Nutritional transition in children under five years and women of reproductive age: a 15-years trend analysis in Peru

Abstract

Background: Rapid urbanization, increase in food availability, and changes in diet and lifestyle patterns have been changing nutritional profiles in developing nations. We aimed to describe nutritional changes in children under 5 years and women of reproductive age in Peru, during a 15-year period of rapid economic development and social policy enhancement.

Materials and methods: Trend analyses of anthropometric measures in children of preschool age and women between 15-49 years, using the Peruvian National Demographic and Family Health Surveys (DHS) from 1996 to 2011. WHO growth curves were used to define stunting, underweight, wasting and overweight in children <5 y. We employed the WHO BMI-age standardized curves for teenagers between 15-19 y. In women >19 years, body mass index (BMI) was analyzed both categorically and as a continuous variable. To statistically analyze the trends, we used regression models: Linear and Poisson for continuous and binary outcomes, respectively.

Results: We analyzed data from 123 642 women and 64 135 children, from 1996 to 2011. Decreases over time were evidenced for underweight (p<0.001), wasting (p<0.001), and stunting (p<0.001) in children under 5 y. This effect was particularly noted in urban settings. Overweight levels in children reduced (p<0.001), however this reduction stopped, in urban settings, since 2005 (∼12%). Anemia decreased in children and women (p<0.001); with higher reduction in urban (↓43%) than in rural children (↓24%). BMI in women aged 15-19 years increased (p<0.001) across time, with noticeable BMI-curve shift in women older than 30 years. Moreover, obesity doubled during this period in women more than 19 y.

Conclusion: Nutrition transition in Peru shows different patterns for urban and rural populations. Public policies should emphasize targeting both malnutrition conditions--undernutrition/stunting, overweight/obesity and anemia--considering age and place of residence in rapid developing societies like Peru.

Figure 1. Stunting, wasting, underweight, and overweight trends of urban and rural children under five years, 1996–2011.

A. Urban children (n = 33,304). B. Rural Children (n = 30,831). C. All Children (n = 64,135).

Figure 2. Categorical BMI trends for Peruvian urban and rural adult women (20–49 years), 1996–2011.

A. Urban adult women (n = 63,895). B. Rural adult women (n = 37,088). C. All adult women (20–49 years) (n = 100,983).

Figure 3. Categorical BMI trends for Peruvian adolescent women (15–19 years), 1996–2011.

Total n = 22,659; 1996 n = 717; 2000 n = 5,340; 2005 n = 1,154; 2007 n = 1,001; 2008 n = 2,462; 2009 n = 4,021; 2010 n = 4,038; 2011 n = 3,926.

Figure 4. Peruvian women BMI curves, 1996–2011, stratified by age.

A. 15–19 years (1996 n = 717/2011 n = 3,926) B. 20–29 years (1996 n = 5,141/2011 n = 6,058) C. 30–39 years (1996 n = 3,836/2011 n = 5,928) D. 40–49 years (1996 n = 1,149/2011 n = 5,075). Y-axis Percentage of women with a given BMI in each age group; X-axis Women BMI.

Figure 5. Peruvian Children BMI curves standardized for age and sex using WHO reference, 1996–2011.

A. Urban Children (1996 n = 7,938/2011 n = 4,774) B. Rural children (1996 n = 7,171/2011 n = 3,960). Y-axis Percentage of children with a given BMI; X-axis WHO age-sex Standardized BMI.