title: A double burden of overall or central adiposity and anemia or iron deficiency is prevalent but with little socioeconomic patterning among Moroccan and Tunisian urban women.
abstract: In North Africa, overnutrition has dramatically increased with the nutrition transition while micronutrient deficiencies persist, resulting in clustering of opposite types of malnutrition that can present a unique difficulty for public health interventions. We assessed the magnitude of the double burden of malnutrition among urban Moroccan and Tunisian women, as defined by the coexistence of overall or central adiposity and anemia or iron deficiency (ID), and explored the sociodemographic patterning of individual double burden. In cross-sectional surveys representative of the region around the capital city, we randomly selected 811 and 1689 nonpregnant women aged 20-49 y in Morocco and Tunisia, respectively. Four double burdens were analyzed: overweight (body mass index ≥25 kg/m(2)) or increased risk abdominal obesity (waist circumference ≥80 cm) and anemia (blood hemoglobin <120 g/L) or ID (C-reactive protein-corrected serum ferritin <15 μg/L). Adjusted associations with 9 sociodemographic factors were estimated by logistic regression. The prevalence of overweight and ID was 67.0% and 45.2% in Morocco, respectively, and 69.5% and 27.0% in Tunisia, respectively, illustrating the population-level double burden. The coexistence of overall or central adiposity with ID was found in 29.8% and 30.1% of women in Morocco, respectively, and in 18.2% and 18.3% of women in Tunisia, respectively, quite evenly distributed across age, economic, or education groups. Generally, the rare, associated sociodemographic factors varied across the 4 subject-level double burdens and the 2 countries and differed from those usually associated with adiposity, anemia, or ID. Any double burden combining adiposity and anemia or ID should therefore be taken into consideration in all women. This trial was registered at clinicaltrials.gov as NCT01844349.
authors.affiliation: Research Unit Nutripass (Prevention of Malnutrition and Associated Diseases), Institute of Research for Development, Montpellier, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Gartner
authors.forename: Jalila
authors.initials: J
authors.lastname: El Ati
authors.forename: Pierre
authors.initials: P
authors.lastname: Traissac
authors.forename: Abdellatif
authors.initials: A
authors.lastname: Bour
authors.forename: Jacques
authors.initials: J
authors.lastname: Berger
authors.forename: Edwige
authors.initials: E
authors.lastname: Landais
authors.forename: Houda
authors.initials: H
authors.lastname: El Hsaïni
authors.forename: Chiheb
authors.initials: C
authors.lastname: Ben Rayana
authors.forename: Francis
authors.initials: F
authors.lastname: Delpeuch
mesh_terms: D050154:Adiposity; D000328:Adult; D000740:Anemia / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D016000:Cluster Analysis; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood; D044342:Malnutrition / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D009752:Nutritional Status; D056128:Obesity, Abdominal / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D050177:Overweight / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D015995:Prevalence; D012959:Socioeconomic Factors; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron