International Journal of Environmental Research and Public Health Article Provincial Dietary Intake Study (PDIS): Prevalence and Sociodemographic Determinants of the Double Burden of Malnutrition in A Representative Sample of 1 to Under 10-Year-Old Children from Two Urbanized and Economically Active Provinces in South Africa Marjanne Senekal 1 , Johanna H Nel 2 , Sonia Malczyk 1 , Linda Drummond 1 , Janetta Harbron 1 and Nelia P Steyn 1, * 1 Division Human Nutrition, University of Cape Town, UCT Medical Campus, Anzio Road, Anatomy, Building, Observatory 7925, Cape Town, South Africa 2 Department of Logistics, Stellenbosch University, Stellenbosch, 7600, South Africa * Correspondence: nelia.steyn@uct.ac.za; Tel.: +27-22-4238684 Received: 12 August 2019; Accepted: 5 September 2019; Published: 10 September 2019   Abstract: The objective of this study was to determine the prevalence and socio-demographic predictors of malnutrition in two urbanized economically active provinces (Gauteng N = 733, Western Cape N = 593) in South Africa. A multistage stratified cluster random sampling design was applied. Fieldworkers visited homes, measured children aged 1-<10-years old (N = 1326) and administered a questionnaire (mother/primary caregiver). In under-five year old children (N = 674) 21.6% were stunted [height-for-age z-score < -2 SD], 5.6 % underweight [weight-for-age z-score < -2 SD], 10.3% overweight (body mass index-for-age z-score) (BAZ)>+2 SD ≤ +3 SD] and 7.0% obese (BAZ >+3 SD). In 5–<10-year olds (N = 626) 6.7% were stunted, 6.8% underweight, 13.4% overweight and 6.8% obese. Stunting and overweight in the same child was present in 5.7% under-five year olds and 1.7% in 5–<10-year olds. Multiple logistic regression analyses identified having a mother with a post-grade 12 qualification (OR = 0.34) and having an obese mother (OR 0.46) as protectors and being in the under-five age group (OR = 3.73) as a risk factor for stunting. Being in the under-five age group was also a risk factor for a BAZ > 1 (OR 2.39), while being in the third wealth quintile was protective (OR = 0.62). Results indicate that stunting and overweight/obesity are still present at concerning levels, especially in the under-five age group. Keywords: malnutrition; double burden; children 1 to under 10 years old; stunting; wasting; overweight; obesity 1. Introduction Many countries in sub-Saharan Africa, including South Africa, have both a high prevalence of stunting in children and of overweight and obesity in children and adults, also referred to as the double burden of malnutrition [1]. Stunted children may become obese adults, who in turn appear to be more at risk of developing non-communicable diseases (NCDs) in adulthood [2]. Furthermore, undernutrition and overnutrition have been found in the same household [3]; a study in Benin, for example, showed that child protein energy malnutrition coexisted with maternal overweight/obesity in 16.2% of 148 households in poor neighborhoods. The authors theorized that child malnutrition and maternal overweight could both stem from poor socioeconomic conditions, lack of sanitation, and Int. J. Environ. Res. Public Health 2019, 16, 3334; doi:10.3390/ijerph16183334 www.mdpi.com/journal/ijerph