title: Association of socioeconomic position with under- and overnutrition in Pakistan.
abstract: OBJECTIVE
  We assessed the relationship between socioeconomic position (SEP) and under- and overnutrition in Pakistani adults.
  
  
  METHODS
  In 2006, we conducted a cross-sectional study including adult participants ≥20 years of age (n = 3500) residing in district Khairpur in Sindh province of Pakistan. We categorized body mass index (BMI) into <18.5 (underweight), 18.6-22.5 (normal BMI), 23-24.9 (preoverweight), 25-29.9 (overweight), and ≥30 (obese). We assessed the association of SEP based on wealth index measured as quintiles of a linear index derived from household assets and utilities score with categories of BMI through multinomial regression with the use of normal BMI as reference category while accounting for sampling design.
  
  
  RESULTS
  After adjusting for age, sex, education level, and occupation, there was no significant association of SEP and underweight, whereas SEP was positively associated with the categories of preoverweight, overweight, and obesity. In comparison with the 1st quintile, those in upper wealth quintiles had significantly greater odds of being preoverweight (4th quintile: adjusted odds ratio [adjOR], 1.47; 95% confidence interval [95% CI], 1.04-2.08; 5th quintile: adjOR, 1.57; 95% CI, 1.12-2.21), overweight (4th quintile; adjOR, 1.97; 95% CI, 1.43-2.72; 5th quintile: adjOR, 2.66; 95% CI, 1.91-3.69) and obese (4th quintile: adjOR, 2.24; 95% CI, 1.37-3.69; 5th quintile: adjOR, 3.65; 95% CI, 2.14-6.22).
  
  
  CONCLUSIONS
  Shift from under- to overnutrition across SEP groups is occurring in Pakistan. There is a need for re-evaluating national policies and programs to tackle the growing burden of emerging over-nutrition along with rampant under-nutrition.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. Naveed.Janjua@bccdc.ca
authors.forename: Naveed Zafar
authors.initials: NZ
authors.lastname: Janjua
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.forename: Bushra
authors.initials: B
authors.lastname: Mahmood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D012923:Social Class; D011795:Surveys and Questionnaires; D055815:Young Adult