Double burden of malnutrition by mid-childhood in an Indian birth cohort: a longitudinal study (2010-2021)

The double burden of malnutrition (DBM) is characterized by concurrent malnourishment and obesity and is largely prevalent in low- and middle-income countries. This study evaluated the longitudinal patterns of body mass index (BMI) from birth to 9 years of age in an urban Indian birth-cohort: Malnutrition and Enteric Disease (MAL-ED) cohort, to understand the emergence of DBM and the role of early-life factors.

The MAL-ED study recruited 251 children from urban slums in Vellore, Tamil Nadu, India, between 2010 and 2012, with further follow-ups conducted until 9 years of age. Standardized anthropometric measurements were performed at the ages of 2, 3, 4, 5, 7, and 9 years, with additional BMI calculations performed at each time point. After normality checks, appropriate statistical analyses were performed for individual variables, and later-life BMI was modeled using multinomial regression.

Approximately 45% of children were stunted at 2 years of age. By 7 years, 26.3% of children were classified as thin with 5.2% of children classified as overweight/obese. By 9 years, the prevalence of underweight was 21.6%, while overweight/obesity increased to 14.6%. Maternal BMI was a predictor of childhood thinness, particularly at ages 5 and 9.

DBM though present in early childhood, became more pronounced after 5 years of age and intensified by 9 years. Low maternal BMI was associated with the BMI trajectory of the offspring. Hence, age-specific and maternal health interventions are crucial for addressing the risk of DBM in vulnerable children.

This research was supported by the Bill and Melinda Gates Foundation (grant no. OPP 47075) for the original MAL-ED study, DBT/Wellcome Trust India Alliance fellowship (grant no. IA/CPHI/19/1/504611) for the follow-up and TIFR-DAE funding (RTI4003; 19P-0911).