Dietary diversity moderates household economic inequalities in the double burden of malnutrition in Tanzania.

OBJECTIVE:Improved food availability and a growing economy in Tanzania may insufficiently decrease pre-existing nutritional deficiencies and simultaneously increase overweight within the same individual, household, or population, causing a double burden of malnutrition (DBM). We investigated economic inequalities in DBM at the household level, expressed as a stunted child with a mother with overweight/obesity, and the moderating role of dietary diversity in these inequalities. DESIGN:We used cross-sectional data from the 2015-2016 Tanzania Demographic and Health Survey. SETTING:A nationally representative survey. PARTICIPANTS:2,867 children (aged 6-23 months) and their mothers (aged 15-49 years). The mother-child pairs were categorized into two groups based on dietary diversity score: achieving and not achieving minimum dietary diversity. RESULTS:The prevalence of DBM was 5.6% (SD=0.6) and significantly varied by region (ranging from 0.6%-12.2%). Significant interaction was observed between dietary diversity and household wealth index (p for interaction <0.001). The prevalence of DBM monotonically increased with greater household wealth among mother-child pairs who did not achieve minimum dietary diversity (p for trend <0.001; however, this association was attenuated in those who achieved minimum dietary diversity (p for trend=0.16), particularly for the richest households (p=0.44). Analyzing household wealth index score as a continuous variable yielded similar results (odds ratio [95% confidence interval]: 2.10 [1.36-3.25] for non-achievers of minimum dietary diversity, 1.38 [0.76-2.54] for achievers). CONCLUSIONS:Greater household wealth was associated with higher odds of DBM in Tanzania; however, the negative impact of household economic status on DBM was mitigated by minimum dietary diversity.