|Patterns, distribution, and determinants of under- and overnutrition: A population-based study of women in India1|
||Subramanian, S.V., G.D.Smith
||American Journal of Clinical Nutrition, Vol 84, Page: 633-640
||Background: Little systematic evidence exists for the relation between
socioeconomic position and nutritional status in countries
experiencing the simultaneous presence of under- and overnutrition.
Objective: We investigated the socioeconomic distribution of nutritional
status in India and whether state-level macroeconomic factors
modify the relation between socioeconomic position and nutritional
Design: Our analysis was based on a nationally representative sample
of 77 220 women from India, with multiple categories of body
mass index (BMI; in kg/m2) as the outcome, namely,18.5 (underweight),
23–24.9 (pre-overweight), 25–29.9 (overweight), or 30
(obese), with 18.5–22.9 as the reference category.
Results: In adjusted models, being underweight was inversely related
to socioeconomic position, whereas socioeconomic position
was positively related to being pre-overweight, overweight, and
obese, and the socioeconomic gradient was most marked for obesity.
State-level measures of affluence did not modify the positive association
between socioeconomic position and categories of overweight.
The risk of underweight was lower in affluent states, but this
was seen mainly in women of high socioeconomic position.
Conclusions: Undernutrition and overnutrition are epidemics of the
impoverished and the affluent, respectively, in India, and this association
is consistent at the individual and ecologic levels. Policies
should focus on the complex patterns of social distribution of both
under- and overnutrition in the Indian context.