Objective: To document the double burden of malnutrition and cardiometabolic risk factors (CMRF) in adults and its occurrence according to different sociodemographic parameters. Design: Population-based cross-sectional observational study. We first randomly selected 330 households stratified by tertile of the income levels proxy as low, middle and high income. Setting: Northern district of Ouagadougou, the capital city of Burkina Faso. Subjects: In each income stratum, 110 individuals aged 25–60 years and who had lived permanently in Ouagadougou for at least 6 months were randomly selected, followed with collection of anthropometric, socio-economic and clinical data, and blood samples. Results: The overall obesity/overweight prevalence was 24?2% and it was twice as high in women as in men (34?1% v. 15?5%, P,0?001). Hypertension, hyperglycaemia and low HDL cholesterol prevalence was 21?9%, 22?3% and 30?0%, respectively, without gender difference. The prevalence of the metabolic syndrome was 10?3%. Iron depletion and vitamin A deficiency affected 15?7% and 25?7% of participants, respectively, with higher rates in women. Coexistence of at least one nutritional deficiency and one CMRF was observed in 23?5% of participants, and this ‘double burden' was significantly higher in women than in men (30?4% v. 16?1%, P50?008) and in the low income group. Conclusions: CMRF are becoming a leading nutritional problem in adults of Ouagadougou, while nutritional deficiencies persist. The double nutritional burden exacerbates health inequities and calls for action addressing both malnutrition and nutrition-related chronic diseases.