Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in India.
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 status.


METHODS
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 > 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.
Subramanian
S V
SV
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA. svsubram@hsph.harvard.edu
Smith
George Davey
GD
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data / Q000639:trends; D012923:Social Class; D012959:Socioeconomic Factors; D013851:Thinness / Q000453:epidemiology* / Q000209:etiology; D014504:Urban Health / Q000706:statistics & numerical data / Q000639:trends