title: Income inequality and the double burden of under- and overnutrition in India.
abstract: OBJECTIVE
  Developing countries are increasingly characterised by the simultaneous occurrence of under- and overnutrition. This study examined the association between contextual income inequality and the double burden of under- and overnutrition in India.
  
  
  METHODS
  A population-based multilevel study of 77,220 ever married women, aged 15-49 years, from 26 Indian states, derived from the 1998-99 Indian National Family Health Survey data. The World Health Organization recommended categories of body mass index constituted the outcome, and the exposure was contextual measure of state income inequality based on the Gini coefficient of per capita consumption expenditure. Covariates included a range of individual demographic, socioeconomic, behavioural and morbidity measures and state-level economic development.
  
  
  RESULTS
  In adjusted models, for each standard deviation increase in income inequality, the odds ratio for being underweight increased by 19% (p = 0.02) and the odds ratio for being obese increased by 21% (p<0.0001). Income inequality had a similar effect on the risk of being overweight as it did on the risk of obesity (p = 0.01), and state income inequality increased the risk of being pre-overweight by 9% (p = 0.01). While average levels of state economic development were strongly associated with degrees of overnutrition, no association was found with the risk of being underweight.
  
  
  CONCLUSIONS
  Rapidly developing economies, besides experiencing paradoxical health patterns, are typically characterised by increased levels of income inequality. This study suggests that the twin burden of undernutrition and overnutrition in India is more likely to occur in high-inequality states. Focusing on economic equity via redistribution policies may have a substantial impact in reducing the prevalence of both undernutrition and overnutrition.
authors: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115-6096, USA. svsubram@hsph.harvard.edu
authors: S V
authors: SV
authors: Subramanian
authors: Ichiro
authors: I
authors: Kawachi
authors: George Davey
authors: GD
authors: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D006306:Health Surveys; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D012935:Social Justice
references: Am J Clin Nutr. 2005 Mar;81(3):714-21
references: 15755843
references: Hum Biol. 1998 Oct;70(5):901-17
references: 9780518
references: Int J Obes (Lond). 2005 Jun;29(6):656-67
references: 15782225
references: Lancet. 2005 Oct 1;366(9492):1197-209
references: 16198769
references: Int J Obes (Lond). 2006 Jan;30(1):106-11
references: 16189502
references: Am J Clin Nutr. 2006 Sep;84(3):633-40
references: 16960179
references: Soc Sci Med. 2000 Mar;50(5):673-87
references: 10658848
references: Demography. 2001 Feb;38(1):115-32
references: 11227840
references: J Nutr. 2001 Mar;131(3):866S-870S
references: 11238776
references: Nutr Rev. 2001 Dec;59(12):379-90
references: 11766908
references: J Epidemiol Community Health. 2002 Nov;56(11):876-80
references: 12388581
references: Am J Clin Nutr. 2003 Feb;77(2):341-7
references: 12540392
references: Diabetes Care. 2003 May;26(5):1380-4
references: 12716792
references: Lancet. 2004 Jan 10;363(9403):157-63
references: 14726171
references: Soc Sci Med. 2004 May;58(10):1961-7
references: 15020011
references: BMJ. 2004 Apr 3;328(7443):801-6
references: 15070637
references: Soc Sci Med. 2004 Jun;58(12):2645-54
references: 15081212
references: Nutrition. 2004 May;20(5):482-91
references: 15105039
references: Epidemiol Rev. 2004;26:78-91
references: 15234949
references: Int J Obes Relat Metab Disord. 2004 Aug;28(8):1048-58
references: 15197412
references: Int J Obes Relat Metab Disord. 2004 Sep;28(9):1181-6
references: 15211362
references: Proc Nutr Soc. 2004 Aug;63(3):387-96
references: 15373948
references: Econ Hum Biol. 2003 Jan;1(1):105-21
references: 15463967
references: Eur J Clin Nutr. 1992 Mar;46(3):173-86
references: 1559522
references: Int J Obes Relat Metab Disord. 1992 May;16(5):367-75
references: 1319972
references: Proc Nutr Soc. 1992 Aug;51(2):135-44
references: 1438321
references: Eur J Clin Nutr. 1994 Nov;48 Suppl 3:S131-40
references: 7843150
references: Eur J Clin Nutr. 1994 Nov;48 Suppl 3:S56-67
references: 7843161
references: World Health Organ Tech Rep Ser. 1995;854:1-452
references: 8594834
references: Soc Sci Med. 1997 Oct;45(7):1121-7
references: 9257403
references: Soc Sci Med. 2005 Jul;61(1):83-96
references: 15847964