The Association of Food Insecurity and Dietary Patterns with Simultaneous Obesity and Stunting in Primary School Pupils of Zahedan City (Iran)

Prevalence of food insecurity in some parts of the country has been identified however, no studies have been conducted in Zahedan regarding co-existing of stunting and overweight and its relationship with food insecurity and dietary patterns. The aim of this study was to determine the association of food insecurity and dietary patterns with simultaneous obesity and stunting in the primary school pupils of Zahedan city, Iran. Using two-stage cluster sampling, a total of 2400 students, aged 7-12 years, were randomly selected from primary school pupils in Zahedan. From these, 45 students with (BMI Z-score, BMIZ&rsaquo1 and BMIZ&rsaquo2) and stunting (Height-for-age Z-score, WHZ<-1) were defined having stunting with concurrent overweight, and 90 pupils of the same age and gender with normal height-for-age Z-score and weight for age were selected as controls. Data were collected through face to face interview with mothers using 24-hour food-recall and USDA food insecurity and general information questionnaires. Healthy Eating Index (HEI) has been developed to track the quality of diet in different societies. HEI was calculated based on 9 components (food guide pyramid groups, the percent of fat and saturated fatty acid intake, cholesterol consumption and dietary variety score). The HEI score was categorized into three groups: less than 45 (poor diet), 45-72 (needs improvement) and more than 72 (good diet). Independent sample T test and Chi-square were used for normal distributed data and Mann-Whitney’s U test for asymmetrical distribution to compare and analyze the data among the case and control groups. The prevalence food insecurity was, respectively, 57.8% and 61.1% in the stunting with concurrent overweight and children with normal height and weight. Also 15.6% of stunting with concurrent overweight and 4.4% of children with normal height and weight had food insecurity with severe hungry. The mean score of HEI was 40.9±13.53 in stunting with concurrent overweight children and 46.11±12.73 in children with normal height and weight)P<0/05. Diet quality scores ranged from 12.5 to 70. There were no significant differences among the case and control groups for the components of HEI (P>0/05). Diet quality scores showed that all of the children have poor diet or diet that needs improvement, and none of the subjects had a “good diet”. The overall diet quality and nutritional habits of Zahedan primary school pupils need modification and improvement (case and control groups). Also the prevalence of food insecurity is high among Zahedan primary school students.