Longitudinal transitions of the double burden of overweight and stunting from childhood to early adulthood in India, Peru, and Vietnam
File(s)
Published version
Author(s)
Escher, Nora
Carillo-Larco, Rodrigo M
Parnham, Jennie C
Curi-Quinto, Katherine
Ghosh-Jerath, Suparna
Type
Journal Article
Abstract
Background
Examining trajectories of undernutrition and overnutrition separately limits understanding of the double burden of malnutrition. We investigated transitions between normal, stunting, overweight, and concurrent stunting and overweight (CSO) and associations with sociodemographic factors in children and adolescents.
Methods
We used data from the Young Lives cohort in India, Peru, and Vietnam, which follows children 1 to 15 (N=5,413) and 8 to 22 years (N=2,225) over five rounds between 2002 and 2016. We estimated transitions between nutritional states using a Markov chain model and estimated sociodemographic associations employing a logit parametrization.
Results
Transitions into stunting peaked in ages 1-5 years (India: 22.9%, Peru: 17.6%, Vietnam: 14.8%), while stunting reversal was highest during adolescence across all countries. Transitions into overweight peaked in ages 19-22, while overweight reversal increased in ages 1-5 and 12-15 years. Transitions away from stunting to overweight were rare; more commonly, stunted individuals developed overweight while remaining stunted, leading to a CSO state. In Peru, 20.2% of 19-year-olds who were stunted reached CSO by age 22, with 4% shifting from stunted to overweight. Reversion to a normal state is least likely for those in a CSO state. Household wealth gradually reduced the likelihood of transitioning into stunting (odds ratios (ORs) for wealthiest quartile in Peru: 0.29; 95% confidence interval (CI): 0.20 to 0.41, India: 0.43; 95% CI: 0.32 to 0.57, Vietnam: 0.36; 95% CI: 0.26 to 0.50), with stunting reversal only being more likely in the two wealthiest quartiles across all countries (ORs for wealthiest quartile in Peru: 2.39; 95% CI: 1.57 to 3.65, India: 1.28; 95% CI: 1.05 to 1.54, Vietnam: 1.89; 95% CI: 1.23 to 2.91). In Vietnam, only the richest quartile was at higher risk of transitioning into overweight (OR: 1.87; 95% CI: 1.28 to 2.72), while in Peru and India, the risk gradually rose across all wealth quartiles (ORs for wealthiest quartile in Peru: 2.84; 95% CI: 2.14 to 3.77, India: 2.99; 95% CI: 1.61 to 5.54).
Conclusions
Childhood and adolescence represent critical periods for prevention and reversal of stunting and overweight, thereby averting the development of CSO later in life. Context-specific interventions are crucial for preventing disparate transitions towards the double burden of malnutrition across socioeconomic groups.
Examining trajectories of undernutrition and overnutrition separately limits understanding of the double burden of malnutrition. We investigated transitions between normal, stunting, overweight, and concurrent stunting and overweight (CSO) and associations with sociodemographic factors in children and adolescents.
Methods
We used data from the Young Lives cohort in India, Peru, and Vietnam, which follows children 1 to 15 (N=5,413) and 8 to 22 years (N=2,225) over five rounds between 2002 and 2016. We estimated transitions between nutritional states using a Markov chain model and estimated sociodemographic associations employing a logit parametrization.
Results
Transitions into stunting peaked in ages 1-5 years (India: 22.9%, Peru: 17.6%, Vietnam: 14.8%), while stunting reversal was highest during adolescence across all countries. Transitions into overweight peaked in ages 19-22, while overweight reversal increased in ages 1-5 and 12-15 years. Transitions away from stunting to overweight were rare; more commonly, stunted individuals developed overweight while remaining stunted, leading to a CSO state. In Peru, 20.2% of 19-year-olds who were stunted reached CSO by age 22, with 4% shifting from stunted to overweight. Reversion to a normal state is least likely for those in a CSO state. Household wealth gradually reduced the likelihood of transitioning into stunting (odds ratios (ORs) for wealthiest quartile in Peru: 0.29; 95% confidence interval (CI): 0.20 to 0.41, India: 0.43; 95% CI: 0.32 to 0.57, Vietnam: 0.36; 95% CI: 0.26 to 0.50), with stunting reversal only being more likely in the two wealthiest quartiles across all countries (ORs for wealthiest quartile in Peru: 2.39; 95% CI: 1.57 to 3.65, India: 1.28; 95% CI: 1.05 to 1.54, Vietnam: 1.89; 95% CI: 1.23 to 2.91). In Vietnam, only the richest quartile was at higher risk of transitioning into overweight (OR: 1.87; 95% CI: 1.28 to 2.72), while in Peru and India, the risk gradually rose across all wealth quartiles (ORs for wealthiest quartile in Peru: 2.84; 95% CI: 2.14 to 3.77, India: 2.99; 95% CI: 1.61 to 5.54).
Conclusions
Childhood and adolescence represent critical periods for prevention and reversal of stunting and overweight, thereby averting the development of CSO later in life. Context-specific interventions are crucial for preventing disparate transitions towards the double burden of malnutrition across socioeconomic groups.
Date Issued
2024-12
Date Acceptance
2024-10-29
Citation
International Journal of Epidemiology, 2024, 53 (6)
ISSN
0300-5771
Publisher
Oxford University Press
Journal / Book Title
International Journal of Epidemiology
Volume
53
Issue
6
Copyright Statement
© The Author(s) 2024. Published by Oxford University Press on behalf of the International Epidemiological Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://academic.oup.com/ije/article/53/6/dyae151/7900877
Publication Status
Published
Article Number
dyae151
Date Publish Online
2024-11-14