Multiple burdens of malnutrition and relative remoteness in rural Ecuadorian communities

Gwenyth O. Lee, Cynthia Gutierrez, Nancy Castro Morillo, William Cevallos, Andrew D. Jones, Joseph N.S. Eisenberg

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia. Design: Adult anthropometry was collected through serial case-control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community. Setting: Northern coastal Ecuador. Participants: Adults (n 1665) and children under 5 years of age (n 2618). Results: From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness-OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age. Conclusions: The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.

Original languageEnglish
Pages (from-to)4591-4602
Number of pages12
JournalPublic Health Nutrition
Issue number14
StatePublished - 6 Oct 2021


  • Afro-Ecuadorian
  • Anaemia
  • Double burden of malnutrition
  • Ecuador
  • Human nutrition
  • Nutrition transition
  • Overweight
  • Stunting


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