Obesity has become a global health problem. According to the World Health Organization (WHO) in 2005 about 1.6 billion adults were affected worldwide, with about 400 million adults categorized as obese [
In developed and developing countries, with the reduction of underweight status, there has been widespread concern over the increase in overweight and obesity in children [
The definition of both overweight and obesity in children and adolescents is still a matter of debate [
Recent studies in Cameroon specifically have pointed out the association of obesity with hypertension and diabetes in adults [
Subjects were recruited from a cross-sectional school-based survey: the Douala Child and Adolescent Obesity Study in Cameroon (DCAO study). A total of 2689 school children ranging from 8 to 15 years old were recruited between February and May 2010 in the city of Douala, including girls (
Anthropometric variables were measured according to existing standards by trained enumerators. Height was measured without shoes to the nearest 0.1 cm using a portable stadiometer, and body weight was measured to the nearest 0.1 kg using an indoor weighing scale with the student’s shoes, coats, and other heavy outerwear removed. Height and weight were used to calculate BMI as body mass (kg)/square of height (m2).
Our database-derived reference (Database) was first built according to various methods and second compared to other published references for the assessment of grades of nutritional status based, respectively, on BMI, weight for height, weight for age, and height-for-age. The LMS method was used to summarize the dataset in three smooth age specific values of skewness (
Database percentiles passing through BMI values of 16, 17, 18.5, 25, and 30 kg/m² at 18 years were compared to Cole 2007 and IOTF similar published data [
Database-derived 85th and 95th BMI percentiles were compared with similar cutoffs as the old US (Must et al.) [
The 97th centile from database was compared with the Europe-French 97th BMI percentile reference [
WHO 2007 reference [
Quantitative data are presented as median with coefficient of variation and skewness or means with standard error of the mean where stated. Differences between boys versus girls were tested by Student’s
Table
(a) Descriptive statistics for height, weight, and body mass index (BMI) of boys in our study population. (b) Descriptive statistics for height, weight, and body mass index (BMI) of girls in our study population.
Age (years) |
|
|
|
|
|
|
|
|
---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
|
Height (cm) | 127.3 (0.64) | 132.6 (0.76) | 136.9 (0.75) | 142.1 (0.62) | 148.2 (0.63) | 153.1 (0.69) | 158.3 (0.67) | 163.7 (0.76) |
Weight (kg) | 25.7 (0.38) | 29.1 (0.59) | 31.6 (0.63) | 36.0 (0.50) | 40.3 (0.53) | 44.5 (0.65) | 47.7 (0.56) | 53.1 (0.82) |
BMI (kg/m²) | 15.8 (0.20) | 16.3 (0.20) | 16.7 (0.21) | 17.7 (0.17) | 18.2 (0.17) | 18.8 (0.21) | 18.9 (0.17) | 19.7 (0.20) |
Age (years) |
|
|
|
|
|
|
|
|
---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
|
Height (cm) | 128.6 (0.64) | 132.3 (0.59) | 138.1 (0.67) | 146.7 (0.62) | 152.7 (0.54) | 156.4 (0.42) | 159.3 (0.45) | 160.3 (0.46) |
Weight (kg) | 27.4 (0.58) | 28.5 (0.51) | 32.9 (0.57) | 40.2 (0.68) | 45.1 (0.58) | 49.3 (0.62) | 52.6 (0.67) | 55.6 (0.71) |
BMI (kg/m²) | 16.4 (0.23) | 16.1 (0.20) | 17.1 (0.18) | 18.5 (0.24) | 19.2 (0.20) | 20.1 (0.22) | 20.6 (0.23) | 21.6 (0.24) |
Based on the
Age specific
Age (years) |
|
|
|
|
|
85th | 95th | 97th | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
| |||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Age specific
Age (years) |
|
|
|
|
|
85th | 95th | 97th | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
| |||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Age- and gender-specific BMI cutoffs for the classification of nutritional status, obtained by using LMS method applied to our Cameroon database.
Age (years) | Thinness III | Thinness II | Thinness I | Overweight | Obesity | |||||
---|---|---|---|---|---|---|---|---|---|---|
Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Thinness III, Thinness II, Thinness I, overweight, and obesity correspond, respectively, to BMI values of
In Figure
Comparison of age- and gender-specific body mass index (BMI) cut-off curves of our Database population of 8 to 15 years old presented relative to different published reference groups: International Obesity Task Force (IOTF) cutoffs for overweight and obesity matching, respectively, BMI of 25 and 30 kg/m2 at 18 years old (a and b), World Health Organization (WHO) 2007 85th and 95th percentiles (c and d), Must et al. or “old United States” 85th and 95th percentiles (e and f), Center of Disease Control (CDC) or “new United States” 85th and 95th percentiles (g and h), and Europe-French 97th percentile for overweight including obesity (i and j). In all panels, corresponding cutoffs derived from our Database are presented as solid lines presented beside reference cutoffs with dotted lines.
Table
Prevalence (%) of overweight and obesity in the study population according to different references.
References | Boys ( |
Girls ( |
Boys + girls ( |
Chi-squared test | |||
---|---|---|---|---|---|---|---|
Overweight |
obese | Overweight |
obese | Overweight |
obese |
|
|
|
|||||||
Database lms |
|
|
|
|
|
|
— |
IOTF [ |
|
|
|
|
|
|
<0.001 |
|
|||||||
Database 85th |
|
|
|
|
|
|
— |
WHO 2007 [ |
|
|
|
|
|
|
<0.001 |
Must et al. [ |
|
|
|
|
|
|
<0.001 |
CDC [ |
|
|
|
|
|
|
<0.001 |
|
|||||||
Database 97th |
|
— |
|
— |
|
— | — |
French 97th |
|
— |
|
— |
|
— | <0.001 |
Table
Prevalence of undernutrition defined as underweight (low weight for age), stunting (low height for age), wasting (low weight for height) and thinness (low BMI for age) based on several references used: WHO 2007, CDC, Cole et al. 2007, and our Database.
Reference | Status | Range |
Boys: |
Girls: |
Boys + girls | |||
---|---|---|---|---|---|---|---|---|
WHO 2007 [ |
Underweight | <10 yrs |
|
|
|
|
|
|
Stunting | 8/15 yrs |
|
|
|
|
|
|
|
Wasting | <163 cm |
|
|
|
|
|
|
|
Wasting I | <163 cm |
|
|
|
|
|
|
|
Wasting II | <163 cm |
|
|
|
|
|
|
|
| ||||||||
CDC [ |
Underweight | 8/15 yrs |
|
|
|
|
|
|
Stunting | 8/15 yrs |
|
|
|
|
|
|
|
Wasting | <121 cm | — |
|
|
|
|
||
Wasting I | <121 cm | — | — | — | ||||
Wasting II | <121 cm | — | — | — | ||||
| ||||||||
Cole et al. 2007 [ |
Thin | 8/15 yrs |
|
|
|
|
|
|
Thin I | 8/15 yrs |
|
|
|
|
|
|
|
Thin II | 8/15 yrs |
|
|
|
|
|
|
|
Thin III | 8/15 yrs |
|
|
|
|
|
|
|
| ||||||||
Our Database | Thin | 8/15 yrs |
|
|
|
|
|
|
Thin I | 8/15 yrs |
|
|
|
|
|
|
|
Thin II | 8/15 yrs |
|
|
|
|
|
|
|
Thin III | 8/15 yrs |
|
|
|
|
|
(0.2) |
This study was conducted in 2010 in urban Cameroonian children and adolescents aged 8 to 15 years old. According to Cole et al. 2007 and IOTF references, we report an overall prevalence of 9.5% thinness and 12.4% overweight including 1.9% obesity. Prevalence of thinness was comparable to that of other developing regions [
This study has several limitations that need to be considered. First the collection of data was only in one urban area of one region of the country, which limits the potential conclusions to that area, and is not applicable to general rural areas. From a total of 3239 children and adolescents selected, 550 (16.9%) were eliminated because of missing data or they were not within the proposed age range (below 8 or above 15 years old). Nonetheless, the final sample within inclusion criteria included 2689 subjects comprising 47.8% boys (
The results of this study showed that, in general, regardless of the reference parameter used, overweight and obesity affect an important percentage of children and adolescents in an area and a continent that has typically not been associated with this problem. To our knowledge, this is the first study to report the prevalence of overweight, obesity, and leanness in Cameroon children and adolescents with such a large sample and specifically the comparison of data to several existing indices. We noted major differences between our Database analysis and published reports, according to the reference used [
Gender showed a high impact on the prevalence of overweight and obesity as prevalence in girls (IOTF, 16.24%) was about twice that in boys (IOTF, 8.40%). The same trend remained, irrespective of the reference parameter used. Similar findings were reported in the Cameroonian adult population [
Previous studies have noted a progressive reduction in thinness in developing countries facing social changes, while overweight and obesity are increasing [
In conclusion, to our knowledge, this study is among the first in Cameroon pointing out the prevalence of grades of nutritional status in children and adolescents at the urban level. As reference indices and cut-offs are often population-specific and sensitive and obesity/overweight varies widely worldwide, this highlights the importance of establishing a Cameroon-based reference. This study could then serve as a baseline and contribute to ongoing evaluation of the adverse effects of nutrition in transition. The important findings presented here are (i) a relatively high prevalence of overweight and obesity, compared to what was expected in this population, especially in girls, and (ii) yet at the same time, maintenance of thinness which is more prevalent in boys. Further studies are needed to follow the influence of socioeconomic environment on nutritional status grades in the context of economic growth.
Ponce Cedric Fouejeu Wamba is a Cameroonian participant directly involved in interaction with children from an educational and research viewpoint. Julius Enyong Oben is a researcher in Cameroon with academic nutritional expertise, and Katherine Cianflone is a Canadian researcher, with expertise in obesity, and has participated in several international studies on children in different ethnic groups.
The authors declare no conflict of interests. The authors alone are responsible for the content and writing of the paper.
Ponce Cedric Fouejeu Wamba was responsible for the design of the project, direct collection of the data, data and statistical analysis, and paper preparation. Julius Enyong Oben contributed to the study design and paper preparation, and Katherine Cianflone contributed to the study design, data interpretation, statistical analysis, and paper preparation.
The authors would like to thank all local school authorities for the permission to work in their respective schools and to all parents and guardians for their collaboration in the project.