BACKGROUND Examining trajectories of undernutrition and overnutrition separately limits understanding of the double burden of malnutrition. We investigated transitions between normal, stunting, overweight and concurrent stunting and overweight (CSO) and associations with sociodemographic factors in children and adolescents. METHODS We used data from the Young Lives cohort in India, Peru and Vietnam, which follow children 1-15 (N = 5413) and 8-22 years (N = 2225) over five rounds between 2002 and 2016. We estimated transitions between nutritional states using a Markov chain model and estimated sociodemographic associations employing a logit parametrization. RESULTS Transitions into stunting peaked in ages 1-5 years (India: 22.9%, Peru: 17.6%, Vietnam: 14.8%), while stunting reversal was highest during adolescence across all countries. Transitions into overweight peaked in ages 19-22, while overweight reversal increased in ages 1-5 and 12-15 years. Transitions away from stunting to overweight were rare; more commonly, stunted individuals developed overweight while remaining stunted, leading to a CSO state. In Peru, 20.2% of 19-year-olds who were stunted reached CSO by age 22, with 4% shifting from stunted to overweight. Reversion to a normal state is least likely for those in a CSO state. Household wealth gradually reduced the likelihood of transitioning into stunting [odds ratios (ORs) for wealthiest quartile in Peru: 0.29, 95% confidence interval (CI) 0.20-0.41; India: 0.43, 95% CI 0.32-0.57; Vietnam: 0.36, 95% CI 0.26-0.50), with stunting reversal only being more likely in the two wealthiest quartiles across all countries (ORs for wealthiest quartile in Peru: 2.39, 95% CI 1.57-3.65; India: 1.28, 95% CI 1.05-1.54; Vietnam: 1.89, 95% CI 1.23-2.91). In Vietnam, only the richest quartile was at higher risk of transitioning into overweight (OR 1.87, 95% CI 1.28-2.72), while in Peru and India, the risk gradually rose across all wealth quartiles (ORs for wealthiest quartile in Peru: 2.84, 95% CI 2.14-3.77; India: 2.99, 95% CI 1.61-5.54). CONCLUSIONS Childhood and adolescence represent critical periods for prevention and reversal of stunting and overweight, thereby averting the development of CSO later in life. Context-specific interventions are crucial for preventing disparate transitions towards the double burden of malnutrition across socioeconomic groups.

中文翻译：

---

印度、秘鲁和越南从童年到成年早期超重和发育迟缓双重负担的纵向转变。


背景 分别研究营养不良和营养过剩的轨迹限制了对营养不良双重负担的理解。我们调查了儿童和青少年正常、发育迟缓、超重和并发发育迟缓和超重 （CSO） 之间的转变以及与社会人口学因素的关联。方法 我们使用了来自印度、秘鲁和越南的 Young Lives 队列的数据，这些数据在 2002 年至 2016 年期间的五轮比赛中跟踪了 1-15 岁 （N = 5413） 和 8-22 岁 （N = 2225） 的儿童。我们使用马尔可夫链模型估计营养状态之间的转换，并使用 logit 参数化估计社会人口学关联。结果 过渡到发育迟缓在 1-5 岁时达到顶峰（印度：22.9%，秘鲁：17.6%，越南：14.8%），而发育迟缓逆转在所有国家的青春期最高。超重过渡在 19-22 岁达到顶峰，而超重逆转在 1-5 岁和 12-15 岁时增加。从发育迟缓到超重的转变很少见;更常见的是，发育迟缓的个体在保持发育迟缓的同时超重，导致 CSO 状态。在秘鲁，20.2% 的 19 岁发育迟缓青少年在 22 岁之前达到 CSO，其中 4% 从发育迟缓转变为超重。对于处于 CSO 状态的人来说，恢复到正常状态的可能性最小。家庭财富逐渐降低了转变为发育迟缓的可能性 [秘鲁最富有的四分之一的比值比 （ORs）：0.29,95% 置信区间 （CI） 0.20-0.41;印度：0.43,95% CI 0.32-0.57;越南：0.36,95% CI 0.26-0.50），在所有国家中最富有的两个四分位数中，发育迟缓逆转的可能性更大（秘鲁最富有四分位数的 OR：2.39,95% CI 1.57-3.65;印度：1.28,95% CI 1.05-1.54;越南：1.89,95% CI 1.23-2.91）。 在越南，只有最富有的四分位数转变为超重的风险较高（OR 1.87,95% CI 1.28-2.72），而在秘鲁和印度，所有财富四分位数的风险逐渐上升（秘鲁最富有的四分位数的 OR：2.84,95% CI 2.14-3.77;印度：2.99,95% CI 1.61-5.54）。结论 儿童期和青少年期是预防和逆转发育迟缓和超重的关键时期，从而避免了 CSO 在以后的生活中的发展。针对具体情况的干预措施对于防止不同社会经济群体向营养不良双重负担的不同过渡至关重要。