Obesity, undernutrition and the double burden of malnutrition in the urban and rural southern Free State, South Africa

This study compared the diet and anthropometric status of adults (25-64 years) in rural and urban South Africa. Anthropometric status of adults and preschool children (<7 years old) from the same households were also determined. A descriptive cross-sectional design was applied. All adults from three towns in the rural southern Free State (n = 553) and a stratified proportional cluster sample from urban Mangaung (n = 419) participated. Anthropometric assessments included body mass index and waist circumference. Trained students administered a qualitative food frequency questionnaire in a structured interview with each participant to assess frequency of consumption of foods. The 35 foods that were included were chosen as a measure of protection or predisposition to obesity and non-communicable diseases. The height-for-age, weight-for-age and weight-for-height of 60 rural and 116 urban children were also assessed. Sugar was the most frequently consumed food item, eaten at least twice per day by all groups. Cooked porridge was the most frequently consumed starchy food (range 47.3-53.2 times a month), followed by bread, consumed at a mean frequency of 20 or more times per month in all groups. Tea was the most frequently consumed fluid (used at least once a day by all). Salt and/or stock was used more than once a day, while margarine, oil and other fats were consumed at least once per day. Fruit and vegetables were consumed at a mean frequency of less than once a day, while milk was consumed less than once daily in urban participants and once per day in rural participants. Chicken or eggs were the most frequently consumed protein-rich food (approximately 10 times per month). Overweight/obesity was identified in 65.6% rural and 66.2% urban women. Fewer men (23.3% rural and 16.0% urban) were overweight/obese. More than 66% of stunted, underweight and wasted children lived with an overweight/obese caregiver. Daily consumption of sugar, salt and fats and inadequate frequency of consumption of vegetables, fruits and milk was confirmed in both rural and urban participants. In addition, a double burden of malnutrition was evident.