Double burden of malnutrition and its associated factors among adolescents aged (10–19) years in a rural district of Pakistan

The double burden of malnutrition (DBM) is a growing concern in Pakistan, particularly among children and adolescents. This study assessed the prevalence and determinants of DBM in a rural district of Tando Muhammad Khan (TMK) in Pakistan. A representative cross-sectional study was conducted in a rural district of TMK using multistage cluster sampling. A total of 1,304 households were surveyed, and one eligible adolescent per household was selected. Anthropometric measurements were taken to assess nutritional status based on WHO criteria. Data were analyzed using multinomial logistic regression with survey design adjustments, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Among 1,159 adolescents, the prevalence of underweight was 18.3% (95% CI: 15.0–20.0) and 4.2% were overweight/obese (95% CI: 3.0–5.0). The associated factors for underweight included working (AOR = 1.61, 95% CI: 1.01–2.50), no soap available/handwash supplies (AOR = 1.47, 95% CI: 0.99–2.20), inadequate sleep (AOR = 1.86, 95% CI: 1.34–2.59), and mild to moderate depression (AOR = 1.76, 95% CI: 1.04–3.00). The protective factors were being female (AOR = 0.57, 95% CI: 0.40–0.80) and always eating between meals (AOR = 0.64, 95% CI: 0.30–1.001). For overweight/obesity, snacking between meals was a risk factor (AOR = 2.00, 95% CI: 0.99–4.20), while larger family size was protective (AOR = 0.44, 95% CI: 0.24–0.80). Addressing DBM requires integrated strategies that improve hygiene, support mental health, and promote healthy eating. Gender-sensitive education and access to clean water, sanitation, and diverse diets are essential for better adolescent health outcomes.