Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka

Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5–10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child’s body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08–5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16–0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.

儿童营养不良与母亲肥胖是斯里兰卡面临的重大公共卫生问题。本研究旨在探讨学龄儿童及其家庭层面的社会经济地位与营养双重负担之间的关联。本研究纳入斯里兰卡甘帕哈区（Gampaha District）的543名5~10岁小学生（其中男生204名，女生339名）用于分析。儿童与母亲的消瘦、体重正常、超重及肥胖营养状态，均依据世界卫生组织（World Health Organization, WHO）生长参照标准及体质量指数（Body Mass Index, BMI）进行判定。本研究采用母亲受教育程度、家庭等价收入及母亲就业状况作为社会经济地位的评估指标。儿童消瘦与超重的占比分别为19.3%与13.4%，母亲超重（体质量指数≥25 kg/m²）的占比为36.5%。在年龄较大的男生与年龄较小的女生中，母亲体质量指数与儿童年龄别体质量指数Z评分呈正相关。多因素逐步Logistic回归分析结果显示，母亲受教育程度较低与儿童消瘦风险升高显著相关（校正比值比=2.33，95%置信区间：1.08~5.00）。母亲超重或肥胖者，其子女出现消瘦的概率更低（校正比值比=0.30，95%置信区间：0.16~0.58）。母亲就业状况及家庭等价收入与儿童超重、肥胖虽无显著关联，但存在一定边际相关性。社会经济不平等与母亲营养状态共同影响儿童营养不良状况。本研究结果提示，改善儿童营养不良状况需考虑家庭内部的潜在影响因素。