Double Burden of Malnutrition among Children from North Korean Refugee and Immigrant Families

Background

This study aimed to compare the nutritional status of children from South Korean (SK), North Korean refugee (NKR), and immigrant families.

Methods

A total of 336 children from NKR families and 597 from immigrant families were recruited from community centers, non-governmental organizations, and alternative schools between 2021 and 2025. Data for 2,856 children from SK families were obtained from the 2021–2023 Korea National Health and Nutrition Examination Survey. Participants were assessed through structured interviews, and anthropometric measurements (height and weight) were obtained. Nutritional status was evaluated using WHO AnthroPlus. Stunting was defined as height-for-age z-score < −2 SD, underweight as weight-for-age z-score < −2 SD, and undernutrition as the presence of either condition. Obesity was defined as BMI-for-age z-score > +2 SD.

Results

Children from NKR families showed higher prevalence of stunting (3.2% vs. 0.7%, p < 0.001) and undernutrition (5.0% vs. 1.7%, p < 0.001) compared to those from SK families. Similarly, children from immigrant families had higher prevalence of stunting (2.7% vs. 0.7%, p < 0.001) and undernutrition (3.4% vs. 1.7%, p = 0.009). Obesity was also more prevalent in NKR (19.2% vs. 13.3%, p = 0.003) and immigrant (18.5% vs. 13.3%, p < 0.001) groups. No significant differences were found between NKR and immigrant groups. Duration of residence in South Korea was not associated with nutritional outcomes.

Conclusions

Children from NKR and immigrant families experience a double burden of malnutrition, with higher levels of both undernutrition and obesity compared to SK children. These disparities are not alleviated by longer residence in South Korea, highlighting the need for targeted nutritional support and education programs.

Key messages

• Children from NKR and immigrant families experience a double burden of malnutrition, with higher levels of both undernutrition and obesity compared to SK children.

• These disparities are not alleviated by longer residence in South Korea, highlighting the need for targeted nutritional support and education programs.