Rural Bangladesh is currently undergoing a nutrition transition, defined by changes in diet and physical activity patterns associated with increasing rates of morbidity and mortality due to chronic disease [1, 2]. The nutrition transition hypothesis posits that populations experience similar changes in subsistence, diet, and physical activity with increasing economic development and globalization. This is thought to present in five stages with the first three stages being collection of food, nutritional stress due to famine, and the end of famine. The last two stage include (a) diets high in fat and sugar alongside a sedentary lifestyle, which is presently occurring in much of the less developed world, and (b) improved diet to include nutritious foods alongside increased physically activity, which is presently occurring in high-income countries . Epidemiologic transitions are often linked with nutrition transitions, as diets high in fat and sugar, especially co-occurring with low physical activity, increase rates of overweight and obesity in previously lean or underweight populations  and contribute to risk for chronic disease  including for hypertension and diabetes [6, 7]. The last major famine occurred in Bangladesh in the mid-1970s, and the transition towards less healthy diets and lower levels of physical activity is presently occurring in Bangladesh. Evidence exists for a nutrition transition in Bangladesh with increasing prevalence of overweight and obesity in urban and rural areas, alongside a decreasing prevalence of underweight and micronutrient deficiency, including iron deficiency and anemia [2, 8]. Consistent with an epidemiological transition, mortality from chronic diseases such as cardiovascular disease, hypertension, and diabetes has also increased in Bangladesh over the past several decades [9–11].
Increasing rates of labor migration have dramatically redefined family structures in rural Bangladesh leaving wives with increased purchasing power, which has potential implications for nutrition . A large fraction of labor migrants from rural Bangladesh are men whose wives and children remain in the village . The number of rural Bangladeshi men moving to urban areas within Bangladesh and abroad to pursue economic opportunities is expected to continue to increase, as persistent population growth and climate change yield smaller landholdings and poorer farming conditions, which push men out of rural communities, while urban employment opportunities continue to surge, with economic development and globalization pulling men toward large population centers [14, 15]. Wealth from remittances in rural areas of Bangladesh is growing [13, 16]. Because labor migration generally results in greater wealth and economic stability for families ‘left behind’, families pursue such opportunities despite expectations for long-term family separation .
Significant variation exists in patterns of labor migration and remittance. Some migrants move abroad (e.g. Oman, Qatar, Singapore, and United Arab Emirates) to pursue unskilled or skilled labor at relatively high wages, while others with more limited resources move to pursue unskilled and skilled labor jobs within Bangladesh [18, 19]. A large fraction of labor migrants send regular remittances to their families in the village, allowing significant investment in household maintenance, healthcare for their kin, and the education and marriages of their children . The experiences of the families of men who migrate for work abroad versus men who migrate to other parts of Bangladesh may differ, as international labor migration tends to lead to higher earnings and larger flows of remittances . Higher remittances have been found to increase financial savings, allowing families to accumulate wealth .
Increased wealth through remittances may improve migrants’ families’ diets, reducing undernutrition. Yet increased wealth may also contribute to obesogenic and diabetogenic diets, increasing risk for cardiovascular disease, hypertension, and diabetes . Additionally, with rising socio-economic status (SES), activity levels have been shown to decrease, particularly among women, which could also exacerbate risks for chronic disease [22, 23]. Wives ‘left behind’ may be adversely affected by psychosocial stress from the loss of their husband’s social support and/or household labor or altered family dynamics [24, 25]. Psychological stress has been linked with several chronic diseases, including hypertension , diabetes , obesity , and anemia . Psychosocial stress may be exacerbated if husbands are gone for longer periods, as is generally the case for international labor migrants from Bangladesh, who often remain in their destination country for years at a time. By contrast, domestic migrants may remain in their destinations for only days or weeks before returning to visit their families in the village.
We assessed associations between (a) having a labor migrant husband, and (b) having a husband who migrated internationally, and indicators of chronic disease among a sample of married rural Bangladeshi women. We hypothesized that wives ‘left-behind’ by migrant husbands will experience an increase in indicators of adiposity and chronic disease, and a reduction in underweight and micronutrient deficiencies. We explored the extent to which marriage to a labor migrant and specifically to an international labor migrant was independently associated with chronic disease outcomes, indicating an effect of psychosocial stress, and the extent to which predicted associations were mediated by increased household monthly income, food security, and/or purchasing (rather than producing) food.