Dual Burden of Malnutrition among Older Adults Aged 45 Years and Above in High Burden States in India

Background: India faces a dual burden of malnutrition, with undernutrition and overnutrition coexisting in the population. Rapid population ageing makes it crucial to understand the prevalence and determinants of underweight and overweight/obesity among older adults for effective public health planning. This study aims to estimate the prevalence and determinants of underweight and overweight/obesity among older adults in high-burden states in India. Methodology: This study utilizes data from Wave 1 (2017-18) of the Longitudinal Ageing Study in India (LASI). Nutritional status was assessed using Body Mass Index and categorized into underweight, normal, and overweight/obese. Two separate dichotomous outcome variables were created for underweight and overweight/obesity. Descriptive statistics were used to estimate prevalence, and binary logistic regression analysis was conducted to identify associated factors. Results: At the national level, 21 percent of older adults were underweight, and 28 percent were overweight/obese, indicating a substantial dual burden. Underweight prevalence was particularly high in Chhattisgarh (32%), Odisha (30%), Jharkhand (28%), and Uttar Pradesh (29%). In contrast, overweight/obesity was more prevalent in Punjab (48%), Karnataka (47%), Kerala (46%), and Andhra Pradesh (42%). Logistic regression results revealed that females were less likely to be underweight (AOR=0.77; 95% CI: 0.72-0.81) but significantly more likely to be overweight/obese (AOR=1.88; 95% CI: 1.77-1.99) compared to males. The likelihood of underweight increased significantly with advancing age, whereas the odds of overweight/obesity declined in older age groups. Higher educational attainment showed a protective effect against underweight for ≥10 years of schooling but was positively associated with overweight/obesity. Urban residence reduced the likelihood of underweight while significantly increasing the odds of overweight/obesity. Individuals from the richest quintile had lower odds of underweight but higher odds of overweight/obesity. Conclusion: The findings reveal the need for targeted, region-specific nutrition strategies that simultaneously address both forms of malnutrition in India’s ageing population.