Double Burden of Malnutrition and the Relationship Between Reported Intestinal Parasitosis and Anemia in School-Aged Children from a Peri-Urban Community of Limpio (Paraguay): A Cross-Sectional Study

Abstract

Background/Objectives: The nutrition transition in low- and middle-income countries has produced a double burden of malnutrition (coexistence of excess weight, undernutrition, and micronutrient deficiencies), with scarce evidence in schoolchildren from vulnerable peri-urban areas of Paraguay. The objective was to characterize, in a multidimensional way, the nutritional status of children and adolescents from Limpio and to explore its associations with anemia and clinical, dietary, and environmental variables, in particular, reported intestinal parasitosis. Methods: Cross-sectional observational study in 90 participants aged 6 to 16 years recruited by convenience at six community settings. Anthropometry, body composition, capillary hemoglobin, dietary patterns, and environment were assessed. Weight status was classified using the WHO 2007 references (z-scores), anemia was described using WHO thresholds, and central obesity was assessed using a waist-to-height ratio > 0.5. Non-parametric tests, Fisher's exact test, Spearman correlations, and multivariable logistic regression were used. Results: Overweight or obesity affected 39.3% (obesity, 16.7%) and central obesity 22.4%, with no cases of thinness, coexisting with anemia (27.0%), stunting (8.2%), and reported intestinal parasitosis (24.1%). Anemia was more frequent in children with reported intestinal parasitosis (45% versus 20%; adjusted OR 5.44; 95% CI 1.44-20.51). Height-for-age was inversely associated with the number of siblings (rho = -0.25). Conclusions: This population showed a double burden of malnutrition. The association between reported, non-laboratory-confirmed intestinal parasitosis and capillary-hemoglobin-defined anemia was exploratory and non-causal, given the cross-sectional design. Together with the high burden of anemia, these findings raise the hypothesis of a possible triple burden of malnutrition, which would require confirmation through stool parasitological testing and biomarkers of iron status, inflammation, and other micronutrients. These findings are compatible with integrated community strategies addressing dietary quality, sanitation, and access to safe water; decisions on deworming and micronutrient supplementation should be guided by local parasitological surveillance and biomarker-based assessment rather than by these data alone. Because the study used a convenience sample from a single peri-urban community during one fieldwork period, the findings should not be generalized beyond similar vulnerable settings without further confirmation.