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Community-based interventions addressing multiple forms of malnutrition among adolescents in low- and middle-income countries: a scoping review

Nutrition Journal volume 24, Article number: 69 (2025) Cite this article

Abstract

Background

Community-based interventions hold promise for addressing adolescent malnutrition, but there is limited knowledge of their nature and impact on adolescent nutrition outcomes in low- and middle-income countries (LMICs). This scoping review aimed to characterize community-based adolescent nutrition interventions in LMICs and summarize their effects on adolescent nutrition outcomes.

Methods

We systematically searched MEDLINE via PubMed, Embase, and CENTRAL through the Cochrane Library for studies published between 2000 and 2023. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Eligible studies included randomized controlled trials and quasi-experimental studies addressing adolescent malnutrition in LMIC community settings, involving adolescents aged 10–19 years. A narrative synthesis was employed to analyze and describe the evidence.

Results

Our review included 37 records from 36 studies conducted in 27 countries. Interventions included micronutrient supplementation, nutrition education, food supplementation and fortification, physical activity education, and multicomponent approaches. The intervention duration ranged from 3 weeks to 2 years, with limited studies grounded in theoretical frameworks. Fifty-seven percent of interventions (n = 21) targeted adolescent girls, indicating a gap in programs for boys and other vulnerable groups, such as out-of-school adolescents and migrants. The intervention delivery agents included research staff and healthcare professionals. The majority of interventions were delivered in person; few utilized social media strategies. Among the studies reviewed, nine out of ten evaluating micronutrient supplementation, six out of seven assessing nutrition education, and seven out of eight examining multicomponent interventions reported improvement in at least one nutrition or diet-related outcome.

Conclusions

Community-based interventions hold promise for improving adolescent nutritional status in LMICs. However, our review highlights gaps in the evidence base, marked by significant variability in intervention design, delivery, and implementation platforms. This underscores the need for integrated approaches and rigorous evaluations of their implementation outcomes, including acceptability, relevance, feasibility, effectiveness, and sustainability, in addressing adolescent nutrition challenges.

Registration

The review protocol was registered prospectively with the Open Science Framework on 19 July 2023 (https://osf.io/t2d78).

Peer Review reports

Introduction

Approximately 1.3 billion adolescents aged 10–19 years constitute 16% of the global population [1], and of these, 90% reside in low- and middle-income countries (LMICs) [2]. Because adolescence is characterized by rapid body growth and physiological changes, proper nutrition is critical as it lays the foundation for well-being in adulthood [3]. However, adolescents in LMICs face significant nutritional challenges, including the double burden of malnutrition (DBM). This condition is characterized by the coexistence of persistent underweight and widespread micronutrient deficiencies—particularly iron deficiency—alongside rising rates of overweight and obesity [4]. For example, in Southeast Asia, thinness is prevalent among 11.7% of boys and 8.9% of girls, while overweight is prevalent among 19.5% of boys and 15.0% of girls [5]. Furthermore, in northern Africa, 5.8% of boys and 3.6% of girls are affected by thinness, while 30.1% of boys and 32% of girls are overweight and 12.8% of boys and 14.6% of girls are obese [5]. Lastly, iron deficiency anaemia among adolescents is a leading cause of disability-adjusted life years globally, with prevalence rates reaching up to 50% among girls and 30% among boys in some countries [6,7,8]. The COVID- 19 pandemic could have further exacerbated these rates due to food crises and inflation. Moreover, data on dietary diversity and quality among adolescents in LMICs is limited, posing significant challenges for monitoring and evaluating existing programs and developing effective interventions to address the DBM in this population [9].

Undernutrition and micronutrient deficiencies during adolescence lead to numerous adverse health consequences, including poor cognitive skills and academic performance, increased susceptibility to infectious diseases, stunted bone growth, diminished vision, complications during pregnancy and birth, and decreased economic productivity [10]. Conversely, overweight and obesity contribute to noncommunicable diseases (NCDs), including hypertension, coronary heart disease, stroke, diabetes, and certain cancers [10]. Therefore, addressing all forms of malnutrition among adolescents in LMICs is a public health priority. The recent rise in the DBM has sparked increased interest in interventions, policies, and programs that address multiple forms of malnutrition simultaneously, often referred to as double-duty actions [11]. These actions help address common drivers of undernutrition and overweight/obesity at once and are advantageous given the limited public health and policy resources available to address nutrition-related challenges and diseases.

Nutrition interventions for adolescents in LMICs include health education, dietary and nutritional programs, and multicomponent strategies. These interventions can be categorized into nutrition-specific interventions, which address the immediate causes of malnutrition, or nutrition-sensitive interventions, which target the underlying causes. [12, 13]. Despite the existence of these interventions, significant gaps remain in our understanding of the DBM among adolescents in LMICs. Historically, most interventions have been delivered through schools, which are considered promising platforms for addressing the nutritional needs of adolescents [12]. Consequently, there is limited evidence on community-based nutrition programs targeting out-of-school and vulnerable adolescents, such as migrants, those engaged in work to support their families, and those living with HIV. Furthermore, many interventions focus primarily on older adolescent girls, leaving a gap in knowledge about their effectiveness for younger adolescent girls and adolescent boys.

To address these gaps, we conducted a scoping review to characterize community-based interventions targeting various forms of malnutrition among adolescents in LMICs and to describe their effects on nutrition and health outcomes. Within this review, community-based interventions encompass all initiatives implemented in community settings, excluding schools, aiming to improve the health and nutrition of both in- and out-of-school adolescents within specific local communities. Examples of such settings include, but are not limited to, homes, religious centres, clubs, and youth centres.

Methods

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist [14], summarized in Online File 1. The review protocol has been published elsewhere [15], with registration on Open Science Framework (https://osf.io/t2d78).

Eligibility criteria

Eligibility criteria were determined using the participants, concept, and context (PCC) model without any restrictions on outcomes for a broad search. We included both quantitative and qualitative data from randomized controlled trials (RCTs) of individuals or clusters, quasi-experimental studies, and controlled before-after studies addressing adolescent malnutrition in community settings within LMICs (according to the World Bank’s classification in 2022–2023) [16]. Studies were eligible if they focused on adolescent boys and/or girls aged 10–19 years and included interventions such as micronutrient supplementation, feeding interventions, nutrition education, physical education, or other relevant interventions aimed at improving adolescent health and nutrition [15]. The criteria did not impose restrictions on language, sample size, or intervention duration. The exclusion criteria included quasi-experimental studies without comparator groups, observational studies, editorials, commentaries, opinions, and review articles. Additionally, studies exclusively focusing on individuals with specific conditions, including malnourished individuals, were excluded [15]. We also excluded school-based interventions because of their extensive coverage and synthesis in the literature [12, 17, 18]. We focused on community-based interventions that are less common, less understood, and more challenging to implement than school-based interventions and yet hold promise for reaching the most vulnerable groups of adolescents [15].

Information sources and search

We conducted a comprehensive search of MEDLINE via PubMed, Embase, and CENTRAL through the Cochrane Library to identify relevant studies published between January 1, 2000, and July 14, 2023. Additionally, we carefully examined the references and bibliographies of the included studies and relevant reviews to identify additional sources of information. We employed keyword search terms pertaining to the adolescent population, interventions (nutrition education, physical activity, food supplements and fortification, micronutrient supplements, community gardens, and WASH), types of studies (RCTs and quasi-experimental studies), and settings (LMICs). The search strategy was not restricted by predefined outcomes, enabling the review to capture the full range of outcomes addressed by community-based nutrition interventions for adolescents and to identify trends in their effectiveness. The detailed search strategy for all the databases is provided in Online File 2. We exported the final search results into Covidence (Veritas Health Innovation, Melbourne, Australia), where duplicates were removed [15].

Selection of sources of evidence

Initially, two researchers independently screened titles/abstracts and later progressed to full-text screening. Disagreements were resolved through discussion. We documented and summarized the study exclusions using the PRISMA flow diagram for scoping reviews [14].

Data extraction process and data items

Using a prespecified Excel form for all eligible studies, we extracted publication details and study methods, including study type, age, sex, country, sample size, and inclusion criteria. For the intervention strategy, we collected data on the timing, duration, and frequency of the intervention, guiding theories, intervention topics, delivery mechanisms, and selection and training of delivery agents. We also extracted outcome data, details of the measures used, and qualitative findings.

Critical appraisal of individual sources of evidence

We used the Cochrane Collaboration’s revised tool for assessing the risk of bias in randomized trials (RoB2) [19]. For the risk of bias in clustered trials, we used the risk of bias 2 for the cluster-randomized trials tool (RoB2 CRT) [20]. Finally, we used the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool [21] to assess the risk of bias for controlled before-after studies and nonrandomized controlled trials.

Synthesis of evidence

We systematically synthesized the findings from all included studies, both in textual form and in tabular format, following the Synthesis Without Meta-analysis (SWiM) guidelines [22]. Where reported, the impact of interventions was described through mean differences for continuous variables and percentage or percentage point changes for binary outcomes. We presented simple frequency counts to summarize the overall direction of effects for each outcome. We analyzed qualitative studies using thematic analysis, with narrative descriptions provided for each identified theme.

Results

Study description

Our initial search generated 28,315 records (Fig. 1). Following title and abstract screening, 20,985 records were excluded. We reviewed 149 full-text records for eligibility. Ultimately, 37 records from 36 studies met the eligibility criteria and were included in the review. Table 1 summarizes the study characteristics, including study type, intervention content and delivery mechanism, comparator group, outcomes, and overall evidence quality.

Fig. 1
figure 1

Scoping literature review flow chart

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Table 1 Characteristics of the included studies on community-based interventions targeting nutrition and physical activity for adolescents
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Study design, setting, and population

Of the 37 records from 36 studies included in the review, 18 were RCTs, 10 were cluster RCTs (cRCTs), 2 were mixed-methods evaluations, 5 were non-RCTs, and 2 were qualitative assessments (Table 1). The included studies were conducted in 27 different countries. A significant proportion of the studies (47.2%) were conducted in Asia (nine in India, two each in Bangladesh and Malaysia, and one each in Indonesia, Iran, Pakistan, and Thailand), 22.2% were conducted in Africa (two in Tanzania, and one each in Benin, Ethiopia, Ghana, Niger, Uganda, and Zambia), 13.9% were conducted in South America (two each in Brazil and Peru, and one in Colombia), 5.6% were conducted in North America and the Caribbean (one each in Jamaica and Mexico), Oceania (one each in Fiji and Tonga), and 2.8% were conducted in Europe (one in Bulgaria, Croatia, and Romania). One study was conducted across four countries in Asia and Africa—the Philippines, Sri Lanka, Madagascar, and Tanzania. Overall, the participants’ ages ranged from 5–44 years across the studies. Specifically, 20 interventions focused on adolescents aged 10–19 years, two interventions targeted children and younger adolescents aged 5–14 years, five interventions were aimed at children and adolescents aged 5–19 years, two interventions focused on adolescents and young adults aged 15–24 years, and seven interventions targeted a wider age range of the population (aged 12–44 years). The total number of participants involved in these studies ranged from 36 to 2,948.

Intervention characteristics

Intervention duration

The interventions varied in duration, ranging from three weeks to over two years, with eighteen interventions spanning from three weeks to six months, thirteen interventions lasting from six months to one year, and one extending for an entire year, whereas five interventions were implemented over periods exceeding two years.

Theoretical framework

Seven studies used eight distinct theoretical frameworks to support their interventions. Specifically, social cognitive theory was applied in three studies [36, 42, 52]. Additionally, one study combined the asset-building framework with social cognitive theory [36]. The theory of planned behaviour and the model of goal-directed behaviour were used in another study [43], whereas a separate study employed the social media and technology acceptance model [41]. Another study utilized social learning theory [56]. Lastly, one study developed a theory of change framework involving adolescent groups and incorporated youth leadership activities, livelihood promotion, and community engagement and support [55].

Intervention focus

Ten studies provided micronutrient supplementation, whereas eight focused on nutrition education, workshops, or training. Another eight studies implemented multicomponent interventions. Furthermore, seven studies incorporated food supplementation and food fortification, two focused on physical education, and one addressed behavioural changes through a lifestyle modification intervention.

Delivery platform

Seventeen studies utilized diverse delivery platforms to implement their interventions. Home visits were the most commonly used approach, reported in seven studies [23, 27, 28, 32, 35, 49, 59]. Supplements were delivered either door-to-door or at community health centres in four studies [24, 28, 29, 47]. Educational interventions were delivered through face-to-face interactions, group sessions, and multimedia content in nine studies [26, 33, 34, 39, 41, 42, 52, 56, 59]. Social media platforms, such as Instagram, Facebook, and WhatsApp, were leveraged in three studies [38, 41, 52]. Other platforms included youth project centres [30], sports fields [51], and community-based distribution points for fortified foods [46, 50]. Additionally, one study integrated interactive workshops and SMS messaging to reinforce intervention content [34], while another used innovative approaches like illustrative vignettes and participatory methods in in-person workshops [36].

Intervention content

The goal of micronutrient supplementation interventions, which lasted eight to 26 weeks, was to address multiple forms of malnutrition and improve the nutritional status of adolescents. Of the ten micronutrient supplementation interventions, three were administered daily [26, 27, 30], while six were administered weekly [23,24,25, 28, 29, 31] and one study [32] did not report the frequency of administration. Among the ten micronutrient supplementation studies, nine provided iron supplements, either alone or in combination with other micronutrients. For example, one study administered 400 mg of ferrous sulfate weekly [25], whereas others provided it in combination with folic acid and different vitamins and minerals [23, 24, 26,27,28,29,30]. Additionally, one study provided a multi-micronutrient supplement [31], whereas another investigated the impact of two types of cooking pots (i.e., cast iron or blue steel) on anaemia over six months [32]. Micronutrient supplements were administered by investigators and research staff [24, 27] and community workers in collaboration with other healthcare workers [23, 28,29,30,31,32].

Nutrition education interventions have aimed to motivate adolescents to adopt healthy eating habits [33,34,35,36,37,38,39,40,41]. These studies employed diverse methods for nutrition education, such as face-to-face workshops, lectures, counselling, and interviews, complemented by digital interactions via SMS, phone calls, Facebook, WhatsApp, email, and websites. Educational materials were also disseminated through posters, recipe booklets, leaflets, pencil cases, t-shirts, and school folders. The delivery agents for the intervention varied across the studies and included healthcare workers, community kitchen staff, peers, and research and study personnel.

Two studies incorporated a physical activity education component to promote exercise among participants. They focused on setting specific goals such as daily step counts and active minutes, identifying self-efficacy and outcome expectations related to these goals, and presenting both positive and negative messages about physical activity [42, 43]. Three studies supplied participants with flour fortified with acacia colei, zinc, vitamin A, and iron [44, 46, 50]. Additionally, two studies provided snacks made from leafy green vegetables, dried fruits, and whole milk [45, 47], whereas another two studies supplied fortified milk containing zinc, vitamin D, and additional micronutrients [48, 49]. The interventions, which lasted from three weeks to six months, were implemented by community kitchen workers, mothers of adolescents, and researchers.

Eight studies incorporated multicomponent interventions, including fortification, nutrition and/or physical activity education, deworming, and behaviour modification. Among these, five studies focused on nutrition and physical activity education [52, 55,56,57,58], two studies implemented deworming, health education, and fortified salt [53, 54], and one study evaluated the year-long effects of iron supplementation, accompanied by educational materials, cooking demonstrations, and deworming [59]. These interventions varied in duration from four months to three years and were implemented by health workers, peer facilitators, project committees, and study technicians. Finally, only one study focused on a physical activity intervention [51], conducted over nine weeks, which included a football league for adolescent boys and girls. Each week, the participants engaged in a 40-min football game and peace-building activities designed to promote physical activity and improve their body mass index scores.

Risk of bias

Quantitative outcomes were reported for 35 records, for which the risk of bias was assessed. On the basis of the risk of bias assessment, nine studies were rated as having a high risk of bias, twelve as having some concern, and nine as having a low risk of bias. Among non-randomized RCTs, four were judged as having a serious risk of bias, and one had a moderate risk of bias.

Main findings of the interventions

Table 2 summarizes the intervention effects on the basis of the direction of the effects by intervention type. The studies assessing micronutrient supplementation focused on nutritional status outcomes, with all ten studies measuring haemoglobin, five measuring serum ferritin, and three measuring anthropometric outcomes. Nine studies reported positive results for at least one nutritional indicator. Six out of ten studies reported significant improvements in haemoglobin in the intervention group following supplementation [23, 24, 26, 28,29,30], whereas four reported no improvements [25, 27, 31, 32]. Analysis of the serum ferritin levels in five studies revealed significant improvements in the intervention group [23,24,25, 28, 32]. Furthermore, two studies reported a significant increase in folic acid concentrations [24, 28], one study noted a significant improvement in vitamin A levels [23], and another reported a significant increase in the zinc status of the intervention group participants compared with the control group participants [26]. Two micronutrient supplementation studies also reported significant weight gain in experimental group participants [25, 30], whereas one study reported no changes in participants'BMI across study groups [31].

Table 2 Summary of quantitative studies of included studies on community-based interventions targeting nutrition and physical activity for adolescents
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Studies on multicomponent interventions primarily assessed anthropometric outcomes such as BMI and body fat percentage, whereas three studies analyzed nutritional status and dietary outcomes. Seven of the eight multicomponent interventions yielded significant results in terms of at least one nutritional outcome. Three biomarkers, namely haemoglobin, serum ferritin, and zinc concentration were measured. One study reported significant improvements only in haemoglobin levels [59]. In contrast, two studies reported significant improvements in all measured biomarkers in experimental group participants compared with control group participants [53, 54]. None of the three studies examining dietary intake and other nutritional variables noted improvements [55, 57, 59]. Four studies evaluated anthropometric indicators, with two reporting improved body mass index [52, 56], while the remaining two reported positive changes in body fat percentage among the participants in the intervention groups [57, 58].

Nutrition education studies have predominantly evaluated dietary outcomes, especially nutritional knowledge, attitudes and practices, and micronutrient intake. Six out of seven studies reported improvements in at least one nutritional outcome. Four studies assessed outcomes related to nutrition knowledge, attitudes, behaviours, and understanding of nutrition labels. Of these, two studies reported significant improvements across all measured outcomes, including nutrition knowledge, attitudes, and behaviour, as well as food-focused media literacy among the participants in the intervention group [34, 39]. However, two studies reported improvements only in attitudes toward and practices related to nutrition labels among participants in the intervention groups, without any gains in nutrition knowledge outcomes [36, 38]. Regarding dietary intake, two studies reported significant improvements in all outcomes [33, 37], whereas another study reported improved vitamin C intake, with no improvements in other intake outcomes between study groups [35]. Additionally, two studies reported no significant changes in anthropometric indicators between the study arms [35, 36].

Food fortification studies have largely investigated nutritional status alongside dietary outcomes, particularly intake practices. All seven studies reported at least one positive nutritional outcome. These studies primarily assessed blood biomarkers, such as zinc, haemoglobin, ferritin, and folate concentrations, and dietary outcomes. One study reported a significant increase in zinc concentrations in intervention group participants compared with control group participants [48]. In contrast, others reported no significant changes in haemoglobin, ferritin, folate, or ascorbate levels between intervention and control groups [46, 47, 50]. Another study reported an increased total of 25(OH)D levels in the intervention group due to supplementation with fortified milk, but free 25(OH)D levels did not change [49]. With respect to dietary outcomes, one study reported no change in energy or protein intake but reported greater zinc intake in the intervention group than in the control group [48], and another study reported no significant differences in the consumption of green leafy vegetables, pulses, legumes, or ALA-rich foods [45] between the intervention and control groups. One study reported significant increases in BMI and mid-arm circumference in the intervention group compared with the control group [44].

Physical activity education and behaviour (lifestyle) interventions investigated only physical activity outcomes and anthropometric outcomes, respectively. Two studies focusing on physical activity education demonstrated significant improvements in physical activity outcomes, reporting substantial improvements in the intervention groups in outcomes such as daily steps, resting heart rate, leisure activity score, and intent to engage in physical activity [42, 43]. A study focusing on behavioural changes and physical activity reported no significant changes in BMI-for-age-z scores between the intervention and control groups [51].

Of the 37 records from 36 studies, we grouped seven reported qualitative findings across five key themes: stakeholders’ acceptability of the intervention, their satisfaction with the intervention activities, the perceived effectiveness of the intervention, challenges encountered in participating in the intervention, and suggestions for improving the intervention [34, 38, 49, 52, 55]. The qualitative findings from each study are summarized in Table 3.

Table 3 Key themes and their corresponding results of qualitative evaluations of included studies
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Six studies that documented the acceptability of interventions [38, 40, 41, 49, 52, 55] reported moderate to high acceptability among stakeholders, including adolescents and young adults. However, one study noted challenges in engaging adolescents in intervention discussions. One study reported that parents were more accepting of online intervention activities than face-to-face interactions [55]. Two studies reported satisfaction with the type of intervention [34, 52]. Parents generally supported the interventions, whereas adolescents expressed satisfaction with the workshops and SMS communications.

Four studies highlighted the perceived effectiveness of the interventions, indicating positive impacts on knowledge and behaviours [34, 38, 52]. We identified challenges in adolescent participation in five studies [34, 38, 40, 41, 55]. These included limited engagement due to involvement in household economic activities, examination preparations, and embarrassment related to literacy levels and school dropout [55]. A social media intervention faced issues such as insufficient phone credit, message failure, and limited response time [34], whereas another study identified barriers such as limited time, lack of cooking skills, and low self-efficacy affecting healthy eating [41]. A nutrition program highlighted tight academic schedules, cultural norms, poverty, and patriarchal practices as hurdles for girls’ nutritional intake [40].

To improve interventions, adolescents in two studies suggested using trending songs and vibrant graphics to capture attention and shorter discussions to increase participation [38]. They also expressed a desire for more detailed nutritional information, updated statistics, and longer training sessions to gain a better understanding of nutrition-related issues [40].

Discussion

This review analyzed 37 reports from 36 studies on community-based interventions addressing various forms of malnutrition among adolescents in LMICs. The interventions covered a range of approaches: micronutrient supplementation, nutrition education, physical activity education, food fortification, behavioural interventions, and multicomponent interventions, with durations ranging from three weeks to more than two years. The frequency of intervention delivery varied: micronutrient supplementation was typically administered weekly, nutrition education was offered either weekly or monthly, and food fortification occurred daily. Demographically, 21 interventions (57%) targeted adolescent girls, 16 (43%) aimed at both genders, and one did not specify the target gender. This finding reveals a gap in interventions specifically designed for adolescent boys and other vulnerable groups, such as out-of-school adolescents and migrants. Notably, it is also crucial to focus on adolescent boys, who face high rates of iron-deficiency anaemia, similar to adolescent girls [60]. Additionally, most interventions targeted a wide range of age groups (11–18 years), indicating a need for more tailored approaches that cater to adolescents'distinct developmental and nutritional needs.

Our findings highlighted a diverse range of delivery agents and platforms for these community-based interventions addressing adolescent malnutrition in LMICs. The delivery agents included frontline health workers, community kitchen staff, dietitians, nutritionists, peers, and mothers of adolescents. Platforms for delivery vary by intervention type and include door-to-door outreach, healthcare centres, community kitchens, and digital channels such as SMS, phone calls, websites, and emails. Some interventions also involved social and religious gatherings. This diversity underscores the potential to leverage various platforms and community members to effectively reach adolescents with specific needs. The increasing use of digital technology, including social media, gaming environments, educational websites, and mobile applications, reflects a trend toward enhancing the reach and effectiveness of nutrition interventions. Additionally, exploring platforms such as adolescent sports clubs and recreational areas, where adolescents typically congregate, warrants further investigation. Diversifying platforms for delivering nutrition and physical activity interventions might increase the likelihood of engaging adolescents in manners that resonate with their interests and needs.

The geographic distribution of studies reveals significant gaps, particularly in Africa, where only a small proportion of studies were conducted, highlighting the need for more research in sub-Saharan Africa. Additionally, regions such as Oceania, Europe, and the Americas are underrepresented, with limited studies from countries like Fiji, Tonga, and several Latin American nations. Cross-regional studies are sparse, suggesting an opportunity to explore diverse contexts and nutrition challenges across regions. Expanding research in these underserved areas could provide valuable insights into region-specific adolescent nutrition issues [61]. To address these diverse needs effectively, high-quality data are critical to accurately define them [61]. Such data should inform the development of contextually driven and culturally appropriate interventions, ensuring that nutrition strategies effectively respond to the complex needs of adolescents.

Our findings also highlight the importance of using theoretical frameworks to develop interventions for addressing adolescent malnutrition, as recommended by global guidelines [62,63,64]. Initiatives such as the World Health Organization's Global Accelerated Action for the Health of Adolescents (AA-HA!), the Global Strategy for Women's, Children's and Adolescents'Health, and the Sustainable Development Goals (SDGs) encourage countries to invest in adolescent health and nutrition [65]. The AA-HA! Guidance specifically emphasizes tailoring interventions to meet adolescents’ unique developmental stages and challenges. Seven studies included in this review, published between 2014 and 2022, were based on theories. While no major differences in outcomes or success were observed between interventions with and without theoretical frameworks, these frameworks were instrumental in guiding evaluations, particularly identifying constructs such as self-efficacy, and self-regulation using social cognitive theory for internet-based physical activity interventions [42] or shaping the evaluation process for interventions based on the technology acceptance model in a social media campaign intervention [41]. Overall, theoretical frameworks seem to enhance the design of evidence-based interventions, facilitate outcome evaluation, and provide structured approaches for tackling complex health challenges [66]. Their careful consideration might be useful during intervention development, implementation, and evaluation.

Nutritional challenges among adolescents are often addressed through isolated strategies, leading to fragmented efforts [4]. Our review reflects this trend, with most studies focusing on single aspects of nutrition. However, there is a growing recognition of the need for integrated approaches that address multiple forms of malnutrition simultaneously [67]. Double-duty actions, for example, aim to combat all forms of malnutrition by reducing the risks or burdens of both undernutrition (including wasting, stunting, and micronutrient deficiency or insufficiency) and overweight or obesity, as well as diet-related NCDs simultaneously [67]. These actions are particularly relevant in countries undergoing rapid nutrition transitions, where focusing solely on undernutrition might inadvertently increase the risks of obesity and NCDs [67]. Our findings also indicate that most interventions have a narrow focus, with few addressing body weight as a nutritional indicator. To address the intertwined issues of undernutrition and overweight/obesity effectively, a holistic approach that integrates healthy diets, physical activity, and accessible services is necessary.

Despite the clear need for integrated nutritional strategies, community-based interventions incorporating physical activity are notably rare. This is a significant issue given the effects of globalization and urbanization on reducing available spaces for physical activity, particularly for adolescents [68]. Additionally, no interventions included a multisectoral approach, underscoring the need for strategies that involve schools, families, and communities [69]. Integrating adolescent nutrition programs within multisectoral systems—such as food, health, water and sanitation, urban planning, education, and social protection— is critical [70]. While progress has been made in identifying effective strategies, their implementation remains constrained, highlighting the need for convergent approaches that consider broader socioeconomic and environmental contexts, especially for vulnerable adolescents [10, 71, 72].

Community-based interventions enable engagement with diverse adolescent groups and foster collaboration across local entities, from nongovernmental organizations and religious groups to local businesses, self-help groups, and recreational clubs [73]. Such approaches can enhance local food environments and choices, tailoring support to adolescent needs. In high-income countries, many of the most effective obesity prevention interventions often account for the social context and are implemented within community settings. For example, mentoring conducted by African American community members in the U.S. increased the impact of nutrition interventions on African American young people [74]. These approaches can also influence social norms, support vulnerable populations, and address the environmental factors affecting nutritional challenges [75, 76].

Evidence suggests that longer-duration interventions tend to facilitate better integration and a more comprehensive approach, supporting sustainable behaviour changes and providing ongoing support critical for maintaining gains [73, 77]. However, the evidence on the actual effects on malnutrition-related outcomes favours shorter and medium-duration interventions. In our review, eighteen interventions lasted less than six months, with fifteen showing significant results in at least one outcome, and nine demonstrating positive results in most or all outcomes measured. All twelve interventions lasting between six months and a year showed improvements in at least one measured outcome. In contrast, of the seven interventions lasting a year or longer, only four showed significant results for at least one outcome, and three included a broader age range, not exclusively adolescents, limiting the ability to ascertain conclusions specific to adolescent populations. Furthermore, few studies have included implementation science indicators. Evidence on implementation indicators such as acceptability, appropriateness, feasibility, adoption, fidelity, cost, penetration, and sustainability is crucial to ensure that interventions are both effective in practice and relevant to local contexts [78]. Researchers should consider including these metrics in their evaluation processes.

To our knowledge, this is the first review to synthesize evidence of community-based approaches addressing multiple forms of malnutrition among adolescents in LMICs. Our extensive search covered various interventions, settings, and contexts. However, our review has several limitations, including the incorporation of only English-language databases and engines, which potentially omits significant research in other languages. Furthermore, owing to the diverse nature of interventions and outcomes, conducting a meta-analysis was not feasible within our scoping review approach. Our focus was on summarizing existing evidence about the interventions and identifying gaps in knowledge. The searches for relevant studies were conducted in July 2023, and while we aimed to capture all available data at the time of the search, it is possible that significant findings published since then are not included in this scoping review. A total of seven studies [31, 32, 42, 43, 45, 47, 59] included an overlapping age range than only adolescents, with participants up to 45 years of age. We decided to include these studies to ensure that data specific to adolescents was not excluded from our review.

Despite the limited evidence on community-based nutrition interventions for adolescents, our review highlights the need for tailored, multifaceted community-based nutrition programs, especially for vulnerable groups such as out-of-school adolescents. Future efforts should integrate dietary, physical activity, and educational strategies to ensure sustainable behavioural changes. Research should develop context-specific, intervention designs based on a human-centred approach, and theory-based interventions that integrate various public health sectors and employ multiplatform and multisectoral approaches for comprehensive malnutrition solutions. Additionally, long-term studies focused on specific age groups are crucial for assessing the effectiveness and sustainability of these interventions over time.

Conclusion

In conclusion, our scoping review identified evidence of community-based nutrition interventions for adolescents in LMICs, with most studies focusing on micronutrient deficiencies. The available evidence suggests that community-based interventions may hold significant potential for improving adolescent health and nutrition in LMICs. However, substantial gaps remain in documenting and understanding these interventions. Given the complexity of the double burden of malnutrition and the various determinants of adolescent health, especially for the most vulnerable adolescents, there is a critical need for integrated, context-specific interventions. Leveraging diverse delivery platforms and agents is essential to ensure effective, acceptable, feasible, and sustainable nutrition programs addressing multiple forms of adolescent malnutrition.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

ARISE-NUTRINT Collaborators: Michael Laxy, Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany. Jacob Burns, Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany. Mary Mwanyika Sando, Africa Academy for Public Health, Dar es Salaam, Tanzania. Ayoade Oduola, University of Ibadan Research Foundation, Ibadan, Nigeria. Mosa Moshabela, University of KwaZulu-Natal, Durban, South Africa. Ali Sié, National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso. David Guwatudde, School of Public Health, Makerere University, Kampala, Uganda. Yemane Berhane, Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. Adom Manu, Department of Population, Family, and Reproductive Health, University of Ghana, Accra, Ghana. Jan A.C. Hontelez, Erasmus Universitair Medisch Centrum, Rotterdam, The Netherlands. Magda Rosenmöller, Center for Research in Healthcare Innovation Management, IESE Business School, Barcelona, Spain. Irene Brandt, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Psychiatry and Psychotherapy, (Campus Charité Mitte) Charité – Universitätsmedizin Berlin, Germany. Ina Danquah, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany; Transdisciplinary Research Area (TRA) Sustainable Feature, University of Bonn, Germany; Center for Development Research (ZEF), University of Bonn, Bonn, Germany. Matthias Kern, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. Joy Mauti, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. Shannon McMahon, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. Japhet Killewo, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Amani Tinkasimile, Africa Academy for Public Health, Dar es Salaam, Tanzania. Mashavu Yussuf, Africa Academy for Public Health, Dar es Salaam, Tanzania. Innocent Yusufu, Africa Academy for Public Health, Dar es Salaam, Tanzania. Laetitia Paumard, Center for Research in Healthcare Innovation Management, IESE Business School, Barcelona, Spain. Millogo Ourohiré, National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso. Jabulani Ncayiyana, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. Bruno Sunguya, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Tiwatayo Lasebikan, Center for Research in Healthcare Innovation Management, IESE Business School, Barcelona, Spain. Marina Taonda, National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso. Sylvain Somé, National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso. Katian Napon, National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso. Moussa Ouédraogo, National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso.

Funding

This study was under the ARISE-NUTRINT project and was funded by the European Union Horizon 2022 (Nr. 101095616). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them.

Author information

Authors and Affiliations

  1. Center for Health, Exercise and Sport Sciences, Public Health Nutrition Division, Belgrade, Serbia

    Marijana Ranisavljev & Sergej M. Ostojic

  2. Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia

    Marijana Ranisavljev & Sergej M. Ostojic

  3. Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany

    Adi Lukas Kurniawan, Erick Agure, Christine Neumann, Fiona Walsh & Till Bärnighausen

  4. Transdisciplinary Research Area (TRA) “Technology and Innovation for Sustainable Futures” and Center for Development Research (ZEF), Rheinische Friedrich-Wilhelms University of Bonn, Bonn, Germany

    Adi Lukas Kurniawan & Erick Agure

  5. Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, 02120, USA

    Elisabetta Ferrero, Sachin Shinde, Shuangyu Zhao, Uttara Partap, Wafaie W. Fawzi & Till Bärnighausen

  6. Center for Inquiry Into Mental Health, Pune, Maharashtra, India

    Sachin Shinde

  7. Vanke School of Public Health, Tsinghua University, Beijing, China

    Shuangyu Zhao

  8. Research Division, University of KwaZulu-Natal, Durban, South Africa

    Ntombizodumo Mkwanazi

  9. Developmental, Capable and Ethical State Division, Human Sciences Research Council (HSRC), Pretoria, South Africa

    Ntombizodumo Mkwanazi

  10. National Institute of Public Health, Nouna Health Research Center, Nouna, Burkina Faso

    Noubar Clarisse Dah

  11. Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia

    Hanna Y. Berhane

  12. Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana

    Deda Ogum Alangea

  13. Department of Psychiatry and Psychotherapy (Campus Charité Mitte), Charité – Universitätsmedizin, Berlin, Germany

    Shuyan Liu

  14. German Center for Mental Health (DZPG), Berlin, Germany

    Shuyan Liu

  15. Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway

    Sergej M. Ostojic

  16. Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Wafaie W. Fawzi

  17. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Wafaie W. Fawzi

  18. Africa Health Research Institute, Durban, South Africa

    Till Bärnighausen

Authors
  1. Marijana Ranisavljev
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  2. Adi Lukas Kurniawan
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  3. Elisabetta Ferrero
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  4. Sachin Shinde
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  5. Shuangyu Zhao
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  6. Uttara Partap
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  7. Ntombizodumo Mkwanazi
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  8. Noubar Clarisse Dah
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  9. Erick Agure
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  10. Hanna Y. Berhane
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  11. Christine Neumann
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  12. Deda Ogum Alangea
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  13. Shuyan Liu
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  14. Sergej M. Ostojic
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  15. Wafaie W. Fawzi
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  16. Fiona Walsh
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  17. Till Bärnighausen
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Consortia

ARISE-NUTRINT collaborators

  • Michael Laxy
  • , Jacob Burns
  • , Mary Mwanyika Sando
  • , Ayoade Oduola
  • , Mosa Moshabela
  • , Ali Sié
  • , David Guwatudde
  • , Yemane Berhane
  • , Adom Manu
  • , Jan A.C. Hontelez
  • , Magda Rosenmöller
  • , Irene Brandt
  • , Ina Danquah
  • , Matthias Kern
  • , Joy Mauti
  • , Shannon McMahon
  • , Japhet Killewo
  • , Amani Tinkasimile
  • , Mashavu Yussuf
  • , Innocent Yusufu
  • , Laetitia Paumard
  • , Millogo Ourohiré
  • , Jabulani Ncayiyana
  • , Bruno Sunguya
  • , Tiwatayo Lasebikan
  • , Marina Taonda
  • , Sylvain Somé
  • , Katian Napon
  •  & Moussa Ouédraogo

Contributions

MR, ALK, EF, SS, UP, and SZ contributed to the methods and supported the drafting, editing, and finalizing of the manuscript. SS conceived the idea and developed the methods. MR and ALK contributed meaningfully to the design of the search strategy. MR, ALK, EF, SS, UP, NM, NCD, EA, and HYB screened titles and abstracts. MR, ALK, EF, SS, UP, and SZ screened full texts and extracted data. ALK, MR, EF, and SZ wrote the manuscript. CN, SL, SMO, DOA, WWF, FW, TB, and ARISE-NUTRINT collaborators supervised and reviewed the manuscript. All authors approved the final manuscript.

Corresponding authors

Correspondence to Adi Lukas Kurniawan or Sachin Shinde.

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Ranisavljev, M., Kurniawan, A.L., Ferrero, E. et al. Community-based interventions addressing multiple forms of malnutrition among adolescents in low- and middle-income countries: a scoping review. Nutr J 24, 69 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12937-025-01136-2

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Nutrition Journal

ISSN: 1475-2891

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