Double burden of malnutrition and its associated factors among women in low and middle income countries: findings from 52 nationally representative data

(2023) 23:1479 Alem et al. BMC Public Health https://doi.org/10.1186/s12889-023-16045-4 BMC Public Health Open Access RESEARCH Double burden of malnutrition and its associated factors among women in low and middle income countries: findings from 52 nationally representative data Adugnaw Zeleke Alem1*, Yigizie Yeshaw1,2, Alemneh Mekuriaw Liyew1, Zemenu Tadesse Tessema1, Misganaw Gebrie Worku3, Getayeneh Antehunegn Tesema1, Tesfa Sewunet Alamneh1, Achamyeleh Birhanu Teshale1, Dagmawi Chilot2,4 and Hiwotie Getaneh Ayalew5 Abstract Background Double burden of malnutrition (DBM) is an emerging global public health problem. The United Nations member states adopted eradicating all forms of malnutrition as an integral component of the global agenda. However, there is evidence of a high burden of undernutrition among women and rising rates of overweight and obesity, especially in low and middle income countries (LMICs). Therefore, this study aimed to investigate the prevalence and associated factors of underweight, overweight, and obesity among women of reproductive age in LMICs. Methods Data for the study were drawn from a recent 52 Demographic and Health Surveys (DHS) conducted in LMICS. We included a sample of 1,099,187 women of reproductive age. A multilevel multinomial logistic regression model was used to identify factors associated with DBM. Adjusted relative risk ratio (RRR) with a 95% Confidence Interval (CI) was reported to show an association. Results The prevalence of underweight, overweight, and obesity in LMICs among women of reproductive age was 15.2% (95% CI: 15.1–15.3), 19.0% (95% CI: 18.9- 19.1), and 9.1% (95% CI: 9.0–9.2), respectively. This study found that women aged 24–34 years, aged ≥ 35 years, with primary, secondary, and above educational level, from wealthy households, using modern contraceptives, exposed to media (radio and television), and with high parity (more than one birth) were more likely to have overweight and obesity and less likely to have underweight. Moreover, the risk of having obesity (RRR= 0.59; 95% CI = 0.58–0.60 and overweight (RRR= 0.78; 95% CI = 0.77–0.79) were lower among rural women, while the risk of being underweight was (RRR= 1.13; 95% CI = 1.11–1.15) higher among rural women compared to urban women. Conclusion The prevalence of underweight, overweight, and obesity was high among women of reproductive age in LMICs. Underweight, overweight, and obesity are influenced by sociodemographic, socioeconomic, and behavioral-related factors. This study shows that, in order to achieve Sustainable Development Goal 2, a multifaceted intervention approach should be considered to prevent both forms of malnutrition in women of reproductive age. This *Correspondence: Adugnaw Zeleke Alem Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Alem et al. BMC Public Health (2023) 23:1479 Page 2 of 16 can be achieved by raising awareness and promoting healthy behaviors such as healthy eating and physical activity, especially among educated women, women from wealthy households, and women exposed to the media. Keywords Double burden of malnutrition, Low- and middle-income countries, Women of reproductive age Background The double burden of malnutrition (DBM) continues to be a major global public health problem. It is defined as the coexistence of both undernutrition and overnutrition in the same population across the life course [1, 2]. Globally, nearly one-third of the population suffered from at least one form of malnutrition [3]. The double burden of malnutrition is increasing globally, particularly in low and middle income countries (LMICs). Globally, obesity has doubled over the past 30 years, while obesity in LMICs has tripled over the past 20 years [4, 5]. Even though underweight among women has been a major public health concern in LMICs for several decades, due to population aging and increased prevalence of risk factors such as unhealthy diets, physical inactivity, and substance use such as alcohol consumption and cigarette smoking led to a significant shift in epidemiological trend from underweight to overweight and nutritional transitions [6–8]. Nutrition-related diseases and conditions such as nutritional deficiencies, obesity, hypertension, cardiovascular diseases, cancer, and diabetes mellitus are emerging at a faster rate in LMICs than in high-income countries [9]. Overweight/obesity is a major risk for non-communicable diseases (NCDs) morbidity and mortality such as cardiovascular diseases (CVDs), chronic kidney diseases, cancer, musculoskeletal disorders, type 2 diabetes mellitus, and respiratory problems [10–16]. Globally, NCDs are the leading causes of mortality and morbidity, and one of the major challenges of the 21st century [17]. Non-communicable diseases kill 41 million people annually, accounting for 71% of all deaths [18]. Eighty percent of NCD deaths occur in LMICs [19]. The World Health Organization (WHO) projects that by 2030, NCDs will overtake infectious, maternal, neonatal, and nutritional conditions as the leading cause of morbidity and mortality and that the most percentage increase in deaths from NCD will occur in LMICs [20]. Moreover, individuals with underweight are at a major risk of experiencing CVDs including stroke, heart attack, coronary artery disease, and infectious diseases [21]. The DBM is devastating and higher among women than men [4, 5]. It affects their health and the health of their offspring. Overweight/obesity among women is associated with increased pregnancy and childbirth related complications such as gestational diabetes, pre-eclampsia, gestational hypertension, postpartum hemorrhage, instrumental delivery, cesarean delivery, low birth weight, preterm birth, congenital malformation, large-for-gestational-age babies and perinatal death [22–28]. In addition, underweight women are more likely to have p (...truncated)