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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Nutritional Status
of Households of Rural Field Practice Area of a Tertiary Care Hospital
in India |
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MK Sharma, Professor & Head,
Dept., of Community Medicine, College of Medicine & JNM Hospitals, Kalyani, West
Bengal,
Neeraj Gour, Assistant Professor, Dept., of Community Medicine, College of Medicine & JNM Hospitals, Kalyani, West
Bengal,
Dinesh Kumar Walia, Assistant Professor, Dept., of Community Medicine, Government Medical College, Sector -32, Chandigarh,
NK Goel, Professor & Head, Dept., of Community Medicine, Government Medical College, Sector -32, Chandigarh,
Neeraj Agarwal, Associate Professor, Dept., of Community Medicine, Government Medical College, Sector -32, Chandigarh. |
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Address For Correspondence |
R-14, Rishi Nagar
Hem Singh ki Pared,
Lashkar, Gwalior,
Madhya Pradesh - 474001, India.
E-mail:
drneeraj_g04@yahoo.com |
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Sharma MK, Gour N, Walia DK, Goel NK, Agarwal N. Nutritional Status
of Households of Rural Field Practice Area of a Tertiary Care Hospital
in India. Online J Health Allied Scs.
2011;10(1):3 |
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Submitted: Mar 22,
2011; Accepted: Mar 31, 2011; Published: April 15, 2011 |
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| Abstract: |
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Introduction:
In the world as a whole there appears to be a shift from under-nourishment
towards over-nourishment making more and more children, adolescents,
adults and even elderly to be overweight and obese. Objectives:
Study aimed to find out the age and sex wise commonness of over-weight
& obesity amongst the families of an overtly different socio-economic
environment and its trend in the members of one type of families.
Materials & Methods: The undergraduate medical students are
supposed to maintain record of individual health (including height &
weight) of their own family as well as that of the allotted family.
The data collected (record maintained ) by students was utilized to
calculate Body Mass Index (BMI). Results: Out of total 291 subjects
(males 168; females 123) in students own family 28.9% (28.0%; 30.1%)
were overweight and 5.9% (6.0%; 5.7%) were obese. The similar figures
for 262 subjects (males 143 & females 119) in the allotted families
were 20.2% (18.5%; 20.2%) and 6.5% (4.2%; 8.4%) respectively. The respective
percentages of under nourished individuals were 18.6 (17.9; 19.5) and
35.5 (37.8; 32.8). Thus over-nutrition was more common amongst the members
of students own families (34.8% vs. 26.7%) and under-nutrition was more
common amongst the members of allotted families (35.5% vs. 18.6%) For
the years 2000-2003, BMI amongst individuals of students own families
the under-nutrition in the age group of 15-24 years amongst males increased
from 15.9% to 32.9% and over-nutrition from 13.6% to 20.5%. There was
no case of overweight and obesity up to the age of 34 years in the previous
analysis which was 2.6% in the present analysis Previous results
demonstrated overweight to be more common in males (32.4% Vs. 24.4%
in females) and obesity being more common females ( 6.3% Vs. 2.6% in
females). Conclusion: Males are increasingly becoming prey of
malnutrition (adolescents for under-nutrition and adults & elderly
for over-nutrition. More studies covering larger samples are required
to be conducted on a more frequent basis.
Key Words:
Nutritional
status; Underweight; Overweight; Obesity.
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Nutritional status of
the people in the entire world is becoming poorer and poorer- crippling
the developed nations with over-weight and the developing nations with
both under-weight & over-weight. Also the relationship between obesity
and poverty is complex: being poor in one of the world’s poorest countries
(i.e. in countries with a per capita Gross National Product [GNP] of
less than $ 800 per year) is associated with under-weight and malnutrition,
whereas being poor in a middle income country (with a per capita GNP
of about $ 3,000 per year) is associated with an increased risk of obesity.
Some developing countries faced the paradox of families in which the
children are underweight and the adults are overweight. Today more than
1.1 billion adults1 (1.7 billion with revised definition2,3) worldwide are overweight. The obesity accounts for 16% of
global disability –adjusted life-years (DALYs). Anti-obesity day is
observed on 26th November each year. As per WHO the 10 fattest
countries of last decade were -American Samoa-93.5%, Kiribati 81.5%
USA 66.7%, Germany 66.5%, Egypt 66%, Bosonia-Herzegovina 62.9%, New
Zealand 62.7%, Israel 61.9% and U.K. 61%. Taiwan is the first country
to introduce Junk Food Tax, it is followed by Romania and then by Australia.
The Health Secretary of Britain on 7th January2010 commented,”
We are really in danger of being known as the best in the world for
watching sport but one the worst for getting out there and
doing it for ourselves.” Nationally representative surveys show recent
increase in the prevalence of over-weight and obesity among women of
reproductive age in Bangladesh , Nepal and India.4 The daily
news ‘The Hindu’ in the year 2007 itself also mentioned that
India is facing obesity epidemic. Due to large number, India has been
requested to join the International Congress on obesity, making it the
first nation of developing countries in Asia to be put on obesity map.
In a letter to Asia Pacific International Herald Tribune, the then Health
Minister Dr. Ramadoss described the nutritional situation in India as
“A War with Two Fronts: Hunger and Obesity.” In fact in India the
double burden of underweight and overweight appears to be present even
amongst the adolescents.5 In a recently conducted nationally
representative Indian survey,6
the overall prevalence of overweight and obesity combined for India
was 13% and 9% in respect of females and males respectively. The
same survey demonstrated that the state of Punjab ranks 1st
in India for obesity. The Chandigarh being the capital of Punjab and also
because it was not covered in the above-mentioned survey, the present
study was conducted as a pilot project with the following objectives.
- To find out the prevalence
of under nutrition and over nutrition among the members of the families
allotted to under graduate medical students.
- To measure the burden of overweight
and obesity among the members of students’ own families.
- To compare the results aimed
as above (No.2) with the similar results obtained five years back to
find out trend in nutritional status of families’ individuals.
- To compare the nutrition status
of medical students families with the similar result of other workers
in India and abroad.
Chandigarh is
the best planned city of India, having just 10% area earmarked as rural. A portion
of this area is utilized by the department of community medicine of
Government Medical College and Hospital, Chandigarh for the purpose
of the field training to medical students. As a part of the curriculum,
one family is allotted to each student (who is also supposed to look
after his/ her own family). The allotted families are overtly quite
different (having lower socio-economic status) from the students own
families which are of higher socio-economic status. The undergraduate
medical students (numbering 50 in each batch) are supposed to complete
the manual provided by the department of Community Medicine. In doing
so each student is supposed to be meticulous in ensuring the recording
of height and weight of each individual in the family. The faculty members
are supervising this process of data collection by accompanying the
medical students in the field and also by checking the completeness
of manuals at frequent intervals in the department. The medical students
are briefed before proceeding to field with special emphasis on methods
of height and weight recording. The present study was conducted between 26th Oct 2010 to 5th of Dec 2010.
The height was measured in centimeters
to the nearest 0.5 cm, and weight was measured in kilograms up to the
nearest of 0.5 kg using a bathroom scale. The students were advised
to ensure its validation on a daily basis with known weights. The height
of the participants was measured by asking them to stand barefoot by
facing the back adjacent to the wall and keeping a scale straight on
the head. A point was marked by the pencil on the wall. The participants
were then asked to move and the length was measured using measuring
tape in meters. For calculation of the weight, the participants were
asked to stand on the bathroom scale weighing machine, which was placed
horizontally on a level surface and participants were asked to stand
on it without any footwear and with minimum covered clothing. The data
collected (records maintained by students) was utilized to calculate
Body Mass Index (BMI) since its measurement has been considered as one
of the easiest ways to determine the transition of a person from normal
weight to obesity. BMI is simple to calculate and it categorizes a person
as underweight, normal, overweight and obese with its stages. Among
the study subjects, those who fallen under underweight category, were
taken as under nutrition, on the other hand those who fallen under overweight
and obese categories were taken as over nutrition respectively.
Thus, BMI not only identifies
the obesity but also persons in pre-obese stages. So a screening Program me
based on BMI would be helpful not only in defining obese but also pre-obese
persons so that timely measures would be taken for its correction, prevention
and control in a person and in the community as a whole. BMI ranging
from 20-24.9 kg /m2 was considered as optimum, <20 kg/m2
as underweight and 25-29.9 kg /m2 as overweight and equal to as or more
than 30 kg /m2 as obese. The cut off point for overweight was taken
as 25 and above because few workers7 still feel that BMI
cutoff points for obesity should not vary with ethnic groups. Similarly
for underweight the cutoff points were taken as 20 or less as has been
used by few workers.8 Another reason to use the above mentioned
cutoff points as 20 or less for underweight and 25 or more for
overweight was aimed to compare the results presently obtained with
the one obtained in the year 2000-2003 when same cutoff points were
used. In fact it is stated that the universally accepted/suggested ideal
BMI is 20-24.9 kilogram squaremeter.9
Table-1 demonstrates
that out of total 291 subjects in students own families, 28.9% were
overweight, 5.9% were obese and 18.6% were under-nourished. The
percent prevalence of under-nutrition decreased as the age advanced
from 63.6% in the age group of 5-14 years to 2% in the age group of
45-54 years. There was no individual having under-nutrition from the
age of 55 years onwards. The percentage proportion of overweight and
obesity (over-nutrition) increased from 16.6% in the age group of 15-24
years to 58.6% in the age group of 45-54 years. After this it decreased
to 40.7% in the age group of 55+ years. Obesity alone increased from
2.6% in the age group of 15-24 years to 12.1% in the age group of 45-54
years and then decreased to 7.4%. There was no individual having
over nutrition in the age group of 5-14 years.
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Table 1:
Nutritional Status of Individuals of Students' Own Families |
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Age (years) |
Sex |
BMI<20 |
20-24.9 |
25-29.9 |
30 or more |
Total |
P Value |
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5-14 |
Male |
3(60.0) |
2(40.0) |
0 |
0 |
5
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P= 0.81 |
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Female |
4(67.7) |
2(33.3) |
0 |
0 |
6
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Total |
7(63.6) |
4(36.4) |
0 |
0 |
11
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15-24 |
Male |
24(32.9) |
32(43.8) |
15(20.5) |
2(2.7) |
73
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P= 0.93 |
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Female |
16(39.0) |
23(56.1) |
1(2.4) |
1(2.4) |
41
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Total |
40(35.1) |
55(48.2) |
16(14.0) |
3(2.6) |
114
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25-34 |
Male |
2(13.3) |
10(66.7) |
3(20.0) |
0 |
15
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P=0.71 |
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Female |
1(25.0) |
3(70.0) |
0 |
0 |
4
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Total |
3(15.8) |
13(68.4) |
3(15.8) |
0 |
19
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35-44 |
Male |
0 |
0 |
1(100) |
0 |
1
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US |
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Female |
2(10) |
9(45.0) |
9(45.0) |
0 |
20
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Total |
2(9.5) |
9(42.9) |
10(47.6) |
0 |
21
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45-54 |
Male |
1(1.8) |
24(43.6) |
22(40.0) |
8(14.5) |
55
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P=0.33 |
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Female |
1(2.3) |
15(34.1) |
24(54.5) |
4(9.1) |
44
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Total |
2(2.0) |
39(39.4) |
46(46.5) |
12(12.1) |
99
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55+ |
Male |
0 |
13(68.4) |
6(31.6) |
0 |
19
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P= 0.13 |
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Female |
0 |
3(37.5) |
3(37.5) |
2(25.0) |
8
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Total |
0 |
16(59.3) |
9(33.3) |
2(7.4) |
27
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All
ages |
Male |
30(17.9) |
81(48.2) |
47(28.0) |
10(6.00 |
168
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P= 0.83 |
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Female |
24(19.5) |
55(44.7) |
37(30.1) |
7(5.7) |
123
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Total |
54(18.6) |
136(46.7) |
84(28.9) |
17(5.9) |
291
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US = Unspecified,
parenthesis indicate percentages |
It is seen from
Table-2
that amongst 262 subjects in the allotted families, 20.2% were over-weight,
6.1% were obese and 35.5% were under-nourished. The percent proportion
of under-nutrition decreased as age advanced; from 92.3% in the age
group of 5-14 years to 8.5% in the age group of 35-44 years and then
increased to 14.3% in the age group of 55+years. Contrary to under-nutrition,
the over-nutrition decreased with age, being 20% in the age group of
15-24 years to 55% in the age group of 45-54 years and then decreased
to 42.9% in the age group of 55+years. Obesity alone increased from
2% in the age group of 15-24 years to 2.8% in the age group of 25-34
years, further to 17% in the age group of 35-44 years and eventually
to 20% in the age group of 45-54 years after which the prevalence decreased
to 4.8%.
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Table 2:
Nutritional Status of Individuals of Families Allotted to Students |
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Age (years) |
Sex |
BMI<20 |
20-24.9 |
25-29.9 |
30 or more |
Total |
P Value |
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5-14 |
Male |
30(93.8) |
2(6.2) |
0 |
0 |
32
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P= 0.62 |
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Female |
18(90.0) |
2(10.0) |
0 |
0 |
20
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Total |
48(92.3) |
4(7.7) |
0 |
0 |
52
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15-24 |
Male |
9(37.5) |
7(29.2) |
7(29.2) |
1(4.2) |
24
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P= 0.12 |
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Female |
13(48.1) |
11(40.0) |
2(7.4) |
1(2.0) |
27
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Total |
22(43.1) |
18(35.3) |
9(17.6) |
2(2.0) |
51
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25-34 |
Male |
9(21.4) |
24(57.1) |
7(16.7) |
2(4.8) |
42
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P= 0.88 |
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Female |
5(15.6) |
18(56.3) |
7(21.9) |
2(2.8) |
32
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Total |
14(18.9) |
42(56.8) |
14(18.9) |
4(5.4) |
74
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35-44 |
Male |
3(11.5) |
10(38.5) |
8(30.8) |
3(14.3) |
24
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P= 0.40 |
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Female |
1(4.8) |
10(47.6) |
7(33.3) |
8(17.0) |
26
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Total |
4(8.0) |
20(40.0) |
15(30.0) |
11(34.0) |
50
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45-54 |
Male |
0 |
5(55.6) |
3(27.2) |
3(27.2) |
11
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P= 0.46 |
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Female |
2(18.2) |
2(18.2) |
4(36.4) |
4(36.4) |
12
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Total |
2(8.7) |
7(30.4) |
7(30.4) |
7(30.4) |
23
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55+ |
Male |
3(13.1) |
4(30.8) |
6(46.2) |
1(12.5) |
14
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P= 0.28 |
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Female |
0 |
5(62.5) |
2(25.0) |
1(4.8) |
8
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Total |
3(13.6) |
9(40.9) |
8(36.4) |
2(9.1) |
22
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All
ages |
Male |
54(36.7) |
52(35.4) |
31(21.1) |
10(6.8) |
147
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P= 0.21 |
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Female |
39(31.2) |
48(38.4) |
22(17.6) |
16(12.8) |
125
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Total |
93(34.2) |
100(36.8) |
53(19.5) |
26(9.6) |
262
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Parenthesis indicate percentages |
As per the Table-3, for the block year 2000-2003 (previous
analysis10, the percentage of individuals with optimum BMI
was 51.7% and for present analysis (block Year 2004-2008) it was just
46.7%. There was no case of obesity up to the age of 34 years in previous
analysis the proportion of which was 2.6% in the present analysis for
the same age group. As per the previous analysis, amongst males aged
15-24 years, the under-nutrition and over-nutrition were15.9% and13.6%
respectively The similar figures for the present analysis were 32.9%
and 23.2% respectively. This indicates an increase of abnormal BMI (both
towards under-nutrition and towards over-nutrition) among males which
is a point of concern. Previous results demonstrated overweight to be
more common in males (32.4% Vs. 24.4% in females) and obesity being
more common in females (6.3% Vs. 2.6% in males). The similar figures
for present analysis were 28% Vs. 30.1% and 5.7% Vs. 6.0%
indicating the blurring of gender difference in overweight and obesity over the time. According
to present analysis, for student’s own families, among individuals
aged 15-24 years, the prevalence of overweight in males and females
was 20.5% and 2.4% respectively. For the individuals belonging to the
allotted families, similar figures were 30.4% &7.4% respectively.
After the age of 24 years overweight were more common in females. This
trend of overweight being more common among females continued in all
age groups up to 54 years (21.9% v/s 17.5% in the age group 25-34 years,
33.3% v/s 30.8% in the age group 35-44 years and 36.4% v/s 33.3% in
the age group of 45-54 years). In the age group of 55+ years the prevalence
of overweight for males was significantly more (46.2%) as compared to
females (25%).For student’s own families’ similar trend could not
be observed due probably to the small number of individuals in each
age group. However, in the age group of 55+ years overweight in males
was less (31.6%) as compared to females (37.5%).
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Table 3: Comparison of
Nutritional Status of Individuals of Students' Own Families and Allotted
Families |
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Age (years) |
Sex |
2000 - 2003 |
2004-2008 |
2004 - 2008 |
|
BMI<20 (Own family) |
BMI > 25 (Own family) |
BMI<20 (Own family) |
BMI
> 25 (Own family) |
BMI<20 (allotted family) |
BMI > 25 (allotted family) |
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5-14 |
Male |
9(50.0) |
2(11.1) |
3(60.0) |
0 |
30(93.8) |
8(34.8)
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Female |
7(77.8) |
2(22.2) |
4(67.7) |
0 |
18(90.0) |
3(11.1)
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Total |
16(59.3) |
4(14.8) |
7(63.6) |
0 |
48(92.3) |
11(22.4)
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15-24 |
Male |
34(15.9) |
29(13.6) |
24(32.9) |
17(23.3) |
9(37.5) |
9(22.5)
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Female |
77(39.3) |
16(8.2) |
16(39.0) |
2(4.9) |
13(48.1) |
9(28.1)
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Total |
111(27.1) |
45(11.0) |
40(35.1) |
19(16.6) |
22(43.1) |
18(25.0)
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25-34 |
Male |
4(9.1) |
26(59.0) |
2(13.3) |
3(20.0) |
9(21.4) |
11(42.3)
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Female |
6(27.3) |
6(27.3) |
1(25.0) |
0 |
5(15.6) |
15(71.4)
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Total |
10(15.2) |
32(48.5) |
3(15.8) |
3(15.8) |
14(18.9) |
26(55.3)
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35-44 |
Male |
0 |
2(66.7) |
0 |
1(100) |
3(11.5) |
6(16.7)
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Female |
2(5.0) |
90(47.5) |
2(10.0) |
9(45.0) |
1(4.8) |
8(72.7)
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Total |
2(4.7) |
21(48.8) |
2(9.5) |
10(47.6) |
4(8.0) |
14(70.0)
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45-54 |
Male |
5(2.9) |
92(53.5) |
1(1.8) |
30(54.5) |
0 |
7(53.8)
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Female |
2(1.2) |
85(50.0) |
1(2.3) |
28(63.6) |
2(18.2) |
3(37.5)
|
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Total |
7(2.1) |
177(51.8) |
2(2.0) |
58(58.6) |
2(8.7) |
10(47.6)
|
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55+ |
Male |
2(3.6) |
26(47.3) |
0 |
6(31.6) |
3(13.1) |
0
|
|
Female |
2(7.4) |
14(51.9) |
0 |
5(62.5) |
0 |
0
|
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Total |
4(4.9) |
40(48.8) |
0 |
11(40.7) |
3(13.6) |
0(00)
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All
ages
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Male |
54(10.7) |
177(35.0) |
30(17.9) |
57(33.9) |
54(36.7) |
41(28.7)
|
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Female |
96(21.7) |
142(30.6) |
24(19.5) |
44(35.8) |
39(31.2) |
38(31.9)
|
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Total |
150(15.5) |
319(32.9) |
54(18.6) |
101(37.1) |
93(34.2) |
79(30.2)
|
| |
P< 0.001; X2=14.73 |
P = 0.94; X2=0.01 |
P = 0.51;
X2=0.43 |
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Parenthesis
indicate percentages |
The present study demonstrated
that the prevalence of over-nutrition (obesity and overweight) was 36.1%
in own families and 33.3% in allotted families in the age group of 15+
years. A nationally representative Indian survey6 has observed
that the national average prevalence of it is 11%. The reason for the
higher prevalence of over-nutrition in our study might be the overall
higher socio-economic status of Chandigarh population as a similar positive
correlation of obesity with higher education and wealth index has been
by the same survey. The other workers11,12 have also demonstrated
a higher prevalence of obesity amounting to 42.2% & 61.8% respectively
using BMI cutoff points of 25 or above and 22.2% and 26% respectively12,13
using BMI cutoff points or 23 or above amongst north Indian population.
The prevalence of obesity has also been observed higher amounting to
45.9% amongst south Indian urban population14, 16.4% in South
Indian rural population15, 32.8% among the population of
Madhya Pradesh16 and 63.9% in Turkey’s population.17
In an Assam based study18 covering 510 laborers aged
20- 59 years the prevalence of overweight was just 5.7% whereas the
prevalence of underweight was 14.3%. In our study for allotted families,
in the age group of 15+ years, under nutrition was just 21.4%
but over nutrition was 33% indicating a strong point of research
as there appears to be something inherent in the environment of Chandigarh
which is responsible for higher chances of overweight amongst its residents.
Higher prevalence of overweight was observed even for adolescents by
other workers e.g. 5.8% in Karnataka amongst affluent school children
aged 10-15 years19, 9.8% in the age group of 7-12 years in
Kerala20, 14.5% in children of Gujrat21. However,
in another Karnataka based study22
covering 250 adolescent girls aged 13-19 years; none was found to suffer
from overweight or obesity whereas 27.6% were under-nourished. In our
study for allotted families we observed that in the age group of 15-24
among females, 48.1% were under-nourished in addition to 11.1% being
overweight. Regarding the association of overweight with age, in our
study for allotted families we observed an increase in overweight as
the age advanced, from 18% in the age group of 15-24 years to 38.1% in
the age group of 55 years and older. A nationally representative Indian
survey 6 demonstrated an increase of overweight from 1.4%
in the age group of 15-19 years to 12.9% in the age group of 40-49 years
among males and 2.1% to 17.4% among females. The similar figures for
obesity were 0.2%, 2.3% and 0.2%, 6.4% respectively. For students' own
families the prevalence of overweight increased from 14% in the age
group of 15-24 years to 46% in the age group of 45-54 years and then
declined to 33.3% in the age group of 55+ years. In the same way the
prevalence of obesity also increased from 2% in the age group of 15-24
years to 20% in the age group of 45-54 years for allotted families and
from 2.6% to 12.1% for students' own families. However in the age group
of 55+ years, the prevalence went down to 4.8% for allotted families
and to 7.4% for students own families. An exactly similar relationship
of overweight and obesity with the age has been observed by other workers16
who observed an increase of overweight from 18.1% in the age group of
21-30 years to 44.5% in the age group of 51-59 years and the increase
of obesity from zero per cent in the sage group of 21-30 years to 4%
in the age group of 41-50 years and a decrease of obesity to 3.8% as
age advanced to 51-59 years. A Turkey based study17 has also
observed a decrease in the prevalence of overweight after 60 years of
age. In Madhya Pradesh based study16 the prevalence of overweight
was 36.7% in the age group of 40-50 years and 31.3% in the age group
of 70+years.The sex-wise distribution of overweight and obesity was
variable and inconsistently directed. The prevalence of extreme obesity
(BMI more than 40 kg /sq.m) among males was 6.4 % which gradually decreased
to 0% in the age group of 60+ years. In females there was none with
extreme obesity in the age group of 30-40 years while in the age group
of 40-50 years its prevalence was 1% which gradually decreased to 0%
in the age group of 60+ years. In our study in the age group of 15 years
and above, the prevalence of overweight was more in females (35.8%)
compared to its lower prevalence of 33.9% in males. Similar observations
of obesity being more common in females has been observed by different
workers in various states/provinces e.g. at National level in India6 (11% in females v/s 9% in males), 47.4% v/s 43.2% in urban South India14,
18.2% v/s 14.5% in rural South India.15 However a study16
conducted among individuals of high income group in Madhya Pradesh demonstrated
that over-nutrition was more (34.4%) in males as compared its lower
prevalence of 31.3% in females. In our study among students own families
in the individuals aged 25+ years these similar figures were 44.4% and
55.3% indicating higher proneness (of this area) for overweight and
obesity. The prevalence of overweight in females is higher also among
elderly e.g. in a Delhi based study23 it was 40.3% v/s 34.0%.
In fact most studies24 demonstrate a higher prevalence of
overweight among females as compared to males. A study on Greek children
and adolescents25 has demonstrated an almost equal prevalence
(20.7 in males; 20.9 in females) of over nutrition amongst males and
females. However in the age group of 15-24 years as per our study overweight
and obesity was more in males (23.2% vs.4.8% in females) in own family
and 4.8% & 11.1% for allotted families. A similar observation of
overweight being more common in males has been made by others in a study21
covering 5664 children (3231 boys; 2433 girls) aged 12 -18 years demonstrating
17.2% of boys and 10.8% of girls as overweight and obese. Prevalence
of overweight was high in children belonging to middle socio-economic
status as compared to children of higher socio-economic status as per
this study and our study. The prevalence of under-nutrition however
was almost same in both sexes (70% females; 70.8% males) as per this
study.21 However, an important study26 has demonstrated
that over nutrition was more in females (16.6%) compared to the lower
prevalence of 12.5% in males. In our study higher prevalence of under-nutrition
among females was observed. A Karnataka based study19 also
observed a higher prevalence of obesity in females (8.8% in females
and 4.4% in males). Among allotted families, (one with poor socio-economic
status) the children are malnourished and adults are obese. Similar
observations have been made by other workers.27 In a North
India based study28 higher prevalence of over-weight (13.3%
in males and 15.6% in females) has been observed even in slums. In our
study the observation of lesser prevalence of overweight in the females
aged 15-24 years belonging to allotted families may very well be due
to the fact that in such poor families majority of the females remain
unmarried girls by then and they try to keep themselves fit to get married
as they do not have much say in such families. After marriage they get
relax and rapidly start gaining weight surpassing their counterpart
males. Regarding the trends of overweight and obesity, a nationally
representative survey4 covering 161755 women of reproductive
age (15-49 years) demonstrated an increase in obesity during a decade
from 10.6% to 14.8%. This increase was both in rural and urban area
but more in rural area. It was positively related with age, increase
socio-economic status and urban residents. Amongst US population aged
20-74 years29, the prevalence of obesity in males increased
from 10.7% for the year 1960-1962 to 28.1% for the year 1999 – 2002
and in females from 15.7% to 34.0% for same years. Also extreme obesity
is increasing more than over-weight. The trend of more obesity amongst
females as compared to male was continuous throughout the years from
1960-2002. NNMB in a study30 covering nine states demonstrated
that the under nutrition among adult males decreased from 56% in
the year 1975- 1989 to 37% in the year 2000-2001 and then a slow decline
to 33% in the year 2004-2005. Among adult females the similar figures
were 52%, 39% and 36% respectively. In our study we observed that there
was no decline of under nutrition among males aged 25-44 years; on the
contrary it was increased from 8.5% in the years 2000-2003 to 12.5%
in the year 2004-2008. However in females there was slight decrease
from 12.9% to 11.3% for the same years. An important study31
on a cohort of 75868 subjects aged 35years and above from the year 1995-2004
demonstrated that the lower BMI was a predictor of mortality, while
high BMI was not. A Malaysia based study32 demonstrated a
small increase (from 20.7% in the year 1996 to 26.7% in the year 2003
and 29.1% in the year 2006) in overweight and a larger increase (from
5.5% in the year 1996 to 12.2% in the year 2003 and 14% in the year
2006) in the obesity among adults over the years 1996 to 2009. We in
our study did not observe any increase in overweight; instead a decrease
was observed (from 32.4% in the year 2000-2003 to 21.7% in the year
2004-2005 in males and from 24.4% to 18.5% in females). However, an
increase in obesity from 2.6% to 8.4% in males and from 6.3% to 6.5%
in females for the corresponding years was observed paralleling the
trends in US29 where increase in obesity has been found more
than overweight increase. An important study33 covering north
Indian adolescents of both sexes conducted over the last five years
(2003-2008) had demonstrated a significant BMI increase in both sexes
(more so in females).
Small sample size, uni
centric and small scale study were some of limitations of study which
somehow makes these results less generalizable and applicable .nevertheless
it gives an idea and starting point to the researchers to explore it
more and more by planning a multicentric ,large scale if possible a
longitudinal study in a bid to make these results more valid and implicable.
People are continuously
getting succumbed by this creeping and emerging health problem of Malnutrition
and dissemination of this problem is not confined with one group, one
sex or one race of society, everybody is becoming prey of it. So that
it appeals from both at governmental and individual level to make a
strategic and effective plan to curtail this rapidly rising malady at
earliest.
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