Asian Journal of Research in Nursing and Health

Adolescent malnutrition remains a pressing global public health concern, particularly in low- and middle-income countries where the coexistence of undernutrition and overnutrition—the so-called double burden of malnutrition—is increasingly documented. Household socioeconomic status (SES) is widely theorised as a key structural determinant of this burden, yet internationally indexed, disaggregated evidence from West African adolescent populations remains scarce. This study examined how SES moderates the relationship between feeding patterns and the physical health and cognitive development of secondary school adolescents in Anambra State, Nigeria. A descriptive cross-sectional design was adopted. From a population of 18,297 senior secondary II (SS2) students across 261 public secondary schools in six education zones, a sample of 2,160 students was selected through a multistage, proportionate stratified sampling procedure; 1,873 valid responses were retained for analysis. Data were collected with a structured, expert-validated 50-item questionnaire (Cronbach's α = 0.66–0.73; KR-20 = 0.70) and analysed using simple linear regression at the 0.05 level of significance. Feeding patterns significantly predicted physical health (β = 0.272 for low-SES, β = 0.379 for high-SES adolescents; both p = .000) and cognitive development (β = 0.241 for low-SES, β = 0.319 for high-SES adolescents; both p = .000), with the strength of the relationship consistently and significantly greater among high-SES adolescents than among low-SES adolescents. These findings corroborate the global evidence base indicating that socioeconomic inequality does not merely coexist with, but actively conditions, the developmental returns of nutrition. The results carry implications for international nutrition and school-health policy, particularly efforts aligned with Sustainable Development Goal 2 (Zero Hunger) and Goal 3 (Good Health and Well-Being), and argue for equity-targeted rather than universal feeding interventions in resource-constrained school systems.