Background: Chronic energy deficiency (Under-nutrition) is an indicator of inadequate household food supply and a coexisting malnutrition in developing countries. Under-nutrition continues to be health significance especially in Ethiopia. Malnutrition during middle age is risky for onset of metabolic diseases and its complication in elders’ health; however early diagnosing at community setting was not practiced. 

Objective: To investigate chronic energy deficiency using anthropometric variables. 

Methods: Primary data was collected using simplest assessment tool (anthropometric variables) for nutritional status at community setting. Data were collected from 266 adults living in Nekemte town. The prevalence of under-nutrition was measured with independent methods of body mass index and Waist circumference.  The association between dependent and independent variables were considered at p-value<0.05.

Result: The percentage of under-nutrition was 6.77% and 28.59% as of body mass index and waist circumference category respectively. More than 81.58% of the study samples were had meal frequency < 3times daily (eat none, once or twice a day). Being low (body mass index, waist circumference, hip circumference, and waist-to-hip ratio) were associated with chronic energy deficiency in the bi-variable analysis. On multivariable analysis only MBI ≤18.49Kg/m2 (aOR=2.47, 95% CI:  1.81-5.33; p<0.001) and waist circumference<94cm for male and 80cm for female (aOR=1.96, 95%CI: 1.14, 3.53) were associated to under-nutrition. 

In conclusion: Diagnosing under-nutrition targeting middle age is neglected in Nekemte town. The magnitude of chronic energy deficiency was relatively had low public health significance, but it is high in projection because the selected participants were from healthier that do not visit health institute or yet not under medication. 

Early diagnosing both the risk factors (under and over-nutrition) of degenerative diseases were crucial to improving community health. Under-nutrition (Chronic energy deficiency) is defined as a steady-state at which a person is in energy balance, although at a “cost” either in terms of health risks or as impairment of functions and health [5]. According to world health organization [6], under-nutrition can also be defined as body mass index (BMI) less than18.5 kg/m2 for adults. 

The magnitude of under-nutrition was community health concern throughout under developing world [12]; this is especially in Ethiopia.  For example, study conducted in University Referral Hospital finds the overall prevalence of chronic energy deficiency was 18.3 percentage (95 percentageCI: 14.5 percentage–22.7 percentage) among HIV/AIDS adults patients in Gondar [13]. Similar study in Gondar showed the prevalence of chronic energy deficiency among populations aged≥ 65 years was 17.6 percentage [14]. And the prevalence of under-nutrition among adults aged between 18-59 years was 28.7 percentage  [15].

From the pooled data of Ethiopia Demographic Health Survey (9), the prevalence of male adult thinness was 28.9 percentage. Of these, 21.4 percentage was mild underweight and 7.3 percentage was moderate to severe underweight [22]. The prevalence of chronic energy deficiency was highest in the Somali region (62.0 percentage) and lowest in Addis Ababa (22.0 percentage) [22]. In Ethiopia, the prevalence of male adult chronic energy deficiency increased from 10.8 percentage in 2003 to 25.3 percentage in 2011 [22].

Ethiopia is among agriculture-industrializing country. The country is in under developing, food in secured and impoverished nation. To overcome these challenging, the government has developed various development plans and strategies to increase food security, improve nutrition and reduce poverty [2,3]. Despite some studies propagate prosperity; still Ethiopia is suffering with double burden of malnutrition. Undernourishment or malnutrition repeatedly refers to under-nutrition and its impediments [10]. All food, nutrition and health sectors in Ethiopia give priority to under-nutrition focusing targeting vulnerable groups (like children, adolescents, pregnant, lactating and elderly). However, early diagnosing under-nutrition among mid- adulthood is a neglected public health concern in urban and rural area of Oromia. Thus, the study designed to investigate the prevalence of under-nutrition (chronic energy deficiency) using anthropometric measurements in Nekemte town. 

Study design, setting and period

A community based cross-sectional study conducted in accordance with approaches of [11] from 08/11/2020 to15/12/ 2020.  We selected Nekemte town purposively, since it is midpoint for four corners of western towns. It is found in west Oromia, has six kebeles, has one public university (Wollega) and the distance between Addis Ababa and Wallaga University was 328km.

Study population 

Data was collected from 266 selected participants’ among adults aged between 41-64years. The study was approved by the Ethical Committee of wollega University and prior to study performed written informed consent from the participants. 

Sample size determination 

Study participants calculated by considering with the following assumptions: margin of error of 5 percentage, confidence level of 95 percentage, 80 percentage power, 10 percentagenon-response rate and central obesity (19.6 percentage) the most common prevalent metabolic syndrome component Ethiopian adults [9]. Finally, 266 samples were recruited.

Sampling Techniques

Two communes were selected from six kebeles (small administrative unit) of Nekemte city. Of this one commune was selected by lottery system and the other was purposively allocated with buffering zone through natural geography. The study units were selected randomly. 

Anthropometric Variables

Anthropometric measurements were obtained according based on different literatures [1]. Length of height (SHt.) was measured nearest to (0.1 cm) by Martin’s anthropometric rod (GPM, Switzerland). Weight (Wt.) was measured (0.1 kg) with an electronic scale (Omron HBF-375 Karada Scan, Japan). Waist circumference (WC) and hip circumference (HC) were measured by using measuring tape.

Data processing

The data was coded, checked and entered into Epi Info Version seven and exported to SPSS version 24. Statistical results were analyzed and the findings were reported using tables. Variables with p less than 0.20 on bivariate logistic regression were geared to multivariable logistic regression to adjust for potential confounders to identify the determinants of chronic energy deficiency among none pregnant and none lactating women. In the final model, variables with P-value less than 0.05 were considered as statistically significant and aOR of 95 percentage CI was used to see the strength of association. Using multiple linear regressions, no evidence of multi-collinearity was found between the independent variables and using Hosmer& Lemshow model fitness was checked. 

Descriptions of mid-adulthoods 

Finally two hundred sixty six healthier adults with age of 41-64 years participated in the study; of this 62.78 percentage of them were females. Adults age between 41-48 years accounted for 54.5 percentage and more than half (54.9 percentage) of the participants were poor in their living standard (less than1.25dollar/day/person). Concerning the religious, about 63.9 percentage of the study units were protestant Christians and followed with orthodox (33.1 percentage). Regarding their marital status, more than two third of them was married. Other social determinants show, 32.3 percentage (nearly about one third) of the study participants was illiterate (unable to read and write). Concerning the meal frequency, majority (81.58 percentage) of the respondents consume less than three times a day (Table 1). 

Incidence of chronic energy deficiency

The status of under-nutrition is shown in table 2. From the total samples selected mid-adulthood Nekemte populations, 6.77 percentage of them had Body mass index less then 18.49 kg/m2. Relatively this magnitude is low because the sample was collected from healthier population that cannot visit health institutions or under treatment for any diseases.

The incidence of under-nutrition among male participants was 11.11 percentage. From the total adults who had under-nutrition, the percentage of undernourishment was high in age group range from 41- 48 which was (8.85 percentage) followed by age group 57-64 accounted (4.55 percentage) (table 3). 

Association of anthropometric variables and chronic energy deficiency

From the total of 110(41.4 percentage) adults who had low waist circumference, 76(28.58 percentage) of them where with chronic energy deficiency. New thing about BMI is that, adults in normal cutoff points with BMI=18.5-24.99Kg/m2, 2(1.37 percentage) of them were found with chronic energy malnutrition.

Being low (Body Mass Index, waist circumference, hip circumference, and waist to hip ratio) were associated with under-nutrition in the bi-variable analysis. On multivariable logistic regression only BMI and waist circumference were showed association with chronic energy deficiency. Being having MBI less then 18.49Kg/m2 increased the risk of developing chronic energy deficiency by more than two fold (aOR =2.47, 95 percentageCI: 1.81-5.33; pless than0.001). Waist circumference and chronic energy deficiency show significant association; the odds of chronic energy deficiency was nearly twice (1.96) times more among those had low waist circumference (aOR =1.96, 95 percentageCI: 1.14, 3.53) as compared to those having high waist circumference.

Discussion 

Malnutrition during middle age is indicator for poor health of late adults and elderly. The study revealed the prevalence of under-nutrition was 6.77 percentage based on Body Mass Index. According to Nutrition Landscape Information System (NLIS) cutoff values [11], the magnitude of chronic energy malnutrition (5-9 percentage) was founds to be in low burden of public health significance. This figure is warning sign for stakeholders and need holistic monitoring, because the study units were selected from healthier and/or not under medication for any of nutrition related chronic diseases.

To compare the statistical differences of under-nutrition, we couldn’t get a research conducted at community setting with a representative sample of Ethiopian adults aged 41-64 years. In contrary to our study, different studies targeting different age groups shows, the prevalence of under nutrition or thinness among adults in Ethiopia was high. 

The prevalence of chronic energy deficiency from current finding was lower than study performed in Ethiopia Gondar zone (18.3 percentage) [13], Amhara region (28.7 percentage) [15], in Somali region (62.0 percentage) and Addis Ababa (22.0 percentage) [17]. Likewise, study conducted in Uganda (22.3 percentage) [19], India (19.5 percentage) [20], and Botswana (19.5 percentage) [21] were higher than our study.

Regarding sex, male adults are highly affected by chronic energy deficiency. Similar to our study, male adults from Ethiopia Tigray region state (AOR = 2.23, 95 percentage CI: 1.61, 3.09) was associated to chronic energy deficiency [22].

This study is the first study to diagnosis chronic energy deficiency targeting middle aged adults in western Ethiopia.  Study had limitations due to nature of cross-sectional design. Other thing is the intention of the questions the relationship between under-nutrition and anthropometric variables there will be some cofounder that may increase or under estimate the prevalence of chronic energy deficiency. 

In conclusion

Under-nutrition is neglected public health concern targeting middle age. The identified chronic energy deficiency using anthropometric variables was relatively low public health significance, however it is high because the selected participants were from healthier that do not visit health institute or yet not under medication. 

Ethical consent

Institute of Health Science Review Board of Wollega University declared the study, ethical clearance obtained from the college of medical and health sciences. Written informed consent was collected from participants prior to the study.

Authors Contributions 

All authors equally credited from conceptualization, construction, data collection, interpretation, draft of manuscript writing to reviewing.

Disclosure

The authors declare that they have no conflicts of interest.

Acknowledgments

I and my co-author have highly appreciation  for study units, data collectors, Wollega University and Nekemte health Bureau for the accomplishment of research.