Diet healthiness and double burden of malnutrition among women aged 15-49 years: a global monitoring tool approach using national dietary data in Sri Lanka.

Introduction: The increasing prevalence of non-communicable diseases (NCDs) is strongly linked to unhealthy diets. In Sri Lanka, malnutrition remains a public health issue, with rising rates of overweight and obesity coexisting with persistent underweight and micronutrient deficiencies. This study assesses the relationship between dietary patterns and the double burden of malnutrition (DBM) in Sri Lankan women, aged 15-49 years.

Methods: Data from 24-hour dietary recalls, collected during a nationally representative cross-sectional household survey in 2021, were analysed. DBM prevalence was defined using body mass index (BMI) classifications, including women categorised as underweight, overweight or obese. Diet quality was assessed using three globally recognised dietary tools: Global Dietary Recommendations (GDR) score, Global Diet Quality (GDQ) score and Minimum Dietary Diversity for Women (MDD-W). A total of 722 women aged 15-49 years were studied.

Results: The prevalence of DBM was 57.3% (95% CI: 53.7% to 60.9%), with the lowest prevalence observed among women aged 20-29 years. Most participants (98%) met at least 6 out of 11 GDR scores, with an average score of 8.0±1.2. Underweight women had significantly lower GDR scores compared with other BMI groups (p<0.05). Regarding MDD-W, only 0.6% of women consumed all 10 food groups, while 87.5% consumed five or more (mean score: 6.2±1.5). Women from the Muslim ethnicity (100%), the wealthiest quintile (94.5%) and urban areas (96.3%) had higher MDD-W scores (p<0.05). The average GDQ score was 24.8±3.4, with 71.1% of women classified as having low NCD risk. Medium NCD risk was observed among women aged 15-19 years, and those of Tamil ethnicity (p<0.05). However, no direct relationship was found between DBM and dietary scores (p≥0.05).

Conclusions: Global dietary scoring tools provide useful insights into diet quality but do not directly associate with DBM in this population. Further longitudinal studies are needed to explore causal links between diet quality and malnutrition outcomes.