Nutritional status among North Korean refugee and immigrant children in South Korea: evidence of a double burden of malnutrition.

OBJECTIVES: Children from migrant and refugee families may face a double burden of malnutrition, with undernutrition and obesity occurring within the same population. However, evidence on the nutritional status of North Korean refugee (NKR) and immigrant children in South Korea (SK) remains limited. This study compared nutritional status among SK, NKR, and immigrant children. METHODS: Data for 2,856 SK children were obtained from the 2021-2023 Korea National Health and Nutrition Examination Survey. Separately, 336 NKR children and 597 immigrant children were recruited between 2021 and 2025. Nutritional status was evaluated using the World Health Organization AnthroPlus software. RESULTS: After adjustment for sex and age, NKR and immigrant children had significantly higher odds than SK children of undernutrition (odds ratio [OR]: 3.18; 95% confidence interval [CI]: 1.90-5.31; and OR: 2.39; 95% CI: 1.50-3.80, respectively), stunting (OR: 5.16; 95% CI: 2.42-10.99; and OR: 4.13; 95% CI: 2.12-8.04, respectively), and obesity (OR: 1.58; 95% CI: 1.16-2.14; and OR: 1.54; 95% CI: 1.21-1.96, respectively). Among first-generation immigrant children, longer residence in SK was associated with higher odds of obesity (OR: 2.08; 95% CI: 1.02-4.24). Second-generation NKR children also had higher odds of obesity than first-generation NKR children (OR: 2.97; 95% CI: 1.61-5.48). CONCLUSION: NKR and immigrant children showed a double burden of malnutrition, with both persistent undernutrition and elevated obesity. Targeted nutrition interventions are needed to reduce nutritional disparities and improve outcomes among migrant and refugee children in SK.