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Baxter JAB, Wasan Y, Hussain A, Soofi SB, Ahmed I, Bhutta ZA. Drivers of malnutrition among late adolescent and young women in rural Pakistan: a cross-sectional assessment of the MaPPS trial. BMJ Open 2023; 13:e063734. [PMID: 37221027 DOI: 10.1136/bmjopen-2022-063734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE This study aimed to characterise the burden of malnutrition and assess how underlying determinants at the structural and intermediary levels contributed to malnutrition among late adolescent and young women in rural Pakistan. DESIGN Cross-sectional enrolment data assessment. SETTING AND PARTICIPANTS This study was conducted using data from adolescent and young women (n=25 447) enrolled in the Matiari emPowerment and Preconception Supplementation Trial, collected from June 2017 to July 2018 in Matiari District, Pakistan. The WHO-based cut-offs were applied to anthropometric measures to estimate body mass index (BMI) categories (underweight, overweight, obese) and stunting. Hierarchical models were generated to evaluate the association between the determinants with BMI categories and stunting among late adolescent girls and young women, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcomes of interest were BMI categories and stunting. Explanatory variables included measures of socioeconomic status, education, occupation, health, well-being, food security, empowerment and food practices. RESULTS Regardless of age group, the prevalence of underweight was high (36.9%; 95% CI 36.3% to 37.5%). More late adolescent girls were underweight, while more young women were overweight/obese (p<0.001). Stunting affected 9.2% (95% CI 8.9% to 9.6%) of participants, of which 35.7% were additionally underweight and 7.3% overweight/obese. Compared with those in the normal weight category, those underweight were more likely to be impoverished and less empowered. Those overweight/obese were more likely to be from a higher wealth quintile and food secure. Increased education level and food security were associated with reductions stunting risk. CONCLUSIONS This study informs the data gap and need for comprehensive research on adolescent nutritional status. Findings suggest factors related to poverty played an important, underlying role in undernutrition among participants. Commitment to improving the nutritional status of all adolescent and young women in Pakistan will be critical given the observed burden of malnutrition. TRIAL REGISTRATION NUMBER NCT03287882.
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Affiliation(s)
- Jo-Anna B Baxter
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Amjad Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Giri D, Vajanapoom N, Langkulsen U. Factors Influencing Undernutrition among Female Adolescent Students in Darchula District, Nepal. Nutrients 2023; 15:nu15071699. [PMID: 37049539 PMCID: PMC10097115 DOI: 10.3390/nu15071699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Failure to understand and address the problem of malnutrition and its associated factors among female adolescents could lead to a vicious cycle of intergenerational malnutrition. A cross-sectional study was conducted in six secondary schools of four rural municipalities in Darchula District, Nepal. Data collection for the study was conducted from November 2021 to February 2022. Four hundred female adolescent students aged 15 to 19 years old were selected using quota sampling. The study aims to examine the prevalence of malnutrition by assessing different levels of body mass index (BMI) that is thinness (BMI less than 18.5 kg/m2), normal (18.5 kg/m2 to 24.9 kg/m2), overweight (25 kg/m2 to 29.9 kg/m2) and obese (BMI more than or equal to 30 kg/m2). Along with BMI, factors associated with undernutrition, here identified as thinness, are assessed using a structured questionnaire. Additionally, key informant interviews and review of interventions was performed to understand the gaps in nutrition-related policies and programs of school going adolescents in the study district. Quantitative data analysis included a prevalence study and chi-square test along with simple and multiple logistic regression to obtain crude and adjusted odds ratio at 95% confidence interval for the significant factors with p < 0.05 identified in the chi-square test. Thematic analysis and reviews were used for the synthesis of qualitative data. The results show a 24.7% prevalence of thinness in the study participants. Pre-mensuration status (OR = 5.015, CI = 1.257–20.011, p < 0.022), father having a monthly paying job (OR = 4.384, CI = 1.135–16.928, p < 0.032), father’s foreign employment (OR = 6.96, CI = 1.649–29.377, p < 0.008), household (HH) food insecurity status (OR = 2.079, CI = 1.182–3.658, p < 0.011) and grain/roots/tuber as most commonly bought food (OR = 9.487, CI = 1.182–76.138, p < 0.034) were found to be significantly associated with thinness. Information from the qualitative part identified gaps in existing interventions for an improved nutritional outcome among school going adolescent females. Further studies to understand the nutritional practices and its contributory factors in relation to thinness is encouraged. Stakeholders are urged to effectively address the shortcomings in existing interventions and adopt a more adolescent-centered approach to enhance the nutritional status of female adolescents.
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Affiliation(s)
- Deepika Giri
- Faculty of Public Health, Thammasat University, Bangkok 12120, Pathum Thani, Thailand
| | - Nitaya Vajanapoom
- Faculty of Public Health, Thammasat University, Bangkok 12120, Pathum Thani, Thailand
| | - Uma Langkulsen
- Faculty of Public Health, Thammasat University, Bangkok 12120, Pathum Thani, Thailand
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Islam MR, Rahman SM, Selling K, Näsänen-Gilmore P, Kippler M, Kajantie E, Rahman A, Pervin J, Ekström EC. Dietary patterns and indicators of cardiometabolic risk among rural adolescents: A cross-sectional study at 15-year follow-up of the MINIMat cohort. Front Nutr 2023; 10:1058965. [PMID: 36761218 PMCID: PMC9905110 DOI: 10.3389/fnut.2023.1058965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Background Diet being a modifiable factor, its relationship with cardiometabolic risk is of public health interest. The vast majority of studies on associations of dietary patterns with cardiometabolic risk indicators among adolescents are from high-income countries and urban settings. We sought to describe dietary patterns and examine their associations with selected cardiometabolic risk indicators-waist circumference (WC), systolic blood pressure, fasting lipid profile and insulin resistance-along with its gender stratification among adolescents in a low-income, rural setting. Methods This cross-sectional study utilized data from the 15-year follow-up of the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort in southeast Bangladesh. The children who were born as singletons to the mothers randomized in the MINIMat trial and had valid birth anthropometrics were eligible for the follow-up. We employed a single, qualitative 24-hour recall to assess diet. Dietary patterns were derived from simple K-means cluster analysis, and calculation of dietary diversity score (DDS) using a validated instrument. Anthropometric parameters and systolic blood pressure were recorded. Fasting plasma triglyceride, total cholesterol, low- and high-density lipoproteins, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Three right-skewed outcome variables were natural log (Ln) transformed: WC, triglyceride and HOMA-IR. Omnibus and gender-specific multiple linear regression models were fitted. Results Among 2,253 adolescents (52.1% girls, 7.1% overweight/obese), we identified four diet clusters: Traditional, Fish-dominant, Meat-dominant, and High-variety. No significant associations were found between the clusters and indicators. On gender-stratification, triglyceride levels were lower among boys in the Fish-dominant (Ln-triglyceride βadjusted: -0.09; 95% confidence interval (CI): -0.15, -0.02) and Meat-dominant (Ln-triglyceride βadjusted: -0.08; 95% CI: -0.15, -0.004) clusters than among boys in the Traditional cluster. Compared to boys in the bottom quartile of DDS, boys in the top quartile had 2.1 mm of Hg (95% CI: 0.5, 3.6) higher systolic blood pressure and 1.9% (95% CI: 0.01-3.8%) higher WC. Conclusion While statistically significant, the gender-specific differences in triglyceride, systolic blood pressure, and waist circumference across dietary patterns were small. Associations between dietary patterns and cardiometabolic risk indicators may require a time lag beyond mid-adolescence to manifest in a rural setting. Prospective studies are warranted to delineate the magnitude and direction of those associations.
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Affiliation(s)
- Mohammad Redwanul Islam
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,*Correspondence: Mohammad Redwanul Islam,
| | - Syed Moshfiqur Rahman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Katarina Selling
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Pieta Näsänen-Gilmore
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eero Kajantie
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Anisur Rahman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Agaba M, Azupogo F, Brouwer ID. Maternal nutritional status, decision-making autonomy and the nutritional status of adolescent girls: a cross-sectional analysis in the Mion District of Ghana. J Nutr Sci 2022; 11:e97. [PMID: 36405098 PMCID: PMC9641508 DOI: 10.1017/jns.2022.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
A mother's nutritional status and participation in household decision-making, a proxy for empowerment, are known determinants of improved nutrition and health outcomes for infants and young children; however, little is known about the association among adolescents. We examined the association between maternal nutritional status, decision-making autonomy and adolescent girls' nutritional status. We analysed data of 711 mother-adolescent girl pairs aged 10-17 years from the Mion District, Ghana. Maternal nutritional status and decision-making autonomy were the independent variables while the outcomes were adolescent girls' nutritional status as defined by anaemia, stunting and body mass index-for-age Z-score categories. Girl-level (age, menarche status and the frequency of animal-source food consumption), mother-level (age, education level, and monthly earnings) and household-level (wealth index, food security status and family size) covariates were adjusted for in the analysis. All associations were examined with hierarchical survey logistic regression. There was no association between maternal height and adolescent girls being anaemic, underweight or overweight/obese. Increasing maternal height reduced the odds of being stunted [adjusted odds ratio (OR) 0⋅92, 95 % CI (0⋅89, 0⋅95)] for the adolescent girl. Maternal overweight/obesity was positively associated with the girl being anaemic [OR 1⋅35, 95 % CI (1⋅06, 1⋅72)]. The adolescent girl was more than five times likely to be thin [OR 5⋅28, 95 % CI (1⋅64-17⋅04)] when the mother was underweight. Maternal decision-making autonomy was inversely associated with stunting [OR 0⋅88, 95 % CI (0⋅79, 0⋅99)] among the girls. Our findings suggest that intergenerational linkages of a mother's nutritional status are not limited to childhood but also during adolescence.
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Affiliation(s)
- Monicah Agaba
- Wageningen University and Research, 239 Hoevestein, 6708AK Wageningen, The Netherlands
| | - Fusta Azupogo
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food and Consumer Sciences, University for Development Studies, Tamale, Ghana
| | - Inge D. Brouwer
- Division of Human Nutrition, Wageningen University and Research Centre, Stippeneng 4, 6708WE Wageningen, The Netherlands
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Sharma S, Maheshwari S, Kuwatada J, Chandrashekhar, Mehra S. Assessing Dietary Intake Patterns Through Cluster Analysis Among Adolescents in Selected Districts of Bihar and Assam From India: A Cross-Sectional Survey. Front Nutr 2021; 8:592581. [PMID: 34901099 PMCID: PMC8655107 DOI: 10.3389/fnut.2021.592581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In the recent decade, dietary pattern assessment has evolved as a promising tool to describe the whole diet and represent inter-correlations between different dietary components. We aimed to derive the dietary patterns of adolescents (10–19 years) using cluster analysis on food groups and evaluate these patterns according to their socio-demographic profile. Methods: This community-based cross-sectional study was conducted in two districts, each from Bihar and Assam in India. Adolescents (10–19 years) were enrolled from both rural and urban areas. The dietary intake was assessed through a pre-validated single food frequency questionnaire. Cluster analysis was performed by a 2-step procedure to explore dietary patterns, pre-fixed at 2 clusters. Clusters were analyzed with respect to socio-demographic characteristics using binomial logistic regression. Results: A total of 826 girls and 811 boys were enrolled in the study. We found two major dietary patterns, namely a low- and high-mixed diet. The low-mixed diet (76.5% prevalence) had daily consumption of green vegetables, including leafy vegetables, with less frequent consumption of other foods. The high-mixed diet (23.5% prevalence) had more frequent consumption of chicken, meat, egg, and milk/curd apart from green vegetables. Adolescent boys had 3.6 times higher odds of consuming a low-mixed diet compared to girls. Similarly, adolescents with lower education grades and from marginalized social classes had two times higher odds of taking a low-mixed diet than their respective counterparts. Conclusions: The high consumption of a low-mixed diet and relatively less milk consumption limit the comprehensive growth of adolescents. Improvement in dietary intake of adolescents from marginalized sections of society can prove to be an important deterrent in mitigating India's nutritional challenges.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Malmo, Sweden.,Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sonali Maheshwari
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Jitesh Kuwatada
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Chandrashekhar
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sunil Mehra
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
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Akter F, Hossain MM, Shamim AA, Khan MSA, Hasan M, Hanif AAM, Hossaine M, Urmy NJ, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Bulbul MMI, Mridha MK. Prevalence and socio-economic determinants of inadequate dietary diversity among adolescent girls and boys in Bangladesh: findings from a nationwide cross-sectional survey. J Nutr Sci 2021; 10:e103. [PMID: 35059184 PMCID: PMC8727722 DOI: 10.1017/jns.2021.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018-19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
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Affiliation(s)
- Fahmida Akter
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Nushrat Jahan Urmy
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
| | | | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Mamun AA, Murray FJ, Sprague M, McAdam BJ, Roos N, de Roos B, Pounds A, Little DC. Export-Driven, Extensive Coastal Aquaculture Can Benefit Nutritionally Vulnerable People. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.713140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Export-orientated shrimp and prawn farming in coastal ghers has been associated with negative environmental, social, and nutritional impacts. This study challenges these perceptions based on field observations from four communities in South West Bangladesh. Most households observed (>60%) were either directly involved in seafood farming or engaged elsewhere in the seafood value chain. Our study set out to establish how the type and location of aquaculture impacted on access to and consumption of aquatic animals. Additionally, we assessed the effects of both household socioeconomic status and intra-household food allocation on individual diet and nutritional outcomes. We used a blended approach, including a 24-h consumption recall on two occasions, analysis of the proximate composition of aquatic animals and biomarkers from whole blood from a sample of the target population. The diverse polyculture systems generated broad social benefits, where “export-oriented” production actually supplied more food locally than to global markets. Key findings: (1) worse-off households achieved higher productivity of farmed aquatic animals on smaller landholding than better-off households with larger landholdings; (2) vegetable production on gher dikes was a significant source of nutrition and income in lower saline gradients; (3) more fish was eaten in lower saline gradients although fish consumption was highly variable within and between households; (4) intra-household allocation of specific foods within diets were similar across communities; (5) recommended nutrient intakes of protein and zinc exceeded daily requirements for adolescent females, but energy, calcium, and iron were below recommended intake levels; (6) n-3 LC-PUFA, expressed as percentage of total fatty acids, in whole blood samples of adolescent females declined with ambient salinity level regardless of household socioeconomic status; (7) analysis of aquatic animals consumed found that mangrove species and tilapia harvested from higher saline ghers contained high levels of desirable PUFAs. These findings suggest that export-driven, extensive coastal aquaculture can be nutrition sensitive when co-products are retained for local consumption.
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Baxter JAB, Wasan Y, Islam M, Cousens S, Soofi SB, Ahmed I, Sellen DW, Bhutta ZA. Dietary diversity and social determinants of nutrition among late adolescent girls in rural Pakistan. MATERNAL AND CHILD NUTRITION 2021; 18:e13265. [PMID: 34467621 PMCID: PMC8710090 DOI: 10.1111/mcn.13265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
The conditions in which adolescent girls mature shape their health, development and nutrition. Nutrient requirements increase to support growth during adolescence, but gaps between consumption and requirements exist in low- and middle-income countries. We aimed to identify and quantify the relationship between dietary intake and diverse social determinants of nutrition (SDN) among a subset of adolescent girls 15-18.9 years (n = 390) enrolled within the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The primary outcome, dietary diversity score (DDS), was derived by applying the Minimum Dietary Diversity for Women 10-item scale to 24-h dietary recall data collected three times per participant. To examine the associations between the SDN-related explanatory variables and DDS, we generated a hierarchical, causal model using mixed effects linear regression to account for the cluster-randomized trial design. Using all data, diets lacked diversity (DDS mean ± SD: 3.35 ± 1.03 [range: 1-7; n = 1170]), and the minimum cut-off for dietary diversity was infrequently achieved (13.5%; 95% CI: 11.6-15.6%). Consumption of starches was reported in all recalls, but micronutrient-rich food consumption was less common. Of the SDN considered, wealth quintile had the strongest association with DDS (P < 0.0001). The diets of the sampled Pakistani adolescent girls were insufficient to meet micronutrient requirements. Poverty was the most important predictor of a diet lacking in diversity, indicating limited purchasing power or access to nutritious foods. Dietary diversification and nutrition education strategies alone are unlikely to lead to improved diets without steps to tackle this barrier, for example, through fortification of staple foods and provision of supplements.
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Affiliation(s)
- Jo-Anna B Baxter
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Daniel W Sellen
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Pike V, Kaplan Ramage A, Bhardwaj A, Busch‐Hallen J, Roche ML. Family influences on health and nutrition practices of pregnant adolescents in Bangladesh. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13159. [PMID: 34241958 PMCID: PMC8269142 DOI: 10.1111/mcn.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
Abstract
Adolescent pregnancy can result in serious risks to the mother and her baby; yet, adolescents are among the least likely to access healthcare. Specific nutrition or antenatal care (ANC) guidelines for supporting pregnant adolescents are not available. To understand experiences and decision-making of pregnant adolescents in Bangladesh related to ANC and nutrition practices, peer interviewers were trained to conduct qualitative interviews in Dhaka and Rangpur with pregnant adolescents (n = 48), adolescent mothers (n = 48), adolescents' family members (n = 64) and health service providers (n = 32). Key themes explored included perception and support of adolescent pregnancy, experiences in seeking ANC, dietary practices, sources of information and roles of male and female family members. Spheres of influence on adolescent pregnancy were identified through analytical framework informed by the socio-ecological model. Respondents felt that adolescent pregnancy is risky and that adolescents require support and guidance through this experience. Families were highly influential on the care seeking, health and nutrition of pregnant adolescents, and mothers/mothers-in-law primarily took on the decision-making roles, with husbands actively participating. Adolescents valued family support but felt a loss of autonomy and agency upon becoming pregnant. Financial constraints were the greatest perceived barrier to appropriate nutrition and healthcare; yet, both were valued. There is sometimes discord of health and nutrition beliefs between families and health service providers; more research is needed to understand this further. It is essential to engage family members and adolescents in initiatives to increase access to quality ANC for pregnant adolescents, improve dietary practices and support the ability to delay pregnancy.
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Affiliation(s)
- Vanessa Pike
- Global Technical ServicesNutrition InternationalOttawaOntarioCanada
| | | | - Anjali Bhardwaj
- Asia Regional OfficeNutrition InternationalOttawaOntarioCanada
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Salwa M, Subaita F, Choudhury SR, Khalequzzaman M, Al Mamun MA, Bhuiyan MR, Haque MA. Fruit and vegetables consumption among school-going adolescents: Findings from the baseline survey of an intervention program in a semi-urban area of Dhaka, Bangladesh. PLoS One 2021; 16:e0252297. [PMID: 34101740 PMCID: PMC8186781 DOI: 10.1371/journal.pone.0252297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/10/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Interventions aimed at promoting healthy eating habits in adolescence can help prevent chronic diseases and promote healthy ageing. The aim of this paper is to describe the fruit and vegetables consumption habits of adolescents in Dhaka, Bangladesh as well as to identify the socio-environmental, personal, and behavioral factors that influence these habits. MATERIALS AND METHODS The baseline data from an intervention study involving 823 grade ten students from two randomly selected secondary schools in a semi-urban area of Dhaka were analyzed. The intake of fruit and vegetables was measured in terms of serving size per day. Hierarchical multiple regression was used to assess the ability of socio-environmental factors such as social support, perceived barriers, and living with patient with chronic diseases; personal factors such as knowledge, self-rated practice, behavioral intention, and body mass index; and behavioral factors such as physical activity, sedentary hours, and sleep duration to predict the level of daily fruit and vegetables intake, after controlling the effect of demographic characteristics of adolescents. RESULTS The average daily consumption of fruit and vegetables was 1.22 and 1.99 servings, respectively. Only one-fifth of the respondents (21%) reported eating five servings of fruit and vegetables a day. Inaccessibility at home was reported as the most perceived barrier for both fruit and vegetables intake. Adolescents' higher fruit and vegetables intake was found to be associated with higher maternal educational attainment, more social support, adequate self-rated practice, positive behavioral intention, higher body mass index, better physical activity, and adequate daily sleeping. CONCLUSION The findings revealed insufficient fruit and vegetables intake among adolescents in a semi-urban area of Bangladesh and associated socio-environmental, personal, and behavioral factors that were utilized in developing an intervention program for this transient age group. TRIAL REGISTRATION Trial was registered at ClinicalTrials.gov (NCT03975335) https://clinicaltrials.gov/ct2/show/NCT03975335 on June 01, 2019.
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Affiliation(s)
- Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Fatima Subaita
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Mahfuzur Rahman Bhuiyan
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - M. Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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11
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Micronutrient Adequacy in the Diet of Reproductive-Aged Adolescent Girls and Adult Women in Rural Bangladesh. Nutrients 2021; 13:nu13020337. [PMID: 33498750 PMCID: PMC7911270 DOI: 10.3390/nu13020337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
Micronutrient deficiencies remain a serious nutritional concern in Bangladesh, especially among rural women of reproductive age (WRA). This study assesses the diet quality of reproductive-aged adolescent girls and adult women (referred to together as WRA in this study), including socio-demographic factors associated with their diet quality. The diet quality of adolescent girls was compared with that of adult women to assess which group was most at risk. The diet quality was measured by calculating the nutrient adequacy ratio (NAR), using the preceding 24 h dietary recall method. The mean adequacy ratio (MAR) was calculated as an overall measure of diet quality using the NAR. Nearly three quarters of WRA (adolescents: 73.1-88.5%; adult women: 72.9-86.4%) had an inadequate intake of calcium, vitamin A, folic acid, and vitamin B12. The prevalence of inadequate dietary intakes of calcium, zinc, and energy was significantly higher in adolescent girls (p < 0.001) than in adult women. Overall diet quality was significantly better in adult women (0.51 ± 0.21, p < 0.001) than in adolescent girls (0.49 ± 0.22). Age, marital status, educational level, and monthly household income were important factors associated with the diet quality of WRA. Micronutrient inadequacy is widely prevalent in the diets of WRA in Bangladesh, and adolescent girls with poor socio-economic status and lower educational levels are at higher risk.
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12
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Madhari RS, Boddula S, Ravindranadh P, Jyrwa YW, Boiroju NK, Pullakhandam R, Mamidi RS, Nimmathota A, Kulkarni B, Thingnganing L. High dietary micronutrient inadequacy in peri-urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 3:e13065. [PMID: 33347729 PMCID: PMC7752122 DOI: 10.1111/mcn.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/04/2022]
Abstract
Multiple micronutrient deficiencies (MNDs) co-exist, often because of poor intakes and adversely impact health. Habitual diets were assessed in 300 school children (6-17 years old) recruited from two government schools by simple random sampling. Probability of adequacy (PA) for 11 micronutrients and mean probability of adequacy (MPA) was calculated. Haemoglobin, plasma ferritin, folic acid, vitamin B12 and C-reactive protein were estimated. Descriptive statistics and regression analysis were used to estimate magnitude and factors associated with MNDs. The contribution of fortified foods and/or supplements in addressing inadequacies and excessive intakes was modelled. The PA ranged from 0.04 for folate to 0.70 for zinc, and the MPA was 0.27. Prevalence of anaemia (53%), iron deficiency (57%; ID), iron deficiency anaemia (38%; IDA), folate deficiency (24%) and B12 deficiency (43%) was high. Dietary inadequacy of iron, zinc and a low MPA was associated with anaemia and IDA. Inclusion of double fortified salt (DFS), fortified rice (FR) or iron folic acid (IFA) supplements individually in habitual diet reduced probability of iron inadequacy significantly from 82% to ≤13%. Inclusion of DFS and FR simultaneously led to disappearance of iron inadequacy, but risk of excessive intake increased to 16%. Inclusion of DFS, FR and IFA together increased risk of excess iron intake to 40%. Nevertheless, intakes of folate and B12 remained inadequate even with FR and/or IFA. These results indicate a high risk of dietary MNDs in children and suggest need for more systematic intake measurements in representative sample and adjustment of iron dosages to avoid excessive intakes.
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Affiliation(s)
- Radhika S. Madhari
- Department of DieteticsICMR‐National Institute of NutritionHyderabadIndia
| | - Swetha Boddula
- Department of DieteticsICMR‐National Institute of NutritionHyderabadIndia
| | | | | | | | | | - Raja Sriswan Mamidi
- Division of Clinical EpidemiologyICMR‐National Institute of NutritionHyderabadIndia
| | - Arlappa Nimmathota
- Division of Public Health NutritionICMR‐National Institute of NutritionHyderabadIndia
| | - Bharati Kulkarni
- Division of Maternal and Child HealthICMR‐National Institute of NutritionHyderabadIndia
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13
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Wable Grandner G, Dickin K, Kanbur R, Menon P, Rasmussen KM, Hoddinott J. Assessing statistical similarity in dietary intakes of women of reproductive age in Bangladesh. MATERNAL AND CHILD NUTRITION 2020; 17:e13086. [PMID: 32990382 PMCID: PMC7988869 DOI: 10.1111/mcn.13086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/28/2023]
Abstract
Women of reproductive age (WRA) need adequate nutrient intakes to sustain a healthy pregnancy, support fetal growth, and breastfeed after childbirth. However, data on women's dietary intake in low‐ and middle‐income countries (LMICs) are limited, and assessment of differences between dietary intakes of pregnant or lactating women compared with that of nonpregnant, nonlactating (NPNL) women is untested. Using single, multiple‐pass 24‐h dietary recall data from a sample of WRA residing in rural Bangladesh, we examined women's dietary intakes for energy, protein, calcium, iron, vitamin A, and dietary diversity for three groups: NPNL (n = 2,903), pregnant (n = 197), and lactating women (n = 944). We used equivalence testing to examine similarity in adjusted intakes for pregnant versus NPNL women and lactating versus NPNL women with a predetermined equivalence threshold based on recommendations specific for each reproductive stage. On average, both pregnant and lactating women had insufficient intakes for all dietary measures. Although statistically significant differences were observed between pregnant and NPNL women for energy intake and dietary diversity and between lactating and NPNL women for energy and protein intake, the magnitudes of these differences were too small to reject equivalence. Statistical similarity was also evident in all micronutrients and dietary diversity for both two‐group comparisons. Understanding statistical differences and similarities between dietary measures of women in distinct reproductive stages has important implications for the relevance, appropriateness, and evaluation of maternal diet‐enhancing interventions in LMICs, especially during pregnancy and lactation, when demand for macronutrients and micronutrients is elevated.
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Affiliation(s)
| | - Katherine Dickin
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Ravi Kanbur
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, USA
| | - Purnima Menon
- Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | | | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.,Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, USA
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14
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Exploring Rural Adolescents' Dietary Diversity and Its Socioeconomic Correlates: A Cross-Sectional Study from Matlab, Bangladesh. Nutrients 2020; 12:nu12082230. [PMID: 32722644 PMCID: PMC7468778 DOI: 10.3390/nu12082230] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 12/01/2022] Open
Abstract
The majority of 36 million Bangladeshi adolescents live in rural areas. Improved understanding of their dietary patterns is of great public health importance. This study aimed to explore dietary diversity (DD) with its socioeconomic and gender stratification in a rural adolescent cohort and to isolate factors associated with inadequate DD. Household survey provided data for constructing dietary diversity scores (DDS) and assessing relevant socio-demographic variables. Final analysis included 2463 adolescents. Means and proportions were compared, and a binary logistic regression model was fitted. Inadequate DD was observed among 42.3% (40.3–44.2). Consumption of nutrient-rich foods varied significantly across gender and SES categories. Belonging to the poorest households (adjusted odds ratio (aOR) 1.59; 95% CI: 1.27, 2.00) and food insecure households (aOR 1.34; 95% CI: 1.13, 1.59), adolescents’ attainment of secondary education (aOR 1.38; 95% CI: 1.11, 1.71), and having mothers with secondary education or above (aOR 0.76; 95% CI: 0.60, 0.96) were associated with inadequate DD. Compared with girls from food secure households, girls from food insecure ones had higher odds of inadequate DD (aORgirl 1.42; 95% CI: 1.12, 1.81). Improving rural adolescents’ DD would require targeted interventions as well as broader poverty alleviation.
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15
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Harding KL, Aguayo VM, Webb P. Trends and Correlates of Overweight among Pre-School Age Children, Adolescent Girls, and Adult Women in South Asia: An Analysis of Data from Twelve National Surveys in Six Countries over Twenty Years. Nutrients 2019; 11:nu11081899. [PMID: 31416224 PMCID: PMC6722576 DOI: 10.3390/nu11081899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 01/19/2023] Open
Abstract
Overweight has become a global pandemic and is associated with a rise in diet-related non-communicable diseases and associated co-morbidities. Most of the world’s undernourished people live in South Asia, yet the number of overweight and obese individuals in this region is growing. This study explores trends and correlates of overweight among pre-school age children, adolescent girls, and adult women in South Asia. Using pooled data from 12 national surveys in six countries, generalized linear mixed models were run to analyze relationships. Overweight children had significantly higher odds than non-overweight children of having an overweight mother (Adjusted Odds Ratio: 1.34, p < 0.01). Overweight adolescent girls were more likely to come from a wealthier household (Adjusted Prevalence Ratio (APR): 2.46, p < 0.01) in an urban area (1.74, p < 0.01), and have formal education (1.22, p < 0.01), compared to non-overweight girls. Similar relationships were seen among overweight vs. non-overweight adult women. In Bangladesh, India, and Nepal, overweight among girls and women increased over time, while differentials associated with household wealth, urban residence, and formal education attenuated over time. Overweight and obesity are becoming more prevalent across South Asia in a context of persisting undernutrition. Once a condition of the wealthier, more educated and urban, rates of overweight are increasing among poorer, less educated, and rural women. This requires immediate attention to ‘multi-use’ policies and programmes.
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Affiliation(s)
- Kassandra L Harding
- Yale School of Public Health, Yale University, New Haven, CT 06515, USA.
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Victor M Aguayo
- United Nations Children's Fund (UNICEF) Programme Division, New York, NY 10017, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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16
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Thorne-Lyman AL, Shaikh S, Mehra S, Wu LSF, Ali H, Alland K, Schultze KJ, Mitra M, Hur J, Christian P, Labrique AB, West KP. Dietary patterns of >30,000 adolescents 9-15 years of age in rural Bangladesh. Ann N Y Acad Sci 2019; 1468:3-15. [PMID: 31403718 PMCID: PMC7318683 DOI: 10.1111/nyas.14207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
Little is known of the usual food intakes of rural adolescents in South Asia. This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. Latent class analysis was used to assign individuals to dietary patterns based on class membership probabilities. The following five dietary patterns (class membership probabilities) were identified: (1) “least diverse” (0.20); (2) “traditional” (0.28); (3) “low vegetable/low fish” (0.23), (4) “moderately high meat” (0.20); and (5) “most diverse” (0.09). The least diverse pattern had the lowest median consumption of most foods and traditional had a relatively higher intake of most vegetables and fish. The most diverse pattern consumed both healthy and processed foods much more often than other patterns. The two most diverse patterns (4 and 5) were associated with higher socioeconomic status, body mass index, height‐for‐age Z‐score, and male gender, and the least diverse pattern showed inverse associations with these characteristics. The most diverse pattern may represent an early wave of the nutrition transition in rural Bangladesh.
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Affiliation(s)
- Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee S F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | - Kelsey Alland
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kerry J Schultze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maithilee Mitra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jinhee Hur
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill and Melinda Gates Foundation, Seattle, Washington
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Tumilowicz A, Beal T, Neufeld LM, Frongillo EA. Perspective: Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition. Adv Nutr 2019; 10:563-575. [PMID: 31046079 PMCID: PMC6628942 DOI: 10.1093/advances/nmy133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/22/2018] [Accepted: 12/31/2018] [Indexed: 01/22/2023] Open
Abstract
Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status.
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Affiliation(s)
| | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
- Department of Environmental Science and Policy, University of California, Davis, CA
| | | | - Edward A Frongillo
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC
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18
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Blum LS, Khan R, Sultana M, Soltana N, Siddiqua Y, Khondker R, Sultana S, Tumilowicz A. Using a gender lens to understand eating behaviours of adolescent females living in low-income households in Bangladesh. MATERNAL AND CHILD NUTRITION 2019; 15:e12841. [PMID: 31083774 PMCID: PMC6852560 DOI: 10.1111/mcn.12841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/22/2019] [Accepted: 04/24/2019] [Indexed: 01/22/2023]
Abstract
Adolescence is a critical period characterized by rapid physical, psychological, and social development and growth. In Bangladesh, high rates of undernutrition persist among adolescent females living in low‐income households. Prevalence of adolescent marriage and pregnancy is extremely high, with almost half of Bangladeshi women giving birth by 18 years of age. Qualitative research was carried out from April to June 2017 to examine individual, social, and environmental factors influencing eating behaviours of female adolescents between 15 and 19 years of age living in low‐income families in urban and rural settings in Bangladesh. Methods included freelisting exercises (33), key informant interviews (11), in‐depth interviews (24), direct observations (16), and focus group discussions (12). Findings show that household food insecurity necessitates adjustments in meal food quality and frequency. Gender norms prescribe that females receive small meal portions and make sacrifices in food consumption so that male family members can eat more. Work and school schedules cause long breaks between meal consumption, restricting food intake of adolescent females for extended periods. Gender discrimination and its manifestations likely amplify susceptibility to psychological stresses in adolescent females. An inferior social position makes adolescent females living in food insecure households vulnerable to undernutrition, with factors affecting food deprivation increasing as they approach childbearing. Policies to increase age of marriage and reduce adolescent pregnancy must continue. Programmes must ensure that school‐going adolescents eat adequately during the school day. Prolonging school education and strengthening the economic viability of women should alter cultural expectations regarding marriage age and normative female roles.
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Affiliation(s)
- Lauren S Blum
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
| | - Rasheda Khan
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
| | - Marzia Sultana
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
| | - Nahian Soltana
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
| | | | - Rudaba Khondker
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
| | - Sabiha Sultana
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
| | - Alison Tumilowicz
- Global Alliance for Improved Nutrition (GAIN), House 20, Road 99, Level 4, Gulshan 2, Dhaka, 1212, Bangladesh
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19
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Nguyen PH, Huybregts L, Sanghvi TG, Tran LM, Frongillo EA, Menon P, Ruel MT. Dietary Diversity Predicts the Adequacy of Micronutrient Intake in Pregnant Adolescent Girls and Women in Bangladesh, but Use of the 5-Group Cutoff Poorly Identifies Individuals with Inadequate Intake. J Nutr 2018; 148:790-797. [PMID: 30053285 PMCID: PMC7413035 DOI: 10.1093/jn/nxy045] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background The Minimum Dietary Diversity for Women (MDD-W) indicator based on a 10-food group women dietary diversity score (WDDS-10) has been validated to assess dietary quality in nonpregnant women. Little is known about its applicability in pregnant women, and specifically pregnant adolescent girls with higher nutrient requirements. Objectives This study aimed to 1) compare the adequacy of micronutrient intakes between pregnant adolescent girls and women, 2) examine the performance of WDDS-10 in predicting the mean probability of adequacy (MPA) of 11 micronutrients, and 3) assess how well the MDD-W cutoff of 5 groups performed in pregnant adolescent girls and women. Methods We used data from a 2015 household survey in Bangladesh (n = 600). Nutrient intakes were estimated with a multiple-pass 24-h recall and WDDS-10 was assessed through the use of a list-based method. Multiple linear regression models adjusted for geographical clustering assessed the association between WDDS-10 and MPA. Sensitivity and specificity analysis assessed the accuracy of MDD-W in correctly classifying individuals into high (MPA >0.6) or low MPA. Results Dietary intakes of pregnant adolescent girls and women were similar in energy intake, WDDS-10 (5.1 ± 1.4), MPA (0.40 ± 0.12), and micronutrient intakes. Probabilities of adequacy were ∼0.30 for riboflavin, vitamin B-12, calcium, and zinc; 0.12-0.15 for folate; 0.16-0.19 for vitamin A; and extremely low for iron at 0.01. The WDDS-10 was significantly associated with MPA in both groups and predicted MPA equally well at population level (SD of residuals 0.11 for both). Use of the 5-food groups cutoff for MDD-W to classify individuals' diets into MPA >0.6, however, resulted in a low correct classification (∼40%). A cutoff of 6 food groups markedly improved correct classification. Conclusions The WDDS-10 predicted MPA equally well for pregnant adolescent girls and women at population level. The MDD-W indicator performed poorly in classifying individuals with MPA >0.6.
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Affiliation(s)
| | | | | | | | | | - Purnima Menon
- International Food Policy Research Institute, Washington, DC
| | - Marie T Ruel
- International Food Policy Research Institute, Washington, DC
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