Analysis of interactive causes of undernutrition in minority children in the Liangshan Yi region, Western China

Abstract

Objective

This study aimed to investigate the epidemiological characteristics and interactive causes of child undernutrition in the Liangshan Yi region of western China and identify potential interaction mechanisms among influencing factors to provide evidence for improving children's nutritional status in this ethnic minority region.

Methods

A cross-sectional survey was conducted among 3358 primary and middle school students from Xide and Yuexi counties using multistage cluster sampling. Data on demographics, dietary patterns, health behaviors, family functioning, and quality of life were collected using validated questionnaires. Nutritional status was assessed using the BMI-for-age z-scores. Univariate and multivariate logistic regression analyses identified the risk factors, whereas decision-tree models revealed interactive effects between the determinants.

Results

The undernutrition rate was 18.97%, which was significantly higher than the national average and primarily manifested as wasting (14.23%) and stunting (4.73%). The weekly pocket money demonstrated protective effects (OR = 0.63), but synergistic interactions revealed complexities: adequate economic resources combined with supportive living environments (OR = 0.57) and moderate parental control (OR = 0.52) provided enhanced protection, whereas excessive pocket money with higher household income paradoxically increased the risk (OR = 2.56). Moderate-to-high vegetable and fruit intake increased the risk of undernutrition (OR = 1.38). Local economic poverty led to children primarily consuming plant-based foods. This reveals the risk of insufficient protein intake due to the lack of dietary diversity in plant-based diets.

Conclusions

Child undernutrition in the Liangshan Yi region exhibits a complex multifactorial causation characterized by interactive rather than linear relationships. The "vegetable and fruit paradox" and "double-edged sword effect" of economic resources challenge conventional assumptions. Effective interventions require ecological approaches that address economic support, dietary quality improvement, family functioning enhancement, and supportive community environments simultaneously, rather than isolated single-factor interventions.