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. 2003 Aug;88(8):671–675. doi: 10.1136/adc.88.8.671

Coexistence of social inequalities in undernutrition and obesity in preschool children: population based cross sectional study

J Armstrong 1, A Dorosty 1, J Reilly 1, H Child 1, P Emmett 1
PMCID: PMC1719615  PMID: 12876159

Abstract

Aims: To test for the coexistence of social inequalities in undernutrition and obesity in preschool children.

Methods: Retrospective, cross sectional, study of routinely collected data from 74 500 children aged 39–42 months in 1998/99. Main outcome measures were weight, height, sex, and age routinely recorded by health visitors. Body mass index (BMI) standardised for age and sex, relative to UK 1990 reference data, was used to define undernutrition (BMI <2nd centile) and obesity (BMI >95th centile; BMI >98th centile). Social deprivation was assessed as Carstairs deprivation category (1 = most affluent to 7 = most deprived).

Results: Both undernutrition (3.3%) and obesity (8.5% above 95th centile; 4.3% above 98th centile) significantly exceeded expected frequencies from UK 1990 reference data. Undernutrition and obesity were significantly more common in the more deprived families. Odds ratios in deprivation category 7 relative to category 1 were 1.51 (95% CI 1.22 to 1.87) for undernutrition (BMI <2nd centile) and 1.30 (95% CI 1.05 to 1.60) for obesity (BMI >98th centile). The cumulative prevalence of under and overnutrition (malnutrition) in the most deprived group was 9.5% compared to 6.9% in the least deprived group.

Conclusions: Undernutrition and obesity are significantly more common than expected in young children and strongly associated with social deprivation. Both undernutrition and obesity have adverse short and long term health effects. Public health strategies need to tackle malnutrition (both undernutrition and obesity) in children and take into consideration the association with social deprivation.

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Selected References

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  1. Alaimo K., Olson C. M., Frongillo E. A., Jr Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development. Pediatrics. 2001 Jul;108(1):44–53. [PubMed] [Google Scholar]
  2. Ben-Shlomo Y., Smith G. D. Commentary: socioeconomic position should be measured accurately. BMJ. 1999 Mar 27;318(7187):844–845. [PubMed] [Google Scholar]
  3. Bundred P., Kitchiner D., Buchan I. Prevalence of overweight and obese children between 1989 and 1998: population based series of cross sectional studies. BMJ. 2001 Feb 10;322(7282):326–328. doi: 10.1136/bmj.322.7282.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chalmers J., Capewell S. Deprivation, disease, and death in Scotland: graphical display of survival of a cohort. BMJ. 2001 Oct 27;323(7319):967–968. doi: 10.1136/bmj.323.7319.967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chinn S., Rona R. J. Prevalence and trends in overweight and obesity in three cross sectional studies of British Children, 1974-94. BMJ. 2001 Jan 6;322(7277):24–26. doi: 10.1136/bmj.322.7277.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dietz W. H. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998 Mar;101(3 Pt 2):518–525. [PubMed] [Google Scholar]
  7. Doak Colleen, Adair Linda, Bentley Margaret, Fengying Zhai, Popkin Barry. The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China. Public Health Nutr. 2002 Feb;5(1A):215–221. doi: 10.1079/PHN2001296. [DOI] [PubMed] [Google Scholar]
  8. Drake A. J., Smith A., Betts P. R., Crowne E. C., Shield J. P. H. Type 2 diabetes in obese white children. Arch Dis Child. 2002 Mar;86(3):207–208. doi: 10.1136/adc.86.3.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Egger G., Swinburn B. An "ecological" approach to the obesity pandemic. BMJ. 1997 Aug 23;315(7106):477–480. doi: 10.1136/bmj.315.7106.477. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Eriksson J. G., Forsén T., Tuomilehto J., Osmond C., Barker D. J. Early growth and coronary heart disease in later life: longitudinal study. BMJ. 2001 Apr 21;322(7292):949–953. doi: 10.1136/bmj.322.7292.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fagot-Campagna A., Narayan K. M., Imperatore G. Type 2 diabetes in children. BMJ. 2001 Feb 17;322(7283):377–378. doi: 10.1136/bmj.322.7283.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Freedman D. S., Dietz W. H., Srinivasan S. R., Berenson G. S. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999 Jun;103(6 Pt 1):1175–1182. doi: 10.1542/peds.103.6.1175. [DOI] [PubMed] [Google Scholar]
  13. Golding J., Pembrey M., Jones R., ALSPAC Study Team ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology. Paediatr Perinat Epidemiol. 2001 Jan;15(1):74–87. doi: 10.1046/j.1365-3016.2001.00325.x. [DOI] [PubMed] [Google Scholar]
  14. Gortmaker S. L., Must A., Perrin J. M., Sobol A. M., Dietz W. H. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med. 1993 Sep 30;329(14):1008–1012. doi: 10.1056/NEJM199309303291406. [DOI] [PubMed] [Google Scholar]
  15. Inchley J., Todd J., Bryce C., Currie C. Dietary trends among Scottish schoolchildren in the 1990s. J Hum Nutr Diet. 2001 Jun;14(3):207–216. doi: 10.1046/j.1365-277x.2001.00285.x. [DOI] [PubMed] [Google Scholar]
  16. Jackson Maria, Samms-Vaughan Maureen, Ashley Deanna. Nutritional status of 11-12-year-old Jamaican children: coexistence of under- and overnutrition in early adolescence. Public Health Nutr. 2002 Apr;5(2):281–288. doi: 10.1079/PHN2002262. [DOI] [PubMed] [Google Scholar]
  17. Kinra S., Nelder R. P., Lewendon G. J. Deprivation and childhood obesity: a cross sectional study of 20,973 children in Plymouth, United Kingdom. J Epidemiol Community Health. 2000 Jun;54(6):456–460. doi: 10.1136/jech.54.6.456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Monteiro Carlos A., Conde Wolney L., Popkin Barry M. Is obesity replacing or adding to undernutrition? Evidence from different social classes in Brazil. Public Health Nutr. 2002 Feb;5(1A):105–112. doi: 10.1079/PHN2001281. [DOI] [PubMed] [Google Scholar]
  19. Morrison J. A., Barton B. A., Biro F. M., Daniels S. R., Sprecher D. L. Overweight, fat patterning, and cardiovascular disease risk factors in black and white boys. J Pediatr. 1999 Oct;135(4):451–457. doi: 10.1016/s0022-3476(99)70167-8. [DOI] [PubMed] [Google Scholar]
  20. Morrison J. A., Sprecher D. L., Barton B. A., Waclawiw M. A., Daniels S. R. Overweight, fat patterning, and cardiovascular disease risk factors in black and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 1999 Oct;135(4):458–464. doi: 10.1016/s0022-3476(99)70168-x. [DOI] [PubMed] [Google Scholar]
  21. Nelson M. Childhood nutrition and poverty. Proc Nutr Soc. 2000 May;59(2):307–315. doi: 10.1017/s0029665100000343. [DOI] [PubMed] [Google Scholar]
  22. Popkin Barry M. An overview on the nutrition transition and its health implications: the Bellagio meeting. Public Health Nutr. 2002 Feb;5(1A):93–103. doi: 10.1079/phn2001280. [DOI] [PubMed] [Google Scholar]
  23. Reilly J. J., Dorosty A. R., Emmett P. M., Avon Longitudinal Study of Pregnancy and Childhood Study Team Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord. 2000 Dec;24(12):1623–1627. doi: 10.1038/sj.ijo.0801436. [DOI] [PubMed] [Google Scholar]
  24. Reilly J. J., Dorosty A. R., Emmett P. M. Prevalence of overweight and obesity in British children: cohort study. BMJ. 1999 Oct 16;319(7216):1039–1039. doi: 10.1136/bmj.319.7216.1039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Reilly J. J., Dorosty A. R. Epidemic of obesity in UK children. Lancet. 1999 Nov 27;354(9193):1874–1875. doi: 10.1016/S0140-6736(99)04555-9. [DOI] [PubMed] [Google Scholar]
  26. Reilly J. J., Wilson M. L., Summerbell C. D., Wilson D. C. Obesity: diagnosis, prevention, and treatment; evidence based answers to common questions. Arch Dis Child. 2002 Jun;86(6):392–394. doi: 10.1136/adc.86.6.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Sargent J. D., Blanchflower D. G. Obesity and stature in adolescence and earnings in young adulthood. Analysis of a British birth cohort. Arch Pediatr Adolesc Med. 1994 Jul;148(7):681–687. doi: 10.1001/archpedi.1994.02170070019003. [DOI] [PubMed] [Google Scholar]
  28. Teranishi H., Nakagawa H., Marmot M. Social class difference in catch up growth in a national British cohort. Arch Dis Child. 2001 Mar;84(3):218–221. doi: 10.1136/adc.84.3.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tomkins A. Malnutrition, morbidity and mortality in children and their mothers. Proc Nutr Soc. 2000 Feb;59(1):135–146. doi: 10.1017/s0029665100000161. [DOI] [PubMed] [Google Scholar]
  30. Wang Youfa, Monteiro Carlos, Popkin Barry M. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr. 2002 Jun;75(6):971–977. doi: 10.1093/ajcn/75.6.971. [DOI] [PubMed] [Google Scholar]
  31. Wright C. M., Booth I. W., Buckler J. M. H., Cameron N., Cole T. J., Healy M. J. R., Hulse J. A., Preece M. A., Reilly J. J., Williams A. F. Growth reference charts for use in the United Kingdom. Arch Dis Child. 2002 Jan;86(1):11–14. doi: 10.1136/adc.86.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Wright C., Loughridge J., Moore G. Failure to thrive in a population context: two contrasting studies of feeding and nutritional status. Proc Nutr Soc. 2000 Feb;59(1):37–45. doi: 10.1017/s0029665100000057. [DOI] [PubMed] [Google Scholar]
  33. Yajnik C. Interactions of perturbations in intrauterine growth and growth during childhood on the risk of adult-onset disease. Proc Nutr Soc. 2000 May;59(2):257–265. doi: 10.1017/s0029665100000288. [DOI] [PubMed] [Google Scholar]
  34. Yajnik C. Interactions of perturbations in intrauterine growth and growth during childhood on the risk of adult-onset disease. Proc Nutr Soc. 2000 May;59(2):257–265. doi: 10.1017/s0029665100000288. [DOI] [PubMed] [Google Scholar]

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