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Double burden of malnutrition in urbanized settled Tibetan communities on the Tibetan plateau.

BACKGROUND AND OBJECTIVES
A previous pilot study revealed stunted children and obese adults in urbanized settled Tibetan communities. A survey with a representative population in selected communities was conducted to test the preliminary findings.


METHODS AND STUDY DESIGN
A cross-sectional study on the nutritional status involving 504 children (244 boys and 260 girls, 5-16 y) and 927 adults (422 men and 505 women, 18-90 y) was conducted in communities, with anthropometric parameters measured. The z-scores for height-for-age (HAZ) and BMI-for-age (BAZ) in children were calculated according to WHO 2007 reference.


RESULTS
The children showed a double burden of both under- and over-nutrition. The prevalence of under-nutrition in children was high - stunting (HAZ <-2) 10.7%, underweight (BAZ <-2) 9.5%, combined prevalence of stunting and underweight 19.4%. The rate of over-nutrition was also alarming - obesity 12.7% (BAZ >2). The mean value of HAZ (- 0.45±1.41) was lower than, whereas that of BAZ (0.05±1.76) was comparable to, the WHO reference. No significant differences were found in under- or over-nutrition between genders. Specifically, 8.9% of children demonstrated both short stature (HAZ <-1) and overweight (BAZ >1). By contrast, community adults showed almost a one-way direction tilted towards over-nutrition - overweight 61.4% (BMI ≥24 kg/m2), obesity 30.1% (BMI ≥28 kg/m2), and central obesity 62.0% (waist circumference, men ≥85 cm, women ≥80 cm). Women were marginally more likely to be obese than men (p=0.061).


CONCLUSIONS
The co-existence of under- and over-nutrition in the community may have reflected the suboptimal early life nutrition and the obesogenic environment afterwards. Potential determinants need to be explored for future interventions.