Objective: To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry. Design: Cross-sectional nationwide survey. Setting: Mandatory national screening programme before entrance to elementary school in 2008 in Iran. Subjects: All Iranian children entering public and private elementary schools. Results: The study population comprised 862 433 children (48?4 % girls, 77?2 % urban resident). Overall, 6?5 % of children had short stature, 19?1 % were underweight, 12?8 % were overweight and 3?4 % were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces. Conclusions: The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children's growth.

Until a few years ago, childhood undernutrition has been the major nutritional problem in our community and still is the focus of nutritional policies and related medical education curriculum; however the higher prevalence of overweight other than underweight obtained in the current national survey is alarming and confirms the importance of considering childhood overweight as a health priority. This should be taken into account for all Middle Eastern countries that are expected to bear one of the world's greatest increases in the burden of chronic diseases notably diabetes in the next two decades.

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