Nutrients
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
By Dengcheng Zhang, Jianuo Jiang, Liming Tan and 13 others.
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.