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In the last few decades, the prevalence of obesity has increased significantly throughout the world including low- and middle-income countries (LMIC), as well as high-income countries(1,2). According to recent epidemiological data from the WHO, the prevalence of obesity in the world has nearly tripled since 1975(1,2). In LMIC, although the rate of obesity is rising, nutritional deficiencies are still frequent(3,4), increasing the risk of growth faltering and stunting in children(4,5). Whilst nutritional deficiencies increase the risk of infection(6), obesity is often associated with chronic metabolic diseases including diabetes and CVD(7,8). Consequently, while LMIC continue to deal with the problems of undernutrition and infectious diseases, they are also experiencing a rapid upsurge in obesity and chronic metabolic diseases(3). This uncommon coexistence of undernutrition and obesity creates a ‘double burden’ situation that increases social and economic stress in countries with limited resources(3,5).
Ecuador is a South American Andean middle-income country with about 16·5 million population, of which about 60 % live in urban areas. Its population is heterogeneous with the majority (about 72 %) is represented by the descendants of inter-ethnic unions (commonly called Mestizos). Minorities are represented mostly by Afro-Ecuadorians, the descendants of Black Africans (about 7·2 %); Native Ecuadorians, the descendants of native Indigenous inhabitants (about 7 %); and White Caucasians, the descendant of European immigrants (about 6·1 %). Geographically, Indigenous populations are located mostly in remote regions in the Amazon forest and highlands, which often have less access to healthcare facilities(9,10). Because of the geographic and economic disparities, minorities are more vulnerable to nutritional deficiencies and diseases(10–12). At the same time, rapid economic and demographic changes in Ecuador are altering the balance of dietary intake and promoting the replacement of low-energy plant-based diet with high-energy diet rich in fat predominantly from animal sources(11,13). With this change, which is mostly located in urban areas, the occurrence of obesity and metabolic diseases is rapidly increasing. Independent studies were conducted to determine the importance of obesity and undernutrition in different locations in Ecuador, but the trend of occurrence and disparity in Ecuadorian population is still unclear. The objective of this study was to conduct a...