Background: Pediatric nutrition plays a critical role in shaping metabolic health and overall development during early childhood. The increasing prevalence of malnutrition, both undernutrition and obesity, poses a global threat to long-term health outcomes in children.

Objective: This study aimed to assess the nutritional status and basic metabolic indicators in children aged 2–10 years and to examine associations with dietary patterns and socio-demographic factors.

Methods: A cross-sectional study was conducted involving 600 children from three urban primary care centers. Anthropometric measurements, dietary intake records, and fasting blood samples were analyzed for glucose and lipid profiles. Parental interviews assessed socio-economic background and feeding practices.

Results: Among participants, 18.2% were classified as overweight or obese, while 12.7% were undernourished. Poor dietary diversity was associated with elevated fasting glucose levels (p < 0.05), and sedentary behavior showed a positive correlation with triglyceride concentrations (p < 0.01). Children from lower-income families demonstrated both higher undernutrition and early metabolic risk markers.

Conclusion: Urban pediatric populations face a dual burden of malnutrition. Early metabolic changes are linked with poor dietary quality and socioeconomic disparities. Interventions promoting balanced diets and active lifestyles are crucial to improve pediatric metabolic outcomes.

Proper nutrition during early childhood is essential for physical growth, neurodevelopment, immune competence, and metabolic regulation. In recent years, rapid urbanization and dietary transitions have contributed to a paradoxical increase in both undernutrition and obesity among children globally. Malnutrition during this critical window may predispose children to long-term health consequences such as insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular disease.
Previous studies have established links between diet quality and metabolic health in children; however, few have addressed these associations in the context of diverse urban populations facing socioeconomic disparities. This study investigates the prevalence of nutritional imbalances and evaluates basic metabolic markers among children aged 2–10 in urban health settings.

Study Design and Participants
A cross-sectional study was conducted between January and June 2025 in three urban primary care centers located in Madrid (Spain), Mumbai (India), and Vancouver (Canada). A total of 600 children aged 2 to 10 years were recruited during routine pediatric visits. Informed consent was obtained from parents or guardians.

Anthropometric and Clinical Assessment
Weight and height were measured using calibrated instruments. BMI-for-age z-scores were calculated according to WHO standards. Fasting blood samples were collected from 400 participants aged ≥5 years to evaluate serum glucose, total cholesterol, HDL, LDL, and triglycerides using standardized enzymatic assays.

Dietary and Behavioral Survey
A 3-day food recall was collected from parents and caregivers, including one weekend day. A dietary diversity score was computed based on WHO indicators. Physical activity levels and screen time were also recorded. Socioeconomic status was determined using a composite index of parental education, income, and household size.

Statistical Analysis
Data were analyzed using SPSS version 26. Descriptive statistics were computed, and chi-square and t-tests were used to assess group differences. Multivariate linear regression was applied to explore associations between nutritional variables and metabolic markers. A p-value of <0>

Among 600 enrolled children, 52% were male, and the mean age was 6.4 ± 2.3 years. Nutritional classification revealed that 69.1% were within normal weight range, 18.2% were overweight/obese, and 12.7% were undernourished (stunted or wasted).
Children from lower-income households exhibited significantly lower dietary diversity (mean DDS = 3.4 ± 1.2) compared to higher-income counterparts (mean DDS = 5.2 ± 1.5; p < 0>3 hours/day), even after adjusting for BMI (p = 0.03). Triglyceride levels positively correlated with sedentary behavior and sugar intake (p < 0>
Multivariate models showed that low dietary diversity, inadequate physical activity, and low household income were independent predictors of elevated metabolic risk markers.

This study highlights the co-existence of undernutrition and early-onset metabolic dysfunction among urban children, emphasizing the shifting landscape of pediatric nutrition. The association between poor diet quality and metabolic markers supports the growing concern of "hidden hunger" in children who appear to have adequate caloric intake but insufficient micronutrient diversity.
Sedentary lifestyles, especially screen exposure, were strongly associated with abnormal lipid profiles, echoing findings from other urban health studies. Socioeconomic inequalities further exacerbate nutritional risk, suggesting a need for policy measures that address food access and health literacy in vulnerable communities.
Our findings are consistent with global trends and underscore the importance of early screening and interventions to prevent long-term health consequences.

This study highlights the co-existence of undernutrition and early-onset metabolic dysfunction among urban children, emphasizing the shifting landscape of pediatric nutrition. The association between poor diet quality and metabolic markers supports the growing concern of "hidden hunger" in children who appear to have adequate caloric intake but insufficient micronutrient diversity.
Sedentary lifestyles, especially screen exposure, were strongly associated with abnormal lipid profiles, echoing findings from other urban health studies. Socioeconomic inequalities further exacerbate nutritional risk, suggesting a need for policy measures that address food access and health literacy in vulnerable communities.
Our findings are consistent with global trends and underscore the importance of early screening and interventions to prevent long-term health consequences.