Association between the prevalence of overweight/obesity and dietary intake among mothers and children in urban and rural Malawi

Abstract

Childhood and adult obesity are emerging public health concerns in sub-Saharan Africa, driven by rapid nutrition transition and changing food environments. To prevent the rising rate of childhood obesity and overweight/obesity among women in sub-Saharan Africa, and to understand factors influencing food consumption in this population, this study aimed to examine the associations between overweight/obesity and dietary intake among children and mothers in urban and rural Malawi. A cross-sectional survey was conducted in Lilongwe City (an urban area) and Mzimba District North (a rural area) from November to December 2022. Anthropometric measurements were taken for children aged 2.0–4.9 years and their mothers. Questionnaire interviews were conducted with mothers of children. The dietary survey consisted of a 24-h recall and a food frequency questionnaire (FFQ). Participants' mothers were classified as overweight/obese (body mass index: BMI ≥ 25 kg/m 2 ) or normal weight (18.5≦BMI < 25 kg/m 2 ). Associations between overweight/obesity and dietary factors (nutrient intake, food consumption, FFQ, Minimum dietary diversity for women [MDD-W], Minimum dietary diversity 6–23 months [MDD], and questionnaire variables) were assessed using chi-square tests, independent t-tests, and multivariable logistic regression analyses adjusted for age, education, and income. Of the 229 mother–child pairs that participated, the data of 200 pairs were included in the final analysis. Consequently, 37.5% of mothers (urban 34.0% and rural 40.2%) were classified as overweight/obesity (BMI ≥ 25), and 4.5% of children (urban 8.0% and rural 1.8%) were classified as obese (weight-for-height Z-score: WHZ ≥ 3). Compared with rural children, urban children consumed greater amounts of energy, protein, fat, meat, poultry, and fish, as well as other vegetables, and experienced lower levels of nutrient inadequacy. Multivariable logistic regression analyses showed that several dietary factors were independently associated with maternal overweight/obesity in both urban and rural areas. In urban areas, maternal egg intake (adjusted odds ratio [AOR]: 4.72; 95% confidence interval [CI]: 1.57–14.19) and children’s fat intake (AOR: 8.73; 95% CI: 1.79–42.57) were positively associated with maternal overweight/obesity, whereas meat and fish intake was negatively associated with overweight/obesity (AOR: 0.28; 95% CI: 0.09–0.83). In rural areas, increased income (AOR: 7.10; 95% CI: 2.37–21.24) and children’s carbohydrates intake (AOR: 4.05; 95% CI: 1.25–13.08) were positively associated with overweight/obesity. Meanwhile, higher dietary diversity among children (MDD ≥ 5) was negatively associated with maternal overweight/obesity (AOR: 0.40; 95% CI: 0.18–0.89). The dietary factors associated with maternal overweight/obesity differed between urban and rural areas. Tailored nutrition education and interventions may therefore be needed throughout the life course for urban and rural populations.