Assessing the nutritional status and disparities among schoolchildren in three districts in the North-West of Pakistan

Owing to the stern importance of nutritional intakes for the growth and shaping life long events , we aim to elucidate the nutritional status of the schoolchildren according to the as definitions of the International Obesity Task Force (IOTF) and the Centres of Disease Control and Prevention (CDC) in 6 to 12 year-old schoolchildren from the rural districts of the Khyber Pakhtunkhwa (KPK) province of Pakistan. Anthropometric data was collected from 3595 schoolchildren (1811 boys and 1784 girls) in a random cluster sampling study. Underweight, overweight and obesity was determined from body mass index (BMI) and associated with age and sex by multinomial regression, while age was associated to BMI z-score by linear regression. Kappa statistics determined agreement/disagreement between the two cut-offs in our data. A higher frequency of children was affected by underweight (IOTF: 29.5%, CDC: 21.1%), than overweight (IOTF: 3.60%, CDC: 11.5%) and obesity (IOTF: 5.80%, CDC: 9.32%). There was high overweight prevalence in boys, while a positive association of age and female sex with prevalence of underweight, and of age only for prevalence of obesity was observed. The two cut-offs showed substantial agreement when assessing underweight {(kappa (κ) = 0.78)} and obesity (κ= 0.75). The frequency of underweight prevalence was high in socioeconomically deprived districts. We hypothesize that cultural tendencies apart from other factors were contributing to the higher prevalence and critical co-existence of underweight and obesity particularly in girls. The disparity in our results, between CDC and IOTF cut-offs in comparison to other populations, suggest the influence of different socioeconomics, cultural and genetic factors