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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*
Department of Epidemiology, University of Michigan, School of Public Health, M5071 SPH II, 1415 Washington Heights, Ann Arbor 48109-2029, MI , USA
Cynthia Gutierrez
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
Carrera de Nutrición y Dietética, Universidad de San Francisco de Quito, Quito, Ecuador
William Cevallos
Centro de Biomedicina, Carrera de Medicina, Universidad Central, Quito, Ecuador
Andrew D Jones
Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
Joseph NS Eisenberg
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



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.


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.


Northern coastal Ecuador.


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


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.


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.

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

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