Frontiers in nutrition · 2026
Longitudinal reversals and evolving patterns of the double burden of malnutrition among adults in Southwest China: a population-based cohort study.
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Long Hongjiang, Sun Yan, Liu Yiya, Luo Peng, Guo Hua
Аннотация
BACKGROUND: The double burden of malnutrition (DBM), the co-occurrence of micronutrient deficiencies and overweight/obesity, is a rising challenge in transitioning economies. However, longitudinal evidence on its structural evolution and demographic shifts remains limited.
OBJECTIVE: To analyze the long-term trajectories and socio-metabolic determinants of DBM among adults in Southwest China using three decades of cohort data.
METHODS: A total of 10,703 person-wave observations from 3,117 adults (aged ≥18) across 11 rounds of the China Health and Nutrition Survey (the Guizhou cohort, 1991-2023) were analyzed. Nutrient intake was derived from three-day 24-h recalls and household salt/oil weighing. Joinpoint regression characterized temporal trends, and Generalized Estimating Equations (GEE) identified population-averaged associations between DBM and socio-metabolic factors.
RESULTS: DBM prevalence surged from 12.8% (95% CI: 10.8-14.9%) in 1991 to 53.4% (95% CI: 49.8-56.9%) in 2023, with an overall AAPC of 4.97% (95% CI: 4.21-5.74%). Growth significantly decelerated after the 2015 inflection point, shifting from an APC of 5.37% (95% CI: 4.50-6.24%) to 3.79% (95% CI: 1.11-6.55%; p = 0.013). Notably, distinct growth rates across subgroups led to a reversal of prevalence patterns by 2023, at which point DBM prevalence in rural areas (53.8%) and among males (57.6%) exceeded that of their urban and female counterparts. GEE models further indicated that while urban residency, female gender, and higher education were historically associated with higher DBM risk, the absence of hypertension (OR: 0.79; 95% CI: 0.71-0.87) and higher riboflavin intake (OR: 0.74; 95% CI: 0.62-0.89) were significantly associated with a lower risk.
CONCLUSION: The DBM landscape in this regional cohort has undergone a fundamental shift, with the burden shifting toward rural residents and males. Targeted public health strategies should prioritize these emerging high-risk groups, emphasizing dietary improvements such as riboflavin optimization to mitigate the dual burden of adiposity and micronutrient inadequacy.
OBJECTIVE: To analyze the long-term trajectories and socio-metabolic determinants of DBM among adults in Southwest China using three decades of cohort data.
METHODS: A total of 10,703 person-wave observations from 3,117 adults (aged ≥18) across 11 rounds of the China Health and Nutrition Survey (the Guizhou cohort, 1991-2023) were analyzed. Nutrient intake was derived from three-day 24-h recalls and household salt/oil weighing. Joinpoint regression characterized temporal trends, and Generalized Estimating Equations (GEE) identified population-averaged associations between DBM and socio-metabolic factors.
RESULTS: DBM prevalence surged from 12.8% (95% CI: 10.8-14.9%) in 1991 to 53.4% (95% CI: 49.8-56.9%) in 2023, with an overall AAPC of 4.97% (95% CI: 4.21-5.74%). Growth significantly decelerated after the 2015 inflection point, shifting from an APC of 5.37% (95% CI: 4.50-6.24%) to 3.79% (95% CI: 1.11-6.55%; p = 0.013). Notably, distinct growth rates across subgroups led to a reversal of prevalence patterns by 2023, at which point DBM prevalence in rural areas (53.8%) and among males (57.6%) exceeded that of their urban and female counterparts. GEE models further indicated that while urban residency, female gender, and higher education were historically associated with higher DBM risk, the absence of hypertension (OR: 0.79; 95% CI: 0.71-0.87) and higher riboflavin intake (OR: 0.74; 95% CI: 0.62-0.89) were significantly associated with a lower risk.
CONCLUSION: The DBM landscape in this regional cohort has undergone a fundamental shift, with the burden shifting toward rural residents and males. Targeted public health strategies should prioritize these emerging high-risk groups, emphasizing dietary improvements such as riboflavin optimization to mitigate the dual burden of adiposity and micronutrient inadequacy.