Acta Scientific Nutritional Health (ASNH)(ISSN: 2582-1423)

Research Article Volume 4 Issue 2

The Use of Anthropometrics, BMI and Isotope Dilution Methods in Assessing the Double Burden of Malnutrition in Children (3-5 Years) in the Southern and Northern Regions of Botswana

Ramolefhe-Mutumwa Tshepiso Galase1*, Oatametse Boingotlo2, Motswagole Boitumelo Stokie1, Mulol Helen3 and Kwape Lemogang1

1Department of Nutrition and Dietetics, National Food Technology Research Centre, Kanye, Botswana
2Department of Food Chemistry, National Food Technology Research Centre, Kanye, Botswana
3University of KwaZulu-Natal, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, Durban, South Africa

*Corresponding Author: Tshepiso Galase Ramolefhe-Mutumwa, Department of Nutrition and Dietetics, National Food Technology Research Centre, Kanye, Botswana.

Received: January 17, 2020; Published: January 27, 2020



Objective: To assess the prevalence of under- and over- nutrition using three different assessment methods. 

Design: Pilot cross sectional study

Setting: Malaria prone rural area in the northern (Shakawe) and non-malaria prone rural area in the southern (Moshupa) parts of Botswana.

Subjects: A convenience sample (n=197) of children aged three-five years and attending growth monitoring as a standard component of paediatric services. 

Outcome Measures: Double burden of malnutrition defined according to the three methods as follows: anthropometrics (weight for height z score -2SD vs. weight for height z score + 2SD), BMI calculated according to the Centers for Diseases Control and Prevention gender and age specific growth charts (<5th percentile vs. > 85th percentile) and deuterium oxide (D2O) dilution method calculating body fat mass percentage (< 13% fat mass percentage for boys and < 23% for girls (low fat mass) vs. > 20% fat mass percentage for boys and >30% for girls as under- and overnutrition respectively.

Results: Observations indicate that anthropometrics under-underestimated the prevalence of the double burden of malnutrition while BMI and D2O overestimated it. There was a significant difference on the assessment of under-nutrition using the three methods [H(2) =48.190, P<0.05]. Similarly on over-nutrition, there was a significant difference on the three methods in assessing over-nutrition [H(2) =77.434, P<0.05]. All three methods significantly reduced under - and/or over-nutrition at different magnitudes.

Conclusion: A gap still exists between the methods in assessing the double-burden of malnutrition. All three methods, anthropometry, BMI and D2O dilution method have significantly different effects towards the assessment of either under- and/or over-nutrition and thus it is recommended that a thorough decision be made prior to choosing which method to use based on the aim of the assessment. This study reflects the need to carefully select an appropriate method to use in assessing the burden of malnutrition. 

Keywords: Double Burden Malnutrition; Under-Fives; Isotope Dilution Method; Anthropometrics; BMI



  1. Fields A. “Discovering statistics using SPSS (Introducing statistical methods series)”. Second (2nd) Edition. Hardcover. January 30 (2005).
  2. Prentice AM. “The double burden of malnutrition in countries passing through the economic transition”. Annals of Nutrition and Metabolism 72 (2018): 47-54.
  3. Gavin-Smith B. “Double burden of malnutrition”. Sight and life 32.2 (2018): 01-202.
  4. WHO. “Malnutrition Key Facts” (2017).
  5. Friedman G. “Review of National Nutrition Surveillance Systems”. Washington, DC: FHI 360/FANTA, (2014). 
  6. KreysJer J. “Nutritional Surveillance”. Ministry of Health (Nutrition Unit). Gaborone (1978). 
  7. Nnyepi M., et al. “Comparison of estimates of malnutrition in children 0-5 years between clinic-based nutrition surveillance and national surveys”. Journal of Public Health Policy 32.3 (2011): 281-292.
  8. Romero-Corral A., et al. “Diagnostic performance of body mass index to detect obesity in patients with coronary artery disease”. European Heart Journal 28 (2007): 2087-2093.
  9. Gavriilidou NN., et al. “High degree of BMI misclassification of malnutrition among Swedish elderly population: Age-adjusted height estimation using knee height and demispan”. European Journal of Clinical Nutrition 69.5 (2014): 565-571.
  10. Zhang Y., et al. “Double burden of malnutrition among children under 5 in poor areas of China”. PLoS One 13.9 (2018): e0204142. 
  11. Chumlea WM and Guo SS. “Assessment and prevalence of obesity application of new methods to a major problem”. Endocrine 13 (2) (2000): 135-142.
  12. Eckhardt CL., et al. “Estimating body fat from anthropometry and isotopic dilution: A four-country comparison”. Obesity Research 11.12 (2003): 1553-1562.
  13. Duren DL., et al. “Body composition methods: comparisons and interpretation”. Journal of Diabetes Science and Technology 2.6 (2008): 1139-1146.
  14. WHO. “Nutrition Landscape Information System (NLIS) Country Profile Indicator. Interpretation Guide”. ISBN 978 92 4 159995 5, Printed by the WHO Document Production Services, Geneva, Switzerland (2010). 
  15. Lindholm A., et al. “Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age”. Pediatric Research 85 (2019): 30-35.
  16. Cole TJ., et al. “Establishing a standard definition for child overweight and obesity worldwide: International survey”. BMJ 320 (2000): 1240-1243.
  17. Centers of Disease Control and Prevention. “Defining childhood obesity. BMI for children and teens” (2018).
  18. Wells JCK. “Body composition assessment in children and adolescents” in Ranke, M.B., Mullis,P.E. (ed.) Diagnostics of endocrine function in children and adolescents (4th, revised and extended edition). Basel: Karger (2011): 465-482.
  19. Wells JC and Fewtrell MS. “Measuring body composition”. Archives of Disease in Childhood 91 (2006): 612-617. 
  20. Botswana National Malaria Programme. “Extended malaria strategic plan, 2014-2018”. Gaborone, Botswana: Ministry of Health (2013).
  21. Nations Online Project. Adapted from the political map of Botswana. 1998-2019.
  22. Centers for Diseases Control and Prevention. “How to determine Body Mass Index (BMI) percentiles for children and teens” (2015).
  23. IAEA Human Health Series. “Introduction to Body Composition Assessment Using the Deuterium Dilution Method with Analysis of Saliva Samples by Fourier Transform Infrared Spectrometry”, Human Health Series No. 12, IAEA, Vienna (2011). 
  24. Lohman TG. “Advances in Body Composition Assessment”. 1992, Champaign IL, Human Kinetics Publishers
  25. Laerd Statistics. “Kruska-Wallis H Test using SPSS Statistics” (2018).
  26. Kreysler J., et al. “Evaluation of Weight Chart Surveillance”. Gaborone Health Region. Ministry of Health (Nutrition Unit) Gaborone. (1977). 
  27. Comprehensive Africa Agriculture Development Programme (CAADP)/African Union, NEPAD and Botswana Government. “CAADP Nutrition Development Workshop for the Southern Africa Region”. Nutrition country paper-Botswana (2013).
  28. Moepeng PT. “Rural development in Botswana: Experience from elsewhere and emerging issues”. Prepared for the Rural Development Council Pitso. May 30th, (2013).
  29. Kgathi DL., et al. “The Okavango; a river supporting its people, environment and economic development”. Journal of Hydrology 331 (2006): 3-17.
  30. Mmopelwa G., et al. “Direct use values of selected vegetation resources in the Okavango Delta Wetland”. South African Journal of Economic and Management Sciences 12.2 (2009): a279. 
  31. United Nations Children’s Fund (UNICEF), World Health Organization, International Bank for Reconstruction and Development/The World Bank. “Levels and trends in child malnutrition: key findings of the 2019 Edition of the Joint Child Malnutrition Estimates”. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO (2019).
  32. Global Nutrition Report. Botswana country profile. Overview. Malnutrition Burden.
  33. Olhager E., et al. “Studies on human body composition during the first 4 months of life using magnetic resonance imaging and isotope dilution”. Pediatrc Research 54 (2003): 906-912
  34. Rogg E. “Body composition and body index in 5-year-old children”. A thesis submitted to the graduate degree program in Dietetics and Nutrition and the Graduate Faculty of the University of Kansas in partial fulfilment of the requirements for the degree of Master of Science (2013).
  35. Diouf A., et al. “Body mass index vs deuterium dilution method for establishing childhood obesity prevalence, Ghana, Kenya”. Bulletin of the World Health Organisation 96.11 (2018): 772-781.
  36. Cole TJ., et al. “What is the best measure of adiposity in growing children: BMI, BMI %, BMI Z scores or BMI centile?” European Journal of Clinical Nutrition 59 (2005): 419-425.
  37. Rothman KJ. “BMI-related errors in the measurement of obesity”. International Journal of Obesity 32 (2008): S56-S59.
  38. Kuriyan R. “Body composition methods”. Indian Journal of Medical Research 148.5 (2018): 648-658.
  39. Weber DR., et al. “Body composition analysis in the paediatric population”. Pediatric Endocrinology Reviews 10.1 (2012): 130-139.


Citation: Ramolefhe-Mutumwa Tshepiso Galase., et al. “The Use of Anthropometrics, BMI and Isotope Dilution Methods in Assessing the Double Burden of Malnutrition in Children (3-5 Years) in the Southern and Northern Regions of Botswana". Acta Scientific Nutritional Health 4.2 (2020): 132-138.


Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.316

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US