{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:39:30Z","timestamp":1787017170045,"version":"build-2736575974"},"reference-count":50,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,10]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite global efforts to improve nutrition, young women aged 15\u201324 years in low-income and middle-income countries (LMICs) face persistent dual burdens of malnutrition, marked by high rates of underweight and emerging issues of overnutrition, such as overweight and obesity. Current research often emphasises individual-level factors, potentially overlooking broader regional influences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the burden of abnormal nutritional indices among women aged 15\u201324 years in 40 LMICs using the most recent Demographic and Health Survey conducted between 2015 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>40 LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>357\u2009587 young women aged 15\u201324 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>A multilevel mixed-effect multinomial analysis was conducted to identify determinants of underweight, overweight and obesity. The adjusted relative risk ratio with 95%\u2009CI was used to declare the statistical significance of the association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analysis found that among young women aged 15\u201324 years in LMICs, the pooled prevalence of underweight was 25.7% (95% CI 25.6% to 25.8%), with substantial country-level variation. The highest prevalence was in Timor-Leste (35.4%) and India (31.6%), while Jordan (2.9%) and Zambia (5.5%) had the lowest rates. Overweight and obesity prevalence was 17.7% (95% CI 15.7% to 19.7%), with the highest rates in Jordan (48.9%) and Zambia (40.9%) and the lowest in Timor-Leste (3.9%) and Ethiopia (4.5%). Furthermore, factors such as household wealth, age at marriage, age, education status, access to media, employment status, parity, contraceptive use, toilet facility, region and place of residence were statistically associated with being underweight, overweight and obese.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study highlights significant variations in nutritional status among young women aged 15\u201324 years in LMICs, with a notable prevalence of underweight and emerging challenges of overweight and obesity. Country-specific strategies addressing socioeconomic disparities and regional differences are crucial for effective public health interventions to improve nutritional outcomes among this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-091809","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T09:40:24Z","timestamp":1760002824000},"page":"e091809","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Burden of abnormal nutritional indices among women aged 15\u201324 years in 40 low-income and middle-income countries: a multilevel multinomial logistic regression analysis"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7986-6442","authenticated-orcid":false,"given":"Begetayinoral Kussia","family":"Lahole","sequence":"first","affiliation":[{"name":"Midwifery, Arba Minch University, Arba Minch, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7003-0235","authenticated-orcid":false,"given":"Beriso Furo","family":"Wengoro","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Samara University, Samara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8522-1504","authenticated-orcid":false,"given":"Kusse Urmale","family":"Mare","sequence":"additional","affiliation":[{"name":"Department of Nursing, Samara University, Samara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"2025120415062441000_15.10.e091809.1","unstructured":"Winichagoon P , Margetts BM . The double burden of malnutrition in low- and middle-income countries. In: Romieu I , Dossus L , Willett WC , eds. Energy Balance and Obesity [Internet]. Lyon (FR): International Agency for Research on Cancer (IARC Working Group Reports), 2017."},{"key":"2025120415062441000_15.10.e091809.2","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-14-887","article-title":"The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries","volume":"14","author":"Manyanga","year":"2014","journal-title":"BMC Public Health"},{"key":"2025120415062441000_15.10.e091809.3","unstructured":"Obesity and overweight. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight [Accessed 20 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.4","unstructured":"Obesity in adolescents. Available: https:\/\/www.acog.org\/clinical\/clinical-guidance\/committee-opinion\/articles\/2017\/09\/obesity-in-adolescents [Accessed 20 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0065174","article-title":"The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis","volume":"8","author":"Singh","year":"2013","journal-title":"PLoS ONE"},{"key":"2025120415062441000_15.10.e091809.6","unstructured":"Obesity and type 2 diabetes - statpearls - ncbi bookshelf. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK592412\/ [Accessed 27 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr1606602"},{"key":"2025120415062441000_15.10.e091809.8","unstructured":"The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis | plos one. Available: https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0065174 [Accessed 20 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.9","unstructured":"Knee osteoarthritis: current status and research progress in treatment (review). Available: https:\/\/www.spandidos-publications.com\/10.3892\/etm.2023.12180 [Accessed 20 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.10","unstructured":"Underweight health risks: what you should know. Healthline; 2017. Available: https:\/\/www.healthline.com\/health\/underweight-health-risks [Accessed 27 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.11","unstructured":"Nutrition and wound healing | eat well nutrition. Eat Well Nutrition. Available: https:\/\/www.eatwellnutrition.com.au\/wound-healing\/nutrition-and-wound-healing [Accessed 27 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.12","unstructured":"BMI of Texas . Texas b of. hormones and weight loss: the relation of weight loss and hormones. 2017. Available: https:\/\/www.bmioftexas.com\/blog\/the-important-relationship-between-hormones-and-weight-loss [Accessed 27 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.13","doi-asserted-by":"crossref","first-page":"228","DOI":"10.4103\/2230-8210.176364","article-title":"Prevalence of underweight, overweight, and obesity among 2, 162 Brazilian school adolescents","volume":"20","author":"Silva","year":"2016","journal-title":"Indian J Endocrinol Metab"},{"key":"2025120415062441000_15.10.e091809.14","unstructured":"Prevalence of underweight, overweight and obesity among palestinian school-age children and the associated risk factors: a cross sectional study | bmc pediatrics | full text. Available: https:\/\/bmcpediatr.biomedcentral.com\/articles\/10.1186\/s12887-019-1842-7 [Accessed 27 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.15","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph191811619","article-title":"The Current Prevalence of Underweight, Overweight, and Obesity Associated with Demographic Factors among Pakistan School-Aged Children and Adolescents-An Empirical Cross-Sectional Study","volume":"19","author":"Tanveer","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025120415062441000_15.10.e091809.16","doi-asserted-by":"crossref","DOI":"10.3390\/nu13030921","article-title":"Nutrition Transition with Accelerating Urbanization? Empirical Evidence from Rural China","volume":"13","author":"Ren","year":"2021","journal-title":"Nutrients"},{"key":"2025120415062441000_15.10.e091809.17","doi-asserted-by":"crossref","DOI":"10.1186\/s40608-019-0227-7","article-title":"Prevalence and factors associated with overweight and obesity among adults in Hawassa city, southern Ethiopia: a community based cross-sectional study","volume":"6","author":"Darebo","year":"2019","journal-title":"BMC Obes"},{"key":"2025120415062441000_15.10.e091809.18","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v9.30204","article-title":"Health at the borders: Bayesian multilevel analysis of women\u2019s malnutrition determinants in Ethiopia","volume":"9","author":"Delbiso","year":"2016","journal-title":"Glob Health Action"},{"key":"2025120415062441000_15.10.e091809.19","doi-asserted-by":"crossref","DOI":"10.5888\/pcd15.170401","article-title":"Prevalence and Predictors of Overweight and Obesity Among Kenyan Women","volume":"15","author":"Mkuu","year":"2018","journal-title":"Prev Chronic Dis"},{"key":"2025120415062441000_15.10.e091809.20","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jadohealth.2016.11.003","article-title":"Prevalence of Thinness in Adolescent Girls in Low- and Middle-Income Countries and Associations With Wealth, Food Security, and Inequality","volume":"60","author":"Candler","year":"2017","journal-title":"J Adolesc Health"},{"key":"2025120415062441000_15.10.e091809.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002948","article-title":"Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study","volume":"5","author":"Jiwani","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025120415062441000_15.10.e091809.22","doi-asserted-by":"crossref","unstructured":"Wood D , Crapnell T , Lau L , et al . Emerging adulthood as a critical stage in the life course. In: Halfon N , Forrest CB , Lerner RM , et al , eds. Handbook of Life Course Health Development [Internet]. Available from. Cham (CH): Springer, 2018. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK543712\/","DOI":"10.1007\/978-3-319-47143-3_7"},{"key":"2025120415062441000_15.10.e091809.23","unstructured":"The fight against malnutrition \u2013 commitments and financing - Global Nutrition Report, Available: https:\/\/globalnutritionreport.org\/reports\/global-nutrition-report-2018\/the-fight-against-malnutrition-commitments-and-financing\/ [Accessed 28 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.24","unstructured":"Fact sheets - malnutrition. 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Available: https:\/\/www.ennonline.net\/policies-to-prevent-all-forms-of-malnutrition-among-adolescents-case-studies-from-bangladesh-and-malawi [Accessed 28 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.26","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys184"},{"key":"2025120415062441000_15.10.e091809.27","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1186\/s12874-024-02400-5","article-title":"Evaluating the current methodological practices and issues in existing literature in pooling complex surveys: a systematic review","volume":"24","author":"Mayen","year":"2024","journal-title":"BMC Med Res Methodol"},{"key":"2025120415062441000_15.10.e091809.28","unstructured":"A healthy lifestyle - who recommendations. 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Available: https:\/\/space.mu.ac.zm\/xmlui\/handle\/123456789\/223 [Accessed 26 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.39","doi-asserted-by":"crossref","DOI":"10.1186\/s40795-019-0309-4","article-title":"Prevalence and associated factors of adolescent undernutrition in Ethiopia: a systematic review and meta-analysis","volume":"5","author":"Berhe","year":"2019","journal-title":"BMC Nutr"},{"key":"2025120415062441000_15.10.e091809.40","unstructured":"FastStats. 2023. Available: https:\/\/www.cdc.gov\/nchs\/fastats\/obesity-overweight.htm [Accessed 04 Jul 2024]."},{"key":"2025120415062441000_15.10.e091809.41","unstructured":"Prevalence and associated factors of overweight\/ obesity among children and adolescents in ethiopia: a systematic review and meta-analysis | bmc obesity. 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Available: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8350379\/ [Accessed 26 Jun 2024]."},{"key":"2025120415062441000_15.10.e091809.43","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.puhe.2023.09.013","article-title":"The relationship between overweight and education revisited: a test of the selection hypothesis based on adolescents\u2019 educational aspirations","volume":"225","author":"Diaz-Serrano","year":"2023","journal-title":"Public Health (Fairfax)"},{"key":"2025120415062441000_15.10.e091809.44","doi-asserted-by":"crossref","DOI":"10.2196\/38429","article-title":"The Impact of Social Media Interventions on Weight Reduction and Physical Activity Improvement Among Healthy Adults: Systematic Review","volume":"25","author":"Shiyab","year":"2023","journal-title":"J Med Internet Res"},{"key":"2025120415062441000_15.10.e091809.45","doi-asserted-by":"crossref","first-page":"441","DOI":"10.12944\/CRNFSJ.9.2.08","article-title":"Association of Food Insecurity and Weight Status of Women in Tuba Island, Malaysia","volume":"9","author":"Abdul Hamid","year":"2021","journal-title":"Curr Res Nutr Food Sci"},{"key":"2025120415062441000_15.10.e091809.46","doi-asserted-by":"crossref","first-page":"2533","DOI":"10.1080\/00036840701335629","article-title":"Obesity and employment as predictors of diabetes in Mexican Americans: findings from a longitudinal study","volume":"41","author":"Bastida","year":"2009","journal-title":"Appl Econ"},{"key":"2025120415062441000_15.10.e091809.47","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-039229","article-title":"The association between combined oral contraceptive use and overweight\/obesity: a secondary data analysis of the 2016 Ethiopia Demographic and Health Survey","volume":"10","author":"Endalifer","year":"2020","journal-title":"BMJ Open"},{"key":"2025120415062441000_15.10.e091809.48","doi-asserted-by":"publisher","DOI":"10.1002\/oby.20503"},{"key":"2025120415062441000_15.10.e091809.49","doi-asserted-by":"crossref","first-page":"155217","DOI":"10.1016\/j.metabol.2022.155217","article-title":"A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on","volume":"133","author":"Boutari","year":"2022","journal-title":"Metab Clin Exp"},{"key":"2025120415062441000_15.10.e091809.50","unstructured":"FAO-RLC . 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