Is there an association between parental education level and the risk of malnutrition among children?

In a recent study published in JAMA Network Open, researchers assessed the correlation between parental education level and the risk of malnutrition among children and parents.

Background

In the era of the United Nations' sustainable development goals (SDG), ending all types of malnutrition by 2030 is the top global health agenda. Due to the widespread prevalence of instances of underweight, stunting, and micronutrient deficiencies, low and middle-income countries (LMICs) are deemed as a top priority. To end hunger, progress toward the SDGs must be made, but the double burden of malnutrition (DBM) presents a new obstacle. Yet, research on how parental education affects the prevalence of DBM has not been conducted globally.

About the study

In the present study, researchers examined the correlation of parental education with the co-occurrence of malnutrition in parents and children.

The team performed a cross-sectional analysis utilizing the most recent Directorate of Health Services (DHS) data recorded between 1 January 2010 and 31 December 2021. Using a comprehensive, standardized questionnaire, the cross-sectional surveys obtained socioeconomic, demographic, and health data related to parents and their children. Following are the eligibility requirements for the analytical sample: (1) children aged between zero and 59 months; (2) mothers who were not pregnant during the survey in the cohort involving mother-child pairs, and (3) valid height, weight, and hemoglobin measurements for the child a minimum of one measurement of their parents.

The primary outcomes involved DBM and all subtypes of DBM. DBM in mother-child pairings was described as the presence of a minimum of one type of malnutrition in the mother and her child. Similarly, DBM within father-child pairings was characterized as the simultaneous appearance of the child and paternal malnutrition. The team categorized DBM into four subtypes: (1) coexistence of overnutrition in the mother/father and undernutrition in the child; (2) coexistence of undernutrition in the mother/father and overnutrition in the child; (3) coexistence of overnutrition in both mother/father as well as the child; and (4) coexistence of undernutrition in the mother/father as well as the child.

The team determined parental education based on the highest educational level attained and the number of years spent in school. For each parent, a categorical variable was generated involving illiteracy or elementary, secondary, or tertiary education.

Results

The team identified 42,3340 mother-child pairs belonging to 45 countries using DHS information. The average age of mother-child pairings was 28.2 years. Additionally, there were a total of 2,07,573 mother-child pairings suffering from DBM. At the same time, 1,77,083 had simultaneous undernutrition of the mother and the child, and 56,020 reported overnutrition of the mother and undernutrition of the child. The predominance of DBM was considerably lower in pairings with educated mothers compared to those with uneducated mothers.

Three of the four subtypes of DBM associated with overnutrition were more prevalent in mother-child pairings involving higher maternal education levels. For instance, the frequency of simultaneous overnutrition in the mother and undernutrition in the child was 18.5% among pairings with mothers having a tertiary education level versus 10.5% among pairs with mothers without education. The frequency of simultaneous maternal and child undernutrition was more among pairings with mothers having no education as compared to those educated at a tertiary level.

The study cohort also consisted of 56,720 father-child pairings belonging to 16 countries, including 1,5057 affected by DBM. Also, DBM prevalence was greater among pairs with educated fathers than among those with uneducated fathers. With respect to DBM types, father-child pairings involving higher paternal education levels had a higher likelihood of suffering from any DBM, including overnutrition, and a lower likelihood of being undernourished.

Overall, mother-child pairings with higher levels of maternal education had a lower prevalence of DBM. The team discovered that higher levels of maternal education were related to an increased likelihood of developing DBM subtypes that involved overnutrition. In comparison to mother-child pairings having no maternal education, individuals with secondary maternal education displayed a higher likelihood of simultaneous overnutrition in the mother and undernutrition in the child.

The team found no correlation between paternal education and the incidence of DBM in general. Furthermore, households involving fathers educated with secondary or tertiary education displayed a higher chance of simultaneous overnutrition of the father and undernutrition of the child in comparison to households involving uneducated fathers.

Conclusion

The study findings showed that higher parental education was related to an increased likelihood of incidence of almost all DBM subtypes, including overnutrition and a decreased likelihood of undernourishment of both child and parent. The researchers believe these findings can have significant implications for policymakers' ability to distinguish between subgroups and formulate tailored policies. The team also suggested that more attention is needed to the issue of overnutrition among households with a higher level of education.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.