Factors Associated With the Double Burden of Malnutrition Among Preschool Children in South Asia: A Systematic Review

The double burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition, is a growing concern in South Asia, which is home to over half of the world's undernourished children and nearly 5 million overnourished children. This systematic review aimed to identify factors associated with DBM among South Asian preschool children. Following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines, with protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO), five databases (PubMed, Web of Science, ScienceDirect, EBSCOhost, and Cochrane Library) were searched for studies published from January 2014 to October 2024. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. Of 4714 retrieved articles, 45 met the inclusion criteria. Key factors for undernutrition included older age, male sex, low maternal education, maternal underweight, low birth weight, food insecurity, recent morbidity, maternal employment, more children in the household, and higher birth order. Overnutrition was commonly associated with younger age, male sex, maternal overweight, higher wealth index, and lower birth order. These findings show that malnutrition among South Asian preschoolers is shaped by demographic, maternal, and household determinants, underscoring the need for integrated, context-specific interventions to reduce the burden.