Malnutrition among women and children in India: limited evidence of clustering of underweight, anemia, overweight, and stunting within individuals and households at both state and district levels

In India, the prevalences of stunting and anemia have declined in the last decade, but continue to remain high in many regions, whereas those of overweight and obesity have increased in all age and socioeconomic groups. Determining whether these forms of malnutrition cluster is important for the development of appropriate interventions. Our objective was to describe the prevalence of a comprehensive list of dual burdens of malnutrition in individuals and households across the 36 states and 640 districts of India. We analyzed data from the National Family Health Survey-4, 2015–2016, including 655,156 women aged 15–49 y and 145,653 children aged 6–59 mo in India. We measured the coexistence of 19 combinations of women's anemia, underweight, and overweight and children's stunting, underweight, overweight, and anemia at the individual and household levels. We aggregated this information to the state (n = 36) and district (n = 640) levels. We examined whether the observed dual burden prevalence exceeded the expected prevalence, and whether any such excess was related to household wealth. Of the 19 dual burdens examined, 8 had significant excess prevalence at the state level and 5 had significant excess prevalence at the district level. All but 1 of these instances reflected an excess dual burden of undernutrition as opposed to clustering of overweight with a form of undernutrition. Household wealth was not positively associated with any clustering of burdens. While dual burdens of anemia, stunting, and underweight are prevalent, there is no evidence of clustering of overweight with other forms of malnutrition in India.