Changes in the nutritional status of Bolivian women 1994-1998: demographic and social predictors

Introduction: Bolivia, as one of the poorest Latin American countries, has dealt with the problems of undernutrition for the last 50 y. Little importance has been given to the increase in overweight and obesity among the population, despite the scientific evidence linking overweight and obesity with mortality and morbidity. Objective: To describe the social and demographic determinants of the nutritional status among women in Bolivia between 1989 and 1998 to gain a better understanding of the nutrition transition phenomena and to identify urgent research needs. Methodology: Secondary analysis of the raw data of the Bolivian National Demographic and Health Surveys of 1994 and 1998. Changes in the prevalence of underweight, obesity and overweight are described by sociodemographic characteristics of Bolivian women. Social and demographic determinants of nutritional status have been fitted into a logistic model. Results: The prevalence of overweight (defined as 25<or=BMI<30 kg/m2) among women of reproductive age (20-44 y) increased by 9 percentage points between 1994 and 1998 (P<0.001), while the prevalence of normal BMI decreased by 10 percentage points (P<0.001). The decrease in the prevalence of underweight (defined as BMI <18.5 kg/m2) from 2.4% in 1994 to less than 1% in 1998 was statistically significant (P<0.001). Obesity (defined as BMI >or=30 kg/m2) was positively associated with geographical region (P=0.001), educational level (P<0.001), age (P=0.003) and total number of children (P=0.001) and negatively associated to rural locality (P=0.001) and native languages (P<0.001). Overweight was inversely associated with rural locality (P=0.013) and with Quechua language (P=0.04), while the total number of children (P<0.001) and year of survey (P<0.001) were positively associated. Underweight decreased dramatically (P<0.001), being positively associated with the region of residence (P=0.04) and inversely associated with the total number of children (P=0.006). Conclusions: The present study suggests that the population of Bolivia is in a transitional stage, with overweight becoming as much of a problem as undernutrition.