Double burden of malnutrition among children under five years in Saudi Arabia: a cross-sectional study of prevalence and determinants.

Background: Malnutrition among children under 5 years remains a major global public health concern. It encompasses both undernutrition and overnutrition, which can coexist within the same population. Estimating the prevalence of malnutrition among preschool children, will contribute to the limited body of city-level nutritional epidemiology studies in Saudi Arabia. This study aimed to assess the prevalence and associated factors of malnutrition among children under 5 years attending primary health care centers (PHCs) in Taif, Saudi Arabia. Methods: A cross-sectional study was conducted among 482 children under five attending selected PHCs in Taif, Saudi Arabia. Participants were selected using multistage random sampling. Anthropometric indicators including height-for-age, weight-for-height, weight-for-age, and BMI-for-age were calculated using WHO Child Growth Standards. Sociodemographic, perinatal, feeding, medical history, dietary habits, and lifestyle factors were assessed through caregiver interviews using a structured questionnaire. Logistic regression analysis was performed to identify associated factors of malnutrition. Results: The prevalence of stunting, wasting, underweight, overweight and obesity was 29.5%, 13.5%, 11.8%, 7.7%, and 11.6%, respectively, indicating the coexistence of undernutrition and overnutrition among preschool children. Several factors were found to be significantly associated with different forms of malnutrition. Low birth weight, early feeding before 6 months, recurrent infections, and <1 serving/day protein consumption were significantly associated with of stunting. Wasting was associated with lower protein consumption and increased screen time, while recurrent antibiotic use was associated with underweight. Overweight and obesity were associated with higher consumption of milk and dairy products, frequent fast-food intake, and recurrent diarrhea episodes. Conclusion: Multiple modifiable factors, including low birth weight, early feeding practices, recurrent childhood infections, dietary habits, and lifestyle behaviors, were associated with different forms of malnutrition. These findings underscore the need for targeted interventions focusing on improving infant feeding practices, dietary habits, lifestyle behaviors, and strengthening the prevention and management of recurrent childhood illnesses, with an emphasis on rational antibiotic use. Optimization and reinforcement of existing maternal and child health services, including antenatal care, routine growth monitoring, and caregiver-focused nutrition counseling at the primary health care level, may improve early detection and management of both undernutrition and overnutrition in early childhood.