title: The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations.
abstract: BACKGROUND
  As the prevalence of obesity increases in developing countries, the double burden of malnutrition (DBM) has become a public health problem, particularly in countries such as Guatemala with a high concentration of indigenous communities where the prevalence of stunting remains high.
  
  
  OBJECTIVE
  The aim was to describe and analyze the prevalence of DBM over time (1998-2008) in indigenous and nonindigenous Guatemalan populations.
  
  
  METHODS
  We used 3 National Maternal and Child Health Surveys conducted in Guatemala between 1998 and 2008 that include anthropometric data from children aged 0-60 mo and women of reproductive age (15-49 y). We assessed the prevalence of childhood stunting and both child and adult female overweight and obesity between 1998 and 2008. For the year 2008, we assessed the prevalence of DBM at the household (a stunted child and an overweight mother) and individual (stunting/short stature and overweight or anemia and overweight in the same individual) levels and compared the expected and observed prevalence rates to test if the coexistence of the DBM conditions corresponded to expected values.
  
  
  RESULTS
  Between 1998 and 2008, the prevalence of childhood stunting decreased in both indigenous and nonindigenous populations, whereas overweight and obesity in women increased faster in indigenous populations than in nonindigenous populations (0.91% compared with 0.38%/y; P-trend < 0.01). In 2008, the prevalence of stunted children was 28.8 percentage points higher and of overweight women 4.6 percentage points lower in indigenous compared with nonindigenous populations (63.7% compared with 34.9% and 46.7% compared with 51.3%, respectively). DBM at the household and individual levels was higher in indigenous populations and was higher in geographic areas in which most of the population was indigenous, where there was also a greater prevalence of stunting and DBM at the individual level, both in women and children.
  
  
  CONCLUSIONS
  In Guatemala, DBM is more prevalent in indigenous than in nonindigenous populations at the household and individual levels. To enhance effectiveness, current strategies of national policies and programs should consider DBM and focus on indigenous populations.
authors.affiliation: From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L).
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramirez-Zea
authors.affiliation: From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L).
authors.forename: Maria F
authors.initials: MF
authors.lastname: Kroker-Lobos
authors.affiliation: From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L).
authors.forename: Regina
authors.initials: R
authors.lastname: Close-Fernandez
authors.affiliation: From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kanter
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D015992:Body Mass Index; D001835:Body Weight; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006166:Guatemala / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Guatemala; anemia; double burden; indigenous; malnutrition; obesity; stunting