Determinants of Chronic Energy Deficiency and
Overweight/Obesity Among Non-Pregnant Mothers
19 Years and Older in the Philippines
Eva A. Goyena*, Ma. Lynell Valdeabella-Maniego,
and Mildred O. Guirindola
Nutritional Assessment and Monitoring Division
Food and Nutrition Research Institute, Department of Science and Technology
Bicutan, Taguig City, Philippines
*corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
The study aimed to identify household and maternal characteristics associated with chronic energy deficiency (CED) and overweight/obesity among non-pregnant mothers 19 years old and above in the Philippines. Cross-sectional analysis of the “2011 Updating of the Nutritional Status of Filipino Children and Other Population Groups”, a nationwide nutrition survey conducted by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST), was done using descriptive, bivariate and logistic regression analyses. Results showed that overweight/obesity prevalence (Body Mass Index/BMI)>25.0 kg/m2) was three-folds higher (31.2%) than CED (BMI<18.5) prevalence (10.0%). Single mothers (adjusted Odds Ratio/aOR 1.52, 95% CI=1.13-2.05), mothers with live-in status (aOR 1.39, 95% CI=1.15-1.66) and 19- to 29-year-old mothers (aOR 1.22, 95% CI=1.01-1.48) were more likely to have CED than their counterparts from other marital and age groups. On the other hand, the risk of becoming overweight/obese was found to be higher for mothers 40 years and older (aOR 1.26, 95% CI=1.06-1.50), had at least elementary education (aOR 1.23, 95% CI=1.04-1.45 ), from the richest wealth quintile (aOR 1.44; 95% CI=1.20-1.72) and from households with less than five members (aOR 1.17; 95% CI=1.05-1.32) than their counterparts in other age, educational attainment, wealth quintile and household size groups. The study provides evidence on the emerging double burden of malnutrition among Filipino mothers based on BMI classification. These findings may provide insights to strategies and advocacies that promote healthy lifestyle to improve the nutritional status of Filipino mothers.
INTRODUCTION
The nutritional status of a mother has profound health effects that span throughout the human life stage, highlighting its importance as an indicator of her overall health and survival, a predictor of pregnancy outcome and fetal growth and an influencing factor in subsequent early childhood survival, growth and development (Black et al. 2013). Maternal undernutrition, indicated by a body mass index (BMI) less than 18.5 kg/m2, short stature and micronutrient deficiencies, is associated with short and long term consequences, including increased risk of complications during delivery, higher risk of giving birth to small-for-gestational-age (SGA) infants, higher risk of childhood stunting in the first year of life, increased risk of childhood infections (e.g., diarrhea, pneumonia and measles), impaired cognitive development, lower educational attainment, diminished work capacity and economic productivity (Black et al. 2008) and increased susceptibility to obesity and chronic non-communicable diseases (NCDs) in adult life (Victora et al. 2008). . . . . read more
REFERENCES
BARKER DJP. 2001. The fetal origins of adult disease: No longer just a hypothesis and may be critically important in South Asia. BMJ 322: 375-376. Accessed from http://www.aipro.info/drive/File/The%20fetal%20origins%20of%20adult%20disease.pdf on April 16, 2016.
BLACK RE, ALLEN LH, BHUTTA ZA, CAULFIELD LE, DE ONIS M, EZZATI M, MATHERS C, RIVERA J. 2008. Maternal and child undernutrition: Global and regional exposures and health consequences. The Lancet Series 371: 243-257. Accessed at http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61690-0.pdf on April 12, 2016.
BLACK RE, VICTORA CG, WALKER SP, BHUTTA ZA, CHRISTIAN P, DE ONIS M, EZZATI M, GRANTHAM-MCGREGOR S, KATZ J, MARTORELL R, UAUY R. 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet Series 382: 427-451. Accessed at http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60937-X.pdf on March 12, 2016.
CHAPARRO C. OOT L, SETHURAMAN K. 2014. Overview of the nutrition situation in seven countries in Southeast Asia. Washington, DC: FHI 360/FANTA.18p. Accessed at http://www.fantaproject.org/sites/default/files/download/Southeast-Asia-Nutrition Overview-Apr2014.pdf on April 10, 2016.
DINSA GD, GORYAKIN Y, FURNAGALLI E, SUHRCKE M. 2012. Obesity and socio- economic status in developing countries: a systematic review. Obes Rev 13(11):1067-1079.
DOKU DY, NEUPANE S. 2015. Double burden of malnutrition: Increasing overweight and obesity and stall underweight trends among Ghanian women. BioMed Central 15:670 doi 10.1186/s12889-015-2033-2036.
[DOH] DEPARTMENT OF HEALTH ADMINISTRATIVE ORDER (AO) No. 2010 s. 0010. Revised policy and guide on micronutrient supplementation to support the achievement of 2015 MDG targets to reduce under-five and maternal deaths and address micronutrient needs of the population groups. Bldg. I, San Lazaro Compound, Sta. Cruz, Manila, Philippines. 14p. Accessed from http://www.doh.gov.ph/sites/default/files/publications/DOH_Annual_Report2013.pdf
[DOH] DEPARTMENT OF HEALTH. 2014. Strategic framework for comprehensive nutrition implementation plan 2014-2025. Bldg. I, San Lazaro Compound, Sta. Cruz, Manila, Philippines. p. 1-4.
ERICTA C, FABIAN EMMA. 2009. A documentation of the Philippines’ family income and expenditure survey. Philippine Institute for Development Studies. Discussion Paper Series No. 2009-18.
[FANTA-USAID] FOOD AND NUTRITION TECHNICAL ASSISTANCE- UNITED STATES AGENCY INTERNATIONAL DEVELOPMENT. 2014. Overview of the nutrition situation in the seven countries in Southeast Asia. Accessed at http://www.fantaproject.org/sites/default/files/download/Southeast-Asia-Nutrition-Overview-Apr2014.pdf on April 10, 2016.
[FDA] FOOD AND DRUG ADMINISTRATION.1995. Republic Act No. 8172. An act promoting salt iodization nationwide and for related purposes.
[FNRI-DOST] FOOD AND NUTRITION RESEARCH INSTITUTE-DEPARTMENT OF SCIENCE AND TECHNOLOGY. 2012. Philippine nutrition facts and figures 2011. Bicutan, Taguig City, Metro Manila, Philippines: Food and Nutrition Research Institute-Department of Science and Technology.
[FNRI-DOST] FOOD AND NUTRITION RESEARCH INSTITUTE-DEPARTMENT OF SCIENCE AND TECHNOLOGY. 2015a. Philippine nutrition facts and figures 2013. Anthropometric survey. FNRI Bldg., Bicutan, Taguig City, Metro Manila, Philippines. p. 53-54.
[FNRI-DOST] FOOD AND NUTRITION RESEARCH INSTITUTE-DEPARTMENT OF SCIENCE AND TECHNOLOGY. 2015b. Philippine nutrition facts and figures 2013. Overview. FNRI Bldg., Bicutan, Taguig City, Metro Manila, Philippines. p. xxvii.
[FNRI-DOST] FOOD AND NUTRITION RESEARCH INSTITUTE-DEPARTMENT OF SCIENCE AND TECHNOLOGY. 2013a. Flyers of 8th National Nutrition Survey: Nutritional status of mothers (pregnant, lactating, non-pregnant and non-lactating with 0-36 months old children. FNRI Bldg., Bicutan, Taguig City, Metro Manila, Philippines.
[FNRI-DOST] FOOD AND NUTRITION RESEARCH INSTITUTE-DEPARTMENT OF SCIENCE AND TECHNOLOGY. 2013b. Flyers of 8th National Nutrition Survey: Iodine deficiency disorders in the Philippines: UIE Levels. FNRI Bldg., Bicutan, Taguig City, Metro Manila, Philippines.
[FNRI-DOST] FOOD AND NUTRITION RESEARCH INSTITUTE-DEPARTMENT OF SCIENCE AND TECHNOLOGY. 2015. Flyers on National Nutrition Summit: MDGs by 2015: Did Juan hit the targets? Presented during the Nutrition Summit held on February 16, 2016 at Crowne Plaza Galleria Ortigas, Metro Manila, Philippines.
GNEEZY U, SHAFRIN J. 2009. Why does getting married make you fat? Incentives and appearance maintenance. San Diego: Rady School of Management, University of California. 26p. Accessed from http://jasonshafrin.com/papers/Marriage.pdf on October 12, 2016.
GOUDA J, PRUSTY RK. 2014. Overweight and obesity among women by economic stratum in urban India. J Health Popul Nutr 32(1):79-88. Accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089075/ on October 12, 2016.
HAILESSLASSIE K, MALAGUETA A, GIRMA A. 2013. Feeding practices, nutritional status, and associated factors of lactating women in Samre Woreda, South Easthern Zone of Tigray, Ethiopia. Nutr J 12:28.
JELLIFFE DERRICK BRIAN and JELLIFEE PATRICE EF. 1989. Community nutritional assessment: With special reference to lee technically developed countries. Oxford Medical Publications. Oxford University Press.
LAZZER S, BEDOGNI G, LAFORTUNA C, MARAZZI N, BUSTI C, GALLI R, DE COL A, AGOSTO F, SARTORIO A. 2010. Relationship between BMR, gender, age and body composition in 8,780 white obese subjects. Obesity Research Journal 18(1) Accessed from http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.162/full on October 14, 2016.
LUKE B, BROWN M. 2007. Elevated risk of pregnancy complications and adverse outcomes with increasing maternal age. Human Reproduction 22(5):1264-1272.
MENDEZ MA, MONTEIRO CA AND POPKIN BM. 2005. Overweight exceeds underweight women in most developing countries. Am J Clin Nutr 81:714-721.
MONTEIRO CA, CONDE WL, LU B, POPKIN BM.2004. Obesity and inequalities in health in the developing world. Int J Obes Rela Metab Disord 28:1181-1186 [PubMed 15211362].
MONTEIRO CA, D’A BENICIO MH, CONDE WL, POPKIN BM. 2000. Shifting obesity trends in Brazil. Eur J Clin Nutr 54:342-346.
[NSO] NATIONAL STATISTICS OFFICE AND ICF MACRO. 2009. National demographic health survey 2008. Calverton Maryland: National Statistics Office and ICF Macro.
O’ SULLIVAN JB. 1982. Body weight and subsequent diabetes mellitus. JAMA 248:949-52. Accessed at http://www.ncbi.nlm.nih.gov/pubmed/7097963 on April 1, 2016.
PARIZKOVA J, CHIN M-K, CHIA M, YANG J. 2007. An international perspective on obesity, health and physical activity: Current trends and challenges in China and Asia. J Exerc Sci Fit 5(1): 7-23. Accessed from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105469. On October 12, 2016.
PEDRO MRA, BENAVIDEZ RC, BARBA CVC. 2006. Dietary changes and their health implications in the Philippines. Food and Nutrition Research Institute-DOST, General Santos Avenue, Bicutan, Taguig City, Manila, Philippines. p. 20-23.
POPKIN BM, RICHARDS MK AND MONTEIRO CA. 1996. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. The Journal of Nutrition: 126(12): 3009-3016.
POPKIN BM. 2006. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84:289-98. Accessed from http://ajcn.nutrition.org/content/84/2/289.full.pdf.
SENBANJO I, OLAYIWOLA I, AFOLABI W, SENBANJO O. 2013. Maternal and child under- nutrition in rural and urban community of Lagos State, Nigeria: the relationship and risk factors. Biomedical Central. 6: 283. Accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725170/pdf/1756-0500-6-286.pdf on April 16, 2016
SHRIMPTOM R. 2013. Nutrition capacity development: a practice framework. Public Health Nutrition. p. 1-7. doi:10.1017/S1368980013001213. Accessed from http://wphna.org/wp-content/uploads/2013/05/CB-Shrimpo-paper-as-published.pdf. on October 12, 2016.
SOHLBERG S, STEPHANSSON O, CNATTINGUIS S, WIKSTROM AK. 2012. Maternal body mass index, height and risk of peeclampsia. Am J Hypertens 25:120-125. Accessed at http://www.ncbi.nlm.nih.gov/pubmed/21976280 on April 1, 2016.
ST-ONGE MP, GALLAGHER D. 2010. Body composition changes with aging: The cause or the result of alterations in metabolic rate and macronutrient oxidation? National Institute of Health 6(2): 152-155. doi:10.1016/j.nut.2009.07.004.Accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880224/pdf/nihms201762.pdf.
TARLONI MR, BELTRAN AP, HORTA BL, NAKAMURA MU, ATALLAH AN, MORON AF, VALENTE O. 2009. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of literature with meta-analysis. Obes Rev 10:194-203; Accessed at http://www.ncbi.nlm.nih.gov/pubmed/19055539 on April 1, 2016.
TEMPLE R, MURPHY H. 2010. Type 2 diabetes in pregnancy- an increasing problem. Best Prac Res Clin Endocrinol Metwab 24:591-603 Accessed at http://www.sciencedirect.com/science/article/pii/S1521690X10000576 on April 1, 2016.
TSOI E, SHAIKH H, ROBINSON S, TEO TG. 2010. Obesity in pregnancy: A major healthcare issue. Postgrad Med J 86:617-23. Accessed at http://www.ncbi.nlm.nih.gov/pubmed/20971713 on April 1, 2016.
TZIOIMIS E, ADAIR LS, 2014. Childhood dual burden of under and over-nutrition in low-and middle-income countries: a critical review. National Institutes of Public Health. Food Nutr Bull 35(2): 230-243.
VAN LIESHOUT RJ, TAYLOR VH, BOYLE MH. 2011. Pre-pregnancy BMI and pregnancy obesity and neurodevelopment outcomes in offspring: A systematic review. Obes Rev 12:e548-59. Accessed at http://www.ncbi.nlm.nih.gov/pubmed/21414129 on April 1, 2016.
VICTORA GC, ADAIR L, FALL C, HALLAL PC, MARTORELL R, RICHTER L, SACHDEV HS. 2008. Maternal and child undernutrition: Consequences for adult health and human capital. Lancet Series 371: 340-357. Accessed at http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61692-4.pdf on April 12, 2016.
[WHO] WORLD HEALTH ORGANIZATION. 1995. Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva. Accessed from http://apps.who.int/bmi/index.jsp?introPage=intro_3.html on April 19, 2016.
[WHO] WORLD HEALTH ORGANIZATION. 2007. Maternal Mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA and the World Bank. Accessed from http://www.who.int/whosis/mme_2005.pdf on April 16, 2016.
[WHO] WORLD HEALTH ORGANIZATION. 2014. Global status report on non-communicable diseases. Attaining the nine global non-communicable diseases targets; a shared responsibility”. Geneva, Switzerland: WHO Press. 302p.
[WHO-WHA] WORLD HEALTH ORGANIZATION- WORLD HEALTH ASSEMBLY. 2014. Global Target 2025 to improve maternal, infant and young child nutrition. WHO website at http://www.who.int/nutrition/en/. Accessed last October 16, 2016
