Table 1 Characteristics of the included studies on community-based interventions targeting nutrition and physical activity for adolescents
No | Author (year), country | Study design | Participants characteristics | Description of intervention | Delivery mechanism | Comparator | Summary findings | ROB |
|---|---|---|---|---|---|---|---|---|
Micronutrients supplementation | ||||||||
1 | Ahmed (2001), Bangladesh [23] | RCT | Participants: n = 480 Age range: 14–19 years Gender: women | Multimicronutrient supplementation Intervention I: vitamin A (2.42 mg) tablets Intervention II: iron (120 mg) and folic acid (3.5 mg; IFA) tablets Intervention III: IFA plus vitamin A tablets Duration: 12 weeks Frequency: weekly Follow-up: immediately postintervention | Supplements are given in garment factories either before or after lunch Delivery agent(s): Field staff | Placebo | - Significant increase in haemoglobin in the IFA supplement group than in the placebo group - Significant increase in haemoglobin concentration in the IFA plus vitamin A supplements group versus the IFA supplement group | Low |
2 | Bansal (2016), India [24] | RCT | Participants: n = 446 Age range: 11–18 years Gender: women | Multimicronutrient supplementation (IFA (100 mg iron and 500 mcg folate) and 500 mcg cyanocobalamin for 6 weeks and 15 mcg for 20 weeks) tablets Duration: 26 weeks Frequency: weekly Follow-up: immediately postintervention | Door-to-door weekly delivery of supplements Delivery agent(s): Investigator | IFA and a placebo | - Prevalence of vitamin B12 deficiency reduced in the intervention group; no change in the B12 deficiency in the control group - A significant reduction in the prevalence of serum ferritin deficiency in the intervention group, compared to the control group | Low |
3 | Beasley (2000), Tanzania [25] | RCT | Participants: n = 119 Age range: 12–18 years Gender: women | Iron (400 mg ferrous sulfate) tablets Duration: 16 weeks Frequency: weekly Follow-up: immediately postintervention | Not reported | Cyanocobalamin tablets | - Significant increase in serum ferritin, but not in haemoglobin in the intervention group compared to the control group | Some concerns |
4 | Correia-Santos (2011), Brazil [26] | RCT | Participants: n = 36 Age: mean age 16 years in the control group and 17 years in the intervention group Gender: women | Multimicronutrient supplementation (18 mg iron, 15 mg zinc, 2 mg copper, 162 mg calcium, and other vitamins and minerals) tablets Duration: 15 weeks Frequency: daily Follow-up: at 7, 11, and 15 weeks | Not reported | Placebo | - Significant increase in haemoglobin and zinc concentrations in the intervention group at 11 and 15 weeks compared to the control group - Significant increase in plasma calcium in the intervention group at 11 weeks compared to the control group - Reduction in copper concentration in the placebo group at 7 and 11 weeks | High |
5 | Gunaratna (2015), Tanzania [27] | RCT | Participants: n = 561 Age range: 15–29 years Gender: women | Multimicronutrient supplementation Intervention I: IFA (iron 30 mg and folic acid 0.4 mg) tablets Intervention II: Multivitamin (vitamin A 2500 IU, vitamin B1 1.4 mg, vitamin B2 1.4 mg, vitamin B6 1.9 mg, vitamin B12 2.6 mg, niacin 18 mg, vitamin C 70 mg, vitamin E 10 mg) and IFA tablets Duration: 6 months Frequency: daily Follow-up: immediately postintervention | Supplements are dispensed during monthly home visits Delivery agent(s): Research staff | Folic acid tablets | - No difference in haemoglobin levels across study arms - Compared to the folic acid regimen, a lower risk of hypochromic microcytic anaemia in the two intervention groups | Low |
6 | Handiso (2021), Ethiopia [28] | RCT | Participants: n = 226 Age range: 10–19 years Gender: women | IFA tablets (60 mg iron and 0.4 mg folic acid) Duration: 3 months Frequency: weekly Follow-up: immediately postintervention | IFA tablets are provided every weekend through household visits Delivery agent(s): Nurses and supervisors | No intervention | - Significant increase in haemoglobin, serum ferritin, and serum folate concentrations in the intervention group compared to the control group after 3 months of supplementation | Low |
7 | Kumar (2023), India [29] | RCT | Participants: n = 520 Age range: 11–18 years Gender: women | Micronutrient supplementation Intervention I: weekly IFA (100 mg iron, 500 mg folate) tablets Intervention II: weekly IFA and vitamin C (25 mg) tablets Duration: 6 months Frequency: weekly Follow-up: midpoint and immediately postintervention | Community health workers provided tablets to the participants at the healthcare center Delivery agent(s): Healthcare workers | Daily IFA tablets | - Significant increase in haemoglobin levels in the weekly IFA supplementation group compared to the daily IFA supplementation group - A higher increase in haemoglobin levels with vitamin C supplementation than with only IFA supplementation | High |
8 | Kanani (2000), India [30] | CRCT | Participants: n = 203 (from 3 clusters) Age range: 10–18 years Gender: women | IFA tablets (60 mg iron and 0.5 mg folic acid) Duration: 3 months Frequency: daily Follow-up: immediately postintervention | Tablets delivered through community-based youth project Delivery agent(s): Researchers | Placebo | - An increase in haemoglobin levels in the intervention group and a slight decrease in the placebo group - A significant weight gain (0.83 kg) among girls in the intervention group | Some concerns |
9 | Lopez-de-Romana (2006), Peru [31] | CRCT | Participants: n = 866 households Age range: 12–44 years Gender: women | Multi-micronutrient supplementation by Nutrivit capsules (iron 30 mg, zinc 20 mg, vitamin A 4 mg, vitamin C 60 mg, and folic acid 0.7 mg) Duration: 8 weeks Frequency: 2 RDAs Follow-up: immediately postintervention | Distribution of blister packs of four capsules to households Delivery agent(s): Healthcare staff and facilitators | No intervention | - No significant increase in the mean haemoglobin concentration among adolescents and women in the intervention group - Significantly lower haemoglobin concentration among adolescents and women in the control group - No effect of supplementation on the mean BMI between groups | Some concerns |
10 | Sharieff (2008), Benin [32] | CRCT | Participants: n = 339 (from 161 households) Age range: 11–15, 15–44 years Gender: women | The use of two different forms of iron cooking pots on anaemia Intervention I: cast iron pots Intervention II: blue steel pots Duration: 6 months Frequency: Not reported Follow-up: 12 follow-up visits (once every two weeks) | Home visits Delivery agent(s): Fieldworkers and trained technicians | Daily iron tablets (60 mg iron for 3 months and 30 mg iron for another 3 months) | - No significant differences in haemoglobin concentrations among groups - Higher serum ferritin concentrations in the control group compared with the groups using iron pots | Low |
Nutrition education, workshop, or training | ||||||||
11 | Creed-Kanashiro (2000), Peru [33] | RCT | Participants: n = 121 Age range: 12–17 years Gender: women | An education campaign to improve the menus of the community kitchens and to provide low-cost heme sources of iron and dietary enhancers Duration: 9 months Frequency: Not reported Follow-up: immediately postintervention | Training sessions, distribution of education materials including school folders, pencil cases, T-shirts, posters, recipe booklets, and mobile promoting iron-rich foods Delivery agent(s): Community Kitchen leaders and members | No intervention | - Significant increase in total daily iron intake, intake of heme iron, and total ascorbic acid in the intervention group compared to the control group - No significant change in anaemia prevalence among the intervention group participants in post-intervention | High |
12 | Ferguson (2021), Jamaica [34] | RCT | Participants: n = 92 Age range: 12 years Gender: men and women | JUS Media programme: a food-focused media literacy intervention comprising a workshop on a healthy diet, remote acculturation, and media literacy principles related to food advertising Duration: 6 months Frequency: 90 min and weekly workshop Follow-up: T1 – T4 (baseline, after workshop 1, after workshop 2, immediately following SMS phase) | Face-to-face interactive workshops and SMS messages to reinforce workshop content Delivery agent(s): Jamaican institution | No intervention | - Significant increase in nutrition knowledge among intervention group participants compared to control group participants - Participants in the intervention group were more prepared to eat vegetables and fruits daily than the control group participants | High |
13 | Wiafe (2023a)a, Ghana [35] | RCT | Participants: n = 137 Age range: 10–14 years Gender: men and women | Nutrition education and counseling related to the importance of iron in adolescent health, sources of iron-rich foods, iron-enhancing foods, iron-inhibiting foods, and proper hygiene Duration: 6 months Frequency: monthly for 45 min (education) or every two/three weeks for 30 min (counseling) Follow-up: immediately postintervention | Home visits (counseling), face-to-face interactions, and telephone calls (education and counseling) Delivery agent(s): Registered dietitians and nutritionists | No intervention | - No statistically significant difference between the study groups in terms of underweight, haemoglobin, and dietary iron intake except for vitamin C intake - Reduced prevalence of anaemia, low ferritin levels, inadequate dietary iron, and vitamin C in all groups, with the most significant improvements observed in the intervention group - Higher mean dietary iron in the intervention group compared with the control group - Higher mean haemoglobin and vitamin C levels in the control group than in the intervention group | Some concerns |
14 | Hewett (2020), Zambia [36] | CRCT | Participants: n = 2660 (from 10 clusters) Age range: 10–19 years Gender: women | Adolescent Girl’s Empowerment Program with nutrition curriculum education: nutrition needs for adolescent girls, the role of food in the body, anaemia in adolescent girls, nutrition for pregnant adolescents, infant feeding from birth through six months, and young child feeding and growth monitoring Duration: 2 years Frequency: 1–2 h weekly Follow-up: 1 year after the program was completed | Group meetings with illustrative vignettes, role play, and participatory methods at local community space Delivery agent(s): Older and young women as mentors | Without nutrition curriculum | - Exposure to the nutritional curriculum had limited influence on nutritional knowledge, behavior, or outcomes | Low |
15 | Inacio (2022), Brazil [37] | CBA | Participants: n = 245 Age range: 5–14 years Gender: men and women | Using ‘Intuitive Method’ to conduct interventions that focused on four main topics: (1) classifying food choices, (2) promoting adequate and healthy eating through a cooking workshop, (3) eating and commensality through dramatization, and (4) identifying and overcoming barriers to maintaining a healthy and adequate diet using film session Duration: 3 months (institution A) and 6 months (institution B) Frequency: ranging from 40–120 min for each activity Follow-up: immediately postintervention | Lectures with slides in a classroom Delivery agent(s): Not reported | Standard education | - Decreased ultra-processed food intake and greater self-efficacy with cooking among the intervention group participants compared to control group participants | Serious |
16 | Jefrydin (2020), Malaysia [38] | CBA | Participants: n = 125 Age range: 13–14 years Gender: men and women | Instagram-based nutrition labeling education Duration: 12 weeks Frequency: weekly Follow-up: immediately postintervention | Instagram messages using infographics and short videos Delivery agent(s): Researchers | No intervention | - Significant changes in intervention participants’ attitudes and practices on nutrition labels but no significant effect on nutrition knowledge | Serious |
17 | Wiafe (2023b)a, Ghana [39] | CBA | Participants: n = 137 Age range: 10–14 years Gender: men and women | Nutrition education and counseling program: Nutrition education focused on the importance of iron in adolescent health, sources of iron-rich foods, and proper hygiene and included 30-min counseling sessions on dietary habits for adolescents and guardian Duration: 6 months Frequency: monthly for 30–45 min Follow-up: immediately postintervention | Nutrition education delivered through group discussions, leaflets, charts, and posters Delivery agent(s): Dieticians and nutritionists | No intervention | - Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group | Moderate |
18 | Dyke (2021), Madagascar, Philippines, Sri Lanka, Tanzania [40] | Formative evaluation (qualitative) | Participants: n = 303 Age range: 6–19 years Gender: women | Girl-Powered Nutrition program: nutrition education (curriculum) through a nutrition badge activity and community mobilization through community action initiatives Duration: 2 years Frequency: varies in each country, mostly twice a month, with meetings lasting 1–2 h Follow-up: not reported | Multi-mode strategy, including education, advocacy, and events Delivery agent(s): Advocacy champions, community members, local partners, adult leaders, and regional commissioner of the World Association of Girl Guides and Girl Scouts | Not applicable | - Intervention activities perceived as helpful to keep the girls’ focus (especially the younger group) and their interest and enhance their understanding of nutrition and diet quality, physical activity, and healthy lifestyle | - |
19 | Januraga, (2020) Indonesia [41] | Qualitative evaluation | Participants: n = 37 Age range: 16–19 years Gender: women | Pretty and Picky social media campaign: an online and offline campaign (articles, recipes, and photos) to promote healthy food choices Duration: 2 months Frequency: 40–90 min each interview Follow-up: not reported | Social media campaign (website, Instagram, Facebook, Line, and YouTube), focus group discussion, and in-depth interviews Delivery agent(s): Not mentioned | Not applicable | - Intervention perceived as beneficial for increasing participants’ knowledge and awareness of healthy diets and the health risks of unhealthy diets, as well as improving their motivation to change their behavior and avoid foods containing salt, sugar, and excess fat | - |
Physical activity education | ||||||||
20 | Sriramatr (2014), Thailand [42] | RCT | Participants: n = 220 Age range: 18–24 years Gender: women | Internet-based intervention to promote physical activity: Use of a website to record physical activity, set physical activity goals, and identify self-efficacy and outcome expectations on those goals Duration: 3 months Frequency: weekly Follow-up: postintervention and 3 months after intervention ended | Intervention content delivered via website and emails Delivery agent(s): Not reported | No intervention | - Higher steps/day, a greater leisure time activity score, and a lower resting heart rate among participants in the intervention group than those in the control group - Significantly higher self-efficacy, outcome expectations, and self-regulation among intervention group participants than those in the control group | Some concerns |
21 | Van Bavel (2014), Bulgaria [43] | RCT | Participants: n = 1,200 Age range: 16–24 years Gender: men and women | Using online social-normative messages to measure intention to engage in physical activity Intervention I: Positive normative messages Intervention II: Negative normative messages Duration: one-time survey Frequency: one-time survey Follow-up: not reported | Online administration of the questionnaire Delivery agent(s): Study staff | Without being exposed to social-normative messages | - Significant and positive - effect on intention to be physically active among both the positive and negative normative messages group participants - No difference between the effects of the messages | Some concerns |
Food supplementation and fortification | ||||||||
22 | Adewusi (2006), Niger [44] | RCT | Participants: n = 55 Age range: 15–30 years Gender: men and women | A diet incorporating 15% and 25% of Acacia colei seed flour was mixed with millet, sorghum, and maize flour were given to the participants Duration: 3 weeks Frequency: 3 meals were served each day Follow-up: not reported | Three groups were housed and ate separately but adjacent to one another for the duration of the trial Delivery agent(s): supervisors | 0% of Acacia colei seed flour | - Significant increase in BMI and mid-arm circumference for volunteers on acacia-incorporated diets but not for the control diet | High |
23 | Chopra (2018), India [45] | RCT | Participants: n = 167 Age range: 14–35 years Gender: women | A cooked snack containing green leafy vegetables (25 g), dried fruits (4 g), and whole milk powder (12 g) Duration: 12 weeks Frequency: daily Follow-up: immediately postintervention | Snacks were administered in centers close to the participants’ homes Delivery agent(s): Study kitchen workers | A snack containing foods of lower micronutrient content, such as potato and onion | - No statistically significant differences in the change of intakes of green leafy vegetables, pulses, and legumes or total ALA-rich food between study groups | Some concerns |
24 | Gupta (2022), Pakistan [46] | CRCT | Participants: n = 517 (from 486 households and 34 clusters) Age range: 10–16 years Gender: women | Providing zinc-biofortified wheat flour (Zincol- 16) Duration: 25 weeks Frequency: every 15 days Follow-up: midpoint and immediately postintervention | Participants collected the flour from a distribution point Delivery agent(s): Not reported | Non-biofortified wheat flour | - Increase in zinc intake among the intervention group but no significant effect on plasma zinc concentration | Some concerns |
25 | Kehoe (2015), India [47] | RCT | Participants: n = 222 Age range: 14–35 years Gender: women | Snack supplementation contained green leafy vegetables (25 g), dried fruit (10 g), and whole milk powder (12 g) Duration: 12 weeks Frequency: daily Follow-up: immediately postintervention | Participants visited the local community center six times per week to receive snacks Delivery agent(s): Local community center | Control snack group containing potato, sago, or tapioca | - Significant increase in β-carotene concentrations in the intervention group compared to the control group - No differences in concentrations of ferritin, retinol, ascorbate, folate, or vitamin B12 between the intervention and control groups | Some concerns |
26 | Mendez (2012), Mexico [48] | RCT | Participants: n = 131 Age range: 12–17 years Gender: women | Fortified milk with zinc (11 mg/100 g) and other micronutrients Duration: 27 days Frequency: 2 servings of 250 mL per day Follow-up: immediately postintervention | Not reported Delivery agent(s): Study staff | Consumed regular diet | - No significant differences in energy and protein intake between groups - High intake in zinc intake and plasma zinc in the intervention group than the control group | High |
27 | Villamor (2023), Colombia [49] | RCT | Participants: n = 80 Age range: 12–14 years Gender: men and women | Fortified skim milk with cholecalciferol (2400 IU or 60 μg) Duration: 6 weeks Frequency: daily Follow-up: midpoint and immediately postintervention | Milk was packed in plastic bags of 1-L capacity with light-blocking overwrap and distributed through home visits Delivery agent(s): Research assistants | Unfortified skim milk | - Significant increase in total 25(OH)D concentrations in the intervention group and a decrease in the control group | Low |
28 | Rahman (2015), Bangladesh [50] | CRCT | Participants: n = 334 (from 44 households) Age range: 6–15 years Gender: men and women | Supplementation via wheat flour chapatti fortified with micronutrients (including 66 mg hydrogen-reduced elemental iron and 3030 mg retinol equivalent as retinyl palmitate per kilogram of flour) Duration: 6 months Frequency: weekly Follow-up: midpoint and immediately postintervention | Project staff distributed the flour to the “clusters”, and"mothers"prepared the chapatti for the children."Adults in clusters"checked the consumption and compliance Delivery agent(s): Project staff, mothers, and adults in clusters | Wheat flour without micronutrients | - Micronutrient-fortified wheat flour chapatti increased serum retinol concentration post-intervention - No demonstrable effect of fortified chapatti consumption on iron status, haemoglobin levels, and anaemia | Some concerns |
Behavior (lifestyle) intervention | ||||||||
29 | Richard (2014), Uganda [51] | Mixed methods | Participants: n = 1,350 Age range: 11–14 years Gender: men and women | Competitive football league to promote physical activity Duration: 11 weeks Frequency: weekly for 40 min Follow-up: immediately postintervention | All intervention activities took place at the two most central sports fields Delivery agent(s): six paid staff and 32 volunteer adults as coaches | Waitlist control group and non-registered for the intervention control group | - No impact of the intervention on fitness and a negative effect on - the mental health of participating boys - No significant effect of the intervention on any outcomes for girls | Low |
Multi-component intervention | ||||||||
30 | Ahmad (2018), Malaysia [52] | RCT | Participants: n = 134 Age range: 8–11 years Gender: men and women | REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) intervention: Family-based intervention using social media with the topics of nutrition, physical activity, and behavior modification techniques Duration: 4 months Frequency: weekly training for 4 weeks and 3 months of weekly boosters Follow-up: 3 months and 6 months postintervention | Sessions delivered Face-to-face, via Facebook, and WhatsApp messaging Delivery agent(s): Public health physicians, sports medicine specialists, and trained research assistants | Waitlist group | - Significant reduction in BMI z-scores among all children (overweight and obese) and obese subgroup - Significant reduction in waist circumference percentile and body fat percentage among overweight and obese subgroup of the intervention arm compared with the wait-list arm | Low |
31 | Kumar (2014), India [53] | CRCT | Participants: n = 646 (from 3 villages) Age range: 5–15 years Gender: Not reported | Intervention I: deworming, salt fortification Intervention II: deworming, health education Duration: 8 months Frequency: monthly Follow-up: immediately postintervention | Salt and education were provided each month Delivery agent(s): Not reported | No intervention, but received deworming | - Non-significant increase in haemoglobin in the intervention groups compared with the control group - Improved ferritin, body iron stores, and retinol in the intervention groups compared to the control group | Some concerns |
32 | Kumar (2021), India [54] | CRCT | Participants: n = 212 (from 6 villages) Age range: 5–17 years Gender: men and women | Deworming, educational film on the role of micronutrients in human health, and salt enriched with micronutrients (10 g of the fortified salt contained 10 mg of chelated iron, 400 µg iodine, 4 µg vitamin B12, 100 µg folic acid, and 10 mg of zinc) Duration: 8 months Frequency: monthly Follow-up: immediately postintervention | Salt and education were provided each month Delivery agent(s): Health workers | Deworming and conventional iodized salt | - Significant increase in haemoglobin, serum zinc, ferritin, and body iron stores in the intervention group, compared to the control group - Decrease in the prevalence of anaemia and the burden of zinc deficiency in the intervention group relative to the control group | Some concerns |
33 | Bhatia (2023), India [55] | CRCT | Participants: n = 1,478 (from 38 clusters) Age range: 10–19 years Gender: women | Participatory learning and action (PLA) activities on education, nutrition, gender equity, and health; youth leadership sports activities; and practical livelihood promotion Duration: 33 months Frequency: PLA is held monthly, youth leadership is held every two months, and livelihood promotion is held every three months Follow-up: immediately postintervention | In-person meetings and training Delivery agent(s): Female and male peer facilitators called yuva saathi (friend of youth) | Practical livelihood promotion only | - No intervention effects on the dietary diversity score - No change in the prevalence of anthropometric status of the study participants | High |
34 | Parvin (2022), Iran [56] | CRCT | Participants: n = 2,145 (from 3 clusters) Age range: 4–18 years Gender: men and women | Lifestyle intervention related to diet, physical activity, and smoking Duration: 3 years Frequency: multiple times a year Follow-up: continuous for 17 years | Family-based through group sessions, education, consultation, slides and video presentation, newsletter, and pamphlets/booklets Community-based through social and religious gatherings Delivery agent(s): Health liaisons | No intervention | - Significant impact of the intervention on young overweight adults and at-risk obese young children | High |
35 | Fotu (2011), Tonga [57] | CBA | Participants: n = 2,479 Age range: 11–19 years Gender: men and women | Used social marketing approaches, community capacity building, and grassroots activities to promote healthy behaviors, including eating breakfast, increasing water, fresh fruit, and vegetable consumption, participation in organized sports and physical activity during and after school, and reducing sweet drink consumption and sedentary activities Duration: 3 years Frequency: varied between community Follow-up: 12 months postintervention | Coaching sessions in the community Delivery agent(s): Project committee | No intervention | - Similar and large increase in the prevalence of overweight and obesity in both intervention and control groups - Small decrease in the percentage of body fat in the intervention group and no differences in other anthropometric outcomes between groups | Serious |
36 | Kremer (2011), Fiji [58] | CBA | Participants: n = 2,948 Age range: 13–18 years Gender: men and women | Capacity building to promote healthy eating, breakfast, regular physical activity, and reduce overweight and obesity Duration: 3 years Frequency: not reported Follow-up: immediately postintervention | In settings such as road traffic control offices and religious institutions Delivery agent(s): Local admin (e.g. road traffic control officers, staff in religious institutions) | No intervention | - No significant differences in weight or BMI between groups - Significant reduction in the percentage of body fat among intervention group participants compared to the control group | Serious |
37 | Rao (2014), India [59] | Mixed methods | Participants: n = 317 Age range: 15–35 years Gender: women | Health and nutrition education and counseling (related to anaemia, the importance of macro- and micronutrients, seasonal fruits rich in vitamin C), iron-rich recipe demonstration, distribution of green leafy vegetables, deworming tablets, and iron supplementation Duration: 1 year Frequency: once/fortnight for meetings, monthly for demonstration, and weekly for home visits Follow-up: immediately postintervention | In-person meetings, recipe demonstrations, and home visits Delivery agent(s): Physicians, nutritionists, study technicians, and community health workers | Same intervention but without iron supplementation | - Significant increase in haemoglobin among participants who attended more than 50% of the meetings or repeated more than 50% of the recipes at home in the non-supplemented group; smaller haemoglobin increase in the supplementation group than non-supplemented group | High |