Adolescence is a period of rapid growth, with higher nutritional demands placing adolescents at greater risk of malnutrition. Nutritional problems are compounded in adolescent girls by menstrual blood loss and possible pregnancies. Adolescent fertility still accounts for 11% of all births globally, with 95% of these births occurring in low- and middle-income countries (LMICs).1 Stunting (low height-for-age) begins in utero and manifests itself across infancy and affects brain and muscle growth.2 Among adolescents, stunting is associated with impaired cognitive development and school achievement, and reduced economic productivity.3 It is also associated with poor reproductive health outcomes in females.4 Given that resolution of these height deficits may take several generations,5 stunted children who are also exposed to obesogenic environments may be at greater risk of becoming overweight or obese. In fact, childhood stunting has also been reported to coexist with overweight or obesity at the individual level.6,7 The consequences of concur- rent stunting and obesity in adolescents are likely to compound health issues in adolescence and later in adulthood, particularly for females, given the heightened obstetric risk. Thinness (low BMI-for-age) in adolescence is associated with delayed maturation and poor muscle strength leading to constraints in capacity for physical work and reduced bone density later in life.8 Obesity in adolescence has been associated with an increased risk of early onset of adult chronic diseases (type 2 diabetes, hypertension) and mortality in adult life.9,10 Adults and young children in countries experiencing the nu- trition transition are known to be affected simultaneously by undernutrition and overnutrition .2,11 Yet it is unknown to what extent this double burden of malnutrition affects adolescents in LMICs. Likewise unknown are the macrolevel contextual factors associated with the double burden of malnutrition. Globally, the major focus in nutrition has been on children under the age of five years and pregnant women, while adolescents have not received due attention.12 More recently, there has been a growing interest in adolescent nutrition, particularly girls’ nutrition, as a means to improve the health of women and children.
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