Dietary and Socio‑Economic Predictors of Obesity Among 2–5‑Year Old in Northwest Iran

Rasool Entezarmahdi, Anahita Houshiarrad, Shabnam Gheibi, Abdolmajid Hamisi, Fariba Babayi, Marjan Ajami, Mina Esmaeili, Arezoo Haghighian Roudsari, Leila Khakzad, Hamed Mojarrad, Morteza Abdollahi


Background: As a rising epidemic in developing countries, childhood obesity and overweight need particular attention. Methods: The sample (n = 2432) was randomly selected among children aged 24–59 months living in West Azerbaijan Province whose information was recorded in SIB software. The survey questionnaire is derived from the Demographic and Health Survey and the Multiple Indicator Cluster Survey questionnaires designed by the WHO 2017 and UNICEF 2017, respectively. Results: The prevalence of obesity defined as BMIz (body mass index z‑score)> +2 was 1.4% among children. Dietary diversity score (DDS) was high in 59.3% of children, moderate in 36.1%, and low in 4.6%. Socio‑economic status (SES) of children families was high, moderate, and low in 34%, 28.9%, and 37.1% of families, respectively. Physical activity hours were over 3 in 85.9% of children. The girls were more likely to be obese than the boys (OR = 0.43, P = 0.016). Those with high and moderate DDS were less likely to be obese than those with low DDS (OR = 0.250 and OR = 0.180, respectively). The likelihood of obesity among children with high and moderate SES were 2.6 and 1.6 times more compared to children with low SES, respectively. Conclusions: According to the results, DDS and physical activity levels are related to obesity in children aged 24–59 months. Therefore, establishing proper nutritional behavior and promoting a healthy lifestyle are essential for preventing obesity and non‑communicable diseases in this age group.


Child; dietary diversity score; economic and social status; exercise; obesity

Full Text:



Davoudi‑Kiakalayeh A, Mohammadi R, Pourfathollah AA,

Siery Z, Davoudi‑Kiakalayeh S. Alloimmunization in thalassemia

patients: New insight for healthcare. Int J Prev Med 2017;8:1–5.

Vitolo MR, Gama CM, Bortolini GA, Campagnolo PDB,

Drachler MDL. Some risk factors associated with overweight,

stunting and wasting among children under 5 years old.

J Pediatr (Rio J) 2008;84:251–7.

Derso T, Tariku A, Biks GA, Wassie MM. Stunting, wasting and

associated factors among children aged 6‑24 months in Dabat

health and demographic surveillance system site: A community

based cross‑sectional study in Ethiopia. BMC Pediatr 2017;17:1–9.

Rakotonirainy NH, Razafindratovo V, Remonja CR,

Rasoloarijaona R, Piola P, Raharintsoa C, et al. Dietary diversity

of 6‑ to 59‑month‑old children in rural areas of Moramanga and

Morondava districts, Madagascar. PLoS One 2018;13:1–14.

Ahmadi D, Amarnani E, Sen A, Ebadi N, Cortbaoui P,

Melgar‑Quiñonez H. Determinants of child anthropometric

indicators in Ethiopia. BMC Public Health 2018;18:1–9.

Haghifar S, Naeini YJ, Akbari ME, Abdollahi M, Shadnoush M,

Ajami M, et al. Relationship between diet diversity score and

breast cancer risk. Tehran Univ Med J 2018;76:550‑7.

Agha‑Alinejad H, Farzad B, Salari M, Kamjoo S,

Lee Harbaugh B, Peeri M. Prevalence of overweight and obesity

among iranian preschoolers: Interrelationship with physical

fitness. J Res Med Sci 2015;20:334–41.

Albataineh SR, Badran EF, Tayyem RF. Dietary factors and

their association with childhood obesity in the Middle East:

A systematic review. Nutr Health 2019;25:53–60.

Mirmiran P, Sherafat‑Kazemzadeh R, Jalali‑Farahani S, Azizi F.

Childhood obesity in the middle east: A review. East Mediterr

Health J 2010;16:1009‑17.

de Onis M, Blössner M. The World Health Organization Global

Database on Child Growth and Malnutrition: Methodology and

applications. Int J Epidemiol 2003;32:518–26.

Prista A, Maia JAR, Damasceno A, Beunen G. Anthropometric

indicators of nutritional status: Implications for fitness, activity,

and health in school‑age children and adolescents from Maputo,

Mozambique. Am J Clin Nutr 2003;77:952–9.

Fabic MS, Choi YJ, Bird S. Revisión sistemática de las encuestas

demográficas y de salud: Disponibilidad de los datos y su uso en

investigaciones. Bull World Health Organ 2012;90:604–12.

UNICEF. Fieldwork teams are trained and deployed to sampled

clusters of households [Internet] 2017. [Last cited on 2020

Oct 17]. Available from:


Sorrie MB, Yesuf ME, Gebremichael TGG. Overweight/Obesity and associated factors among preschool children in Gondar

City, Northwest Ethiopia: A cross‑sectional study. PLoS One


Poobalan A, Aucott L. Obesity among young adults in developing

countries: A systematic overview. Curr Obes Rep 2016;5:2–13.

Fox A, Feng W, Asal V. What is driving global obesity trends?

Globalization or “modernization”? Global Health 2019;15:1–16.

Kelishadi R, Haghdoost AA, Sadeghirad B, Khajehkazemi R.

Trend in the prevalence of obesity and overweight among Iranian

children and adolescents: A systematic review and meta‑analysis.

Nutrition 2014;30:393–400.

Saeidlou SN, Rezaiegoyjeloo F, Ayremlou P, Babaie F. Trend

of overweight and obesity, based on population study among

school children in North West of Iran: Implications for when to

intervene. Maedica 2015;10:214–20.

Wang Y, Lim H. The global childhood obesity epidemic and

the association between socio‑economic status and childhood

obesity. Int Rev Psychiatry 2012;24:176–88.

Salehi‑Abargouei A, Esmaillzadeh A, Azadbakht L, Keshteli AH,

Feizi A, Feinle‑Bisset C, et al. Nutrient patterns and their relation

to general and abdominal obesity in Iranian adults: Findings

from the SEPAHAN study. Eur J Nutr 2016;55:505–18.

Abdollahi M, Salehi F, Kalantari N, Asadilari M, Khoshfetrat MR,

Ajami M. A comparison of food pattern, macro‑ and some

micronutrients density of the diet across different socio‑economic

zones of Tehran. Med J Islam Repub Iran 2016;30:340.

Poterico JA, Stanojevic S, Ruiz‑Grosso P, Bernabe‑Ortiz A,

Miranda JJ. The association between socioeconomic status and

obesity in Peruvian women. Obesity 2012;20:2283–9.

Roudsari AH, Vedadhir A, Amiri P, Kalantari N, Omidvar N,

Eini‑Zinab H, et al. Psycho‑socio‑cultural determinants of food

choice: A qualitative study on adults in social and cultural

context. Iran J Psychiatry 2017;12:238–47.

Cameron AJ, Spence AC, Laws R, Hesketh KD, Lioret S,

Campbell KJ. A review of the relationship between

socioeconomic position and the early‑life predictors of obesity.

Curr Obes Rep 2015;4:350–62.

Talarico R, Janssen I. Compositional associations of time spent

in sleep, sedentary behavior and physical activity with obesity

measures in children. Int J Obes 2018;42:1508–14.

Ahmed H, Khalid MM, Osman O, Ballal M, Al‑Hashem F. The

association between physical activity and overweight and obesity in

a population of children at high and low altitudes in Southwestern

Saudi Arabia. J Fam Community Med 2016;23:82‑7.