TY - JOUR
T1 - Longitudinal transitions of the double burden of overweight and stunting from childhood to early adulthood in India, Peru, and Vietnam
AU - Escher, Nora A.
AU - Carrillo-Larco, Rodrigo M.
AU - Parnham, Jennie C.
AU - Curi-Quinto, Katherine
AU - Ghosh-Jerath, Suparna
AU - Millett, Christopher
AU - Seferidi, Paraskevi
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/12/1
Y1 - 2024/12/1
N2 - 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 follow children 1-15 (N = 5413) and 8-22 years (N = 2225) 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) 0.20-0.41; India: 0.43, 95% CI 0.32-0.57; Vietnam: 0.36, 95% CI 0.26-0.50), 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 1.57-3.65; India: 1.28, 95% CI 1.05-1.54; Vietnam: 1.89, 95% CI 1.23-2.91). In Vietnam, only the richest quartile was at higher risk of transitioning into overweight (OR 1.87, 95% CI 1.28-2.72), while in Peru and India, the risk gradually rose across all wealth quartiles (ORs for wealthiest quartile in Peru: 2.84, 95% CI 2.14-3.77; India: 2.99, 95% CI 1.61-5.54). 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.
AB - 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 follow children 1-15 (N = 5413) and 8-22 years (N = 2225) 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) 0.20-0.41; India: 0.43, 95% CI 0.32-0.57; Vietnam: 0.36, 95% CI 0.26-0.50), 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 1.57-3.65; India: 1.28, 95% CI 1.05-1.54; Vietnam: 1.89, 95% CI 1.23-2.91). In Vietnam, only the richest quartile was at higher risk of transitioning into overweight (OR 1.87, 95% CI 1.28-2.72), while in Peru and India, the risk gradually rose across all wealth quartiles (ORs for wealthiest quartile in Peru: 2.84, 95% CI 2.14-3.77; India: 2.99, 95% CI 1.61-5.54). 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.
KW - India
KW - Malnutrition
KW - Markov
KW - Peru
KW - transition analysis
KW - Vietnam
UR - http://www.scopus.com/inward/record.url?scp=85209656538&partnerID=8YFLogxK
U2 - 10.1093/ije/dyae151
DO - 10.1093/ije/dyae151
M3 - Artículo
C2 - 39545485
AN - SCOPUS:85209656538
SN - 0300-5771
VL - 53
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
IS - 6
M1 - dyae151
ER -