Prevalence and determinants of stunting, overweight, and concurrent stunting and overweight among children aged 6 to 23 months in 40 low- and middle-income countries, 2015‒2024

BACKGROUND: Addressing the concurrent stunting and overweight (CSO) is essential for achieving Sustainable Development Goal 2.2 in low- and middle-income countries (LMICs). However, contemporary evidence on its prevalence and feeding-related determinants during the critical 6‒23-mo window remains insufficient in the post-2015 era. OBJECTIVES: To determine the contemporary prevalence of stunting, overweight, and CSO, and to investigate the associations of the 2021 World Health Organization (WHO)/United Nations Children's Fund infant and young child feeding indicators and socioeconomic factors with these outcomes across 40 LMICs. METHODS: We analyzed pooled demographic and health survey data (2015‒2024) from 107,208 children aged 6‒23 mo. Child nutritional status was classified into 4 categories (healthy, stunted only, overweight only, or CSO), according to the WHO child growth standards. Multilevel multinomial logistic regression was used to identify determinants of different nutritional phenotypes. RESULTS: The pooled prevalence was 25.4% for stunting only, 1.7% for overweight only, and 1.5% for CSO. National-level analysis revealed 2 distinct transition patterns: 1 in which CSO comprised the majority of overweight cases (e.g., Papua New Guinea and Timor-Leste) and another where CSO concentrated within a residual stunted subpopulation (e.g., Albania and Armenia). Higher household wealth and maternal education were associated with reduced stunting risk but increased overweight risk. Lower CSO risk was associated with female [adjusted relative risk ratio (RRR): 0.84; 95% confidence interval (CI): 0.72, 0.98)], higher birth order (adjusted RRR: 0.68; 95% CI: 0.54, 0.85), higher wealth (adjusted RRR: 0.56; 95% CI: 0.41, 0.77), and the timely introduction of solid/semisolid/soft foods (adjusted RRR: 0.72; 95% CI: 0.60, 0.86). CONCLUSIONS: Although stunting dominates in LMICs, CSO reveals 2 distinct patterns. The paradox-where maternal education reduces stunting but may raise overweight-combined with the roles of wealth and timely complementary feeding in reducing CSO, necessitates integrated, context-specific "double-duty" interventions.