Systematic review on evidence‐based adolescent nutrition interventions

Abstract

Adolescence is a critical stage in the life cycle, and adequate nutrition is necessary for the proper growth and development of individuals and their offspring. Here, we comprehensively review all published systematic reviews (through October 2016) on adolescents (10-19 years) and women of reproductive age, including pregnant women, which targeted interventions related to nutrition. For interventions where there was no existing systematic review on adolescents, we reviewed primary studies/trials. We included interventions on micronutrient supplementation (iron, folic acid, iron-folic acid (IFA), calcium, vitamin D, vitamin A, zinc, iodine, and multiple micronutrients), food/protein energy supplementation, nutrition education for pregnant adolescents, obesity prevention and management, and management of gestational diabetes. We identified a total of 35 systematic reviews, of which only five were conducted on adolescents, and 107 primary studies on adolescents. Our review suggests that iron alone, IFA, zinc, and multiple micronutrient supplementation in adolescents can significantly improve serum hemoglobin concentration. While zinc supplementation in pregnant adolescents showed improvements in preterm birth and low birth weight, we found a paucity of trials on calcium, vitamin D, vitamin A, and iodine supplementation. We found limited evidence on food/protein energy supplementation in adolescents. Interventions to prevent and manage obesity showed a nonsignificant impact on reducing body mass index. This review underscores the importance of adolescent nutrition interventions. It is imperative that countries design nutritional interventions, particularly for adolescents.

Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks

“…The multiple micronutrient intervention had modest significant benefits and may be a better way to combine provision of individual nutrients. In addition, randomized trials of iron supplementation have been shown to significantly improve hemoglobin concentrations among adolescents (standardized mean difference 1.83, 95% CI 0.59–3.08) based on pooled analysis of 7 studies [43]. Despite the lack of impact on linear growth, this intervention may be worth considering, given the benefit of iron supplementation on cognition in school age children [44].…”

Delivering an action agenda for nutrition interventions addressing adolescent girls and young women: priorities for implementation and research

“…In summary, the general evidence indicates that the means for reducing the risk of stillbirths, neonatal mortality, and LBW are the same for pregnant women across all age groups, including adolescents. Iron supplementation significantly improves hemoglobin concentration and potentially reduces anemia; periconceptional folic acid supplementation can reduce neural tube defects; and high‐dose (≥1 g daily) calcium intake among pregnant women at risk of low calcium intake reduces the risk of preeclampsia, preterm birth, and neonatal high‐care admissions .…”

“…Iron supplementation significantly improves hemoglobin concentration and potentially reduces anemia; periconceptional folic acid supplementation can reduce neural tube defects; and high‐dose (≥1 g daily) calcium intake among pregnant women at risk of low calcium intake reduces the risk of preeclampsia, preterm birth, and neonatal high‐care admissions . Specific studies among adolescent women indicate that zinc supplementation among adolescents is associated with improvements in serum zinc and in hemoglobin concentration, and supplementation among pregnant adolescents significantly reduced preterm birth rates and LBW …”

“…Studies that targeted interventions to address overweight and obesity among adolescents, mostly from high‐income settings, do show some benefits in reducing BMI, but the evidence is limited, and the studies have limited generalizability to LMICs. It is, however, reasonable to promote obesity prevention programs in school/community settings and in urban populations where physical activity among young girls may be limited owing to sociocultural reasons, lifestyle behaviors, or lack of adequate facilities.…”

“…Pregnancy is a special time period during which the body has greater demands for several nutrients, such as iron and folic acid. As highlighted in the systematic review on nutrient interventions, while the available evidence is largely limited to a few micronutrients, it is important. Adding folic acid supplements before and during pregnancy has been shown to reduce the risks of fetal malformations, and adequate provision of iron can contribute to reducing IUGR in LMICs .…”