Secular trends in the prevalence of stunting, overweight and obesity among South African children (1994-2004)

Background/Objectives: Various nutrition programs and free health care for children less than 6 years old were introduced in South Africa in the mid-1990s. We aim to describe secular trends for nutritional status of South African (SA) children in the 10-year period following these reforms. Subjects/Methods: The SA National Primary Schools' Anthropometric Survey (n=105 000) is a cross-sectional survey of children from all SA Education Departments sampled during 1994. The Health of the Nation Study (n=10 295) is a cross-sectional study, including children from primary schools in five SA Provinces sampled from 2001 to 2004. Height and weight of SA children were measured during both surveys. In 8-11 year olds, the National Centre for Health Statistics reference was used to calculate the prevalence of mild and moderate stunting, and overweight and obesity were calculated according to the International Obesity Task Force reference. Coexistence of stunting, overweight and obesity among these two age-and sex-matched cohorts were also calculated. Results: When compared with previous SA data, moderate stunting (24.6-4.9%, P<0.001) decreased over the 7-10 years considered, whereas overweight (1.2-13.0%, P<0.001) and obesity (0.2-3.3%, P<0.001) prevalence increased. There were lower levels of mild stunting and similar levels of moderate stunting among overweight/obese children when compared with non-overweight/non-obese children. Conclusions: Our findings suggest that feeding policies may have been effective in reducing the prevalence of under-nutrition. However, inter-sectoral policies should recognize the apparent secular trend for an increased prevalence in overweight/obesity among young South Africans. European Journal of Clinical Nutrition (2011) 65, 835-840; doi: 10.1038/ejcn.2011.46; published online 20 April 2011