Epidemic Trends and Associated Factors of the Double Burden of Malnutrition Among Children and Adolescents in Xizang: Based on Five Cross-Sectional Surveys from 2019 to 2024
- 1Xizang Center for Disease Control and Prevention, Lhasa 850000, China
- 2Institute of Child and Adolescent Health & School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
Abstract
Introduction: The population-level double burden of malnutrition (DBM), characterized by the coexistence of undernutrition and overnutrition, presents a complex public health challenge. Xizang (Tibet), with its extreme high-altitude geography, rapid economic growth, and targeted school health policies, offers a unique context for nutritional transition, yet large-scale, repeated studies on the region’s DBM trends and multi-level associated factors remain scarce. Methods: Data were obtained from five large-scale cross-sectional surveys conducted in Xizang between 2019 and 2024 (except for 2022, when surveillance was not conducted), covering 301,242 participants aged 6–17 years. Nutritional status was defined using WHO growth standards for stunting, thinness, overweight, and obesity. Children and adolescents with stunting or thinness were classified as having undernutrition, while those with overweight or obesity were classified as having overnutrition. Prevalence was standardized across survey cycles—overall and within demographic, geographic, and socioeconomic strata—using multivariable logistic regression models to control for potential compositional variations. Multivariable mixed-effects models (MMEM) were used to analyze associations between potential correlates and the odds of undernutrition and overnutrition. Results: From 2019 to 2024, the standardized prevalence of undernutrition markedly decreased from 11.30% to 6.09%, driven primarily by stunting (9.42% to 4.12%). Overnutrition standardized prevalence peaked at 12.10% in 2020 (up from 9.42% in 2019), dipped to 11.24% in 2021, rebounded briefly to 11.44% in 2023, and fell to 10.00% in 2024. The standardized prevalence of undernutrition steadily increased with age and was consistently higher among boys, middle school students, and populations in rural, less developed, and high-altitude regions. Conversely, overnutrition decreased with age and predominated among girls, primary school students, and residents of urban, low-altitude, or moderately developed regions. Odds of undernutrition and overnutrition were significantly associated with a multi-level array of factors, including individual behaviors, school health management, socioeconomic status, altitude, and environmental variables. Conclusions: Xizang exhibits a unique “high-altitude DBM” pattern. The findings emphasize that public health strategies must integrate individual behavioral interventions with school-based health management and a nuanced understanding of environmental influences to effectively address the diverse nutritional needs of high-altitude populations.
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BibTeX
@article{zhang2026epidemic,
title = {{Epidemic Trends and Associated Factors of the Double Burden of Malnutrition Among Children and Adolescents in Xizang: Based on Five Cross-Sectional Surveys from 2019 to 2024}},
author = {Dengcheng Zhang and Jianuo Jiang and Liming Tan and Zhuoma Pubu and Sujuan Li and Qiang Zhang and Li Chen and Jinghong Liang and Xinli Song and Yi Zhang and Ruolin Wang and Ziqi Dong and Yang Qin and Zhenting Lu and Jun Ma and Yanhui Dong},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18203340},
url = {https://www.mdpi.com/2072-6643/18/20/3340},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Epidemic Trends and Associated Factors of the Double Burden of Malnutrition Among Children and Adolescents in Xizang: Based on Five Cross-Sectional Surveys from 2019 to 2024
AU - Dengcheng Zhang
AU - Jianuo Jiang
AU - Liming Tan
AU - Zhuoma Pubu
AU - Sujuan Li
AU - Qiang Zhang
AU - Li Chen
AU - Jinghong Liang
AU - Xinli Song
AU - Yi Zhang
AU - Ruolin Wang
AU - Ziqi Dong
AU - Yang Qin
AU - Zhenting Lu
AU - Jun Ma
AU - Yanhui Dong
PY - 2026
DA - 2026/10/01
JO - Nutrients
DO - 10.3390/nu18203340
UR - https://www.mdpi.com/2072-6643/18/20/3340
AB - Introduction: The population-level double burden of malnutrition (DBM), characterized by the coexistence of undernutrition and overnutrition, presents a complex public health challenge. Xizang (Tibet), with its extreme high-altitude geography, rapid economic growth, and targeted school health policies, offers a unique context for nutritional transition, yet large-scale, repeated studies on the region’s DBM trends and multi-level associated factors remain scarce. Methods: Data were obtained from five large-scale cross-sectional surveys conducted in Xizang between 2019 and 2024 (except for 2022, when surveillance was not conducted), covering 301,242 participants aged 6–17 years. Nutritional status was defined using WHO growth standards for stunting, thinness, overweight, and obesity. Children and adolescents with stunting or thinness were classified as having undernutrition, while those with overweight or obesity were classified as having overnutrition. Prevalence was standardized across survey cycles—overall and within demographic, geographic, and socioeconomic strata—using multivariable logistic regression models to control for potential compositional variations. Multivariable mixed-effects models (MMEM) were used to analyze associations between potential correlates and the odds of undernutrition and overnutrition. Results: From 2019 to 2024, the standardized prevalence of undernutrition markedly decreased from 11.30% to 6.09%, driven primarily by stunting (9.42% to 4.12%). Overnutrition standardized prevalence peaked at 12.10% in 2020 (up from 9.42% in 2019), dipped to 11.24% in 2021, rebounded briefly to 11.44% in 2023, and fell to 10.00% in 2024. The standardized prevalence of undernutrition steadily increased with age and was consistently higher among boys, middle school students, and populations in rural, less developed, and high-altitude regions. Conversely, overnutrition decreased with age and predominated among girls, primary school students, and residents of urban, low-altitude, or moderately developed regions. Odds of undernutrition and overnutrition were significantly associated with a multi-level array of factors, including individual behaviors, school health management, socioeconomic status, altitude, and environmental variables. Conclusions: Xizang exhibits a unique “high-altitude DBM” pattern. The findings emphasize that public health strategies must integrate individual behavioral interventions with school-based health management and a nuanced understanding of environmental influences to effectively address the diverse nutritional needs of high-altitude populations.
SN - 2072-6643
ER -