Public Health Nutrition: 5(1A)

Abstract Objective: The goal of this paper is to explore the hypothesis that the nutrition transition is related to households having an underweight and an overweight member simultaneously (under/over households and under/over pairs). Design: The 1993 China Health and Nutrition Survey (CHNS) was used to test the association between being an under/over household and household characteristics related to the nutrition transition. Sociodemographic and diet patterns were tested for the main age combinations of the under/over pairs. Setting: In China, 8.1% of all households were found to have underweight and overweight members within the same household. Subjects: Results are from the 1993 China Health and Nutrition Survey and are based on a sample of 13 814 persons from 3340 households. Results: The under/over household was more urban, had a higher income and was more likely to have assets such as a television, a motor vehicle and a washing machine, even after controlling for sociodemographic confounders. The under/over household had a diet that was higher in fat and protein compared with the underweight and normal weight households. There were no significant differences between the under/over and overweight households, with many of the associations near unity. Comparisons of the under/over subgroups by age of the under/over pairs showed some differences by income and occupation, but not for diet. Conclusions: It is imperative, as more individuals become exposed to the diet and lifestyle patterns of the nutrition transition, to find effective public health programmes that can simultaneously promote a healthy lifestyle, improve diet quality and address both undernutrition and chronic disease. Keywords China Diet Household food distribution Under/over Underweight Overweight A number of scholars have identified the presence of households with undernutrition and overweight coexisting in the same household. This finding has been regarded as a sign of the shift to the nutrition transition stage linked to diet-related non-communicable disease (NCD). Initial observations in South Africa found low-income, overweight women coexisting in communities with a high prevalence of child undernutrition 1,2 . Subsequent research has shown that this is a common condition in a wide range of countries 3 -5 . Garrett and Ruel 6 have also found obesity and overweight among women clustering with stunting among children. We have hypothesised these findings to be the result of diet and activity changes related to the rapid shift in the stage of the nutrition transition. Here and throughout this paper, the term nutrition transition is used to refer to the shift towards the diet-related NCD phase. Furthermore, emerging and rising obesity in many developing countries 7 indicate that this might be a broader global concern. However, few studies have considered households with underweight and overweight individuals of any age, simultaneously. These households, which are the focus of this paper, will be henceforth referred to as under/over households, and the underweight and overweight individuals within these households will be referred to as under/over pairs. The study by Doak et al. 5 found urban residence to be associated with the under/over households in Brazil, China and Russia. In China, the transitions in diet and activity related to overweight and chronic disease occurred first in the urban areas and among high-income households 8 -10 . These factors, as well as other sociodemographic variables such as household assets, may contribute to the likelihood of underweight and overweight clustering within households. The 1993 China Health and Nutrition Survey is used to test the association between household characteristics. Tests were made related to the nutrition transition and being an under/over household. This survey has in-depth anthropometric, dietary and socio-economic status (SES) data from all household members. It was expected that a common set of factors leads to increased overweight status, which are also related to the q The Authors 200

The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China

OBJECTIVE: The goal of this paper is to explore the hypothesis that the nutrition transition is related to households having an underweight and an overweight member simultaneously (under/over households and under/over pairs). DESIGN: The 1993 China Health and Nutrition Survey (CHNS) was used to test the association between being an under/over household and household characteristics related to the nutrition transition. Sociodemographic and diet patterns were tested for the main age combinations of the under/over pairs. SETTING: In China, 8.1% of all households were found to have underweight and overweight members within the same household. SUBJECTS: Results are from the 1993 China Health and Nutrition Survey and are based on a sample of 13814 persons from 3340 households. RESULTS: The under/over household was more urban, had a higher income and was more likely to have assets such as a television, a motor vehicle and a washing machine, even after controlling for sociodemographic confounders. The under/over household had a diet that was higher in fat and protein compared with the underweight and normal weight households. There were no significant differences between the under/over and overweight households, with many of the associations near unity. Comparisons of the under/over subgroups by age of the under/over pairs showed some differences by income and occupation, but not for diet. CONCLUSIONS: It is imperative, as more individuals become exposed to the diet and lifestyle patterns of the nutrition transition, to find effective public health programmes that can simultaneously promote a healthy lifestyle, improve diet quality and address both undernutrition and chronic disease

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