{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:13:49Z","timestamp":1784769229643,"version":"3.55.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Reports about the magnitude of co-existence of under- and over-nutrition is limited in Afghanistan. This study aimed to assess the prevalence of double burden of malnutrition (DBM) at individual and household level in Afghanistan.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This study was done based on the Afghanistan National Nutrition Survey 2013, which included a representative sample of 126,890 individuals (including more than 18,000 households) throughout Afghanistan. Intra-individual DBM was defined as the co-existence of \u201coverweight\/obese\u201d and \u201cstunting or micronutrient deficiencies\u201d (including anemia, vitamin A deficiency, vitamin D deficiency and iodine deficiency). At the household level, DBM was considered as having at least one household member as overweight\/obese and at least one another member of that household as undernourished (stunted, wasted, underweight or any micronutrient deficiency). SPSS and Stata software were used in the current analysis. Cross-tabulations was used to estimate the prevalence and its 95% confidence interval(CI). This study was ethically approved at Tehran University of Medical sciences.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The overall prevalence of intra-individual DBM was 12.5% (95% CI: 12.1; 12.9). Among the whole study participants at individual level of DBM, 11.7% (11.3; 12.1) of individuals had overweight along with stunting simultaneously and 20.5% (18.8; 22.4) had overweight and micronutrient deficiencies at the same time at individual level. The household level of DBM was found among 28.6% (95% CI: 27.9; 29.4) of households; such that 27.3% (26.6; 28.1) of households had at least one member with overweight and another member with stunting or wasting or underweight. Co-existence of overweight and micronutrient deficiencies at the same household was seen in 38.3% (35.5; 41.2).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study demonstrated a high prevalence of DBM at individual and household level in Afghanistan. Therefore, developing appropriate national macro-policies and strategies and designing appropriate programs such as public awareness programs, subsidization, food assistance programs, food fortification and dietary supplementation should be implemented by the ministry of public health, inter- related organs and international health agencies to reduce the burden of this problem in this country.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284952","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T17:39:31Z","timestamp":1685468371000},"page":"e0284952","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Double burden of malnutrition in Afghanistan: Secondary analysis of a national survey"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9196-5371","authenticated-orcid":true,"given":"Obaidullah","family":"Fahim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shafiqullah","family":"Shahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Nawid","family":"Shams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Farshid","family":"Muhammadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8666-0090","authenticated-orcid":true,"given":"Abolghassem","family":"Djazayery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Esmaillzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"issue":"16","key":"pone.0284952.ref001","article-title":"Socio-Ecological Model of Correlates of Double Burden of Malnutrition in Developing Countries: A Narrative Review","author":"T Mahmudiono","year":"2019","journal-title":"International journal of environmental research and public health"},{"issue":"2","key":"pone.0284952.ref002","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1177\/156482651403500210","article-title":"Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review.","volume":"35","author":"E Tzioumis","year":"2014","journal-title":"Food and nutrition bulletin."},{"issue":"10","key":"pone.0284952.ref003","doi-asserted-by":"crossref","first-page":"8376","DOI":"10.3390\/nu7105399","article-title":"Double Burden of Malnutrition in Rural West Java: Household-Level Analysis for Father-Child and Mother-Child Pairs and the Association with Dietary Intake.","volume":"7","author":"M Sekiyama","year":"2015","journal-title":"Nutrients."},{"issue":"6","key":"pone.0284952.ref004","doi-asserted-by":"crossref","first-page":"1644s","DOI":"10.3945\/ajcn.114.083857","article-title":"The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations","volume":"100","author":"M Ramirez-Zea","year":"2014","journal-title":"The American journal of clinical nutrition"},{"issue":"Suppl 3","key":"pone.0284952.ref005","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1740-8709.2011.00349.x","article-title":"Long-term consequences of stunting in early life.","volume":"73","author":"KG Dewey","year":"2011","journal-title":"Maternal & child nutrition.Epub 2011"},{"issue":"4","key":"pone.0284952.ref006","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1753-0407.2011.00139.x","article-title":"Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases","volume":"3","author":"A Misra","year":"2011","journal-title":"Journal of diabetes"},{"issue":"9609","key":"pone.0284952.ref007","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0140-6736(07)61692-4","article-title":"Maternal and child undernutrition: consequences for adult health and human capital","volume":"371","author":"CG Victora","year":"2008","journal-title":"Lancet (London, England)."},{"issue":"9","key":"pone.0284952.ref008","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1056\/NEJMoa035698","article-title":"Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood","volume":"350","author":"SK Bhargava","year":"2004","journal-title":"The New England journal of medicine"},{"issue":"3","key":"pone.0284952.ref009","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1017\/S0029665114000135","article-title":"Nutrition transition and food sustainability","volume":"73","author":"R. 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