La Coexistence du Retard de Croissance et de l'Obésité chez les jeunes enfants de la Région méditerranéenne Orientale : Implication dans les Politiques Nutritionnelles nationales

Other countries in the EMME also showed significant rates of stunting (18. 5 % in Libya - 57. 6 % in Yemen) and overweight (8. 9 % in the Yemen - 20. 2 % in Syria). Certain regions in these countries had higher rates of obesity (Halab and Al-Raka in Syria, 31. 5 and 47. 8 % respectively). The countries of EMME face a dual-burden. The risk factors for overweight in Libya include young age, living in the regions of Al-Akhdar or Alzaouia, boys, stunting and housing conditions. Breast feeding for more than six months decreases the risk of overweight. Risk factors for stunting in Libya include living in Al-Akhdar, boys, a low level of paternal education, poor psychosocial stimulation, drinking filtered water, poor garbage disposal, diarrhea and low birth weight. Older age of father and storing water in tanks were protective factors. The etiologic fraction of stunting in obesity at the population level in EMME extends from 7. 49 % to 69. 76 %. The etiologic fraction among those who have stunting is higher rural areas (80. 27 %) and in children older than four years (81. 24 %) in Libya. With the current modes of treatment for obesity in children, only 1/10 will return to normal weight, but a decrease in BMI/A z-score by 0. 5, which has a significant effect on the atherogenic profile and the insulin sensitivity, is possible in more than 2/5 of patients. Most of children seek treatment late (>5 years). Factors associated with poor and/or failure to respond to treatment include age 11 years at the beginning of management, prolonged duration of obesity, maternal obesity, previous participation in a management program, a high level of glycaemia and abdominal obesity. Stunting and overweight are public health problem in EMME. Risk factors for the higher rates in certain sub-regions need more studies. The results highlight the importance of combining efforts in national programs for overcoming under and overnutrition and the importance of civil engineering, early life factors as home conditions and complementary feeding practices. Interventions should start during the antenatal period. The results emphasize the importance of abdominal fat mass in the validity of the BMI to predict body fat mass and in the failure of management. The relation of this type of obesity with stunting and with high risk of metabolic syndrome as well as its transmission from one to another generation underline the importance of morbidity and mortality due to malnutrition. This gives more arguments for programs as the IYCF and the «life-cycle» concept. Interventions have to be at different levels and must be objectively estimated.