Objective: This study assessed the relationship between urbanization and the double burden of malnutrition (DBM) in Peru. Methods: Cross-sectional analysis of the Demographic and Health Survey (2009-2016). A DBM ‘case’ comprised a child with undernutrition and their mother with overweight/obesity. For urbanization, we used three indicators: an eight-category variable based on district-level population density (inhabitants/km2); a dichotomous urban/rural variable; and place of residence (countryside, towns, small cities, or capital/large cities). Results: The prevalence of DBM was lower in urban than in rural areas (prevalence ratio [PR]0.70; 95% confidence interval [CI] 0.65–0.75); and compared to the countryside, the DBM was less prevalent in towns (PR 0.75; 95% CI 0.69-0.82), small cities (PR 0.73; 95% CI 0.67-0.79) and capital/large cities (PR 0.53; 95% CI 0.46-0.61). Using population density, the adjusted prevalence of DBM was 9.7%(95% CI 9.4-10.1)in low-density settings(1-500 inhabitants/km2), 5.9% (95% CI 4.9-6.8)in mid-urbanized settings (1,001-2,500inhabitants/km2), 5.8% (95% CI 4.5-7.1)in more densely populated settings(7,501-10,000inhabitants/km2), and 5.5% (95% CI 4.1-7.0) in high-density settings (>15,000 inhabitants/km2). Conclusions: The prevalence of DBM is higher in the least urbanized settings such as rural and peri-urban areas, particularly those under 2,500 inhabitants/km2.