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Epidemiology

Examining the relationship between socioeconomic status and the double burden of maternal over and child under-nutrition in Bangladesh

European Journal of Clinical Nutrition volume 73, pages 531–540 (2019)Cite this article

Subjects

Abstract

Background/objectives

There is little research on the association between socioeconomic status (SES) and the familial co-existence of maternal over and child under-nutrition (MOCU). Most of these studies conducted in the Latin American countries. Therefore, we intended to further this important area of query by exploring the relationship between SES and the dual burden of MOCU in Bangladesh.

Subjects/methods

We used data from the 2014 Bangladesh Demographic Health Survey (BDHS). The analyses were based on the responses of 5687 mother–child pairs. We focused standard of living (hereafter referred to as wealth) as a measure of SES. We determined MOCU if there were an undernourished child and an overweight mother in the same household.

Results

Maternal overweight and MOCU prevalence is higher among the wealthier segment whereas prevalence of child under-nutrition is higher among the poorest segment of the households. The relative risk of a household having MOCU increased by the factors of 2.84 (confidence interval (CI) = 1.58–5.12) among households with richest bands of wealth compared to the poorest category. Household from the medium (Relative risk ratio (RRR) = 1.87, 95% CI = 1.07–3.28) and richer SES groups (RRR = 2.56, 95% CI = 1.39–4.69) had increased chance for MOCU as compared to the household from poorest SES group.

Conclusions

As opposed to findings from other Latin American countries, the prevalence of MOCU in Bangladesh is higher in the wealthiest households. Findings of our study therefore suggest that overweight prevention programs in wealthier households of Bangladesh need to think out the possibility that their focus households may also include underweight persons.

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References

  1. Roger S & Claudia R The double burden of malnutrition: a review of global evidence. HNP Discussion Paper Series. The International Bank for Reconstruction and Development, the World Bank, Washington, DC; 2012.

  2. World Health Organization. Double burden of malnutrition.. Geneva: WHO; 2016. http://www.who.int/nutrition/double-burden-malnutrition/en/ Accessed at

    Google Scholar 

  3. Sara D Are stunted child/overweight mother pairs a distinct entity or a statistical artifact? Demographic and Health Surveys, 1991-2009. Rollins School of Public Health of Emory University, 2012.

  4. NIPORT Mitra and Associates, Macro International. Bangladesh Demographic and Health Survey 2004. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and Macro International.

  5. NIPORT Mitra and Associates, Macro International. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and Macro International.

  6. Keino S, Plasqui G, Ettyang G, van den Borne B. Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. Food Nutr Bull. 2014;35:167–78.

    Article  Google Scholar 

  7. Fernald LC, Neufeld LM. Overweight with concurrent stunting in very young children from rural Mexico: prevalence and associated factors. Eur J Clin Nutr. 2007;61:623–2.

    Article  CAS  Google Scholar 

  8. Tzioumis E, Adair LS. Childhood dual burden of under- and over-nutrition in low- and middle-income countries: a critical review. Food Nutr Bull. 2014;35:230–43.

    Article  Google Scholar 

  9. Piernas C, Wang D, Du S, Zhang B, Wang Z, Su C. The double burden of under- and over nutrition and nutrient adequacy among Chinese preschool and school-aged children in 2009-11. Eur J Clin Nutr. 2015;69:1323–9.

    Article  CAS  Google Scholar 

  10. Lee J, Houser RF, Must A, de Fulladolsa PP, Bermudez OI. Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in Guatemala. Econ Hum Biol. 2012;10:232–41.

    Article  Google Scholar 

  11. Barquera S, Peterson KE, Must A, Rogers BL, Flores M, Houser R, et al. Coexistence of maternal central adiposity and child stunting in Mexico. Int J Obes. 2007;31:601–7.

    Article  CAS  Google Scholar 

  12. Garrett JL, Ruel MT. Stunted child-overweight mother pairs: prevalence and association with economic development and urbanization. Food Nutr Bull. 2005;26:209–21.

    Article  Google Scholar 

  13. Sarmiento OL, Parra DC, González SA, González-Casanova, Forero AY, Garcia J. The dual burden of malnutrition in Colombia. Am J Clin Nutr. 2014;100(suppl):1628S–35S.

    Article  CAS  Google Scholar 

  14. Doak CM, Adair LS, Bentley M, Monteiro C, Popkin BM. The dual burden household and the nutrition transition paradox. Int J Obes. 2005;29:129–36.

    Article  CAS  Google Scholar 

  15. Bassett MN, Romaguera D, Giménez MA. Prevalence and determinants of the dual burden of malnutrition at the household level in Puna and Quebrada of Humahuaca, Jujuy, Argentina. Nutr Hosp. 2014;29:322–30.

    Google Scholar 

  16. Jef LL, Jean-Pierre H, Teresa G, Ruel MT. Maternal education mitigates the negative effects of higher income on the double burden of child stunting and maternal overweight in rural Mexico. J Nutr. 2014;144:765–70.

    Article  Google Scholar 

  17. Geok L, Zalilah MS. Dual forms of malnutrition in the same households in Malaysia-a case study among Malay rural households. Asia Pac J Clin Nutr. 2003;12:427–38.

    Google Scholar 

  18. Subramanian SV, Ichiro K, George D. Income inequality and the double burden of under- and over nutrition in India. J Epidemiol Community Health. 2007;61:802–9.

    Article  CAS  Google Scholar 

  19. Oddo VM, Rah JH, Semba RD, Sun K, Akhter N, Sari M, et al. Predictors of maternal and child double burden of malnutrition in rural Indonesia and Bangladesh. Am J Clin Nutr. 2012;95:951–8.

    Article  CAS  Google Scholar 

  20. Jehn M, Brewis A. Paradoxical malnutrition in mother-child pairs: untangling the phenomenon of over- and under-nutrition in underdeveloped economies. Econ Hum Biol. 2009;7:28–35.

    Article  Google Scholar 

  21. Khan AM Income Inequality in Bangladesh. Paper presented at the 19 th Biennial Conference “Rethinking Political Economy of Development” Of the Bangladesh Economic Association Institution of Engineers, Bangladesh. Dhaka, 2014.

  22. Bangladesh Bureau of Statistics. Bangladesh Population and Housing Census 2011. Statistics and Informatics Division (sid), Ministry of Planning Government of the People’s Republic of Bangladesh, 2014

  23. WHO. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. Department of Nutrition for Health and Development (NHD), Geneva, Switzerland, 2010. Available at: http://www.who.int/nutrition/nlis_interpretation_guide.pdf Department of Nutrition for Health and Development (NHD), Geneva, Switzerland

  24. WHO. WHO Global Database on Body Mass Index (BMI). Department of Nutrition for Health and Development (NHD), Geneva, Switzerland, 2013. Available at: http://www.who.int/bmi/index.jsp.

  25. Rahman M, Nakamura K, Masashi K. Socioeconomic differences in the prevalence, awareness, and control of diabetes in Bangladesh. J Diabetes Complicat. 2015;29:788–93.

    Article  Google Scholar 

  26. Mackenbach JP, Stirbu I, Roskam AR. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.

    Article  CAS  Google Scholar 

  27. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.

    Article  Google Scholar 

  28. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3–21.

    Article  Google Scholar 

  29. Popkin BM. Global nutrition dynamics: The world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr. 2006;84:289–98.

    Article  CAS  Google Scholar 

  30. Grijalva-Eternod CS, Wells JC, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C, et al. The double burden of obesity and malnutrition in a protracted emergency setting: A cross-sectional study of Western Sahara refugees. PLoS Med. 2012;9:e1001320.

    Article  Google Scholar 

  31. Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorder. Dietary guidelines for Bangladesh. BIRDEM, Dhaka, 2013. Available at: http://www.fao.org/3/a-as880e.pdf

  32. Islam N Wahidul MH A multivariate analysis of the selection factors of carbonated soft drinks in Bangladesh. Proceedings of the iamb 2009 Conference, New Orleans, Louisiana, USA. 2009.

  33. McDonald SD, Han Z, Mulla S, Beyene J, Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ. 2010;341:c3428. 20

    Article  Google Scholar 

  34. Ni KA, Shankar A, Nunik, Besral B, Jahari AB, Endang A. Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutr. 2017;3:16.

    Article  Google Scholar 

  35. Rahman MS, Howlader T, Masud MS, Rahman ML. Association of low-birth weight with malnutrition in children under five years in Bangladesh: do mothers education, socio-economic status, and birth interval matter? PLoS ONE. 2016;11:e0157814. 29

    Article  Google Scholar 

  36. Aitsi-Selm A. Households with a stunted child and obese mother: trends and child feeding practices in a middle-income country, 1992–2008. Matern Child Health J. 2015;19:1284–91.

    Article  Google Scholar 

  37. Asfaw A. Micronutrient deficiency and the prevalence of mothers’ overweight/obesity in Egypt. Econ Hum Biol. 2007;5:471–83.

    Article  Google Scholar 

  38. Kimani-Murage EW, Muthuri SK, Oti SO, Mutua MK, van de Vijver S, Kyobutungi C. Evidence of a double burden of malnutrition in urban poor settings in Nairobi, Kenya. PLoS ONE. 2015;10:e0129943.

    Article  Google Scholar 

  39. Sally L. Over and under: the role of urbanization on the double burden of nutrition in developing countries. Prognosis. 2015;6:12–9.

    Google Scholar 

  40. Crush J, Bruce F, Milla M. Rapid urbanization and the nutrition transition in Southern African. Urban Food Security Series No. 7. Queen’s University and AFSUN: Kingston and Cape Town, 2011.

  41. Joseg S, Prakash S. The nutrition transition to 2030. Why developing countries are likely to bear the major burden. Food Econ. 2005;2:150–66.

    Google Scholar 

  42. Cervantes VGA, LoÂpez-Espinoza A, Moreno AGM, Cañedo CL, Miramontes EHV, Housni FE, et al. Effect of the number of interruptions in the pattern of sedentary behavior on energy expenditure. Rev Mex de Trastor Aliment. 2016;7:46–55.

    Article  Google Scholar 

  43. Biswas T, Uddin MJ, Mamun AA, Pervin S, Garnett P. Increasing prevalence of overweight and obesity in Bangladeshi women of reproductive age: Findings from 2004 to 2014. PLoS ONE. 2017;12:e0181080. 28

    Article  Google Scholar 

  44. Giashuddin MS, Kabir M. Duration of breast-feeding in Bangladesh. Indian J Med Res. 2004;119:267–72.

    CAS  PubMed  Google Scholar 

  45. ESPGHAN Committee on Nutrition1, Agostoni C, Braegger C, Decsi T, Kolacek S, Koletzko B, et al. Breast-feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2009;49:112–25.

    Article  Google Scholar 

  46. Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black and Hispanic reproductive-age women. Obstet Gynecol. 2010;115:982–8.

    Article  Google Scholar 

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Acknowledgements

We are thankful to the MEASURE DHS for serving us with the 2014 BDHS data set.

Authors contributions

M.R. conceived the study and committed to statistical analysis, and wrote the manuscript. K.S. and S.H.E. contributed to reviewing of the article.

Author information

Authors and Affiliations

  1. UChicago Research Bangladesh House #4, Road #2/B, Sector #4, Dhaka, Uttra-1230, Bangladesh

    Syed Emdadul Hauqe

  2. Teikyo University Graduate School of Public Health Tokyo, Tokyo, Japan

    Kayako Sakisaka

  3. Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, 6205, Bangladesh

    Mosiur Rahman

  4. Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan

    Mosiur Rahman

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  1. Syed Emdadul Hauqe
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Correspondence to Mosiur Rahman.

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Hauqe, S.E., Sakisaka, K. & Rahman, M. Examining the relationship between socioeconomic status and the double burden of maternal over and child under-nutrition in Bangladesh. Eur J Clin Nutr 73, 531–540 (2019). https://doi.org/10.1038/s41430-018-0162-6

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