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. 2023 Aug 19;7(9):101987.
doi: 10.1016/j.cdnut.2023.101987. eCollection 2023 Sep.

Concurrent Undernutrition and Overnutrition within Indian Families between 2006 and 2021

Laxmi Kant Dwivedi  1 , Parul Puri  1 , Anjali Pant  2 , Alka Chauhan  1 , Samuel Scott  2 , Shrikant Singh  1 , Sarang Pedgaonker  1 , Phuong H Nguyen  2
Affiliations

Concurrent Undernutrition and Overnutrition within Indian Families between 2006 and 2021

Laxmi Kant Dwivedi et al. Curr Dev Nutr. .

Abstract

Background: The double burden of malnutrition (DBM), characterized by concurrent undernutrition and overnutrition, is a growing global concern. Families share resources and eating behaviors and programs often target households, yet evidence of the DBM at the family level is scarce.

Objectives: This study examined trends and inequality in the intrahousehold DBM in India between 2006 and 2021.

Methods: Data were from 3 waves of India's National Family Health Survey (NFHS 2006, 2016, and 2021). We examined 3 types of household member (with children aged <5 y) combinations: mother-child (N = 328,039 across 3 waves), father-child, and parent (mother and father)-child (N = 47,139 for each pair). The DBM was defined as one or more individuals with undernutrition (either wasting or stunting in children or underweight in adults) and one or more overweight individuals within the same household. DBM was examined over time, at national and subnational levels, and by residence and wealth.

Results: Nearly all DBM was in the form of an overweight parent and an undernourished weight or stunted child. The prevalence of parent-child DBM increased from 15% in 2006 to 26% in 2021. Father-child pairs experienced the most rapid DBM increase, from 12% in 2006 to 22% in 2021, an 83% increase, driven by increasing overweight among men. In 2021, the DBM was highest in North-Eastern and Southern states, and among relatively rich households from urban areas. The increase in the DBM was faster in rural areas and among poor households compared with that in urban areas and rich households. Urban-rural and rich-poor inequalities in the DBM have decreased over time.

Conclusions: The intrahousehold DBM has increased over time, affecting 1 in 4 households in India in 2021. Family-based interventions that can simultaneously address child underweight and parent overweight are required to address India's increasing intrahousehold DBM.

Keywords: India; anthropometry; double burden of malnutrition; overweight; residence; underweight; wealth.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

FIGURE 1
FIGURE 1
Flowchart depicting exclusion criteria, merging, and sample size for National Family Health Survey (NFHS), 2006-21. Boxes with gray text and dotted gray borders show sample exclusion steps.
FIGURE 2
FIGURE 2
Subnational trends in the double burden of malnutrition among parent–child pair in India over time, National Family Health Survey (NFHS), 2006–2016 (A) and 2016–2021 (B). Comet tail (small dot) indicates earlier timepoint and comet head (large dot) indicates later timepoint. NFHS-3 (2006) does not provide estimates for UTs. A&N, Andaman and Nicobar; AP, Andhra Pradesh; DNHDD, Dadar and Nagar Haveli + Daman and Diu.
FIGURE 3
FIGURE 3
Predicted prevalence and average annual change rate of double burden of malnutrition in India by place of residence (A) and wealth quintile (B), National Family Health Survey (NFHS), 2006–2021.
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