The coexistence of undernutrition or micronutrient deficiencies with excess adiposity—commonly described as the double burden of malnutrition (DBM)—is increasingly observed in low- and middle-income settings undergoing rapid nutritional and epidemiologic transitions. DBM can be measured at population, household, or individual level; this study focuses on the individual-level phenotype defined by concurrent overweight/obesity (OW/OB) and anaemia in non-pregnant women of reproductive age (NpWRA). The authors used Panama’s 2019 National Health Survey (ENSPA-2019) to estimate DBM prevalence, characterize its component conditions, and identify sociodemographic and inflammatory factors associated with the co-occurrence of OW/OB and anaemia.
The analysis used data derived from ENSPA-2019, a nationwide, population-based, cross-sectional survey conducted from 1 June to 31 December 2019. ENSPA-2019 collected a range of health, nutritional, anthropometric, environmental, and service-access indicators across Panama. Eligible household members were residents of at least six months and Spanish speakers. The provided excerpt describes that ENSPA-2019 employed a complex, randomized, three-stage sampling design; further sampling details and full methodological specifications are available in the ENSPA documentation referenced by the authors.
DBM was defined at the individual level as the simultaneous presence of overweight/obesity and anaemia. The analysis also categorized women into three mutually exclusive groups for comparison: OW/OB without anaemia, anaemia without OW/OB, and the double burden (both conditions), with a reference group of women with neither condition. Inflammatory status was assessed and incorporated into multivariable models; the specific inflammation marker(s) and cutoffs are reported in the full methods of the original paper.
Weighted prevalences were estimated to reflect the national population. Associations between sociodemographic factors, inflammatory markers, and nutritional outcomes were evaluated using multinomial logistic regression, reporting odds ratios (ORs) with 95% confidence intervals (CIs). Models compared each malnutrition category with the reference group (neither OW/OB nor anaemia) and adjusted for relevant covariates described in the full methods.
The weighted prevalence of the double burden of malnutrition among non-pregnant women aged 15–49 years was 18.6% (95% CI: 15.9%–21.7%). The ENSPA-2019 context cited by the authors also indicated a high background prevalence of OW/OB among women aged ≥18 years (75.6%) and an anaemia prevalence of 23.4% among women of reproductive age during the survey period.
In multivariable models comparing women with the DBM to those with neither condition, the following factors were significantly associated with greater odds of DBM:
Separate associations for the component conditions were also reported: low education and inflammation were associated with anaemia without OW/OB, while older age, residence in indigenous areas, low education, and inflammation were associated with OW/OB without anaemia.
The study found that nearly one in five NpWRA in Panama had the individual-level DBM, reflecting a substantive overlap between micronutrient deficiency (anaemia) and overnutrition (OW/OB). The prominence of low education and inflammation as shared correlates suggests potential targets for policy and programmatic responses that address both micronutrient status and excess adiposity. The authors situate these findings within Panama’s rapid nutrition transition, marked inequalities (including a high Gini index), and wide geographic and social disparities—especially in indigenous territories—where the burden of malnutrition may have distinct patterns.
Strengths of the analysis include the use of a recent, nationally representative health survey (ENSPA-2019) with anthropometric and biochemical measures and application of survey-weighted multinomial regression to examine multiple nutritional outcomes simultaneously. The provided excerpt does not include the full sample size, laboratory assay details for haemoglobin or inflammatory markers, nor all covariates included in adjusted models; those specifics are reported in the complete article and ENSPA methodological documentation. The cross-sectional design precludes causal inference about the directions of associations between sociodemographic factors, inflammation, and malnutrition outcomes.
The authors conclude that the individual-level double burden of malnutrition affected almost one in five reproductive-age women in Panama in 2019. Low education and inflammation emerged as notable shared factors for anaemia and OW/OB, and living in indigenous areas was associated with OW/OB without anaemia. The article and underlying ENSPA-2019 data are open access; the authors declared no specific funding and no competing interests. The ENSPA dataset referenced by the authors is available at the Gorgas Institute link cited in the publication.