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Stunting and its relationship to Obesity in the US affiliated Pacific: a study of the Children's Healthy Living Program

The US Affiliated Pacific (US Pacific) has experienced nutrition transition over the last decades yet the region is not served by national surveys, and prevalence data on nutritional anthropometry are not widely available. The study will examine prevalence of stunting among young children in the US Pacific and its variability among the indigenous ethnic populations and, to examine whether stunting alters the risk for obesity and whether race/ethnicity modifies this relationship. Children were sampled from 51 communities in 11 US Pacific jurisdictions. Child's race was categorized according to the US Office of Management and Budget (OMB): American Indian or Alaska Native (AIAN), Asian, Black, Native Hawaiian or Other Pacific Islander (NHPI), White, and More than one race. Child's race was also examined by an expansion of OMB race/ethnicity groups and included 18 Pacific ethnic categories. Child's height and weight were measured by trained and standardized staff. Stunting was defined as height‐for‐age z score (HAZ) <−2 SDs below the mean. Child's weight status was categorized based on CDC's 2000 reference data as: (1) underweight <5th percentile BMI; (2) Healthy weight, >=5th<84th BMI percentile; (3) Overweight, >=85th <95th BMI percentile and (4) Obese, >=95th BMI percentile. Cutoff values for biologically implausible values were <−5 or >3 for HAZ and <−4 or >5 for BMI z score. Prevalence estimates were weighted to 2010 census population size of children <10 years of age for each community and adjusted for clustering of communities within jurisdictions. Logistic regression was used to examine the relationship between stunting and obesity, controlling for child's age, sex, and race/ethnicity. 5,376 children were studied. 65% were 2–5 years old and 51% were male. 61% were NHPI, 20% were More than one race group, 9% were Asian, 8% were White, 2% were AIAN and 0.3% were Black. Among NHPI, the 10 most prevalent ethnic groups were Samoan (25%), Chamorro (20%), Chuukese (11%), Marshallese (6%), Yapese (6%), Kosraean (5%), Native Hawaiian (5%), Pohnpeian (5%), Palauan (5%), and mixed within NHPI (10%). Filipino was the dominant Asian ethnic group (84%). The adjusted and weighted prevalence of stunting was 2.5% (SE=0.3%), obesity was 13.8% (SE=0.9%), and underweight was 2.5% (SE=0.3%). A significant difference in stunting prevalence was found by child's race/ethnicity (p<0.001), but not by age group (2–5 vs 6–8y) or sex. The highest prevalence of stunting was among Pohnpeian (13%), Marshallese (11%), Kosraean (5%) and Chamorro (3%) children. No stunting was observed among Black or other NHPI (Carolinian, Tongan, Kiribati, Tokelaun, Tahitian, Etc.) children. Very low prevalence was observed among Native Hawaiian (0.3%), Samoan (0.3%), and Filipino (0.7%) children. Logistic regression showed that stunted children were less likely to become obese among all race/ethnic groups (ORs<0.001, p<0.0001) except for Native Hawaiian (OR=5.8; 95% CI: 3.7–9.0) where stunted children were 6 times more likely to become obese compared to non‐stunted children. No significant relationship was observed between stunting and obesity among Samoan and the “More than one race” groups. The Native Hawaiian relationship of stunting to obesity could be related to an earlier historical nutrition transition. Further examination of behaviors and environments that may explain ethnic differences in stunting and its relationship to obesity is warranted.