PEDIATRIC HIGHLIGHT Coexistence of maternal central adiposity and child stunting in Mexico S Barquera 1,2 , KE Peterson 3 , A Must 4 , BL Rogers 2 , M Flores 1 , R Houser 2 , E Monterrubio 1 and JA Rivera-Dommarco 1 1 Instituto Nacional de Salud Pu´blica, Cuernavaca, Mexico; 2 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; 3 Harvard School of Public Health, Boston, MA, USA and 4 School of Medicine, Tufts University, Boston, MA, USA Objective: To assess the coexistence of maternal adiposity and child stunting (CS) in Mexico, estimate its national prevalence and identify the associated socio-demographic factors. Methods: A secondary analysis from the Mexican Nutrition Survey 1999, a nationally representative survey, was conducted. Mother and children subsamples were matched and a total of 6225 mother/child pairs were obtained. Stunting was defined as height-for-age z-scores o2.0. Maternal body mass index (BMI) was classified according to World Health Organization recommended cutoff points. Waist-to-hip ratio (WHR) was calculated by dividing waist by hip circumferences. Logistic regression models were fitted to explore the coexistence of CS and maternal central adiposity (MCA) (WHRX0.85) while controlling for biological and socio-demographic factors. Results: A total of 5974 pairs had complete information. MCA coexisted with CS in 6.2% of the mother/child pairs. The phenomenon was more prevalent in rural locations, in the south region and among indigenous families (14.5, 12.5 and 23.9%). After controlling for child age and maternal BMI, a 78% increase in the likelihood of CS was related to maternal WHR X0.85 (odds ratio (OR) ¼ 1.78, 95% confidence interval (CI) ¼ 1.53, 2.10). After controlling for maternal height, the magnitude of the OR decreased (OR ¼ 1.33, 95%CI ¼ 1.13, 1.57), but remained significant. Therefore, it is suggested that women with a WHR B1 have had twice the probability of having a stunted child as those with a WHR of 0.65. Conclusion: Although MCA and CS are two conditions frequently regarded as result of opposite determinants, our observation suggests that this is not necessarily the case, particularly in populations undergoing the nutrition transition. MCA was associated not only to chronic diseases, but also to child stunting. International Journal of Obesity (2007) 31, 601–607. doi:10.1038/sj.ijo.0803529; published online 16 January 2007 Keywords: overweight; stunting; nutrition transition; national surveys Introduction The familial coexistence of maternal overweight and child stunting (MOCS) is an emerging phenomenon observed mostly in developing countries undergoing the epidemiolo- gic and nutrition transition. 1–3 According to the nutrition transition theory, populations tend to shift from under- to over-nutrition as they experience dietary and demographic changes associated with socio-economic development. 4–8 Thus, CS, reflecting chronic undernutrition, and adult overweight in developing countries have commonly been construed as resulting from different risk factors. 9,10 Almost two decades ago, a hypothesis relating adult chronic disease to peri-natal undernutrition was proposed by Barker and his colleagues. According to this hypothesis, undernutrition early in life results in an increased risk of hyperinsulinemia, high blood pressure, obesity, diabetes and cardiovascular diseases. 11,12 The proposed mechanisms in- clude the expression of a thrifty genotype, alteration of diverse metabolic functions and regulation of energy intake as a response to poor health and nutrition conditions early in life. 13–16 The association between early age undernutrition and adult overweight, adiposity and chronic diseases has been identified in a number of studies. This phenomenon could explain the coexistence of maternal overweight and child stunting (CS) as part of the same process at different stages in the life cycle. 17 A number of reports have described an association of stunting and obesity within the same Received 27 February 2006; revised 17 October 2006; accepted 28 October 2006; published online 16 January 2007 Correspondence: Dr S Barquera, Chronic Diseases and Diet, Instituto Nacional de Salud Pu ´blica, Av. Universidad No. 655, Col. Sta. Ma., Ahuacatitla ´n, Cuernavaca, Mor. CP. 62508, Mexico. E-mail: sbarquera@insp.mx Webpage: http://www.insp.mx International Journal of Obesity (2007) 31, 601–607 & 2007 Nature Publishing Group All rights reserved 0307-0565/07 $30.00 www.nature.com/ijo