title: The nutrition transition in Colombia over a decade: a novel household classification system of anthropometric measures.
abstract: BACKGROUND
  Overweight and underweight increase the risk of metabolic impairments and chronic disease. Interventions at the household level require the diagnosis of nutritional status among family members. The aim of this study was to describe the prevalence and patterns of various anthropometric typologies over a decade in Colombia using a novel approach that considers all children in the household as well as the mother. This approach also allows identifying a dual burden of malnutrition within a household, where one child may be overweight and another one undernourished.
  
  
  METHODS
  This study used data from the Demographic and Health Survey and the Colombian National Nutrition Survey [2000 n = 2,876, 2005 n = 8,598, and 2010 n = 11,349]. Four mutually exclusive household (HH) anthropometric typologies - normal, undernourished, overweight/obese, and dual burden - were created. Anthropometric information of height-for-age Z-scores (HAZ) and body-mass-index-for-age Z-scores (BMIz) in children under the age of 5 y, and on body mass index (BMI) in mothers, 18-49 y was used.
  
  
  RESULTS
  Prevalence of overweight/obese HHs increased between 2000 (38.2%) and 2010 (43.1%) (p < 0.05), while undernourished and dual burden HHs significantly decreased between 2005 (13.7% and 10.6%, respectively) and 2010 (3.5% and 5.1%, respectively) (p < 0.05). A greater increase of overweight/obesity was observed for the lowest quintile of wealth index (WI), with an increase of almost 10% between 2000 and 2010, compared to 2% and 4% for the fourth and highest WI, respectively. Although in 2010 there is still a higher prevalence of overweight/obesity HHs in urban areas (43.7%), the prevalence of overweight/obesity HHs in rural areas increased sharply between 2000 (34.3%) and 2010 (41.6%) (p < 0.05).
  
  
  CONCLUSIONS
  The observed prevalence of dual burden households was not different from the expected prevalence. Results from this study indicate that although overweight/obesity continues to be more prevalent among high-income Colombian households, it is growing at a faster pace among the most economically disadvantaged.
authors.affiliation: Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO USA.
authors.forename: Diana C
authors.initials: DC
authors.lastname: Parra
authors.affiliation: George Warren Brown School of Social Work, Institute for Public Health, Washington University in St. Louis, St. Louis, MO USA.
authors.forename: Lora
authors.initials: L
authors.lastname: Iannotti
authors.affiliation: Departamento de Medicina Preventiva y Social. Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Gomez
authors.affiliation: Food Fortification Initiative, Atlanta, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
authors.forename: Helena
authors.initials: H
authors.lastname: Pachón
authors.affiliation: Center for Diabetes Translation Research and Center for Obesity Prevention & Policy Research, Washington University in St. Louis, St. Louis, MO USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Haire-Joshu
authors.affiliation: Department of Public Health, School of Medicine, Universidad de los Andes, Bogotá, Colombia.
authors.forename: Olga L
authors.initials: OL
authors.lastname: Sarmiento
authors.affiliation: George Warren Brown School of Social Work, Institute for Public Health, Washington University in St. Louis, St. Louis, MO USA.
authors.forename: Anne Sebert
authors.initials: AS
authors.lastname: Kuhlmann
authors.affiliation: Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA ; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO USA.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
keywords: Colombia; Dual burden; Malnutrition; Nutrition transition; Obesity; Overweight; Stunting