Malnutrition includes both under-nutrition and over-nutrition, which have negative health impacts and social consequences. The present study aims to understand the demographic dynamics, burden of chronic illnesses, and risk factors associated with malnutrition (stunting, thinness, and obesity) among different age groups in urban and rural areas. Data were collected through a cross-sectional study conducted in an urban area in Hyderabad and four rural villages in Andhra Pradesh. A multivariable mixed-effect logistic regression was used to assess the risk factors associated with malnutrition among different age groups. The final analysis included the data of 10,350 individuals, consisting of 8317 (80.4%) from urban areas and 2033 (19.6%) from rural areas. The number of known cases of hypertension in the urban area was 926 (11.1%) and 114 (5.6%) in the rural areas, and that of diabetes was 511 (6.1%) in the urban area and 104 (5.1%) in the rural areas. The burden of stunting among under-five children and obesity among adults was 33.7% (95% CI; 29.7–37.9) and 47.4% (95% CI; 45.8–49.1), respectively. Adults aged 40–59 years (AOR 1.91; 1.59–2.28) and belonging to a clerical/skilled (AOR 1.32; 1.03–1.71) occupation were at higher odds of obesity compared to their counterparts. Policymakers and health practitioners should consider the insights from our findings to tailor effective interventions to address malnutrition.

This article describes how a structured lifestyle modification intervention for hypertension and diabetes was scaled within Kerala’s health system, focusing on how implementation knowledge was generated and embedded in routine practice. Grounded in an implementation research approach, the work documents how evidence-informed strategies were continuously adapted through stakeholder engagement, peer-led delivery, and supportive institutional processes. Drawing on qualitative data from stakeholder consultations, document review, and field observations in Janakeeya Arogya Kendrams (basic unit of primary health care centres in Kerala), the article shows how local context, social learning, and power dynamics shaped iterative learning cycles. The findings outline key facilitators and barriers to knowledge use in practice. It offers practical insights for strengthening sustainable non-communicable disease prevention and control programmes in similar settings.