Prevalence and Determinants of the Double Burden of Malnutrition among Adolescents: A Cross-Sectional Study in Urban Schools of Nepal

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 from 25 ^th April, 2022 up to 25 ^th July, 2025. 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.