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, 1,295 boys and 1,577 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.