Nutritional status among North Korean refugee and immigrant children in South Korea: evidence of a double burden of malnutrition

Background: Children from migrant and refugee families may experienceface a double burden of malnutrition, characterized by the coexistence ofwith undernutrition and obesity.occurring within the same population.However, evidence regardingon the nutritional status of North Korean refugee (NKR) and immigrant children in South Korea (SK) remains limited.This study aimed to compare thecompared nutritional status ofamong SK, NKR, and immigrant children.Methods: Data fromfor 2,856 SK children were obtained from the 2021-2023 Korea National Health and Nutrition Examination Survey.In additionSeparately, 336 NKR children and 597 immigrant children were recruited between 2021 and 2025.Nutritional status was assessedevaluated using the World Health Organization AnthroPlus software.Results Compared with SK children: After adjustment for sex and age, NKR and immigrant children had significantly higher odds than SK children of undernutrition (odds ratio [OR,]: 3.18; 95% confidence interval [CI,]: 1.90-5.31;and OR,: 2.39; 95% CI,: 1.50-3.80,respectively), stunting (OR,: 5.16; 95% CI,: 2.42-10.99;and OR,: 4.13; 95% CI,: 2.12-8.04,respectively), and obesity (OR,: 1.58; 95% CI,: 1.16-2.14;and OR,: 1.54; 95% CI,: 1.21-1.96,respectively) than SK children after adjustment for sex and age.).Among 1 st first-generation immigrant children, a longer duration of residence in SK was associated with higher odds of obesity (OR,: 2.08; 95% CI,: 1.02-4.24).In addition, 2 nd Secondgeneration NKR children also had higher odds of obesity than 1st first-generation NKR children (OR,: 2.97; 95% CI,: 1.61-5.48).Conclusions: NKR and immigrant children experienceshowed a double burden of malnutrition characterized by, with both persistent undernutrition and increasedelevated obesity.Targeted nutritionalnutrition interventions are needed to reduce nutritional disparities and improve nutritional outcomes among migrant and refugee children in SK.