Dual burden of malnutrition in institutionalized children: Insights from a Pakistani orphanage
Ayesha Shoukat1, Mehroz Fatima2, Faizan Bashir2
1Department of Nutrition & Health Promotion, University of Home Economics, Lahore, Pakistan.
Insights
The dual burden of malnutrition affects children in a Pakistani orphanage, with overnutrition more common than undernutrition. Poor diets high in snacks and sugary drinks are a key concern despite adequate food security and physical activity.
Area of Science:
- Pediatric Nutrition
- Public Health
- Malnutrition Studies
Background:
- The dual burden of malnutrition (DBM) presents a significant global health challenge.
- Children in institutional care are a vulnerable population with understudied nutritional status in Pakistan.
Purpose of the Study:
- To assess the DBM in a Pakistani orphanage.
- Determine prevalence of undernutrition and overnutrition.
- Evaluate dietary patterns and lifestyle factors.
Main Methods:
- Cross-sectional study of 30 male children (10-16 years) in a Lahore orphanage.
- Data collection included questionnaires, 24-hour dietary recall, and anthropometry.
- Nutritional status assessed using WHO BMI-for-age z-scores; dietary patterns classified.
Main Results:
- Overnutrition (36.7%) was more prevalent than undernutrition (6.7%), with 56.7% normal weight.
- Dietary patterns were split, with high consumption of packaged snacks and sweetened beverages.
- Favorable psychosocial and lifestyle factors were noted, but no significant association with physical activity and nutritional status.
Conclusions:
- DBM confirmed in Pakistani orphanage, with overnutrition exceeding undernutrition.
- High intake of processed snacks and sugary drinks identified as a primary concern.
- Need for institutional nutritional strategies focusing on diet quality and larger-scale research for interventions.
Background:
The dual burden of malnutrition, involving both undernutrition and overnutrition, is a significant challenge. Children in institutional care are a vulnerable group, yet their nutritional status in Pakistan is understudied.
Objectives:
The aim of this study was to assess the dual burden of malnutrition in a Pakistani orphanage by determining the prevalence of under and overnutrition, evaluating dietary patterns, and exploring associated lifestyle factors.
Methods:
A descriptive cross-sectional study was conducted with 30 male children (aged 10-16 years) at an orphanage in Lahore. Data were collected via a structured questionnaire (assessing socio-demographics, dietary habits, psychosocial factors, and physical activity), 24-hour dietary recall, and anthropometric measurements. Nutritional status was classified using WHO BMI-for-age z-scores. Dietary patterns were categorized as "Balanced" or "Unbalanced" based on predefined food frequency criteria. Data were analyzed using descriptive statistics, with exploratory inferential analyses (Fisher's Exact Test, Kruskal-Wallis H test) conducted cautiously due to the small sample size.
Results:
The study revealed a clear dual burden: 56.7% of children were of normal weight, while 36.7% exhibited overnutrition (30.0% overweight, 6.7% obese) and 6.7% were underweight. Dietary patterns were nearly evenly split (46.7% balanced versus 53.3% unbalanced), with high frequencies of packaged snack (≥2/d: 36.7%) and sweetened beverage (daily: 40%) consumption. Psychosocial and lifestyle factors were generally favorable, with most children reporting no emotional eating triggers (90%), regular sleep (96.7%), and high physical activity levels (93.3% moderately/highly active). No statistically significant associations were found between physical activity and nutritional status in this small sample.
Conclusions:
This study confirms the presence of the DBM within a Pakistani orphanage, with overnutrition being more prevalent than undernutrition. While the institution provides food security and promotes physical activity, poor diet marked by high intake of processed snacks and sugary drinks emerges as a key concern. Findings highlight the need for institutional nutritional strategies that focus on diet quality alongside calorie provision and suggest the importance of larger-scale research to inform targeted interventions for this vulnerable population.
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