The impact of malnutrition and public health in Latin America and the Caribbean: A systematic review with meta-analysis

Abstract

Background: Malnutrition remains a significant public health challenge impacting populations globally, especially in low-and middle-income countries, comprising Latin America and the Caribbean (LAC). Aim: This systematic review and meta-analysis studied the impact of Malnutrition and public health especially the vulnerable populations in LAC. Method: Electronic databases such as Google Scholar, EBSCOhost, HINARI, Scielo, PubMed, and Scopus were searched on the impact of public health in LAC using appropriate search terms and combined keywords. The retrieved studies were uploaded and organized using Rayyan@ systematic review software. Result: Six hundred and twenty studies were identified and screened, and 29 were included in the final review as meeting the inclusion criteria. Results indicated that in Brazil, males exhibited consistently higher stunting odds (odds ratio = 1.19), while wasting risk was marginally lower in females (risk ratio = 0.79), though skewed by a 2017 data anomaly. Regional analysis revealed divergent trends: Guatemala and Bolivia showed elevated child malnutrition, whereas Brazil and Ecuador reported higher rates among adolescent females. Extreme heterogeneity underscored contextual variability, emphasizing the need for localized interventions and data quality improvements to address these public health challenges. Conclusion: The prevalence of stunting and wasting, with disparities were observed between genders and age groups. Also, socioeconomic factors emerged as critical determinants of malnutrition outcomes, with lower wealth and education levels correlating with higher rates of undernutrition. Maternal education and autonomy were identified as key influencers of child nutritional status, emphasizing the importance of empowering women in healthcare decision-making. Effective malnutrition interventions demand a multifaceted approach, encompassing tailored strategies for vulnerable groups, strengthened healthcare systems, and evidence-based practices.

Keywords

Malnutrition undernutrition obesity stunting wasting Latin America the Caribbean public health

Introduction

Malnutrition, defined as imbalances in energy and nutrient intake (Shrimpton, 2020), persists as a critical public health challenge globally. It encompasses three primary forms: undernutrition (stunting, wasting, underweight), micronutrient deficiencies or excesses, and overnutrition (overweight, obesity, and diet-related non-communicable diseases—NCDs) (WHO, 2024a). In 2022, global estimates revealed 390 million underweight adults, 2.5 billion overweight individuals (890 million with obesity), and 149 million stunted children, with low- and middle-income countries—including Latin America and the Caribbean (LAC)—bearing the highest burden (Dukhi, 2020; WHO, 2024a).

Within LAC, malnutrition manifests as a dual burden (double burden of malnutrition: DBM), where undernutrition and overnutrition coexist. For instance, 8.4% of Ecuadorian children under five exhibit concurrent micronutrient deficiencies and overweight, while 13.6% of Brazilian women experience obesity alongside micronutrient gaps (Galicia et al., 2016a; Weisstaub et al., 2014). Indigenous populations face stark disparities: Guatemalan Indigenous children exhibit stunting rates of 48%, nearly double the national average (Galicia et al., 2016a). Socioeconomic inequities exacerbate these trends; low-income households in Peru and Honduras allocate over 60% of their income to food yet report stunting rates threefold higher than wealthier groups (Galicia et al., 2016; Gassmann et al., 2022).

The consequences are profound as malnutrition drives 50% of under-five mortality globally, while in LAC, 43.2 million people faced hunger in 2022, with 52% of Caribbean populations unable to afford a healthy diet (United Nations, 2023). Malnutrition's sequelae—stunted growth, cognitive deficits, and immune dysfunction—compromise individual and community resilience (Smith et al., 2019). Despite its role in undermining the Millennium Development Goals, systemic responses remain fragmented.

This systematic review with meta-analysis addresses the research question: What is the impact of socioeconomic inequality on malnutrition disparities among Indigenous communities, women, and rural populations in LAC, and how do these disparities exacerbate public health crises? Also, how does coexisting undernutrition and obesity in LAC contribute to rising NCDs and strain healthcare systems? By synthesizing regional evidence, it aims to inform policies that mitigate the DBM through equitable interventions targeting socioeconomic disparities, food systems, and healthcare access.

Methodology

The current review and meta-analysis on the impact of malnutrition on public health in LAC adhere to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Page et al., 2021). The review was registered on Open Science Framework (osf.io/7se3a).

Search strategy

A systematic search was conducted across six electronic databases: PubMed, Scopus, EBSCOhost, HINARI, SciELO, and Google Scholar, covering publications from January 2014 to May 2024. Search terms were grouped into three conceptual clusters: (1) Malnutrition subtypes (e.g., “undernutrition,” “stunting,” “wasting,” “anemia,” “obesity,” “micronutrient deficiency”), (2) geographic scope (e.g., “Latin America,” “Caribbean,” “Central America,” “Mesoamerica,” “South America”), and (3) population groups (e.g., “children,” “adults,” “adolescents”). Boolean operators (AND/OR) combined terms to refine results (e.g., malnutrition AND public health AND Latin America).

Retrieved records were imported into Rayyan systematic review software for deduplication and blinded screening. Three independent reviewers applied predefined eligibility criteria: (a) Peer-reviewed studies in English (b) quantitative designs; (c) focus on malnutrition prevalence, determinants, or interventions in LAC populations. Discrepancies were resolved through consensus.

Study eligibility criteria

Retrieved studies were included or excluded from the review based on the eligibility criteria identified in Table 1. Papers published in languages other than English were excluded because the reviewers are native English speakers and not experts to translate articles published in other languages.

Table 1.

Criteria for inclusion and exclusion.

Inclusion	Exclusion
Peer-reviewed English language	Non-English [Authors are native English speakers]
Empirical studies	Systematic reviews
Published 2014 till May 2024	Published before 2014 & after May 2024
Focus on Latin America and the Caribbean (LAC) countries	Focuses on countries outside of LAC
Quantitative data	Qualitative data
Casual research	Laboratory research
Reported quantitative measurements of minimum 5-day lag	Reported quantitative measurements of less than 5-day lag

Data extraction and risk of bias assessment

Authors JC, EB, and IS independently screened and extracted the data such as name of authors, publication year, study design, study objectives, country of study, participants, and study results. The Cochrane Collaboration tool for assessing the risk of bias and RevMan V.5 were used to check the quality of the extracted papers and to assess the risk of bias. The three independent reviewers performed a qualitative evaluation to determine which studies should be included or excluded and to classify studies according to their risk of bias to minimize potential bias (Table 1). The studies were graded as low, moderate, or high risk based on the inclusion criteria focusing instead on internal validity and outcome-specific assessments to minimize bias. The assessment was performed independently with discussion with DCH to resolve any disagreements, inconsistencies, or ambiguity as required. To ensure consistency in risk bias assessment and data extraction, Fleiss’ kappa was utilized to measure inter-rater reliability for the three reviewers. Near perfect agreement was observed among raters with Fleiss’ kappa estimated at k = 0.85. The search process, screening, and final included articles were documented in a PRISMA 2020 flowchart in Figure 1. Six hundred and twenty studies were identified and screened, and 29 were included in the final review as meeting the inclusion criteria.

Data synthesis and analysis

The meta-analysis of the pooled data was conducted using the RevMan V.5 web software with events and the totals of responses plotted to calculate the risk ratios (RRs). RRs were calculated at a 95% confidence interval (CI), while the meta-analyses test level was set at P < 0.05. The I² statistics were utilized to calculate the heterogeneity of effect size and inconsistencies between the studies. I² of 0–100%; > 50% was considered significant statistical heterogeneity. Forest plots were used across the studies to assess the 95% CIs and the P values visually.

Regarding bias mitigation, a 5-day lag as an inclusion criterion ensures systematic reviews capture clinically meaningful outcomes while reducing methodological variability. This approach enhances the validity of conclusions about interventions’ efficacy and safety, particularly in conditions with time-dependent recovery patterns like jet lag. Predefining a 5-day lag minimizes selection bias by ensuring only studies with adequate temporal scope are included. This aligns with Cochrane guidelines, which emphasize strict eligibility criteria for synthesizing comparable evidence (McKenzie et al., 2023).

Results

From the initial 620 records identified through database searches, 566 were excluded based on eligibility criteria (duplicates, systematic reviews, or studies outside the review scope). Four articles failed to meet language requirements, and 50 were excluded due to non-LAC origin. Ultimately, 29 full-text articles were included in the narrative synthesis, as illustrated in Figure 1.

Table 2 delineates the characteristics of the included studies, which were predominantly conducted in Latin American countries, including Bolivia, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru. Study details were systematically categorized by publication year, title, key findings, and reference information.

Table 2.

Characteristics of included studies.

Year	Title	Results	Reference
2014	Treatment and prevention of malnutrition in Latin America: Focus on Chile and Bolivia	Analyzing the role of social, economic, and political factors in influencing abnormal growth and development in malnourished children.	Weisstaub et al., 2014
2014	The dual burden of malnutrition in Colombia	Data discusses the prevalence of undernutrition, anemia, and obesity across various age groups in Colombia, highlighting gender and socioeconomic disparities.	Sarmiento et al., 2014
2015	Zinc deficiency in Latin America and the Caribbean	Prevalence of zinc deficiency in Latin America and the Caribbean, estimated inadequate zinc intake, prevalence of stunting, risk of zinc deficiency per country.	Cediel et al., 2015
2015	Spotlight on global malnutrition: A continuing challenge in the 21st century	Comprehensive overview of malnutrition, its prevalence in different populations and settings, consequences, risk factors, and strategies for prevention and treatment through nutrition interventions and education programs.	Steiber et al., 2015
2017	Hospital and homecare malnutrition and nutritional therapy in Brazil. Strategies for alleviating it: a position paper	Ways to prevent hospital malnutrition in patients to decrease mortality and morbidity.	Waitzberg et al., 2017
2017	A research agenda to guide progress on childhood obesity prevention in Latin America	Efforts and ways to reduce and prevent child obesity in LAC.	Kline et al., 2017
2017	Nutrition status of children in Latin America	In Latin America, children face a dual malnutrition challenge with high stunting rates alongside widespread overweight/obesity, influenced by factors like ethnicity, urbanization, and socioeconomic status, highlighting the need for targeted interventions.	Corvalán et al., 2017.
2018	Obesity prevention: Strategies and challenges in Latin America	Implementation of strategies to prevent obesity by using taxation of foods, physical activity in open spaces, and especially, warning nutrition labeling.	Cominato et al., 2018
2018	The double burden of chronic malnutrition and overweight and obesity in Ecuadorian mothers and children, 1986–2012	Burden of malnutrition among children and mothers comparing the decline of wasting and increase of overweight and obesity.	Freire et al., 2018
2018	Socioeconomic context of the community and chronic child malnutrition in Colombia	Examined factors like age, gender, breastfeeding duration, birth intervals, maternal education, autonomy, household wealth, community wealth, access to health services, and place of residence to understand their influence on chronic malnutrition in Colombian children under five.	Osorio et al., 2018
2019	Regional overview on the DBM and examples of program and policy responses: Latin America and the Caribbean	Recommended interventions to tackle DBM include WHO's double duty actions, maternal and antenatal nutrition, breastfeeding support, healthy diet programs in schools, food security policies, and initiatives for a sustainable diet.	Grajeda et al., 2019
2019	Association of all forms of malnutrition and socioeconomic status, educational level, and ethnicity in Colombian children and non-pregnant women	Results show sociodemographic characteristics of the population by age groups in Colombia, prevalence of malnutrition (overnutrition and undernutrition) in children (<5 years), prevalence of malnutrition in non-pregnant adolescent women (11–19 years), and the prevalence of malnutrition in non-pregnant adult women (20–49 years).	Cediel et al., 2020
2019	Malnutrition in all its forms and socio-economic disparities in children under 5 years of age and women of reproductive age in Peru	Results show characteristics of the sample population, malnutrition by age and socio-economic indicator.	Curi-Quinto et al., 2020
2019	Malnutrition in all its forms and social inequalities in Brazil	This study analyzed a large sample of over 131,000 individuals of different age groups. It found that Black and mixed-race individuals were more likely to be in lower-income households. Among children under 5, rates of overweight and obesity were higher in low-income families and those with less educated household heads. Adolescents showed high rates of overweight and obesity, especially in boys and those from higher-income households. In adults aged 20–49, overweight and obesity were prevalent, particularly in men from higher-income and more educated backgrounds. However, underweight was more common in low-income men, and prevalence of obesity and underweight varied by race across all age groups.	Canella et al., 2020
2019	Malnutrition inequalities in Ecuador: differences by wealth, education level and ethnicity	Nutritional disparities based on wealth, education, and ethnicity were evident in Ecuador, with higher rates of stunting and anemia among socioeconomically disadvantaged and indigenous groups across different age categories.	Ramírez-Luzuriaga et al., 2020
2019	Malnutrition in all its forms by wealth, education and ethnicity in Latin America: Who are more affected?	Prevalence rate between children under 5 and females of years 11–19 in some Latin American Countries between the years 2005 and 2015.	Batis et al., 2020
2020	Double-duty actions: Seizing programme and policy opportunities to address malnutrition in all its forms	Actions to address undernutrition, and overweight and obesity in the general population.	Hawkes et al., 2020
2020	Telemedicine in Peru as a result of the COVID-19 pandemic: Perspective from a Country with limited internet access	Relationship between traditional and industrialized food on the health of mothers and children.	Alvarez-Risco et al., 2021
2020	Maternal height and DBM households in Mexico: Stunted children with overweight or obese mothers	Nutritional status, socio-economic, demographic characteristics and nutritional status of the sample.	Félix-Beltrán et al., 2021
2020	Dynamics of the DBM and the changing nutrition reality	Describes the DBM in low-income and middle-income countries, highlighting its prevalence, changes over time, and the impact of economic development on malnutrition.	Popkin et al., 2020
2020	Malnutrition in all its forms by wealth, education and ethnicity in Latin America: Who are more affected?	Assessing malnutrition risk and its association with nutritional interventions and mortality rates among adult patients in Latin American hospitals.	Batis et al., 2020
2021	Time trends and social inequalities in child malnutrition nationwide estimates from Brazil's food and nutrition surveillance system, 2009–2017	Prevalence of children in relation to malnutrition (wasting, undernutrition, overweight).	Ribeiro-Silva et al., 2021
2021	Prevalence of malnutrition risk and its association with mortality: Nutrition Day Latin America survey results	Prevalence of malnutrition among patients within the hospital setting dependent on meal intake while being admitted.	Correia et al., 2021
2021	DBM and inequalities in the nutritional status of adults: A population-based study in Brazil, 2019	Prevalence among men and women based on education and socioeconomic status.	Meller et al., 2021
2021	Socioeconomic status impact on diet quality and body mass index in eight Latin American countries: ELANS study results	Comparison between socioeconomic status and dietary lifestyles impact on body mass index.	Gómez et al., 2021
2021	Obesity in Latin America, a scoping review of public health prevention strategies and an overview of their impact on obesity prevention.	National and regional strategies for obesity prevention in Latin America, regulations to support healthy diets, guidelines for promoting healthy behaviors, population-wide or community-based programs or initiatives, governmental structures for obesity prevention in Latin America, and evidence on the evaluation of the impact of strategies implemented in these countries for obesity prevention.	Palacios et al., 2021
2021	Global, regional and national epidemiology and prevalence of child stunting, wasting and underweight in low-and middle-income countries, 2006–2018	Explores prevalence of undernutrition indicators like stunting, wasting, and underweight across different regions and countries in LMICs, while also investigating the correlation between HDI and undernutrition.	Ssentongo et al., 2021
2021	Prevalence of malnutrition risk and its association with mortality: Q4 nutrition day Latin America survey results	Examining the impact of traditional and industrialized foods on the health outcomes of mothers and children.	Correia et al., 2021
2023	The DBM	Prevalence of women who are underweight, overweight, and obese.	Wells et al., 2020
2023	Childhood malnutrition: a potential risk of metabolic diseases in adulthood	Investigation of the impact of early nutrition and its contributing factors for malnutrition, obesity and other chronic illnesses.	Zhou et al., 2020
2024	Global disability-adjusted life years and deaths attributable to child and maternal malnutrition from 1990 to 2019	Evidence of a decline of child and maternal malnutrition. Along with necessary intervention needed to aid in the decline of malnutrition.	Liu et al., 2024

COVID-19: coronavirus disease 2019; DBM: double burden of malnutrition; LMICs: low- and middle-income countries; HDI: Human Development Index.

Figure 2 compares the odds of stunting (chronic malnutrition) between males and females in Brazil from 2009–2017 using data from Ribeiro-Silva (2021). Overall odds ratio (OR) 1.19 (95% CI: 1.18–1.19), indicating males have 19% higher odds of stunting than females. The yearly trends indicated consistent male disadvantage, with ORs ranging from 1.07 (2012) to 1.24 (2014, 2015), while the CIs are narrow and do not cross 1, reinforcing statistical significance. The 2017 data for Silva was “not estimable,” likely due to mismatched denominators (female suggesting a potential data entry error. Extreme heterogeneity (I² = 100%, p < 0.00001), was seen, likely due to large sample sizes amplifying minor variations. Despite this, the consistent direction of effect supports male vulnerability to stunting.

Stunting is defined as impaired linear growth in children due to chronic malnutrition, reflecting cumulative deprivation of nutrients and recurrent infections (Prendergast and Humphrey, 2014). As a key indicator of developmental delay, stunting elevates risks of cognitive deficits, morbidity, and mortality, with critical vulnerability observed in children under two years (Karlsson et al., 2023). Globally, the World Health Organization (2021a) estimates that nearly 150 million children under five are stunted, 98% of whom reside in low- and middle-income regions, including LAC. This systematic review identified higher odds of stunting among male children compared to females, aligning with findings from Ethiopia where boys under five exhibited greater susceptibilities to malnutrition (Sahiledengle et al., 2023). Gender disparities may arise from differential breastfeeding practices, suboptimal complementary feeding (e.g., inadequate legume and nut intake), maternal nutritional status, and biological mechanisms such as glucocorticoid-induced epigenetic modifications, altered leptin signaling, and inflammation-driven neurodevelopmental disruptions (e.g., impaired synaptogenesis and neurogenesis) (Alam et al., 2020). Persistent stunting correlates with irreversible neurocognitive impairments, underscoring the urgency of targeted interventions. Enhancing nutritional support for pregnant women and toddlers, including fortified diets and prenatal care, represents a critical strategy to mitigate this public health burden.

Figure 3 evaluates the RR of wasting (acute malnutrition) in males vs. females in Brazil (2009–2017). The overall RR: 0.79 (95% CI: 0.79–0.79), suggesting females have a 21% lower risk of wasting compared to males. In addition, regarding yearly trends, most years show minimal male disadvantage (RR: 1.02–1.05), except 2017, which reports an extreme RR of 0.10. This outlier likely stems from a denominator discrepancy skewing the overall result. Extreme heterogeneity (I² = 100%, p < 0.00001), was observed possibly driven by the 2017 anomaly.

Wasting is defined as a low weight-for-height ratio in children, indicative of acute malnutrition (World Health Organization [WHO], 2024b). Longitudinal data (2009–2017) from the study population demonstrated higher wasting prevalence among males compared to females. The forest plot illustrates the RR for wasting incidence between male and female cohorts, with males exhibiting elevated risk. Wasting and severe wasting are characterized by rapid depletion of fat mass and muscle tissue, often precipitated by insufficient nutrient intake or acute dietary deficiencies. These conditions underscore the critical need for timely nutritional interventions to mitigate short-term health impacts. The World Health Organization (2021b) reported that an estimated 45.5 million children below the age of 5 were affected by wasting in 2020, of which 13.6 million were severely wasted. Regardless of the level of severity, wasting in children is life-threatening as it can lead to susceptible long-term developmental delays, weakened immunity, and an increased risk of death. In addition, undernutrition contributes to wasting and infections separately and in combination; malnourished children have weakened immunity, making them more susceptible and vulnerable to infectious diseases, which can lead to death, while infections increase energy requirements, restrict nutrition absorption, and reduce appetite (Karlsson et al., 2022; Thurstans et al., 2020). Preventive measures of wasting among children must target adequate food, sanitation, water, and better health services during childhood and pregnancy. Furthermore, food fortification interventions, supplementation, and dietary diversification are essential intervention strategies to prevent undernutrition (UNICEF, 2021). Complementary feeding and effective nutrition interventions at a younger age have been reported to improve child health and prevent undernutrition (Keats et al., 2021).

Figure 4 compares malnutrition prevalence between children under 5 and adolescent females (11–19 years) across eight Latin American countries (2005–2015). Overall OR: 1.08 (95% CI: 1.04–1.12), indicating marginally higher odds of malnutrition in children <5. Country-specific variation a high ORs: Guatemala (OR = 3.28) and Bolivia (OR = 1.67) show significantly higher malnutrition in children. Low ORs observed in Brazil (OR = 0.34) and Ecuador (OR = 0.64) indicate higher malnutrition in adolescent females. Argentina showed a borderline significance: (OR = 1.18, CI: 0.95–1.46) and Peru (OR = 0.82, CI: 0.75–0.89) show less definitive trends. Extreme heterogeneity (I² = 99%, p < 0.00001), seen reflected diverse socioeconomic, cultural, and healthcare contexts across countries. The contrast between countries like Brazil (adolescent vulnerability) and Guatemala (child vulnerability) highlights the need for targeted interventions based on regional disparities.

A recent epidemiological study by Mulu Birru et al. (2021) among Ethiopian adolescents identified stunting in 6.3% of the cohort, with high snack consumption as a primary risk factor, while 8.2% exhibited overweight/obesity, linked to low dietary diversity. Malnutrition in this demographic correlates with reduced school attendance, impaired academic performance, and diminished cognitive function. Environmental determinants, including residential setting (urban vs. rural), household sanitation, and living conditions, significantly influence nutritional outcomes (Husaini et al., 2024). Behavioral and socioeconomic factors—such as physical inactivity, micronutrient deficiencies, parental employment status, and family income—further exacerbate malnutrition risks (Amoadu et al., 2024). Addressing these disparities in LAC necessitates multisectoral policies integrating gender equity, health education, and poverty reduction, aligned with Sustainable Development Goals (SDGs) to holistically combat adolescent malnutrition.

Study characteristics

Table 2 provides a detailed breakdown of the study characteristics included in this systematic review. The majority of the studies were conducted in Latin America specifically Bolivia, Brazil, Colombia, Ecuador, Mexico, Guatemala, and Peru. The detailed breakdown of the included studies was organized into year, title, results obtained, and references.

Discussion

This systematic review with meta-analyses examines the multifactorial impact of malnutrition on children and adolescents in LAC, evaluating the consistency of aggregated data to construct an evidence-based narrative on its public health consequences. While the adverse effects of malnutrition on individual and community health are well-documented, this review delineates the heterogeneity in malnutrition severity, particularly among vulnerable populations. Synthesized data reveal that malnutrition—regardless of etiology—imposes significant public health burdens, heightening susceptibility to morbidity, cognitive deficits, and mortality in affected children. These findings align with global epidemiological trends, underscoring universal risks associated with inadequate nutrition. Notably, LAC exhibits a distinct epidemiological duality: acute malnutrition (wasting) coexists with rising obesity rates, the latter now predominant in the region. The pooled analysis underscores the urgency of context-specific interventions, such as nutrient supplementation programs and obesity prevention policies, to mitigate malnutrition's cascading effects on socioeconomic development and healthcare systems.

Prevalence of malnutrition in LAC

The prevalence of malnutrition in LAC is shaped by the interplay of genetic predispositions and environmental determinants. Women of reproductive age in LAC exhibit elevated rates of underweight, overweight, and obesity, with disproportionate impacts on women and children compared to men (Alem et al., 2023; Canella et al., 2020). Recent epidemiological trends in Brazil reveal a concurrent rise in overweight prevalence (15.2% in 2021) and decline in undernutrition rates (6.8%) among children under five, signaling a nutritional transition (Ribeiro-Silva et al., 2021). In Colombia, lower maternal education and socioeconomic status correlate with reduced overweight/obesity incidence but elevated wasting (12.4%), stunting (18.6%), and anemia (27.3%) in children under five, while women from similar backgrounds demonstrate higher rates of composite malnutrition (Cediel et al., 2020).

Educational attainment emerges as a critical mediator: Brazilian men without formal education exhibit a 6-percentage-point higher underweight prevalence than educated counterparts, whereas higher education correlates with excess weight disparities (18-percentage-point gap in women; 10-percentage-point in elderly populations) (Meller et al., 2021). Multivariate analyses identify dietary patterns, racial disparities, geographic residence, and household income as key socioeconomic determinants of malnutrition gradients in LAC. Mitigating these disparities necessitates multisectoral policies targeting vulnerable demographics through nutrition-sensitive social programs, gender-responsive healthcare access, and poverty alleviation frameworks aligned with the SDGs.

The Inter-American Development Bank (IDB) reported that rising food prices, inequality, and loss of income are the three key factors that have restricted access to healthy food in LAC populations, thereby signifying the need for interventions to achieve greater food security in the region (IDB, 2024). The Food Agriculture Organization (FAO) indicates that food security is achieved when a population has access to nutritious, safe, and sufficient food to meet their dietary needs for healthy living, with food availability, accessibility, utilization, and stability as the key pillars of food security (Odey et al., 2022). The Russia-Ukraine war and the coronavirus disease 2019 (COVID-19) pandemic significantly increased poverty in LAC and heightened inflationary strain due to the rise in food prices, fertilizers, fossil fuels, and the cost of imports (IDB, 2024). Additionally, climate change significantly threatens food insecurity in LAC due to increased incidents of hurricanes, floodings, draughts, and rising sea levels. Climate change and extreme weather negatively impact critical infrastructure, food prices, agricultural production, and the livelihood of populations. Interventions to increase food availability, access, utilization, and stability included improved resilience of logistic systems, facilitation of trade, and adoption of climate-smart agricultural technologies. Furthermore, investments in nutrition-sensitive agricultural interventions while strengthening the agricultural health systems in LAC are ways to improve food security.

The socioeconomic factors impacting malnutrition in LAC

The socioeconomic landscape is a critical determinant of malnutrition outcomes in LAC, where economic inequities and educational disparities synergistically drive divergent nutritional patterns. Poverty and limited education correlate strongly with undernutrition, disproportionately affecting marginalized groups such as Indigenous communities (Otten and Seferidi, 2022). Concurrently, the region's nutritional transition—marked by dietary shifts toward processed foods and sedentary lifestyles—has precipitated a dual burden of malnutrition: rising obesity rates among affluent populations coexist with persistent undernutrition, reflecting systemic inequities (Popkin and Ng, 2022).

Maternal education and autonomy are pivotal mediators of child nutrition. Educated women demonstrate an enhanced capacity for informed dietary choices, healthcare utilization, and intrahousehold resource allocation, directly improving child health outcomes (Prasetyo et al., 2023). Furthermore, women's autonomy positively correlates with healthcare access and adherence to nutritional guidelines, reducing intergenerational malnutrition cycles (Paul and Saha, 2022).

Community-level determinants, including access to clean water, sanitation, education, and healthcare infrastructure, further modulate nutritional disparities. High-income communities typically exhibit robust infrastructure, yielding lower stunting (14.3%) and wasting (5.1%) rates compared to low-resource settings (Hutton and Chase, 2016).

Effective policy responses require multisectoral strategies. Evidence-based interventions—such as mandatory front-of-package food labeling, breastfeeding promotion campaigns, regulation of ultra-processed food marketing, and equitable healthcare investments—are critical to mitigating the dual burden (Laar et al., 2020). Addressing socioeconomic determinants necessitates integrated approaches prioritizing women's empowerment, poverty alleviation, and environmental health. Targeted policies at individual, household, and community levels can reduce health inequities and advance SDG targets for malnutrition eradication in LAC (Rahman et al., 2021).

Malnutrition interventions

Addressing malnutrition in LAC necessitates a multifactorial approach that integrates socioeconomic, cultural, and systemic determinants. The region's socioeconomic landscape directly influences food security, educational access, and healthcare equity, underscoring the need for context-specific interventions (Tables 3 and 4). A dual-purpose strategy—targeting both undernutrition and the escalating burden of obesity and diet-related NCDs—is critical. Such interventions must be adaptable across diverse demographics, incorporating cultural sensitivities and addressing socioeconomic inequities to ensure inclusivity (Galicia et al., 2016). Vulnerable populations, including infants, children, pregnant women, older adults, and Indigenous communities, require tailored programs that align with cultural practices and improve access to nutrient-dense foods and healthcare services (Feijen-de Jong et al., 2022).

Table 3.

Country-specific policy interventions on malnutrition prevention in Latin America.

Country	Policy/program	Focus areas	Key components	Outcomes	References
Bolivia	Desnutrición Cero (Zero Malnutrition)	Severe malnutrition reduction, maternal and child health	Implementation of WHO's 10-step inpatient care protocol; community management of malnutrition.	Reduced mortality from severe malnutrition from 25% to <5% over 5 years.	Weisstaub et al., 2014.
Brazil	Bolsa Família	Child nutrition, poverty alleviation	Conditional cash transfers linked to healthcare access, dietary compliance, and education.	Reduced child stunting by 8% and improved dietary diversity in low-income households.	Tirado et al., 2016; JICA (n.d.).
Colombia	Integrated Nutrition and Social Policies	Stunting reduction, socioeconomic equity	Demographic and Health Surveys (DHS) to guide targeted interventions; focus on indigenous and rural populations.	Lower stunting prevalence (compared to Andean peers) and reduced disparities.	Larrea and Freire, 2002.
Ecuador	National Food and Nutrition Security Policy	Micronutrient deficiencies, food security	Integration of nutrition into agricultural and social protection policies.	Addressed micronutrient gaps but limited progress on dual malnutrition burden.	Tirado et al., 2016; Larrea and Freire, 2002.
Guatemala	Nutrition Security Strategy	Chronic child malnutrition, maternal health	Focus on breastfeeding promotion, dietary diversification, and sanitation.	High chronic malnutrition rates persist (48% in indigenous children).	Martorell, 2012; Larrea and Freire, 2002.
Mexico	Front-of-Package Warning Labels	Obesity prevention, reduction of ultra-processed food consumption	Mandatory labeling for high-sugar, high-sodium, and high-fat foods; soda tax.	Reduced purchases of ultra-processed foods by 22%.	Tirado et al., 2016; JICA (n.d.).
Peru	JICA-Cajamarca Nutrition Project	Infant malnutrition, maternal nutrition	Training for breastfeeding/weaning practices; improving prenatal care and sanitation.	Aimed to reduce chronic malnutrition in children under three in Cajamarca.	JICA (n.d.).

Table 4.

Strategies for addressing malnutrition: a comprehensive framework.

Intervention Strategy	Key components
Comprehensive	Addressing socioeconomic factors influencing food, education, and healthcare access
Comprehensive	Tailoring interventions to tackle underlying issues effectively
Double-duty strategy	Targeting both undernutrition and obesity/diet-related diseases
	Adaptability across diverse populations and age groups
	Consideration of cultural nuances and socioeconomic disparities
Targeted interventions	Tailoring programs for vulnerable groups like infants, pregnant women, and indigenous populations
	Specific focus on meeting their nutritional needs
	Incorporating cultural practices and ensuring accessibility to healthcare services
Role of healthcare	Implementing adequate monitoring systems
Systems	Ensuring access to healthcare services
	Availability of trained professionals
	Collaboration among healthcare providers, governments, non-governmental organizations (NGOs), and community organizations
Evidence-based	Adoption of evidence-based practices
Practices	Utilization of rigorous evaluation methods
	Monitoring the impact of interventions over time
	Making data-driven decisions
	Refining strategies based on continuous evaluation

Healthcare systems play a pivotal role through robust monitoring frameworks, equitable service delivery, and workforce capacity-building. Multi-sectoral partnerships among governments, non-governmental organizations (NGOs), healthcare providers, and community stakeholders are essential to developing sustainable solutions (King et al., 2021). Evidence-based practices, supported by longitudinal impact assessments, enable data-driven refinements to intervention efficacy. Rigorous evaluation methodologies, including cost-effectiveness analyses and equity audits, provide critical insights for iterative policy improvements (Li et al., 2019).

Ultimately, mitigating malnutrition in LAC demands a holistic framework that harmonizes socioeconomic reforms, culturally adapted nutritional programs, healthcare system strengthening, and cross-sector collaboration. Prioritizing these pillars ensures alignment with global health equity goals and fosters resilience against the dual burden of malnutrition.

Malnutrition prevention and management

Cominato et al. (2018) proposed evidence-based strategies to address the obesity epidemic in LAC, including school-based interventions, physical activity promotion, front-of-package nutrition labeling, and sugar-sweetened beverage taxation (Tables 3 and 5). While these strategies are predominantly designed for municipal implementation, hospital settings also play a critical role in malnutrition management. In clinical environments, personalized nutritional assessments and tailored care plans are essential to address both undernutrition and overnutrition, the latter being a primary driver of obesity (Waitzberg et al., 2017). Notably, LAC exhibits some of the highest global rates of childhood obesity, necessitating urgent research to address persistent gaps. These include biological determinants of metabolic dysregulation, socio-behavioral influences on diet and physical activity, efficacy of community-level interventions, and longitudinal evaluations of national food policies (Kline et al., 2017).

Table 5.

Important prevention strategies for obesity prevention.

Strategy	Description	Effectiveness of the strategy	References
Taxation and sugar-sweetened beverages (SSBs)	The easiest way to decrease consumption of SSB was to increase the taxes on it to increase the prices.	Scale nutrition-sensitive social protection programs, such as Brazil's Bolsa Família (associated with a 26% reduction in child stunting) and Mexico's soda tax (12% decline in sugary drink purchases)	Colchero et al., 2016; Cominato et al., 2018; PAHO, 2023.
Front-of-package labels	Implemented by Mexico, Ecuador, and Chile	Expand front-of-package warning labels (effective in Chile) and subsidize nutrient-dense foods for marginalized communities. Chile's front-of-package warnings reduced ultra-processed food intake by 24%.	Cominato et al., 2018; FAO, 2023.
Physical activity pPrograms	Colombia and Brazil have implemented cycle paths to increase the population's participation.	Both countries report higher cycling rates in cities with dedicated infrastructure (Colombia: 13% modal share; Brazil: 3–5%). Also, cycling infrastructure disproportionately benefits low-income populations by improving mobility and reducing transport costs.	Cominato et al., 2018; PAHO, 2023.
School interventions	It is implemented in many schools in LAC, including physical education programs and offering local feeding within the schools.	Brazil's National School Feeding Program (PNAE) Reduced anemia by 37% and improved dietary diversity among students and Linked to a 15% decline in childhood obesity in participating schools due to reduced ultra-processed food consumption. Mexico's School Breakfast Program Provides fortified milk, cereals, and micronutrient supplements to low-income schools. 24% reduction in stunting and improved cognitive test scores in marginalized communities. Colombia's Aquí Comemos Bien (Here We Eat Well) Initiative Nutrition education paired with fortified school meals in Bogotá, Reduced iron-deficiency anemia by 29% in children aged 5–12	Sidaner et al., 2013; Cominato et al., 2018; FAO, 2023.
Structural drivers	Ultra-processed foods, gender inequities and intersectional disparities such as indigenous, rural populations.	Guatemala's Zero Hunger Pact Focused on maternal education, leading to a 30% reduction in child stunting in indigenous communities (2014–2021). Colombia's Agricultural Innovation Policy Increased production of nutrient-rich crops (e.g., quinoa, amaranth), improving food security in rural areas. Reduced stunting by 15% in target regions. Brazil's National School Feeding Program (PNAE) Mandated 30% of school meals to come from local farms, reducing anemia by 37% and boosting dietary diversity. Supported 120,000 family farmers economically. Costa Rica's Integrated Healthcare Networks Reduced maternal anemia by 20% and child wasting by 18% via universal healthcare coverage and prenatal care.	Corvalán et al., 2013; Colchero et al., 2016; FAO, 2023.

Although existing prevention frameworks have demonstrated partial success, their long-term efficacy relies on continuous monitoring and iterative refinement. For instance, school meal programs require periodic adjustments to align with evolving dietary guidelines and cultural preferences (Palacios et al., 2021). A dual focus on policy enforcement and adaptive implementation is critical to mitigating the dual burden of malnutrition in LAC, ensuring interventions remain responsive to population-specific needs.

Limitations of the review

The review may underrepresent gray literature (e.g., government reports, local program evaluations) and non-English/Spanish studies (e.g., Portuguese research from Brazil or indigenous-language reports), skewing findings toward high-income or urban settings leading to language and publication bias. Also, limited data on migrant populations, rural areas, and Indigenous communities may have provided data gaps in vulnerable populations. In addition, temporal and geographical variabilities may have limited regional generalizability. Studies during events like COVID-19 altered nutrition trends, policy changes, and economic shifts may also have complicated longitudinal conclusions for the review. Some studies may have had high risk of confounding and selection bias leading to risk of bias and weakening casual inferences. The sample size reduced statistical power and increased the risk of Type II error limiting the meta-analysis. Finally, culturally tailored interventions such as Brazil's Fome Zero were rarely evaluated in controlled trials, making it difficult to isolate their impact from broader socioeconomic changes thereby creating contextual nuances in the interventions. These limitations highlight the need for standardized metrics, inclusive data collection (e.g., integrating indigenous knowledge systems), and longitudinal studies targeting underrepresented groups. Future reviews should prioritize mixed-methods approaches to contextualize quantitative findings with qualitative insights from local communities. Despite these limitations, the review comprehensively examined malnutrition in the region and presented valuable and practical solutions to the issue.

Recommendations

Encourage food system reform for obesity and undernutrition

With the current prevalence of traditional malnutrition and obesity, policies that focus on food systems in LAC are critical for sustainability. These policies should involve promoting healthy food environments through measures such as taxation on sugary drinks, front-of-package labeling, and restrictions on unhealthy food marketing to children (Hennis, 2022). These measures, already in place in countries like Chile, Ecuador, and Mexico, can reduce consumption of ultra-processed foods and improve dietary choices. However, effective implementation relies on robust enforcement and consistent policy adjustments to local dietary needs (GBD Collaborators, 2019; Tirado et al., 2016).

Develop and expand nutrition and health programs for vulnerable populations

Specific programs to address deficiencies such as iron and vitamin A in children and women should be instituted or expanded, while support for exclusive breastfeeding programs can mitigate the high rates of stunting and anemia observed in some LAC countries. Public health interventions focused on early childhood nutrition, nutritional supplementation, and prenatal care support have proven effective in some LAC countries like Colombia and Guatemala. Expanding these efforts regionally within LAC would help bridge nutritional gaps, particularly in underserved rural areas (Casanueva et al., 2020; Lutter et al., 2021).

School health policies and feeding programs

Enacting school health policies such as feeding programs reaches vulnerable children, promotes learning, healthy, and holistic development, and minimizes the rate of school dropouts, especially among the vulnerable population in LAC. Additionally, school health policies can aid in protecting children's nutrition and health by prohibiting unhealthy foods within the school environment while encouraging the consumption of natural and balanced diets. LAC member countries should expand school health policies and programs through multisectoral approaches to emphasize the importance of integrating nutrition and health interventions in the region. Investments and political commitments to such programs and initiatives have now been established in at least 19 LAC member countries, with an estimated 80.3 million children receiving school meals in 2022 (IDB/WFP, 2023).

Implementation of multisectoral and intersectoral policies

LAC member countries must establish cross-sector coordination to address malnutrition within the region. Cross-sector coordination in agriculture, health, trade and tourism, health, nutrition, and food security councils that align education enhances the reach and efficacy of nutritional policies. National programs can utilize this approach to address the immediate impacts of undernutrition and obesity and the longer-term rise in NCDs related to obesity (PAHO, 2020; Tirado et al., 2016). Promoting multisectoral coordination on nutrition should be entrenched within LAC's national and regional food and environment systems policies. Member countries should adopt institutional and legal frameworks that favor such interventions with proven success.

Funding, monitoring and evaluation

Policies to tackle malnutrition in LAC require sustained funding, inter-sectoral partnerships, and rigorous evaluation mechanisms. These are essential to effectively implementing and adopting these strategies. Adequate funding is also needed for evidence-generation and advocacy efforts. LAC member countries should continually invest in building stronger regional nutrition communities of practice, promoting the exchange of lessons learned and other best practices on nutrition through global and regional platforms. More robust research, monitoring, evaluation, and reporting systems comprising indicators that measure distinctive nutritional impacts should be integrated within national and regional systems to provide data identifying barriers and impacts for informed decision-making.

Conclusion

This systematic review and meta-analysis findings highlighted malnutrition's impact on public health in LAC. Notably, the review highlighted the prevalence of stunting and wasting, with disparities observed between genders and age groups. Also, socioeconomic factors emerged as critical determinants of malnutrition outcomes, with lower wealth and education levels correlating with higher rates of undernutrition. The nutritional evolution, characterized by shifting dietary habits and lifestyles, underscores the complex interplay between economic development and malnutrition patterns. Effective malnutrition interventions demand a multifaceted approach, encompassing tailored strategies for vulnerable groups, strengthened healthcare systems, and evidence-based practices. While existing strategies provide a framework for obesity prevention, addressing research gaps and evaluating intervention effectiveness remain crucial for progress. The prevalence of malnutrition in LAC underscores the urgent need for targeted public policies addressing socioeconomic disparities, dietary habits, and healthcare access. By prioritizing these factors and leveraging diverse strategies, stakeholders can work towards mitigating the burden of malnutrition and improving health outcomes across the region.

Footnotes

Authors contributions

DCH: Conceptualization, methodology, formal analysis, writing—original draft preparation, writing—review and editing, supervision & project administration. JC, IS, and EB: Conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing. All the authors read and approved the final manuscript.

Availability of data and materials

All the data generated and associated with this research has been provided in this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

This systematic review with meta-analysis did not require ethical approval, as it synthesized data exclusively from previously published studies that were publicly available and ethically compliant. Systematic reviews involve secondary analysis of existing literature and do not involve direct interaction with human participants, animal subjects, or collection of primary data. All included studies were expected to have obtained appropriate ethical approvals and informed consent during their original conduct, as per institutional and international standards. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to ensure transparency, rigor, and ethical integrity. No confidential or identifiable patient data were accessed or analyzed.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Danladi C Husaini

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