implications in the epidemiology of pediatric obesity. Rev Med Chir Soc Med Nat Iasi 2012, 116(3):739-745.
  • [6]Florencio TM, Ferreira HS, de Franca AP, Cavalcante JC, Sawaya AL: Obesity and undernutrition in a very-low-income population in the city of Maceio, northeastern Brazil. Br J Nutr 2001, 86(2):277-284.
  • [7]Reddy SP, Resnicow K, James S, Kambaran N, Omardien R, Mbewu AD: Underweight, overweight and obesity among South African adolescents: results of the 2002 National Youth Risk Behaviour Survey. Public Health Nutr 2009, 12(2):203-207.
  • [8]Verstraeten R, Roberfroid D, Lachat C, Leroy JL, Holdsworth M, Maes L, Kolsteren PW: Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review. Am J Clin Nutr 2012, 96(2):415-438.
  • [9]Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R: Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013, 382(9890):427-451.
  • [10]Ergo A, Gwatkin DR, Shekar M: What difference do the new WHO child growth standards make for the prevalence and socioeconomic distribution of undernutrition? Food Nutr Bull 2009, 30(1):3-15.
  • [11]Marriott BP, White A, Hadden L, Davies JC, Wallingford JC: World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 2012, 8(3):354-370.
  • [12]McDonald CM, Olofin I, Flaxman S, Fawzi WW, Spiegelman D, Caulfield LE, Black RE, Ezzati M, Danaei G: The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr 2013, 97(4):896-901.
  • [13]Wells JC: Obesity as malnutrition: the role of capitalism in the obesity global epidemic. Am J Hum Biol 2012, 24(3):261-276.
  • [14]Delisle HF, Receveur O, Agueh V, Nishida C: Pilot project of the Nutrition-Friendly School Initiative (NFSI) in Ouagadougou, Burkina Faso and Cotonou, Benin, in West Africa. Glob Health Promot 2013, 20(1):39-49.
  • [15]Tanumihardjo SA, Anderson C, Kaufer-Horwitz M, Bode L, Emenaker NJ, Haqq AM, Satia JA, Silver HJ, Stadler DD: Poverty, obesity, and malnutrition: an international perspective recognizing the paradox. J Am Diet Assoc 2007, 107(11):1966-1972.
  • [16]Kimani-Murage EW: Exploring the paradox: double burden of malnutrition in rural South Africa. Global Health Action 2013, 6:19249.
  • [17]Park MH, Falconer C, Viner RM, Kinra S: The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 2012, 13(11):985-1000.
  • [18]Reilly JJ, Kelly J: Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes 2011, 35(7):891-898.
  • [19]Bovet P, Kizirian N, Madeleine G, Blossner M, Chiolero A: Prevalence of thinness in children and adolescents in the Seychelles: comparison of two international growth references. Nutr J 2011, 10:65.
  • [20]Craig E, Reilly J, Bland R: Body fatness or anthropometry for assessment of unhealthy weight status? comparison between methods in South African children and adolescents. Public Health Nutr 2013, 16(11):2005-2013.
  • [21]Dabone C, Delisle HF, Receveur O: Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou (Burkina Faso). Nutr J 2011, 10:34.
  • [22]Muller O, Krawinkel M: Malnutrition and health in developing countries. CMAJ 2005, 173(3):279-286.
  • [23]Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N: The politics of reducing malnutrition: building commitment and accelerating progress. Lancet 2013, 382(9891):552-569.
  • [24]de Onis M, Blossner M, Borghi E, Frongillo EA, Morris R: Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA 2004, 291(21):2600-2606.
  • [25]Lobstein T, Baur L, Uauy R: Obesity in children and young people: a crisis in public health. Obes Rev 2004, 5(Suppl 1):4-104.
  • [26]te Velde SJ, van Nassau F, Uijtdewilligen L, van Stralen MM, Cardon G, De Craemer M, Manios Y, Brug J, Chinapaw MJ: Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Obes Rev 2012, 13(Suppl 1):56-74.
  • [27]Al-Haifi AR, Al-Fayez MA, Al-Athari BI, Al-Ajmi FA, Allafi AR, Al-Hazzaa HM, Musaiger AO: Relative contribution of physical activity, sedentary behaviors, and dietary habits to the prevalence of obesity among Kuwaiti adolescents. Food Nutr Bull 2013, 34(1):6-13.
  • [28]Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC: Tracking of obesity-related behaviours from childhood to adulthood: a systematic review. Maturitas 2011, 70(3):266-284.
  • [29]Ey Chua EY, Zalilah MS, Ys Chin YS, Norhasmah S: Dietary diversity is associated with nutritional status of Orang Asli children in Krau Wildlife Reserve, Pahang. Malaysian J Nutr 2012, 18(1):1-13.
  • [30]Nasreddine L, Naja F, Akl C, Chamieh MC, Karam S, Sibai AM, Hwalla N: Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in lebanese children and adolescents. Nutrients 2014, 6(3):1038-1062.
  • [31]Williams SL, Mummery WK: Links between adolescent physical activity, body mass index, and adolescent and parent characteristics. Health Educ Behav 2011, 38(5):510-520.
  • [32]Berge JM, Wall M, Larson N, Forsyth A, Bauer KW, Neumark-Sztainer D: Youth dietary intake and weight status: healthful neighborhood food environments enhance the protective role of supportive family home environments. Health Place 2014, 26:69-77.
  • [33]Shields M, Tremblay MS: Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points. Int J Pediatr Obes 2010, 5(3):265-273.
  • [34]Yu BN, Protudjer JL, Anderson K, Fieldhouse P: Weight status and determinants of health in Manitoba children and youth. Can J Diet Pract Res 2010, 71(3):115-121.
  • [35]Meijers JM, van Bokhorst-de van der Schueren MA, Schols JM, Soeters PB, Halfens RJ: Defining malnutrition: mission or mission impossible? Nutrition (Burbank, Los Angeles County, Calif) 2010, 26(4):432-440.
  • [36]Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN, Monczka JL, Plogsted SW, Schwenk WF: Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr 2013, 37(4):460-481.
  • [37]Karnik S, Kanekar A: Childhood obesity: a global public health crisis. Int J Prev Med 2012, 3(1):1-7.
  • [38]Pereira HR, Bobbio TG, Antonio MA, Barros Filho Ade A: Childhood and adolescent obesity: how many extra calories are responsible for excess of weight? Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo 2013, 31(2):252-257.
  • [39]Adesina AF, Peterside O, Anochie I, Akani NA: Weight status of adolescents in secondary schools in port Harcourt using Body Mass Index (BMI). Ital J Pediatr 2012, 38:31.
  • [40]WHO: Global school-based student health survey. WHO. http://www.who.int/chp/gshs/en webcite
  • [41]WHO Multicentre Growth Reference Study Group: WHO child growth standards based on length/height, weight and age. Acta Paediatr (Oslo, Norway : 1992) Suppl 2006, 450:76-85.
  • [42]de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J: Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007, 85(9):660-667.
  • [43]StataCorp: Stata Statistical Software: Release 13. College Station: StataCorp LP; 2013.
  • [44]WHO: GSHS data release and publication policies and procedures. http://www.who.int/chp/gshs/policy/en webcite
  • [45]Assuncao MC, Muniz LC, Dumith SC, Clark VL, Araujo CL, Goncalves H, Menezes AM, Hallal PC: Predictors of body mass index change from 11 to 15 years of age: the 1993 Pelotas (Brazil) birth cohort study. J Adolesc Health 2012, 51(6 Suppl):S65-S69.
  • [46]Galal OM: The nutrition transition in Egypt: obesity, undernutrition and the food consumption context. Public Health Nutr 2002, 5(1A):141-148.
  • [47]Jackson RT, Rashed M, Saad-Eldin R: Rural urban differences in weight, body image, and dieting behavior among adolescent Egyptian schoolgirls. Int J Food Sci Nutr 2003, 54(1):1-11.
  • [48]Salazar-Martinez E, Allen B, Fernandez-Ortega C, Torres-Mejia G, Galal O, Lazcano-Ponce E: Overweight and obesity status among adolescents from Mexico and Egypt. Arch Med Res 2006, 37(4):535-542.
  • [49]Wamba PC, Enyong Oben J, Cianflone K: Prevalence of overweight, obesity, and thinness in Cameroon urban children and adolescents. J Obes 2013, 2013:737592.
  • [50]Mukuddem-Petersen J, Kruger HS: Association between stunting and overweight among 10-15-y-old children in the North West Province of South Africa: the THUSA BANA Study. Int J Obes Relat Metab Disord 2004, 28(7):842-851.
  • [51]Pongou R, Ezzati M, Salomon JA: Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health 2006, 6:98.
  • [52]Omigbodun OO, Adediran KI, Akinyemi JO, Omigbodun AO, Adedokun BO, Esan O: Gender and rural-urban differences in the nutritional status of in-school adolescents in south-western Nigeria. J Biosoc Sci 2010, 42(5):653-676.
  • [53]Mehio Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N: Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab 2010, 57(3–4):193-203.
  • [54]Puoane T, Tsolekile L, Steyn N: Perceptions about body image and sizes among Black African girls living in Cape Town. Ethn Dis 2010, 20(1):29-34.
  • [55]Rguibi M, Belahsen R: Overweight and obesity among urban Sahraoui women of South Morocco. Ethn Dis 2004, 14(4):542-547.
  • [56]Rguibi M, Belahsen R: Fattening practices among Moroccan Saharawi women. East Mediterr Health J 2006, 12(5):619-624.
  • [57]Musa DI, Toriola AL, Monyeki MA, Lawal B: Prevalence of childhood and adolescent overweight and obesity in Benue State, Nigeria. Trop Med Int Health 2012, 17(11):1369-1375.
  • [58]Peltzer K, Pengpid S: Overweight and obesity and associated factors among school-aged adolescents in Ghana and Uganda. Int J Environ Res Public Health 2011, 8(10):3859-3870.
  • [59]Bovet P, Chiolero A, Madeleine G, Paccaud F: Prevalence of overweight and underweight in public and private schools in the Seychelles. Int J Pediatr Obes 2010, 5(3):274-278.
  • [60]Tang KH, Nguyen HH, Dibley MJ, Sibbritt DW, Phan NT, Tran TM: Factors associated with adolescent overweight/obesity in Ho Chi Minh city. Int J Pediatr Obes 2010, 5(5):396-403.
  • [61]Yngve A, De Bourdeaudhuij I, Wolf A, Grjibovski A, Brug J, Due P, Ehrenblad B, Elmadfa I, Franchini B, Klepp KI, Poortvliet E, Rasmussen M, Thorsdottir I, Perez Rodriqo C: Differences in prevalence of overweight and stunting in 11-year olds across Europe: the pro children study. Eur J Public Health 2008, 18(2):126-130.
  • [62]Peltzer K: Leisure time physical activity and sedentary behavior and substance use among in-school adolescents in eight African countries. Int J Behav Med 2010, 17(4):271-278.
  • [63]Mamabolo RL, Kruger HS, Lennox A, Monyeki MA, Pienaar AE, Underhay C, Czlapka-Matyasik M: Habitual physical activity and body composition of black township adolescents residing in the North West Province, South Africa. Public Health Nutr 2007, 10(10):1047-1056.
  • [64]Ahmed J, Laghari A, Naseer M, Mehraj V: Prevalence of and factors associated with obesity among Pakistani schoolchildren: a school-based, cross-sectional study. East Mediterr Health J 2013, 19(3):242-247.
  • [65]Becker AE, Roberts AL, Perloe A, Bainivualiku A, Richards LK, Gilman SE, Striegel-Moore RH: Youth health-risk behavior assessment in Fiji: the reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls. Ethn Health 2010, 15(2):181-197.
  • [66]Beck J, Schaefer CA, Nace H, Steffen AD, Nigg C, Brink L, Hill JO, Browning RC: Accuracy of self-reported height and weight in children aged 6 to 11 years. Prev Chronic Dis 2012, 9:E119.
  • [67]Dubois L, Girad M: Accuracy of maternal reports of pre-schoolers’ weights and heights as estimates of BMI values. Int J Epidemiol 2007, 36(1):132-138.
  • [68]Elgar FJ, Roberts C, Tudor-Smith C, Moore L: Validity of self-reported height and weight and predictors of bias in adolescents. J Adolesc Health 2005, 37(5):371-375.
  • [69]Hayes AJ, Kortt MA, Clarke PM, Brandrup JD: Estimating equations to correct self-reported height and weight: implications for prevalence of overweight and obesity in Australia. Aust N Z J Public Health 2008, 32(6):542-545.
  • [70]Zhou X, Dibley MJ, Cheng Y, Ouyang X, Yan H: Validity of self-reported weight, height and resultant body mass index in Chinese adolescents and factors associated with errors in self-reports. BMC Public Health 2010, 10:190.
  • [71]Clark AE, Taylor JY, Wu CY, Smith JA: Alternative methods for measuring obesity in African American women. Yale J Biol Med 2013, 86(1):29-39.
  • [72]Cornier MA, Despres JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, Lopez-Jimenez F, Rao G, St-Onge MP, Towfighi A, Poirier P, American Heart Association Obesity Committee of the Council on Nutrition; Physical Activity and Metabolism; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Epidemiology and Prevention; Council on the Kidney in Cardiovascular Disease and Stroke Council: Assessing adiposity: a scientific statement from the American Heart Association. Circulation 2011, 124(18):1996-2019.
  • [73]Ferrante E, Pitzalis G, Vania A, De Angelis P, Guidi R, Fontana L, Ferrante L, Cervoni M, Multari G: Nutritional status, obesity and metabolic control in children with type 1 diabetes mellitus. Minerva Pediatr 1999, 51(3):39-46.
  • [74]Lucca A, Moura EC: Validity and reliability of self-reported weight, height and body mass index from telephone interviews. Cad Saude Publica 2010, 26(1):110-122.
  • [75]Twells LK, Newhook LA: Obesity prevalence estimates in a Canadian regional population of preschool children using variant growth references. BMC Pediatr 2011, 11:21.
  • [76]Huerta M, Gdalevich M, Tlashadze A, Scharf S, Schlezinger M, Efrati O, Bibi H: Appropriateness of US and international BMI-for-age reference curves in defining adiposity among Israeli school children. Eur J Pediatr 2007, 166(6):573-578.
  文献评价指标  
  下载次数:10次 浏览次数:4次