Factors associated with overweight/obesity in children under five years of age, using the 2018 National Health and Nutrition Survey (ENSANUT)

Abstract

Introduction: Childhood overweight and obesity are an essential public health problem of multifactorial origin associated with a higher probability of death and premature disability in adulthood. Data from the 2018 National Health and Nutrition Survey (EN-SANTUT) carried out in Ecuador indicate that 13.6% of children under five years of age are overweight/obese (O/S), 60% more than what was reported in 2012 (8.5%).

Methods: With the information collected in ENSANUT 2018, the prevalence of overweight/obesity in 11,050 children under five years of age was analyzed. The stepwise approach was used to construct the multiple logistic regression models (entering the variables according to the evidence), where the variables that presented p<=0.10 in the bivariate analysis were incorporated in the models. Subsequently, the variables that showed a significant association were entered into three logistic regression models: i) national level, ii) urban area, and iii) rural area. The measure of effect used was the OR (at 90, 95 and 99%). To test the robustness of the models, the ROC curve and the Hosmer Lemeshow Test were used, in which the Null Hypothesis (Ho) is tested, with a value >00.5.

Results: The prevalence of overweight/obesity increased by 60% compared to the data collected in 2012. 64.37% of children with overweight/obesity reside in urban areas and 35.63% in rural areas. The factors significantly associated with overweight/obesity common between the national level and the metropolitan area are drinking water belonging to the first quintile of poverty, exclusive breastfeeding for six or more months, history of overweight/ maternal obesity, and birth weight less than 2500 grams; while, for the national level and the urban area, the significantly associated factors were having a mother of Afro-Ecuadorian ethnicity, and residing in the Sierra, Coast or Amazon region. In the rural area, elements not shared either at the national level or with the urban area were observed: belonging to the 3rd quintile of poverty, mothers with less than five prenatal check-ups and less than 12 years of study; delivery after 42 weeks, birth weight between 2,500 and 4,000 grams and having had between 5 and 10 prenatal check-ups.

Conclusions: The prevalence of overweight/obesity presents a significant increase compared to the data collected in 2012, which leads to considerable effects on physical and mental health; children who are overweight/obese are more likely to suffer in the future, among others, diseases such as metabolic syndrome, diabetes, hypertension, orthopedic conditions. In addition, it can cause emotional problems such as low self-esteem. Although there are policies that can contribute to strengthening the protective factors found in the present study, such as breastfeeding, the right to prenatal check-ups, limitation in the use of breast milk substitutes, the right to health of both the child and the mother, the monitoring of its application and in some cases, by the user, the limitations to access to care, to essential services, to the acquisition of healthy products, does not make it entirely possible to apply what is established, according to there, what should be considered within the policies how to make possible its implementation according to the different contexts in a country as diverse as Ecuador