Factors associated with a double burden of malnutrition among preschool-aged ethnic minority children in northern Thailand: a community-based cross-sectional study

The double burden of malnutrition (undernutrition and overnutrition) remains a major public health concern among preschool-aged ethnic minority children in northern Thailand. Cultural and geographic contexts shape caregiving and dietary behaviors while limiting access to health and nutritional services. This study examined the relationship between the double burden of malnutrition and its associated behavioral and socioenvironmental factors among preschool-aged ethnic minority children. A community-based cross-sectional study was conducted among 260 children aged 2–5 years in Chiang Rai Province, northern Thailand. Data on sociodemographic, caregiving, and dietary characteristics were obtained from parents or caregivers using structured questionnaires, and the nutritional status of the children was assessed via WHO-standardized anthropometric measurements. Multivariate logistic regression was used to identify factors associated with stunting, wasting, and overweight/obesity. The findings revealed a high prevalence of the double burden of malnutrition, including stunting (22.3%), wasting (20.8%), and overweight/obesity (11.9%). Stunting was associated with frequent consumption of staple starchy foods (OR 9.03; 95% CI 1.18–69.05). Wasting was associated with meals prepared by nonparental caregivers (OR 2.51; 95% CI 1.12–5.64). Overweight/obesity was related to mothers being the primary income earners (OR 3.14; 95% CI 1.23–8.04) and having low vegetable intake (OR 2.35; 95% CI 1.07–5.20). The coexistence of undernutrition and overnutrition among ethnic minority preschoolers is driven by both behavioral and socioenvironmental determinants. Targeted interventions that enhance caregiver nutrition literacy, promote healthy feeding behaviors, and integrate qualified nutrition professionals into community-based childcare systems are crucial for addressing these nutritional disparities.