Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey

<h2>Summary</h2><h3>Background</h3> The triple burden of malnutrition (TBM)— the coexistence of undernutrition, overweight, and micronutrient deficiencies such as anaemia—is a growing public health challenge in low- and middle-income countries. Amid Ecuador's rapid nutrition transition, we examined the prevalence of TBM and its components among preschool children and assessed inequalities by sociodemographic characteristics and poverty. <h3>Methods</h3> We analysed nationally representative data from the 2022–23 National Survey on Child Undernutrition among children aged 0–59 months. Nutritional outcomes were defined using WHO standards. Weighted bi-probit, logistic and ordinal logistic regression models were used to examine associations between malnutrition and child, maternal, household characteristics and poverty indicators, adjusting for demographic factors. <h3>Findings</h3> Stunting or wasting affected 17.1% (95% CI: 17.2–19.1) of children under 5 (n = 1,293,325), initially higher in boys, then shifting to girls by age three, with the highest prevalence among Indigenous children. Overweight prevalence was 4.9% (95% CI: 4.5–5.4), higher in boys, and highest among White children aged 18–53 months. Coexistence of undernutrition and overweight affected 0.6% (95% CI 0.5–0.7) or ∼7760 children, primarily boys under three. Among children aged 6–59 months (n = 1,172,450), severe anaemia affected 14.8% (95% CI 13.9–15.7) and 0.33% (95% CI 0.24–0.40; n=3869) experienced TBM, disproportionately among socially disadvantaged Indigenous and Afro-Ecuadorian boys under three. <h3>Interpretation</h3> Childhood malnutrition in Ecuador exhibits overlapping, socially patterned, and spatially clustered burdens, concentrated in early childhood. Addressing TBM requires integrated, early, equity-focused "triple-duty" targeted strategies that concurrently tackle undernutrition, overweight, and anaemia as interconnected manifestations of structural inequities. <h3>Funding</h3> This research was funded by the NIHR (grant NIHR134801) using UK international development funding from the UK Government to support global health research.

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Journal
The Lancet Regional Health - Americas
Published
2026-05-29
DOI
https://doi.org/10.1016/j.lana.2026.101501
Primary Topic
Child Nutrition and Water Access
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article
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article

Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey

Bethânia de Araújo Almeida, E. F. Anjos, Ruth Dundas, Rachel Lowe et al.
The Lancet Regional Health - Americas
Child Nutrition and Water Access
article

Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey

Bethânia de Araújo Almeida, E. F. Anjos, Ruth Dundas, Rachel Lowe, Batul Rojeab-Bravo, Viviane Silva de Jesus, Lucas Emanuel da Silva, Luz Marina Llangarí Arizo, Gustavo Corrêa Matta, Roberto F. S. Andrade, A.H. Leyland, Rita Ribeiro, María Alejandra Ruano, Adriana Mendoza Ruiz, Raul Ayala Davila, D. O. Ramos, Gervásio Ferreira dos Santos, Natália Romero, Peter Craig, Mercy Julia Borbor Córdova, Cleônidas Tavares de Souza, Sally Hargreaves, Natalia Cristina Romero Sandoval, Laís Santos de Magalhães Cardoso, Samila Oliveira Lima Sena, Adelyne Mendes Pereira, Grace Navarrete Chávez, Rachel Coelho, Mauricio Barreto, Ana Lucía Moncayo Benalcazar, Gisele Paixão, Batul Rojeab Bravo, Fillipi Nascimento, Daniel Zurita-Loma, Carlos Teles, Maria Yury Ichihara, Fernanda Revorêdo, Robespierre Pita, Carolina Buñay, Carl Kendall, Suelen Goecks Oliveira, Rumão Batista Nunes de Carvalho, Regina Tomie Ivata Bernal, J.F. Sousa Filho, Raiza Taurihno Lima, Juliana Araujo da Cruz Casais e Silva, Andrea Ferreira, Rosemeire Fiaccone Leovigildo, Angie Annabel Alcivar Marcillo, Sara Macdonald, Pablo Alvarez-Mena, Samuel Silva, Sara Caroline Oliveira Junker, Dandara Oliveira Ramos, Junior Pinto, Monsermin Gualan, Pablo Alvarez, Sofia Maito, Diego Oswaldo Andrade Ortiz, Paula M. Santucci, Daniela Torres, Irina Chis Ster, Julia Pescarini, Emmanuelle Freitas Goes, Roberto Carreiro, A.B.N. Einloft, Jonathan R. Olsen, Carlos Jose Cardoso dos Santos, Ligia Franco Sansigolo Kerr, Francisco Javier Padilla, T. Santos de Jesus, Cristina Almeida, Ronal Ruiz, Rodrigo Alejandro Rodriguez Alvarado, Timoteo Rossi, Daniela Lugo, Ericka Browne, Philip J. Cooper, J.M.N. Guimarães, Katie Harron, Luiz Gustavo Araújo da Cruz Casais e Silva, R.J. Lilford, Gabriela Pereira, Srinivasa Vittal Katikireddi, Ila Falcão, Claire Burke, Deborah Carvalho Malta, Erica Miranda Nascimento, Marianne Costa, Francine de Souza Dias, A.A. Fonseca, Nina Micaela Calderon Huachi, Alex Sebastian Garcia Gutierrez, M.R. Sebastiao, Raissa Nothaft, Raphael Sande, Katie Ellen Scandrett
article en

Abstract

<h2>Summary</h2><h3>Background</h3> The triple burden of malnutrition (TBM)— the coexistence of undernutrition, overweight, and micronutrient deficiencies such as anaemia—is a growing public health challenge in low- and middle-income countries. Amid Ecuador's rapid nutrition transition, we examined the prevalence of TBM and its components among preschool children and assessed inequalities by sociodemographic characteristics and poverty. <h3>Methods</h3> We analysed nationally representative data from the 2022–23 National Survey on Child Undernutrition among children aged 0–59 months. Nutritional outcomes were defined using WHO standards. Weighted bi-probit, logistic and ordinal logistic regression models were used to examine associations between malnutrition and child, maternal, household characteristics and poverty indicators, adjusting for demographic factors. <h3>Findings</h3> Stunting or wasting affected 17.1% (95% CI: 17.2–19.1) of children under 5 (n = 1,293,325), initially higher in boys, then shifting to girls by age three, with the highest prevalence among Indigenous children. Overweight prevalence was 4.9% (95% CI: 4.5–5.4), higher in boys, and highest among White children aged 18–53 months. Coexistence of undernutrition and overweight affected 0.6% (95% CI 0.5–0.7) or ∼7760 children, primarily boys under three. Among children aged 6–59 months (n = 1,172,450), severe anaemia affected 14.8% (95% CI 13.9–15.7) and 0.33% (95% CI 0.24–0.40; n=3869) experienced TBM, disproportionately among socially disadvantaged Indigenous and Afro-Ecuadorian boys under three. <h3>Interpretation</h3> Childhood malnutrition in Ecuador exhibits overlapping, socially patterned, and spatially clustered burdens, concentrated in early childhood. Addressing TBM requires integrated, early, equity-focused "triple-duty" targeted strategies that concurrently tackle undernutrition, overweight, and anaemia as interconnected manifestations of structural inequities. <h3>Funding</h3> This research was funded by the NIHR (grant NIHR134801) using UK international development funding from the UK Government to support global health research.

The Lancet Regional Health - AmericasVol. 60
St George's, University of London (GB), Universidad Internacional del Ecuador (EC)
National Institute for Health and Care Research
Zero hunger
Openalex Percentile: Top 8%
Child Nutrition and Water Access
DOIOpen Access PDFOpenAlex
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