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.