The Prevalence and Correlates of Vitamin D Deficiency and Overweight/Obesity of School-Age Children in Colombia–Findings on the Double Burden of Malnutrition from Nationally-Representative Data

The double burden of malnutrition (DBM), defined as the coexistence of overweight/obesity and micronutrient deficiency, is an emerging concern in childhood health. This study aimed to determine the prevalence of DBM and identify associated factors among Colombian schoolchildren aged 5–12 years. Using data from a nationally representative sample of 6,063 participants in the 2015 National Survey of Nutritional Status (ENSIN), DBM was defined as BMI-for-age z-score >1 combined with vitamin D deficiency. To account for the absence of a universal cutoff, three thresholds for vitamin D deficiency (<30, <37.5, and <50 nmol/L) were applied. Prevalence estimates varied by definition, from 0.7% (DBM1) to 6.9% (DBM3). In multilevel analyses, DBM1 and DBM2 were rare but showed associations with behavioral and household factors, including low physical activity, excessive screen time, household size, and head-of-household characteristics. DBM3, the most widely used definition, revealed the highest prevalence and was linked to socioeconomic and community-level factors such as smaller households, parental education, and residence in large cities. These findings indicate that narrower cutoffs identify children with more severe vulnerabilities, while broader thresholds capture structural inequities. Tailored interventions addressing both behavioral risks and social determinants are needed to reduce DBM among Colombian schoolchildren.