Double burden of malnutrition and its social disparities among rural Sri Lankan adolescents

In Sri Lanka, the double burden of nutrition is often neglected, and increase of adolescent obesity is not well investigated. This study determines the double burden of malnutrition among adolescents in Anuradhapura district exploring the differences of prevalence based on different definitions. Students aged 13 to 16 years were selected from 74 schools using probability proportionate to size sampling. Anthropometry was done according to WHO guidelines. Obesity was defined according to body mass index (BMI) based definitions of WHO, International Obesity Task Force and Indian growth references. Central obesity was defined using Indian and British waist circumference cut-offs. Prevalence estimates from different definitions were compared using McNemars test. Socio-demographic determinants of nutritional issues were assessed using Chi-square test for independence. A total of 3105 students (47.7% boys) were studied (mean age 14.8+ 0.8 years). According to WHO definitions, 73 (2.4%, 95% CI; 1.9-2.9) were obese, 222 (7.2%, 95% CI; 6.3-8.1) were overweight, 673 (21.7%, 95% CI; 20.2-23.1,) were thin and 396 (12.8%, 95% CI; 11.6-14.0) were stunted. More boys (3.1%) than girls (1.7%) were obese as well as thin (29.0% compared to 15.0%). Prevalence of overweight/obesity was higher among students in larger, urban schools, and belonging to high social class and more educated parents. Prevalence of overweight/obesity estimated using IOTF-Asian and Indian thresholds were significantly higher than that from WHO and IOTF-international thresholds. Double burden of malnutrition is affecting the adolescents in rural Sri Lanka. Prevalence estimates of obesity largely depend on the definition used.