Double burden of malnutrition in 115 Latin American cities: An ecological analysis.

Background: Using newly harmonized aggregated data on health and socioeconomic environments in Latin American cities (from the Salud Urbana en América Latina (SALURBAL) study), we assessed the association of city-level contextual factors with the prevalence of the double burden of malnutrition (DBM) in urban settings. Methods: This ecological study used aggregated survey data from 115 Latin American cities within five countries (Colombia, El Salvador, Guatemala, Mexico and Peru) collected between 2008 and 2016. DBM were defined as the coexistence of stunting in children under 5y and overweight/obesity among adult women at the city-level. We ran ordinal logistic regression models to examine macrolevel contextual factors that might explain the city-level DBM. Independent variables were city-level socioeconomic development index, female educational attainment, and female labor participation. Results: Out of 115 Latin American cities, 19 cities from five countries were experiencing a moderate to high burden of stunting and simultaneously a very high burden of overweight/obesity in adult women. All cities had overweight/obesity prevalence above 40%. A poor social environment, greater female education and greater female labor participation at the city level were associated with greater levels of DBM. Conclusion: Some Latin American cities are still facing moderate and high DBM, while all cities are experiencing an alarming high burden of overweight/obesity. Social macro-level factors such as poor social environment, high female education and high female labor participation were associated with coexistence of stunting in children and overweight/obesity in adult women.