Table 6: Summary of systematic review and meta-analyses studies on burden of malnutrition/disease in children 5-19 y associated with their diet

|Author (Year)|Study Type &<br>Location|Participants|Diet Assessed|Nutrition, health<br>outcomes assessed|Key Findings|
|---|---|---|---|---|---|
|Undernutrition outcom|es|||||
|Zeinalabedini et al.<br>(2023)|SRM of 20 studies,<br>all LMICs|Children 5-18 y (6<br>studies were girls only)|Diet diversity(17 based<br>on 24HR, 1 7-d recall, 1<br>30-d FFQ, 1 unknown)|Stunting, thinness, wasting|Low diet diversity increased odds of<br>stunting (OR 1.43, 95% CI 1.08, 1.89)<br>and wasting (OR 2.18; 95% CI 1.41,<br>3.36) but not thinness (OR 1.10, 95%<br>CI 0.81,1.49)|
|Berhe et al. (2019)|SRM of 22 cross-<br>sectional studies,<br>Ethiopia|Adolescents<br>(n=17,854)|Dietary DiversityScore,<br>low (DDS<4)|Underweight (BMI-Z <-2<br>SD) (n=5 studies)|Low diet diversity associated with<br>underweight (OR 1.95; 95% CI 1.31,<br>2.92)|
|Berhe et al. (2022)|SRM of 15 cross-<br>sectional studies,<br>Ethiopia<br>(includes 2 national<br>surveys in 2016 –<br>EDHS & MNS)|Adolescent girls 10-19<br>y (n=9,669)|Dietary diversityScore,<br>low (DDS <4 of 9 food<br>groups)|Anemia (using WHO Hb<br>cutoffs)|Low diet diversity (n=2 studies) was<br>associated with anemia (OR=2.81;<br>1.33, 5.90)|
|Habtegiorgis et al.<br>(2022); Endale et al.|SRM of 10 cross-<br>sectional studies,|Adolescent girls|Dietary diversityScore,<br>low (DDS <4 of 9 food|Anemia (using WHO 2011<br>Hb cutoffs by age and|Low diet diversity (n=5 studies)<br>associated with anemia|
|(2022)<br>(both articles based on<br>the same 10 studies)|Ethiopia||groups)|pregnancy status)|(OR 1.35; 95% CI 1.00, 2.34) or<br>(OR 1.56; 95% CI 1.05, 2.32)|
|Jensen (2023)|SRM of 11 cross-<br>sectional studies<br>(most in HICs, 3 in<br>India, 2 in China)<br>8 studies included<br>in meta-analysis|Children and<br>adolescents 5-18 y<br>(n=1545 in meta-<br>analysis)|Adherence toplant based<br>diet(vegan, vegetarian,<br>macrobiotic, etc)|Vitamin B12 level|Vegan or macrobiotic diets<br>associated with lower vitamin B-12<br>levels compared to omnivore diet (-<br>97 pmol/L; 95%CI -187, -7)|
|Overweight and obesit|youtcomes|||||
|Gezaw et al. (2023b)|SRM of 33 studies<br>(32 cross-<br>sectional, 1 case<br>control),Ethiopia|Adolescents 10-19 y<br>(n=25,172)|Diet DiversityScore|Overweight(BMI >+1 SD),<br>obesity(BMI >+2 SD),<br>thinness(WAZ <-2 SD)|Low DDS associated with OW/OB<br>(OR 2.26; 95% CI 1.28, 3.99) based<br>on pooled results from 2 studies, but<br>not thinness(8 studies)|
|Cunha et al. (2018)|SRM of 19 studies<br>(17 cross-<br>sectional, 2<br>cohort), most in<br>HICs, 1 in Tunisia|Boys and girls 7-19 y|Unhealthy dietary pattern<br>[assessed using FFQ<br>(n=11), factor analysis<br>(n=14)]|BMI(n 18),waist<br>circumference(WC) (n 9),<br>systolicblood pressure(n<br>7), diastolic blood<br>pressure (n 6),blood|Dietary patterns with highest vs low<br>intake of unhealthy foods resulted in<br>a higher mean BMI (0.57 kg/m2; 95 %<br>CI 0.51, 0.63) and WC (0.57 cm;<br>0.47, 0·67)|
||7 studies in meta-|||glucose(n 5) and lipid|Low intake of healthy foods|
||analysis(7 with BMI|||profile(n 5)|associated with lower mean BMI|

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