The transition of nutritional status in infants, young children, and school-aged children in Korea and future-oriented nutritional strategies: a narrative review

OBJECTIVES: This study examined the secular trends in anthropometric changes and the nutritional transition among Korean infants and school-aged children, while evaluating the efficacy and constraints of existing state-led nutritional policies. Ultimately, it proposes a "systems-centered" nutrition strategy, aligned with the United Nations Children's Fund (UNICEF) Nutrition Strategy 2020-2030, to ensure health equity for future generations. METHODS: We reexamined comprehensive national health statistics, including school health examination data (1965-2024) and the Korea National Health and Nutrition Examination Survey (1998-2023). Additionally, Dietary Screening Test results from 126,768 young children (2021-2024) were reviewed. These quantitative findings were synthesized through a narrative review of South Korean pediatric nutrition policies and UNICEF's global strategic frameworks. RESULTS: While Korean children have historically experienced rapid secular growth, this has decelerated in the 2000s. Conversely, the prevalence of obesity has surged along with stagnant underweight rates. Dietary problems such as insufficient vegetable intake and frequent consumption of sweet snacks were also found, accelerating the "triple burden" of malnutrition. Policies such as school lunches, NutriPlus program, and Center for Children's Foodservice Management have demonstrated great success in reducing nutritional risks and improving dietary habits. However, existing fragmented programs face limitations in comprehensively addressing regional disparities or blind spots and in providing tailored nutritional management. CONCLUSION: A paradigm shift is imperative to fundamentally resolve these multidimensional nutritional crises. Moving beyond fragmented programs, we need to adopt a "systems- centered" approach integrating health, education, and welfare ecosystems. Key policy recommendations include establishing a continuous life-cycle health database, introducing artificial intelligence and FoodTech-driven precision nutrition coaching, and fostering a healthy food environment through public-private partnerships within a community integrated care network.