巴基斯坦农村地区青少年晚期和年轻女性营养不良的驱动因素：MaPPS 试验的横断面评估。

Drivers of malnutrition among late adolescent and young women in rural Pakistan: a cross-sectional assessment of the MaPPS trial.

机构信息

Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.

Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.

出版信息

BMJ Open. 2023 May 23;13(5):e063734. doi: 10.1136/bmjopen-2022-063734.

DOI:10.1136/bmjopen-2022-063734

PMID:37221027

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10230942/

Abstract

OBJECTIVE

This study aimed to characterise the burden of malnutrition and assess how underlying determinants at the structural and intermediary levels contributed to malnutrition among late adolescent and young women in rural Pakistan.

DESIGN

Cross-sectional enrolment data assessment.

SETTING AND PARTICIPANTS

This study was conducted using data from adolescent and young women (n=25 447) enrolled in the Matiari emPowerment and Preconception Supplementation Trial, collected from June 2017 to July 2018 in Matiari District, Pakistan. The WHO-based cut-offs were applied to anthropometric measures to estimate body mass index (BMI) categories (underweight, overweight, obese) and stunting. Hierarchical models were generated to evaluate the association between the determinants with BMI categories and stunting among late adolescent girls and young women, respectively.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcomes of interest were BMI categories and stunting. Explanatory variables included measures of socioeconomic status, education, occupation, health, well-being, food security, empowerment and food practices.

RESULTS

Regardless of age group, the prevalence of underweight was high (36.9%; 95% CI 36.3% to 37.5%). More late adolescent girls were underweight, while more young women were overweight/obese (p<0.001). Stunting affected 9.2% (95% CI 8.9% to 9.6%) of participants, of which 35.7% were additionally underweight and 7.3% overweight/obese. Compared with those in the normal weight category, those underweight were more likely to be impoverished and less empowered. Those overweight/obese were more likely to be from a higher wealth quintile and food secure. Increased education level and food security were associated with reductions stunting risk.

CONCLUSIONS

This study informs the data gap and need for comprehensive research on adolescent nutritional status. Findings suggest factors related to poverty played an important, underlying role in undernutrition among participants. Commitment to improving the nutritional status of all adolescent and young women in Pakistan will be critical given the observed burden of malnutrition.

TRIAL REGISTRATION NUMBER

NCT03287882.

摘要

目的

本研究旨在描述营养不良的负担，并评估结构和中间层面的潜在决定因素如何导致巴基斯坦农村地区青少年和年轻女性营养不良。

设计

横断面登记数据评估。

地点和参与者

本研究使用了来自巴基斯坦马蒂亚里区的青少年和年轻女性（n=25447）参加的马蒂亚里赋权和孕前补充试验的登记数据，这些数据于 2017 年 6 月至 2018 年 7 月收集。应用基于世界卫生组织的标准来衡量人体测量学指标，以估计身体质量指数（BMI）类别（体重不足、超重、肥胖）和发育迟缓。生成层次模型来评估决定因素与青少年后期女孩和年轻女性的 BMI 类别和发育迟缓之间的关联。

主要和次要结果

主要结果为 BMI 类别和发育迟缓。解释变量包括社会经济地位、教育、职业、健康、福祉、粮食安全、赋权和粮食实践的衡量标准。

结果

无论年龄组如何，体重不足的患病率都很高（36.9%；95%CI 36.3%至 37.5%）。更多的青少年女孩体重不足，而更多的年轻女性超重/肥胖（p<0.001）。发育迟缓影响了 9.2%（95%CI 8.9%至 9.6%）的参与者，其中 35.7%的人同时体重不足，7.3%的人超重/肥胖。与正常体重组相比，体重不足的人更有可能贫困和赋权不足。超重/肥胖的人更有可能来自更高的财富五分位数和粮食安全。教育水平和粮食安全的提高与降低发育迟缓的风险有关。