Determinants of Household-Level Double Burden of Malnutrition in South and Southeast Asia: A Systematic Review and Meta-analysis

Background: The double burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition within the same household, is an increasing public health concern in South and Southeast Asia, yet evidence on its household-level determinants remains fragmented. Objectives: This systematic review and meta-analysis aimed to synthesize evidence on factors associated with household-level DBM in South and Southeast Asia. Methods: PubMed, Scopus, and Web of Science were searched for observational studies published between January 2000 and September 2025. Two reviewers (AT & MAS) independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale adapted for cross-sectional studies. Random-effects meta-analyses were conducted for factors reported in ≥5 studies, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Results: Thirty studies were included, of which 26 were eligible for meta-analysis. Urban residence (OR = 1.38, 95% CI: 1.20, 1.59), higher household wealth (OR = 1.55, 95% CI: 1.31, 1.83), older maternal age (OR = 2.22, 95% CI: 1.97, 2.50), maternal short stature (OR = 1.90, 95% CI: 1.69, 2.13), older child age (OR = 1.79, 95% CI: 1.44, 2.23), and cesarean delivery (OR = 1.76, 95% CI: 1.20, 2.57) were associated with higher likelihood of DBM. Higher maternal education and breastfeeding were found to be protective factors. Conclusions: Effective interventions should adopt integrated, life-course approaches that simultaneously address undernutrition and overnutrition across critical stages, particularly during adolescence, pregnancy, and early childhood. Policies should prioritize maternal education, breastfeeding promotion, and adolescent nutrition to break intergenerational cycles of malnutrition.This study was registered at PROSPERO as CRD420251155844.