To examine the prevalence of the double burden of malnutrition and its associated factors among adolescents in rural China.
A birth cohort of adolescents born to women in northwestern China who participated in a double-blind, randomized, controlled trial of micronutrient supplementation during pregnancy from August 2002 to January 2006 was enrolled. Follow-up was conducted from June to December 2016.
A total of 2115 participants were analyzed (median age 12 years; IQR±1), the majority of whom were male (59.7%). The nutritional status distribution was 17.72% underweight, 8.62% overweight, 0.96% obese, and 2.58% stunted. Girls were less likely to be overweight/obese (RRR=0.67, 95% CI= 0.48-0.92) but more likely to be underweight (RRR=1.65, 95% CI=1.25-2.17) or stunted (RRR=2.26, 95% CI=1.21-4.22). Children of underweight mothers (RRR=1.63, 95% CI= 1.19-2.25) with a history of small-for-gestational-age (SGA) (RRR=1.64, 95% CI= 1.14-2.36) or described as being a “picky eater” (RRR=1.53, 95% CI= 1.18-1.99) had a higher risk of being underweight. Children whose fathers’ education was primary or below (RRR=2.25, 95% CI= 1.11-4.59), with maternal height <150.1 cm (RRR=2.46, 95% CI= 1.12-5.39), or who had underweight mothers (RRR=2.80, 95% CI= 1.37-5.72) had a higher likelihood of stunting. Overweight/obesity was associated with high and middle household wealth (RRR=1.62, 95% CI= 1.14-2.32), overweight mothers (RRR=1.86, 95% CI= 1.25-2.78), and picky eating (RRR=0.62, 95% CI= 0.46-0.84).
Malnutrition (undernutrition and overweight/obesity) is common in rural Chinese adolescents and is associated with perinatal, genetic and economic conditions.

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