Risk factors for the intra-individual double burdens of malnutrition among reproductive-age women in India: a secondary analysis of three rounds of the National Family and Health Survey

Journal article

Introduction: Underweight, overweight/obesity and anaemia are prevalent among reproductive-age women in India, but factors affecting their intra-individual co-occurrence are unclear. Our objectives were to examine the prevalence, spatial distribution and risk factors for concurrent ‘double burdens’ of anaemia with underweight or overweight/obesity within the same individual. Methods: Using data from reproductive age women (15–49 years) in the Indian National Family Health Surveys 2005–2006, 2015–2016 and 2019–2021, we calculated the national prevalence of the intra-individual double burdens of malnutrition and mapped their district-level distributions. We examined the association of 28 potential risk factors with anaemia, underweight, overweight/obesity and their co-occurrence using multilevel logistic regression and calculated area under the curve (AUC) statistics. Results: The underweight-anaemia double burden affected 11%, and overweight/obesity-anaemia double burden affected 21% of women in 2019–2021. Overweight/obesity-anaemia was prevalent in northern, southern and coastal districts, while underweight-anaemia was most prevalent in central India. For underweight-anaemia, important risk factors were tobacco consumption, younger age, lower education, lower household wealth, scheduled tribe background, larger household size, region and living in a high malaria transmission area. For overweight/obesity-anaemia, risk factors included older age, being educated, higher household wealth, region and living in an area with more hot days than average in recent years. AUC statistics showed a significant role of environmental factors. Conclusions: The double burdens present significant public health challenges for India. The spatial and sociodemographic distinctness of the burdens suggests the possibility of evidence-informed targeting of programmes.

Authors: Gardner, H; Sethi, V; Cheng, TS; Nair, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Public Health
• Volume: 3
• Issue: 2
• Article number: bmjph-2025-002730
• Publication date: 2025-10-17
• Acceptance date: 2025-07-18
• DOI: 10.1136/bmjph-2025-002730
• EISSN: 2753-4294
• ISSN: 2753-4294
• Language: English
• Keywords: Epidemiology; Female; Body Mass Index; Nutrition Surveys; Obesity