Full Text Article. Also available at: https://doi.org/10.1111/tmi.13331To determine the prevalence and risk factors associated with malnutrition among adolescents in a rural Tanzanian community. Cross-sectional survey of 1226 randomly selected adolescents from the Dodoma Health and Demographic Surveillance System (HDSS) in the Chamwino district in the Dodoma region. Anthropometric measurements for weight and height were collected. Height-for-age-z-scores (HAZs) and body mass index (BMI)-for-age-z-scores (BAZs) were computed. Descriptive estimates were documented in graphs and tables, and weighted linear regression models were used to examine predictors of malnutrition. Stunting prevalence was 18%, and thinness prevalence was 14%. Overweight and obesity affected 5.23% of participants. Girls had higher HAZs (b: 0.46, 95% CI 0.33, 0.59, P < 0.0001) and BAZs (b: 0.20, 95% CI 0.05, 0.35, P = 0.0098) than boys. Age was inversely associated with HAZs (b: _0.13, 95% CI _0.17, _0.08, P < 0.0001) and BAZs (b: _0.05, 95% CI _0.10, _0.004, P = 0.0327). Wealth score (b: 0.10, 95% CI 0.04, 0.16, P = 0.0009) and dietary diversity score (b: 0.04, 95% CI 0.01, 0.07, P = 0.0080) were positively associated with HAZs and BAZs. Out of school adolescents had higher HAZs (b: _0.49, 95% CI _0.75, _0.23, P = 0.0003) and BAZs (b:0.68, 95% CI _0.99, _0.37, P < 0.0001) than adolescents who attended school. There are substantial variations of HAZs and BAZs across gender, age, education and wealth, with an emerging burden of overweight and obesity among adolescents in this rural population. Interventions are urgently required to curb both ends of the malnutrition spectrum.