Overlapping sociodemographic factors of single and multiple forms of malnutrition in Guatemalan households: a secondary data analysis of the Epidemiological Health and Nutrition Surveillance System (2013-2019)

Introduction
To inform initiatives aiming to address all forms of malnutrition in Guatemala, the degree of overlap of sociodemographic factors between the double burden of malnutrition (DBM) and single forms of malnutrition must be further understood. This study aimed to identify sociodemographic factors uniquely associated with households with DBM and those shared with households with single forms of malnutrition in Guatemala.
Methods
This secondary data analysis uses nationally representative household data from the Guatemalan Epidemiological Health and Nutrition Surveillance System 2013-2019. DBM was defined as the coexistence of a woman (15-49 years) with overweight/obesity and an infant or young child (6-60 months) with stunting within the same household. Households with single forms of malnutrition were those with only a woman with overweight/obesity or only a child with stunting. Descriptive statistics and multinomial logistic regression were applied.
Results
From the 3622 households included, one-fifth of households were identified with DBM. Sociodemographic factors uniquely associated with DBM were having a middle-level of household assets (adjusted odds ratio (aOR): 1.55, 95% CI 1.02 to 2 & centerdot;36) and lack of women's health insurance (aOR: 1.62, 95% CI 1.00 to 2 & centerdot;62). Shared factors for households with DBM and households with a woman with overweight/obesity were residence in the Central region, women aged >25 years and children >18 months. For households with DBM and households with a child with stunting, shared factors were women's primary education and Indigenous ethnicity. Women reporting no academic education, parity >3 and having children aged 18-36 months were shared factors across households with DBM and households with both single forms of malnutrition.
Conclusion
These findings emphasise the need for integrated, equity-focused nutrition strategies that address both undernutrition and overnutrition across key life stages. The identified overlapping sociodemographic factors provide actionable opportunities for policymakers to design targeted household-level interventions to reduce both child undernutrition and adult overweight/obesity in Guatemala.