Nutritional Status and Associated Factors among School-Going Adolescents: A Systematic Review from a Socio-Ecological Perspective

Background: Adolescent malnutrition is a major public health concern in low- and middle-income countries (LMICs), including Pakistan, where both under nutrition and over nutrition are increasingly prevalent among school-going adolescents. Objective: This systematic review aimed to synthesize evidence on the nutritional status of school-going adolescents and identify associated determinants, including nutrition-related knowledge, attitudes, and practices (KAP) and water, sanitation, and hygiene (WASH) factors. Methods: A systematic search of PubMed, CINAHL, Science Direct, and Google Scholar was conducted for studies published between 2015 and 2025. Following PRISMA guidelines, 28 studies were included from an initial pool of 886,974 records. Data were synthesized thematically using the Socio-Ecological Model (SEM). Results: Findings showed a dual burden of malnutrition across LMICs, with stunting ranging from 15%–54%, thinness from 11%–49%, and overweight/obesity from 4.8%–43.7%. In Pakistan, underweight prevalence ranged from 32.3%–86.9%. Key determinants included unhealthy dietary practices, physical inactivity, gender, parental education, socioeconomic status, school environment, and policy-level gaps. Poor nutrition-related KAP and inadequate WASH conditions further contributed to adverse nutritional outcomes. Conclusion: Adolescent malnutrition is shaped by multiple interconnected factors at individual, interpersonal, community, and policy levels. Integrated and context-specific interventions are needed to improve adolescent nutritional outcomes and support evidence-based policies in Pakistan.