Prevalence and determinants of stunting, overweight, and concurrent stunting and overweight among children aged 6 to 23 months in 40 low- and middle-income countries, 2015‒2024

Addressing the concurrent stunting and overweight (CSO) is essential for achieving Sustainable Development Goal 2.2 in low- and middle-income countries (LMICs). However, contemporary evidence on its prevalence and feeding-related determinants during the critical 6‒23-mo window remains insufficient in the post-2015 era. To determine the contemporary prevalence of stunting, overweight, and CSO, and to investigate the associations of the 2021 World Health Organization (WHO)/United Nations Children’s Fund infant and young child feeding indicators and socioeconomic factors with these outcomes across 40 LMICs. We analyzed pooled demographic and health survey data (2015‒2024) from 107,208 children aged 6‒23 mo. Child nutritional status was classified into 4 categories (healthy, stunted only, overweight only, or CSO), according to the WHO child growth standards. Multilevel multinomial logistic regression was used to identify determinants of different nutritional phenotypes. The pooled prevalence was 25.4% for stunting only, 1.7% for overweight only, and 1.5% for CSO. National-level analysis revealed 2 distinct transition patterns: 1 in which CSO comprised the majority of overweight cases (e.g., Papua New Guinea and Timor-Leste) and another where CSO concentrated within a residual stunted subpopulation (e.g., Albania and Armenia). Higher household wealth and maternal education were associated with reduced stunting risk but increased overweight risk. Lower CSO risk was associated with female [adjusted relative risk ratio (RRR): 0.84; 95% confidence interval (CI): 0.72, 0.98)], higher birth order (adjusted RRR: 0.68; 95% CI: 0.54, 0.85), higher wealth (adjusted RRR: 0.56; 95% CI: 0.41, 0.77), and the timely introduction of solid/semisolid/soft foods (adjusted RRR: 0.72; 95% CI: 0.60, 0.86). Although stunting dominates in LMICs, CSO reveals 2 distinct patterns. The paradox—where maternal education reduces stunting but may raise overweight—combined with the roles of wealth and timely complementary feeding in reducing CSO, necessitates integrated, context-specific “double-duty” interventions.