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Multiple burdens of malnutrition and relative remoteness in rural Ecuadorian communities

Published online by Cambridge University Press:  06 November 2020

Gwenyth O Lee*
Affiliation:
Department of Epidemiology, University of Michigan, School of Public Health, M5071 SPH II, 1415 Washington Heights, Ann Arbor 48109-2029, MI , USA
Cynthia Gutierrez
Affiliation:
Department of Epidemiology, University of Michigan, School of Public Health, M5071 SPH II, 1415 Washington Heights, Ann Arbor 48109-2029, MI , USA
Nancy Castro Morillo
Affiliation:
Carrera de Nutrición y Dietética, Universidad de San Francisco de Quito, Quito, Ecuador
William Cevallos
Affiliation:
Centro de Biomedicina, Carrera de Medicina, Universidad Central, Quito, Ecuador
Andrew D Jones
Affiliation:
Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
Joseph NS Eisenberg
Affiliation:
Department of Epidemiology, University of Michigan, School of Public Health, M5071 SPH II, 1415 Washington Heights, Ann Arbor 48109-2029, MI , USA
*
*Corresponding author: Email golee@umich.edu

Abstract

Objective:

Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia.

Design:

Adult anthropometry was collected through serial case–control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community.

Setting:

Northern coastal Ecuador.

Participants:

Adults (n 1665) and children under 5 years of age (n 2618).

Results:

From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness–OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age.

Conclusions:

The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.

Type
Research paper
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society

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