Prevalence and Determinants of the Double Burden of Malnutrition among Adolescents: A Cross-Sectional Study in Urban Schools of Nepal
- 1Public Health Promotion and Development Organization
Abstract
Background The double burden of malnutrition (DBM), characterised by coexisting undernutrition and overnutrition, remains a public health concern among adolescents especially in low- and middle-income countries. Adolescents in Nepal are nutritionally vulnerable, yet evidence on the coexistence of stunting and overweight/obesity is limited. This study assessed the prevalence and associated factors of DBM among school-going adolescents in urban Kathmandu Valley, Nepal. Methods A school-based cross-sectional study was conducted to assess factors associated with the double burden of malnutrition among adolescents in Kathmandu Valley, Nepal. A multi-stage cluster random sampling technique, using the Probability Proportional to Size method, was employed to ensure the selection of the desired number of participants. Students from grades 8 to 10 were randomly selected for face-to-face interviews and anthropometric measurements (height and weight were collected to calculate Body Mass Index (BMI)-for-age Z-scores (BAZ)), using tools adapted to the local context. Bivariate and multivariable models examined the associations between the dependent and independent variables. Results This study revealed that 15.3% of the students were stunted, 5.5% were underweight, 16.9% were overweight/obese, and 3% of students with the coexistence of DBM. In the fully adjusted model, the odds of stunting were significantly higher among adolescents aged 15-19 years (aOR = 2.03, 95% CI: 1.35-3.06), salty-snack consumers (aOR = 1.53, 95% CI: 1.00-2.36), those with low nutritional knowledge (aOR = 3.17, 95% CI: 2.17-4.66), and low diet quality (aOR = 7.27, 95% CI: 4.96-10.65). Conversely, fatty-food consumption was associated with lower odds of stunting (aOR = 0.65, 95% CI: 0.42-1.00). For overweight/obesity, older adolescents had significantly lower odds (aOR = 0.49, 95% CI: 0.35-0.67). Regarding the double burden of malnutrition (DBM), low nutritional knowledge (aOR = 2.16, 95% CI: 0.99-4.71) and low diet quality (aOR = 5.27, 95% CI: 2.42-11.48) were significantly associated with higher odds. Conclusion The double burden of malnutrition exists among adolescents in urban Kathmandu Valley, highlighting a critical public health challenge. Socio-demographic, dietary, and behavioral factors significantly influence its prevalence. Comprehensive school- and community-based interventions are crucial for addressing this dual nutritional burden.
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BibTeX
@misc{sunuwar2026prevalence,
title = {{Prevalence and Determinants of the Double Burden of Malnutrition among Adolescents: A Cross-Sectional Study in Urban Schools of Nepal}},
author = {D. R. Sunuwar and A. Shrestha and A. Kiwanayo and S. Karki and M. Shrestha and S. Sunuwar and D. R. Singh and K. Karki and N. K. Chaudhary and D. K.C.},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.02.26367141},
url = {https://www.medrxiv.org/content/10.64898/2026.11.02.26367141v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Prevalence and Determinants of the Double Burden of Malnutrition among Adolescents: A Cross-Sectional Study in Urban Schools of Nepal
AU - D. R. Sunuwar
AU - A. Shrestha
AU - A. Kiwanayo
AU - S. Karki
AU - M. Shrestha
AU - S. Sunuwar
AU - D. R. Singh
AU - K. Karki
AU - N. K. Chaudhary
AU - D. K.C.
PY - 2026
DA - 2026/11/02
PB - medRxiv
DO - 10.64898/2026.11.02.26367141
UR - https://www.medrxiv.org/content/10.64898/2026.11.02.26367141v1
AB - Background The double burden of malnutrition (DBM), characterised by coexisting undernutrition and overnutrition, remains a public health concern among adolescents especially in low- and middle-income countries. Adolescents in Nepal are nutritionally vulnerable, yet evidence on the coexistence of stunting and overweight/obesity is limited. This study assessed the prevalence and associated factors of DBM among school-going adolescents in urban Kathmandu Valley, Nepal. Methods A school-based cross-sectional study was conducted to assess factors associated with the double burden of malnutrition among adolescents in Kathmandu Valley, Nepal. A multi-stage cluster random sampling technique, using the Probability Proportional to Size method, was employed to ensure the selection of the desired number of participants. Students from grades 8 to 10 were randomly selected for face-to-face interviews and anthropometric measurements (height and weight were collected to calculate Body Mass Index (BMI)-for-age Z-scores (BAZ)), using tools adapted to the local context. Bivariate and multivariable models examined the associations between the dependent and independent variables. Results This study revealed that 15.3% of the students were stunted, 5.5% were underweight, 16.9% were overweight/obese, and 3% of students with the coexistence of DBM. In the fully adjusted model, the odds of stunting were significantly higher among adolescents aged 15-19 years (aOR = 2.03, 95% CI: 1.35-3.06), salty-snack consumers (aOR = 1.53, 95% CI: 1.00-2.36), those with low nutritional knowledge (aOR = 3.17, 95% CI: 2.17-4.66), and low diet quality (aOR = 7.27, 95% CI: 4.96-10.65). Conversely, fatty-food consumption was associated with lower odds of stunting (aOR = 0.65, 95% CI: 0.42-1.00). For overweight/obesity, older adolescents had significantly lower odds (aOR = 0.49, 95% CI: 0.35-0.67). Regarding the double burden of malnutrition (DBM), low nutritional knowledge (aOR = 2.16, 95% CI: 0.99-4.71) and low diet quality (aOR = 5.27, 95% CI: 2.42-11.48) were significantly associated with higher odds. Conclusion The double burden of malnutrition exists among adolescents in urban Kathmandu Valley, highlighting a critical public health challenge. Socio-demographic, dietary, and behavioral factors significantly influence its prevalence. Comprehensive school- and community-based interventions are crucial for addressing this dual nutritional burden.
ER -