Nutritional status of Tunisian adolescents: associated gender, environmental and socio-economic factors

Objective: To assess the nutritional status of Tunisian adolescents and associated factors. Design: A cross-sectional study based on a national stratified random cluster sample. Subjects and methods: In all, 1295 boys and 1577 girls aged 15-19 years, of whom 28.4% had already left school. Socio-economic characteristics of the parents, anthropometric measurements, food behaviours and physical activity of the adolescents were recorded during home visits. Results: Prevalence of underweight, overweight and obesity (WHO/National Center for Health Statistics reference) were, respectively, 8.1%, 17.4% and 4.1% among boys and 1.3%, 20.7% and 4.4% among girls; abdominal obesity was highly prevalent among both sexes. Prevalence of overweight differed by region (from 11.5% to 22.2%) and was higher in urban v. rural areas for males (21.7% v. 10.4%) but not for females (21.7% v. 19.2%). These differences were partially mediated by socio-economic and lifestyle factors for males. For females, influence of cultural factors is hypothesised. In rural areas, overweight was more prevalent among boys of higher economic level households, having a working mother or a sedentary lifestyle; for girls, prevalence increased with the level of education of the mother. In urban areas, prevalence of overweight was related to eating habits: it was higher for boys with irregular snacking habits and for girls skipping daily meals. Urban girls having left school were also more overweight. Conclusion: Overweight and abdominal obesity in late adolescence have become a true public health problem in Tunisia with the combined effects of cultural tradition for girls in rural areas, and of rapid economic development for boys and girls in cities.