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Adolescent nutrition in Nigeria: a systematic review

Published online by Cambridge University Press:  18 September 2024

Theophilus Sunday Gabriel
Affiliation:
Faculty of Health Sciences, University of Debrecen, Nyíregyháza, Hungary
Mohammed Kasim
Affiliation:
Department of Animal Health and Production Technology, Yobe State College of Agriculture, Science and Technology Gujba, Damaturu, Yobe, Nigeria
Francis Adah Oluma
Affiliation:
Faculty of Health Sciences, University of Debrecen, Nyíregyháza, Hungary
Taulant Muka
Affiliation:
Epistudia, Bern, Switzerland
Erand Llanaj*
Affiliation:
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany German Centre for Diabetes Research (DZD), München, Germany
*
*Corresponding author: Dr. Erand Llanaj, email: erand.llanaj@dife.de

Abstract

In this systematic review, we scrutinise adolescent nutrition in Nigeria, focusing on dietary patterns, intake, and nutritional status. Through a systematic examination of observational studies across three major databases, we analysed data from 67,844 adolescents. Our exploration revealed 102 studies, predominantly cross-sectional, addressing various nutritional dimensions. However, only 13% of these studies demonstrated low risk of bias, with none offering national representation and most concentrated in specific, school-based regions. The findings underscore a complex nutritional landscape with widespread malnutrition and highlight the critical need for high-quality, comprehensive data. The dominance of cross-sectional designs and regional biases in existing research calls for cautious interpretation and suggests a pressing need for more robust, nationally representative studies to guide future nutritional interventions and policy-making in Nigeria.

Type
Review
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

Introduction

Promoting health and well-being of adolescents in low- and middle-income countries (LMICs) is a global health priority, given that they account for more than 90% of the world’s 1.2 billion adolescent population.(1) This age group, spanning from 10 to 19 years, represents a unique life period marked by physical, cognitive, psychosocial and emotional changes. The health needs of adolescents, particularly those living in LMIC, are distinct from other age groups and overlooking this can have lasting impacts on growth and development of future generations. Thus, adolescence offers a window of opportunity for interventions that can greatly shape health outcomes later in life and foster a sustainable and equitable future for societies.

Recognising the importance of this life phase, the United Nations Sustainable Development Goals (SDGs) explicitly mention adolescence in 12 health-related SDG indicators.(2) Research has further reinforced the role of nutrition on adolescent growth and development, the influence of the food environment on their food choices and which interventions might lead to healthier nutrition and growth.(Reference Norris, Frongillo and Black3) These efforts have renewed the interest in investing in nutrition - a major modifiable risk factor with significant implications for public health.(Reference Afshin, Fay and Cornaby4) Indeed, large prospective human studies have shown that nutritional status in adolescence is a strong predictor of adult cardiovascular health.(Reference Twig, Yaniv and Levine5)

However, in LMIC settings usually, adolescents have limited control over their food choices. In Nigeria, the limited investment in nutritional research, particularly regarding adolescent nutrition, poses a great challenge in monitoring the state and trajectories of nutrition indicators across regions and over time.(Reference Samuel6) Nevertheless, such nutrition surveillance data can be a valuable guide for formulating policies and interventions tailored to this demographic group. According to the latest Global Nutrition Report 2022, Nigeria has only made slight progress towards diet-related non-communicable disease (NCD) targets.(7) Given the effects of the post-pandemic era and the ongoing influence of food prices on household finances, along with the challenges pertaining to food affordability, accessibility of nutritious diets and livelihoods, a careful assessment of the state of adolescent nutrition in Nigeria is warranted.(Reference Osendarp, Verburg and Bhutta8)

Therefore, high-quality evidence on Nigerian adolescent nutrition can inform tailored solutions and support better nutrition and health. Findings and insights can also be used as an invaluable tool in shaping the development and establishment of evidence-based guidelines and nutrition surveillance systems for monitoring dietary risks among Nigerian adolescents. Taking this into account, we conducted a systematic review aiming to comprehensively summarise and examine the state of adolescent nutrition in Nigeria, including dietary intake profile, habits and nutritional status.

Methods

This work was carried out in accordance with established guides for conducting evidence syntheses for medical and health research,(Reference Muka, Glisic and Milic9,Reference Glisic, Raguindin and Gemperli10) as well as PRISMA guidelines for reporting findings from systematic reviews and meta-analyses.(Reference Moher, Liberati and Tetzlaff11) We systematically searched three electronic databases namely: PubMed, Web of Science and Google Scholar, from inception to March 6, 2023. The protocol of this work is registered in the international prospective register of systematic reviews (PROSPERO) with identification code CRD42023399668.

Selection of studies

Studies were considered for inclusion if they met the following criteria: (i) carried out in Nigeria, (ii) included adolescents between the ages of 10–19 years and (iii) reported dietary intake, patterns, adherence to a healthy diet, and/or nutritional status (i.e. anthropometry and other related measures). Only observational studies were considered for inclusion. There have been recent proposals(Reference Sawyer, Azzopardi and Wickremarathne12) to extend the definition of adolescence from 10–19 years to 10–24 years, noting delays in the transition age to adult roles (e.g. marriage and parenthood) in many societies as the main motivation. However, in this work, we use the definition of 10–19 years. Studies were not included if: (i) they were not conducted in Nigeria and (ii) did not report any nutrition-related indicator (e.g. nutritional status, dietary intake or adherence to healthy diet standards). In addition, we did not consider case studies/reports, letters to the editor, conference proceedings, posters, abstracts, reviews or preprints.

Data extraction

Three reviewers independently evaluated the titles and abstracts according to the inclusion and exclusion criteria. For each eligible study, three reviewers assessed the full-text. In cases of disagreement, a decision was made by consensus or, when necessary, a fourth reviewer was consulted. Information was extracted from studies in triplicate and was categorised according to the following variables: study design, study area (region, state), target population, age, sex, sample size, setting, dietary assessment tool used, journal details, intake of macro- and micro-nutrients, etc.

Quality assessment of included studies

We evaluated the methodological rigour of included studies using the Joanna Briggs Institute (JBI) corresponding tool for assessing methodological quality of studies and provided answers to the relevant questions, based on study design.(Reference Briggs13) Detailed assessment can be found in supplementary Table S4. The methodological quality was rated on a scale of maximum 8 points. Based on this evaluation, studies were classified as ‘low risk of bias’ (>= 7 points), ‘some concerns’ for bias (>=4 points), and ‘high risk of bias’ (< 4 points). We included all studies in the synthesis, irrespective of their JBI evaluation classification.

Data synthesis

We synthesised the extracted data from each study and described the information on dietary assessment tool and/or nutritional status (e.g. anthropometry classification) for the target group (10–19 years) with no discrimination to setting (e.g. in school or out of school), location or sex. We extracted primary and composite anthropometric parameters, and dietary intake in comparison to internationally established reference values and the primary aims of each included study were reported. Nutrient, energy and other metrics were converted to same units (e.g. energy in kcal, protein intake in grams, etc.). We also report the food and food group consumption and dietary habits among Nigerian adolescents. In order to show the nutritional status trends over time a summary of results from studies reporting anthropometric indicators ordered by year of publication was produced using R Studio 2022.07.2 Build 576 (Fig. 2). Data used to produce this figure can be found in supplementary Table S3.

Fig. 1. PRISMA flowchart.(Reference Page, McKenzie and Bossuyt14)

Results

Based on the systematic search (Fig. 1), we retrieved 238 articles from Web of Science and 542 from PubMed search engines. In Google Scholar, the first 200 results were considered. Supplementary Table S1 outlines the search strategy and strings used for each database. Based on the bibliographic searches, 980 records were retrieved in total. Following deduplication and merging 837 studies were left. 302 studies were excluded after title and abstract screening, leaving 535 records for full-text screening. Of those, 446 studies were excluded for various reasons. Eventually, 89 studies were included for qualitative synthesis. In addition, 34 studies were found after screening the reference lists of the 89 studies included in the qualitative synthesis. Of these 34 records, only 13 studies were eligible to be added to the previous 89 studies, bringing the number of studies contributing to the systematic review to 102 records.

Fig. 2. Summary of the individual studies reporting anthropometric indicators over time.

Table 1 shows the characteristics of included studies. A total of 102 cross-sectional studies have been examined and reported. Sample sizes ranged from as small as 22 to as large as 7,625. Approximately half of the study sites, representing (n = 51), were located in the south-western region of the country. Conversely, the north western region was the least represented with merely 3.9% of the studies conducted there (4 out of 102 studies). A visual map with study locations and population density of all included studies is available in supplementary Fig. S1. The majority of studies (86%) included both male and female participants. Educational institutions were predominantly utilised as the research setting in over 70% (77 out of 102) of the studies. Substantial heterogeneity was observed with regards to the methodological approach to dietary assessment and anthropometric classification tools adopted in these studies. Questionnaires were the most widely employed data collection instrument, featured in nearly 81 out of 102 studies. Based on the JBI tool evaluation, 13 studies were classified as ‘low risk of bias’, representing 12.7% of the total 102 studies. Conversely, 46 studies, accounting for 45.1%, were assessed as having ‘some concerns’ for bias, while 43 studies, or 42.2%, were rated as at ‘high risk of bias’. The most commonly used dietary assessment tool was a questionnaire. Other tools included the 24-hour dietary recall, food frequency questionnaire, and diet diversity score. The administration method was predominantly self-administered or researcher-administered. Validation: There was a mixed validation status for the instruments used. While many of the questionnaires were not validated, a minority of studies used validated tools. Most of studies (84.3% or 86/102) were published in journals that were not indexed and consequently had no impact factor at the time of publication.

Table 1. Study characteristics of the studies included in the systematic review

Note: ♀, Male; ♂, Female; NR, Not Reported.

Table 2 provides a summary of anthropometric findings of nutritional epidemiology studies conducted in Nigeria among adolescents. Out of the total, sixty-six studies documented either primary or composite anthropometric measures or a combination thereof. Composite anthropometric measures encompassed various indicators such as underweight, overweight, stunting, obesity, thinness and wasting. Of note, 77.2% of the studies reported different manifestations of undernutrition, such as stunting, wasting and/or underweight. Furthermore, 68.2% of the studies indicated the prevalence of overweight and obesity, which constitute forms of over nutrition. Additionally, the height-for-age z-score (HAZ) and weight-for-age z-score (WAZ) were reported in about 39% of the studies (25 out of 66). The overall range for body mass Index (BMI, in kg/m2) across all studies that reported it, ranged from 15.7 to 24.6. Height (in metres) varied within a range of 1.2–1.7 and weight (in kilograms) ranged from 19 to 70. With regard to the prevalence of simple nutritional status phenotypes (expressed as percentages), the overall range was as follows: underweight from 2.5% to 78.3%; overweight from 1.4% to 25.2%; stunting from 2.5% to 77.1%; wasting from 1.7% to 56%; and obesity from 0.2% to 21%.

Table 2. Anthropometric findings from Nigerian nutritional epidemiology studies

Note: Values are given in percentage unless otherwise indicated.

Table 3 presents findings on food and food group consumption for Nigerian adolescents, from 29 nutritional epidemiology studies that reported consumption data for at least one food and/or food group.(Reference Afolabi, Towobola and Oguntona25Reference Agoreyo and Obuekwe27,Reference Akinola, Odugbemi and Bakare31,Reference Ayogu38Reference Bamidele, Oyenike and Olusegun40,Reference Funke and Ajayi56,Reference Ikujenlola and Adekoya60,Reference Ogunkunle and Oludele70,Reference Ogunsile71,Reference Okoro, Ogunbiyi and George74,Reference Olatona, Onabanjo and Ugbaja76,Reference Olatona, Ogide and Abikoye77,Reference Olumakaiye, Atinmo and Olubayo-Fatiregun80,Reference Onyiriuka, Ibeawuchi and Onyiriuka94Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Otemuyiwa and Adewusi101,Reference Otuneye, Ahmed and Abdulkarim102,Reference Samuel, Adenekan and Adeoye104,Reference Sanusi, Wang and Ariyo105,Reference Sholeye, Animasahun and Salako110,Reference Uba, Islam and Haque113,Reference Orisa and Wordu117Reference Ansa, Anah and Ndifon120) Starchy staples, encompassing cereals and starchy roots/tubers, emerged as a commonly consumed dietary component, were reported by eleven studies and consumption levels ranged from 28.2% to 96.7%.(Reference Afolabi, Towobola and Oguntona25,Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Ayogu38,Reference Ogunkunle and Oludele70,Reference Okoro, Ogunbiyi and George74,Reference Olatona, Onabanjo and Ugbaja76,Reference Olatona, Ogide and Abikoye77,Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Otemuyiwa and Adewusi101,Reference Uba, Islam and Haque113,Reference Orisa and Wordu117) However, only two studies reported consumption levels below 50%.(Reference Afolabi, Towobola and Oguntona25,Reference Olatona, Onabanjo and Ugbaja76) Legumes, nuts, and seeds were reported in six studies.(Reference Afolabi, Towobola and Oguntona25,Reference Ayogu38,Reference Ikujenlola and Adekoya60,Reference Ogunkunle and Oludele70,Reference Sanusi, Wang and Ariyo105,Reference Orisa and Wordu117) Similarly, consumption of meat, poultry, fish, and seafood ranged from 19.1% to 62.1%, reported in nine studies.(Reference Afolabi, Towobola and Oguntona25,Reference Ayogu38,Reference Ikujenlola and Adekoya60,Reference Ogunkunle and Oludele70,Reference Okoro, Ogunbiyi and George74,Reference Olatona, Onabanjo and Ugbaja76,Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Otemuyiwa and Adewusi101,Reference Orisa and Wordu117) Vegetable consumption was documented across eleven studies with a range from 10.1% to 83.0%, with seven studies indicating proportions below 50%.(Reference Afolabi, Towobola and Oguntona25,Reference Ayogu38Reference Bamidele, Oyenike and Olusegun40,Reference Ogunkunle and Oludele70,Reference Ogunsile71,Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Uba, Islam and Haque113,Reference Orisa and Wordu117Reference Oroniran, Olawuyi and Fadupin119) Fruit intake ranged from 9.7% to 77.4% and was reported across seventeen studies.(Reference Afolabi, Towobola and Oguntona25,Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Akinola, Odugbemi and Bakare31,Reference Ayogu38,Reference Bamidele, Oyenike and Olusegun40,Reference Ikujenlola and Adekoya60,Reference Ogunkunle and Oludele70,Reference Ogunsile71,Reference Okoro, Ogunbiyi and George74,Reference Olatona, Ogide and Abikoye77,Reference Onyiriuka, Ibeawuchi and Onyiriuka94,Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Otemuyiwa and Adewusi101,Reference Sanusi, Wang and Ariyo105,Reference Orisa and Wordu117Reference Oroniran, Olawuyi and Fadupin119) Conversely, sweets’ consumption was described in six studies(Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Ogunsile71,Reference Okoro, Ogunbiyi and George74,Reference Onyiriuka, Ibeawuchi and Onyiriuka94Reference Onyiriuka, Umoru and Ibeawuchi96) showing variation across the studies (range: 35.3–62.4%). Snacking habits were recorded and reported in ten studies (range: 33–96.8%).(Reference Funke and Ajayi56,Reference Ikujenlola and Adekoya60,Reference Ogunkunle and Oludele70,Reference Olatona, Onabanjo and Ugbaja76,Reference Olatona, Ogide and Abikoye77,Reference Olumakaiye, Atinmo and Olubayo-Fatiregun80,Reference Onyechi and Okolo93,Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Samuel, Adenekan and Adeoye104,Reference Orisa and Wordu117) Additionally, consumption of sugar-sweetened beverages was indicated in 13 studies.(Reference Agoreyo and Obuekwe27,Reference Akinola, Odugbemi and Bakare31,Reference Bamidele, Oyenike and Olusegun40,Reference Ogunsile71,Reference Olatona, Onabanjo and Ugbaja76,Reference Onyiriuka, Ibeawuchi and Onyiriuka94Reference Onyiriuka, Umoru and Ibeawuchi96,Reference Otuneye, Ahmed and Abdulkarim102,Reference Sholeye, Animasahun and Salako110,Reference Orisa and Wordu117,Reference Oroniran, Olawuyi and Fadupin119,Reference Ansa, Anah and Ndifon120) Consumption of such beverages exhibited a wide spectrum, ranging from 8.5% to 99.4%. Only two studies reported egg consumption (range: 3.3–14.3%).(Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Ayogu38)

Table 3. Food and food group-based findings

a Values are provided in percentage (%), unless otherwise indicated.

Table 4 summarises dietary intake among adolescents in Nigeria. Results show that the amount of protein (range: 27–93.5 g), energy (range: 903–5754.7 kcal) and carbohydrate (range: 82–937.60 g) consumed by majority of adolescents were inadequate(Reference Ayogu38,Reference Ene-Obong, Doh and Ikwuagwu46,Reference Ogechi, Akhakhia and Ugwunna68Reference Ogunkunle and Oludele70) also one study reported an inadequate consumption of fat (range: 6.0–157.1 g) by this age group.(Reference Ogunkunle and Oludele70) In contrast, some studies reported an excessive intake of carbohydrate, energy and protein beyond recommended nutrient intake.(Reference Ogunkunle and Oludele70,Reference Olumuyiwa, Israel and Oluwemimo82,Reference Shokunbi and Ukangwa109,Reference Tassy, Eldridge and Sanusi112) Only two studies(Reference Akinlade, Afolabi and Oguntona30,Reference Yunusa, Ahmad and Gidado116) reported on fibre intake (range: 13.1–33.1 g) among Nigerian adolescents. One of the studies showed an intake of fibre less than 20 g (when defined as no starch polysaccharide) from foods—or less than 25 g from foods (when defined as total dietary fibre)—which are also the accepted values recommended for the prevention of NCDs.(122) With regards to vitamin intake, the most commonly reported vitamins in the studies included in this systematic review are vitamin A (range: 132.4–9135.2 mg), vitamin C (range: 7.2–80.8 mg), vitamin B12 (range: 0–1.4 mg) and folate (range: 0–136.6 mg). Virtually all studies reporting them found insufficient consumption of these vitamins among adolescents.(Reference Akinlade, Afolabi and Oguntona30,Reference Akinyemi and Ibraheem32,Reference Ene-Obong, Doh and Ikwuagwu46) Information gathered also shows an inadequate intake of minerals and trace elements, particularly calcium, iron, zinc and potassium. There was a report of excessive sodium intake (2225–2404 mg compared to the recommended value of 1200–1500 mg).(Reference Shokunbi and Ukangwa109)

Table 4. Dietary intake by adolescents in Nigeria

Note: RNI, Recommended Nutrient Intake; NR, Not reported; RDA, Recommended Dietary Allowance; PUFA, Polyunsaturated fatty acids; FFQ, Food Frequency Questionnaire; DDS, Dietary Diversity Score.

Table 5 presents a summary of dietary habits among Nigerian adolescents. The studies included in the table report findings related to key dietary characteristics such as the number of meals, observing breakfast, eating lunch, eating dinner, and skipping meals. Specifically, the table includes findings from twenty-one studies.(Reference Adebimpe17,Reference Afolabi, Towobola and Oguntona25,Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Akinola, Odugbemi and Bakare31,Reference Essien, Emebu and Iseh51,Reference Ikujenlola and Adekoya60,Reference Iyalomhe, Iyalomhe and Nwadike61,Reference Ogunkunle and Oludele70,Reference Ogunsile71,Reference Olatona, Onabanjo and Ugbaja76,Reference Olumakaiye, Atinmo and Olubayo-Fatiregun80,Reference Omuemu and Oko-Oboh86,Reference Onyiriuka, Ibeawuchi and Onyiriuka94,Reference Onyiriuka, Egbagbe and Onyiriuka95,Reference Otuneye, Ahmed and Abdulkarim102,Reference Samuel, Adenekan and Adeoye104,Reference Sanusi, Wang and Ariyo105,Reference Uba, Islam and Haque113,Reference Orisa and Wordu117,Reference Onyechi and Okolo118,Reference Olatona, Oloruntola and Adeniyi123) Among these studies, nine(Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Ikujenlola and Adekoya60,Reference Iyalomhe, Iyalomhe and Nwadike61,Reference Ogunsile71,Reference Olatona, Onabanjo and Ugbaja76,Reference Olumakaiye, Atinmo and Olubayo-Fatiregun80,Reference Omuemu and Oko-Oboh86,Reference Sanusi, Wang and Ariyo105,Reference Orisa and Wordu117) reported the number of meals based on a three-square meal basis. Thirteen(Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Akinola, Odugbemi and Bakare31,Reference Ikujenlola and Adekoya60,Reference Ogunkunle and Oludele70,Reference Ogunsile71,Reference Otuneye, Ahmed and Abdulkarim102,Reference Sanusi, Wang and Ariyo105,Reference Onyechi and Okolo118) studies provided information on the proportion of participants who observe breakfast, while seven(Reference Ogunkunle and Oludele70,Reference Omuemu and Oko-Oboh86,Reference Onyiriuka, Ibeawuchi and Onyiriuka94,Reference Otuneye, Ahmed and Abdulkarim102,Reference Sanusi, Wang and Ariyo105,Reference Uba, Islam and Haque113,Reference Onyechi and Okolo118) studies reported the proportion of participants who observed lunch meal. Only one(Reference Otuneye, Ahmed and Abdulkarim102) study reported the responses of participants regarding the order of importance of meals, fasting to lose weight, using diet pills to lose weight, infrequent intake of fruits/vegetables, consuming alcohol and smoking cigarettes. Furthermore, eight(Reference Adebimpe17,Reference Afolabi, Towobola and Oguntona25,Reference Essien, Emebu and Iseh51,Reference Ikujenlola and Adekoya60,Reference Olatona, Onabanjo and Ugbaja76,Reference Onyiriuka, Ibeawuchi and Onyiriuka94,Reference Samuel, Adenekan and Adeoye104,Reference Orisa and Wordu117) studies examined fast-food consumption, and four(Reference Agofure, Odjimogho and Okandeji-Barry26,Reference Iyalomhe, Iyalomhe and Nwadike61,Reference Onyiriuka, Egbagbe and Onyiriuka95,Reference Otuneye, Ahmed and Abdulkarim102) studies investigated factors that motivate dietary intake.

Table 5. Findings on dietary habits of the available studies

Table 5 provides information on studies reporting dietary habits of Nigerian adolescents. With regards to meal patterns the proportion of participants reporting consuming three-square meals varied across studies, ranging from 33% to 85%. A majority of participants generally observed breakfast, with proportions ranging from 16.4% to 95%. Lunch and dinner were also commonly consumed meals, with proportions ranging from 6.9% to 95.5%. Skipping meals was prevalent among adolescents, with proportions ranging from 10% to 86%. Breakfast skipping was particularly common, reported by 48% to 86% of participants in different studies. Fast food consumption was widespread among adolescents, with proportions ranging from 16.5% to 87.8%. Some studies highlighted a higher prevalence of fast-food consumption among females. Fruit consumption varied across studies, with proportions ranging from 48.3% to not been reported. The frequency of fruit consumption was generally moderate, with a significant proportion reporting eating fruit sometimes.

Fig. 2 shows a summary of results from studies reporting anthropometric indicators and these studies have been ordered by year, to provide a trend over time. For all 5 indicators (obesity, stunting, thinness, underweight and wasting) the trends appear to decrease over time.

Discussion

To the best of our knowledge, this systematic review represents the most comprehensive observational analysis on dietary profile and nutritional status of adolescents in Nigeria. We reviewed and synthesised results from a total of 102 nutritional epidemiological studies among Nigerian adolescents (10–19 years) with a total population of 67,844 participants. However, only 13 % of the included studies were classified being at low risk of bias in terms of methodological quality and with the majority published in unindexed journals (89.2%). No prospective studies were found on the topic. Since included studies were cross-sectional, their reliance on self-reported, unvalidated tools for dietary assessment or anthropometric classification was common. The majority (i.e. 73.5%) of the surveys took place within education settings (e.g. school or university) and some studies focused only on males (12/102), but no study focusing only on females was found. The rest had both males and females. From the results, it is evident that a significant amount of nutrition research has been conducted involving Nigerian adolescents, but there is large variability with regards to assessment and quality of methods, with a substantial proportion of studies using unvalidated tools and instruments and methodologies with high risk of bias.

Although there were no studies focusing exclusively on male participants, some of the nutritional issues reported among the included studies were related mostly to undernutrition, particularly among adolescent girls. Such findings are in line with a UNICEF report, that reported a significant increase in undernourishment among adolescent girls in Nigeria, with the number rising from 5.6 million in 2018 to 7.3 million in 2021.(Reference Hayashi and Mehra124) According to the same data, there are evident malnutrition challenges among school-aged adolescents, with a prevalence of thinness and overweight, 10% and 8% respectively. Further, among girls aged 18 and above, 10% are underweight, while 33% are overweight. The prevalence of anaemia among women aged 15–49 years is 55%. Additionally, 55% of households in Nigeria consume salt with iodine, which is an important indicator for addressing iodine deficiency disorders.

In addition, results from the National Nutrition and Health Survey 2018 show that the prevalence of acute malnutrition was more than four times higher for adolescents (15–19 years) than adult women (20–49 years), 19 per cent compared to 4 per cent, respectively.(125) This report underscored the urgency of developing effective interventions to improve the nutrition of adolescent girls, as they play a crucial role in birth outcomes and subsequent nutrition throughout the lifecycle. Improving nutrition in adolescent girls is critical to improving the nutrition status of the entire population.

Nigeria is one of the 12 countries hit hardest by the global food and nutrition crisis, which has been exacerbated by factors such as COVID-19, conflict, and drought. The dietary diversity of adolescent girls’ and women’s diets is too low, particularly in rural areas and poor households.(126) A recent situation report from the UN Office for the Coordination of Humanitarian Affairs indicates a nutrition crisis is occurring in 6 regions.(127) According to the same report the number of adolescents with severe acute malnutrition requiring inpatient care between January and April 2023 increased by 61% compared to the same period in 2022. Thinness trends in our study are similar to data from UNICEF, showing a temporal downward trend.(128) According to the 2023 edition of the Joint Child Malnutrition Estimates by UNICEF/WHO/World Bank Group that in 2012, Nigeria had a stunting prevalence rate of 37.7%, indicating a high level of stunting. However, by 2022, this rate decreased to 34.2%.(129) In the same report, Nigeria had an overweight prevalence rate of 2.5% in 2012, which remained relatively stable at 2.2% in 2022. Wasting for 2020 was 6.5 % and considered a “medium” prevalence threshold, i.e. 5–10%. It is important to note that the data provided is limited to specific years (2012, 2020, and 2022), does not include most recent estimates of all indicators and reflect mostly the children’s population, not adolescents.

In terms of global targets for nutrition for 2025 outlined in the United Nations Sustainable Development Goals Agenda 2030,(130) Nigeria appears to have made slight progress. This limited progress is also reflected in the updated, Global Nutrition Report 2021(131) that shows the country being “on course” to fulfil one of the global nutrition objectives for which there is adequate data to assess progress. These goals and global programmes have focused mostly on nutrition in childhood and adults, but data on adolescents appear to have been overlooked. National and global policy has also overlooked adolescent and youth nutrition and the UN Decade of Action on Nutrition (2016–25) has no adolescent or youth-specific nutrition indicators. With the current global challenges, malnutrition in all its forms may worsen. Kidnapping, communal conflict, inflation, urbanisation and banditry may have impeded Nigeria’s capacity to make progress.(Reference Lain and Vishwanath132) A review in 2020(Reference Ene-Obong, ChineloAburime and Alozie133) reported that Nigeria’s stunting rate is 37%, making it the world’s second-most-stunted affected nation.

A previous review,(Reference Yunusa and Ezeanyika134) in line with ours, pointed out challenges on insufficiency and scarcity of the data on nutritional status. This is consistent with many low and middle-income countries where malnutrition has been a major concern and, in our synthesis, the included studies reported a range of malnutrition issues, starting from underweight and stunting to overweight and obesity. This is a strong signal reflecting the presence of a double burden of malnutrition. The argument is further supported by a recent analysis on temporal trends in overweight and obesity in Nigerian adolescents and young adults,(Reference Oluwasanu, Akinyemi and Oluwasanu135) that reported the co-existence of under- and over-nutrition challenges.

Furthermore, the included studies in our review that reported intake across different regions in Nigeria, consistently showed inadequate intake of certain nutrients. In particular, energy, protein, iron and calcium intake were the most reported inadequacies and, in some cases, certain nutrient intakes exceeded established recommendations. Taken together, these findings suggest that current or future efforts targeting adolescent nutrition in Nigeria should consider a region- and context-specific approach to address the identified dietary gaps.

Our findings also illustrate an adolescent population with consumption patterns varying widely, but with an overall picture that indicates frequent and widespread consumption of starchy staples, sugar-sweetened beverages and snacks and a highly variable intake across studies of other essential food groups like vegetables, fruits and dairy products. This is in line with a review on dietary intake of schoolchildren and adolescents in developing countries,(Reference Ochola and Masibo136) where it was reported that in Nigeria this population group had inadequate consumption of vegetables, micro-nutrients, fruits and animal protein. In the same analysis, a significant increase in the consumption of snacks and energy-dense nutrient-poor foods and drinks was reported. Another recent analysis also showed that adolescents, in Ogun state (south-western Nigeria), primarily consumed starchy foods, with limited dietary diversity.(Reference Otekunrin and Otekunrin100)

In 2021(Reference Samuel6) a position paper from the Nutrition Society of Nigeria called for urgent action“… to bridge the identified policy and data gaps, enhance coordination and increase delivery platforms to reach adolescents with a minimum package of nutrition interventions giving special consideration for nutritional needs of pregnant adolescent mothers.” Although adolescents have increasing nutritional requirements and constitute about 21% (more than 41 million) of the Nigerian population, surveillance of their well-being and nutrition remains largely underestimated, inconsistently measured and not prioritised for nutrition interventions. Considering all complexities, efforts to address this situation must be culturally relevant, region-specific and address the identified challenges. Considering earlier findings that highlight the influence of the food environment on adolescents’ food choices, it’s evident that fast-food establishments offering processed foods rich in fat, salt and sugar are gaining popularity in Nigeria.(Reference Jaacks, Vandevijvere and Pan137) This trend is especially pronounced among adolescents. Future studies should dissect adolescents’ autonomy and agency within the food environment in Nigeria. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values and input beyond nutrition or health.

Limitations

Although our report is the most comprehensive review of adolescent nutrition in Nigeria, concerns about the scarcity of studies and poor methodological rigour undermine establishment of strong inferences. The available observational studies on adolescent nutrition reveal several methodological limitations, including issues with study design, confounder control, statistical analysis, and sampling, highlighting a crucial need for enhanced investment in robust and rigorous nutrition research to better understand and support adolescent health. In addition, further research is currently ongoing and we did not include intervention studies, but based on current findings and in order to address the identified research gaps, we are conducting an epidemiologic study, for which we have obtained approval from the Yobe State Ministry of Health and Human Service (YB/MOH/HREC/04/22/008). More precise evidence to understand the key nutritional challenges and context of food choices of Nigerian adolescents is needed to increase the potential for impactful and tailored actions.

Conclusions

Our review on the state of nutrition of Nigerian adolescents showcases both the inherent strengths and limitations of nutrition research in the country, emphasizing the urgent need for targeted, evidence-based interventions to address the double burden of malnutrition. This is further nuanced due to cultural and regional differences and other socio-cultural determinants. Overall, findings underscore the need for more rigorous research and establishment of nutrition surveillance for malnutrition in all its forms among Nigerian adolescents.

Abbreviations

BMI: Body mass index; DDS: Dietary diversity score; FFQ: Food frequency questionnaire; HAZ: Height-for-age z-score; JBI: Joanna Briggs institute; LMICs: Low- and middle-income countries; NCD: Noncommunicable diseases; NR: Not reported; PRISMA: Preferred reporting items for systematic reviews and meta-analyses; PROSPERO: International prospective register of systematic reviews; PUFA: Polyunsaturated fatty acids; RDA: Recommended dietary allowance; RNI: Recommended nutrient intake; SDGs: Sustainable Development Goals; UN: United Nations; UNICEF: United Nations Children’s Fund; WAZ: Weight-for-age z-score; WHO: World Health Organization

Supplementary material

The supplementary material for this article can be found at https://doi.org/10.1017/jns.2024.34

Acknowledgements

This paper is a contribution of the authors to the UN Decade of Action on Nutrition (2016–2025): https://www.un.org/nutrition.

Financial support

This study was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—491394008 and a grant from the German Federal Ministry of Education and Research and the State of Brandenburg to the German Centre for Diabetes Research (DZD) (82DZD03D03). TSG, MK and FAO received funding from Stipendium Hungaricum. No additional funding was received.

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Authorship

EL, TSG and MK were responsible for research conceptualisation, implementation and methodology; TSG, MK and FAO were responsible for data collection and analysis, and contributed to drafting the article and revising it; TM provided technical input and revised the work critically for important intellectual content. All authors contributed to and approved the final version of this manuscript.

Ethical approval

Not applicable.

Footnotes

#

These authors contributed equally.

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Figure 0

Fig. 1. PRISMA flowchart.(14)

Figure 1

Fig. 2. Summary of the individual studies reporting anthropometric indicators over time.

Figure 2

Table 1. Study characteristics of the studies included in the systematic review

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Table 2. Anthropometric findings from Nigerian nutritional epidemiology studies

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Table 3. Food and food group-based findings

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Table 4. Dietary intake by adolescents in Nigeria

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Table 5. Findings on dietary habits of the available studies

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