Things seen and unseen: 1. Stunting and overweight/ obesity are predominant malnutrition burdens of urban poor Nigerian adolescents

Background: Economic growth is associated with reductions in undernutrition. However, in developing countries, malnutrition still exists as a double burden. A better understanding of the dynamics of malnutrition in such societies as a means of aiding policymakers and implementers is thus needed. Objectives: This study investigated the prevalence of malnutrition in Ebonyi State, Nigeria, and the role of socio-economic status (SES) in driving it. Methods: Standard protocols were used for all measurements. Overweight/obesity, stunting and thinness were defined using the simplified age- and gender-specific height and body mass index (BMI) field tables of the World Health Organization (WHO). Results: A total of 781 adolescents (65.4% female adolescents) from nine secondary schools were studied. Subjects in the rural and urban low SES groups were shorter than the others despite being older, and were shorter than the WHO reference cohort. In the general population, 3.2% (2.0% for girls and 5.6% for boys) were stunted. Urban low SES boys had the highest prevalence of stunting (18.6%). Thinness was found in 2.6% (7.4% for girls and 2.2% for boys) of the general population. It affected rural female adolescents (16.9%) more than the others and, as with stunting, was absent in the urban upper SES group. Overweight/obesity was found in 13.8% (12.5% for girls and 16.3% for boys) of the general population. It was highest amongst the urban upper SES group (35.9%) and absent amongst rural male adolescents. Stunting coexisting with thinness or with overweight/obesity was found in 0.8% and 0.25% of the general population, respectively. Conclusions: Urban residence without improvements in SES is severely detrimental to the proper nutrition of adolescents.