Food consumption patterns of adolescents aged 14-16 years in Kolkata, India

Nutritional status of school-age children (5-19 years) in South Asia: A scoping review

Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.

Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry

BACKGROUND

Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents' dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers' engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers' views on instilling healthy behaviours in their children.

METHODS

Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10-19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches.

RESULTS

A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents' sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge.

CONCLUSIONS

The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

How do adolescents classify foods as healthy and unhealthy?: A qualitative inquiry from rural India

Indian adolescents exhibit obesogenic dietary habits including low intake of fruits and vegetables and increasing consumption of fast food and carbonated beverages. Adolescents' classification of healthy and unhealthy foods is likely to have significant implications for their dietary behaviour, and consequently, their health. However, there is limited evidence about the ways Indian adolescents classify foods as healthy or unhealthy. Hence, this qualitative study was designed to explore how Indian adolescents classify nutritious or non-nutritious food choices. Convenience sampling was used to recruit the study participants from Tikari village in Uttar Pradesh, India. Underpinned by the social constructivist lens, the adolescents were interviewed face-to-face in Hindi. All the interactions were digitally recorded, transcribed verbatim, and translated into English prior to data analysis. Transcribed data were analysed thematically using inductive as well as deductive coding, and subsequently, conceptual themes were extracted. A total of thirty-nine adolescents (twenty boys; nineteen girls) aged 10-19 years participated in this qualitative inquiry. The adolescents classified healthy and unhealthy foods based on the following six themes: (i) Food groups and nutrients; (ii) Health and immunity; (iii) Type of ingredient; (iv) Place and time of food preparation; (v) Packaging; and (vi) Parental influence. These findings can inform school-based food literacy interventions to foster healthy dietary habits and cooking skills among Indian adolescents.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

A Cross-Sectional Analysis of Health Behavior in School-Aged Children: The Qassim Study

Background Childhood obesity is a worldwide public health epidemic. Sedentary lifestyles and unhealthy dietary patterns increased the rates of overweight and obesity among children. This study aimed to (1) estimate healthy behaviors (including dietary patterns and physical activity) and (2) determine the prevalence of overweight and obesity among Saudi school-aged children in the Qassim region, Saudi Arabia. Methods A population-based cross-sectional study was conducted among Saudi schoolchildren aged between five and 16 years old. The study group consisted of 339 children including 237 males and 102 females. Data were collected using a questionnaire based on the Health Behavior in School-Aged Children (HBSC) survey. Body mass index (BMI) for age and gender was computed for each child using the AnthroPlus 2007 software (World Health Organization {WHO}, Geneva, Switzerland). Statistical Package for Social Sciences (SPSS) version 23.0 (IBM SPSS Statistics, Armonk, NY) was used for data analyses. Results The prevalence of overweight and obesity among Saudi children was 46 (13.6%) and 81 (23.9%), respectively. Males consumed more soft drinks and energy drinks, whereas females consumed more fruit juice. As children grew older, the consumption of unhealthy food and beverages increased. Males engaged in more daily physical activity compared to females. Conclusion Saudi schoolchildren (aged 5-16 years) demonstrated significant gender-specific variations in dietary patterns and levels of physical activity. A significant proportion of Saudi children were overweight or obese. The study highlighted the complex relationship between age, school class, gender, and health behaviors among Saudi school-aged children. Policymakers and parents could benefit from the understanding of such complex relationships to promote healthy behaviors among school-aged children.

Association of bone mineralization markers with dietary nutrient intake in adolescents with and without biochemical osteomalacia

Background

Dietary intake is widely known to play a crucial role in achieving peak bone mass among children and adolescents. Unfortunately, this information is lacking among Arab adolescents, an understudied demographic that has recently been observed to have a high prevalence of abnormal mineralization markers [low serum 25(OH)D, high serum alkaline phosphatase (ALP), low calcium (Ca) and/or inorganic phosphate (Pi)] suggestive of biochemical osteomalacia (OM, defined as any 2 of the 4 parameters). In order to fill this gap, we aimed to evaluate the associations of serum markers of biochemical OM with dietary intake of macronutrients, vitamins and trace minerals.

Methods

Saudi adolescents (N = 2,938, 57.8% girls), aged 12-17 years from 60 different schools in Riyadh, Saudi Arabia were included. Dietary intake of nutrients was calculated following a semi-quantitative 24 h dietary recall over 3 weekdays and 1 weekend-day using a validated food frequency questionnaire. Compliance to reference daily intake (RDI) of macronutrients, vitamins and trace minerals were calculated. Fasting blood samples were collected and circulating levels of 25(OH)D, ALP, Ca, and Pi were analyzed.

Results

A total of 1819 (1,083 girls and 736 boys) adolescents provided the dietary recall data. Biochemical OM was identified in 175 (9.6%) participants (13.5% in girls, 3.9% in boys, p < 0.01) while the rest served as controls (N = 1,644). All participants had serum 25(OH)D levels <50 nmoL/L. Most participants had very low dietary intakes of Ca (median ~ 290 mg) and vitamin D (median ~ 4 μg) which are far below the RDI of 1,300 mg/day and 20 μg/day, respectively. In contrast, excess dietary intakes of Pi, Na, K, and Fe were observed in all participants. In the biochemical OM group, thiamine and protein intake were significant predictors of serum 25(OH)D, explaining 4.3% of the variance perceived (r = 0.23, adjusted r² = 4.3%, p = 0.01). Among controls, dietary vitamin C and vitamin D explained 0.6% of the total variation in serum 25(OH)D (r = 0.09, adjusted r² = 0.6%, p = 0.004).

Conclusion

Arab adolescents do not meet the RDI for dietary Ca and vitamin D, and none have sufficient vitamin D status (25(OH)D levels >50 nmol/L) but they exceed the RDI for dietary Pi. Interpreting these data in the light of the increased prevalence of rickets in Arab countries, food fortification to optimise vitamin D and Ca intake in Saudi adolescents should be considered.

Knowledge, practices and influencing factors defining unhealthy food behavior among adolescents in India: a scoping review

Unhealthy food behaviors are the major contributing factors to the rising burden of non-communicable diseases (NCDs) among adolescents in India. Knowledge and practices related to unhealthy eating are significant factors influencing adolescents' food behavior. In this scoping review, we aim to map evidence and identify gaps on knowledge, practices, and the influencing factors associated with unhealthy food behavior among Indian adolescents by examining the existing literature. Arksey and O'Malley's scoping review framework and the Joanna Briggs Institute Reviewers' manual were used for this review. After the screening, 33 articles were identified according to the inclusion criteria. Data extraction was performed according to the study objectives, followed by narrative summarization. The studies included a total of 20,566 adolescents. Most studies reported insufficient knowledge about healthy food choices among adolescents. Diet intake patterns among the adolescents showed a lower amount of fruits and vegetables and an increase in fried items, sugar-sweetened beverages, packaged food, and fast food in both sexes, with a broader association with peer influence (21.2%), parental unhealthy food behavior (15.1%), place of residence (6.06%), emotional status (6.06%), and mass media exposure (18.1%). The scoping review highlights the need for targeted interventions aimed at improving the knowledge and practices of Indian adolescents by promoting healthy food choices and sensitizing them about the risk of non-communicable diseases. The analysis of evidence around adolescent dietary behavior in India shows a monotonous, limited, and narrow range in scope, indicating the extended need for research.

Analysis of Determinants of Food Preferences in a Polish Population-Based Sample of Primary School Adolescents: Diet and Activity of Youth during COVID-19 (DAY-19) Study

For the choices of food products, food preferences are crucial, as they influence the intake of nutrients and the resultant quality of diet, but in Poland, no studies of food preferences were conducted during the COVID-19 pandemic on a population of young adolescents. The aim of this study was to analyze the determinants of food preferences in a Polish population-based sample of primary school adolescents as part of the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study focused on a national sample of a population of primary school adolescents who were recruited based on cluster sampling of participants from counties and schools, yielding a sample of 5039 individuals. Their food preferences were assessed using the Food Preference Questionnaire (FPQ), and they were compared in subgroups stratified by (1) gender: male and female; (2) age: younger (10-13 years) and older (14-16 years); (3) place of residence: urban and rural; (4) Body Mass Index (BMI): underweight, normal body weight, and overweight/obese (assessed based on Polish growth reference values); and (5) physical activity level: low and moderate (assessed using the International Physical Activity Questionnaire for children aged 10-13 (IPAQ-C) and adolescents aged 14-16 (IPAQ-A)). In the population of adolescents, no statistically significant differences in food preferences between subgroups stratified by gender were observed (p > 0.05). For boys, none of the studied factors (age, place of residence, BMI, physical activity level) was statistically significant determinant of food preferences (p < 0.05), while for girls, all of them were statistically significant determinants (p > 0.05). All the assessed factors (age, place of residence, BMI, physical activity level) in girls were associated with preferences for snacks, and older girls, those from a rural environment, those who were underweight and overweight/obese, as well as those having a low physical activity level declared a higher preference for snacks than younger ones (p = 0.0429), those from an urban environment (p = 0.0484), those of a normal body weight (p = 0.0091), and those having a moderate physical activity level (p = 0.0083). Similarly, girls from rural environments declared a higher preference for starches than those from urban environments (p = 0.0103), and girls having a low physical activity level declared a higher preference for fruit than those having a moderate physical activity level (p = 0.0376). Taking this into account, the population of girls, in particular, needs dedicated educational actions to support proper nutritional habits. Additionally, older age, living in a rural environment, being underweight and overweight/obese, and having a low physical activity level may be indicated as factors predisposing one to food preferences potentially promoting unhealthy dietary habits.

Food environment around schools and adolescent consumption of unhealthy foods in Addis Ababa, Ethiopia

Adolescent diets may be influenced by the retail food environment around schools. However, international research to examine associations between the proximity of retail food outlets to schools and diet provides equivocal support for an association. This study aims to understand the school food environment and drivers for adolescents' consumption of unhealthy foods in Addis Ababa, Ethiopia. Mixed-methods research was conducted, 1200 adolescents (10-14 years) from randomly selected government schools were surveyed, along with vendors within 5-min' walk of the schools and focus group discussions (FGDs) with adolescent groups. Mixed-effect logistic regression investigated the relationship between the number of vendors around the schools and the consumption of selected unhealthy foods. Thematic analysis was used to summarize findings from the FGDs. Consumption of sweets and sugar-sweetened beverages (S-SSB) and deep-fried foods (DFF) at least once a week was reported by 78.6% and 54.3% of the adolescents, respectively. Although all schools were surrounded by food vendors selling DFF and S-SSB, consumption was not associated with the number of vendors available around the school. However, adolescents' awareness and perception of healthy food, and their concerns about the safety of foods in the market, influenced their dietary choices and behaviours. Lack of financial resources to purchase food as desired also played a role in their selection of food and eating habits. Reported unhealthy food consumption is high among adolescents in Addis Ababa. Thus, further research is warranted to come up with school-based interventions that promote access and healthy food choices among adolescents.

A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries

Introduction

Identifying the root causes of iron deficiency anaemia is a prerequisite for effective management and prevention in adolescents. This systematic review assessed risk factors of iron deficiency anaemia among adolescents living in developing countries.

Method

Electronic databases such as PubMed, Cochrane Library, Science Direct, Google Scholar, and SCOPUS were comprehensively searched for studies published between 1990 and 2020 that involved risk factors of iron deficiency anaemia among adolescents living in developing countries. The quality of the included studies was assessed using the American Dietetic Association Quality Criteria Checklist.

Results

A total of 2,252 publications were reviewed, and only fifteen cross-sectional studies were eligible for inclusion, eight of which focused on female adolescents and seven on both genders. Direct risk factors contributing to anaemia among adolescents included food intake practices (n = 10 studies), female adolescents (n = 8 studies), menstruation (n = 5 studies), and parasitic infection (n = 6 studies). Indirect risk factors found to be associated with anaemia among adolescents included low educational status (n = 4 studies) and low socioeconomic status (n = 3 studies). All fifteen studies were of good quality.

Conclusion

Food intake practices, female adolescents, menstruation, parasitic infection, and low educational status were the leading risk factors of iron deficiency anaemia among adolescents. Further research should concentrate on assessing the effectiveness and efficacy of existing interventions aimed at preventing iron deficiency among vulnerable groups in developing countries.

Indian adolescents' perceptions of packaged food and food labels - A qualitative inquiry

In the last two decades, India has witnessed a dramatic rise in the consumption of packaged foods, especially among adolescents. Food labelling is often recognised as an instrumental population-based approach which can enable consumers to make informed food choices by providing all the necessary details about the food product on the packaging. In the Indian context, where adolescent obesity and the ensuing non-communicable diseases are escalating, it is crucial to understand adolescents' views on the use of non-nutritious packaged foods and food labels. Therefore, the aim of this qualitative inquiry was to explore Indian adolescents' perceptions regarding the consumption of packaged food and use of food labels. Convenience sampling was employed to recruit 29 boys and 15 girls (aged 10-19 years) from rural Varanasi, India. Semi-structured, face-to-face interviews were conducted in the local language. Interview recordings were transcribed verbatim and translated to English. Narrative data were subjected to thematic analysis using NVivo software program. The adolescents reported frequent consumption of packaged food like potato chips, biscuits, chocolates, deep-fried Indian snacks both at school and home. Packaged foods were regarded as tasty, safe, and fresh. Brand name, date of expiry and cost were often read by the study respondents. Nevertheless, they reported difficulty in understanding other components of the label (e.g., nutrition information) and they were not aware of the negative impact of consuming unhealthy packaged foods. Nearly all the respondents insisted that food labels should be written in the local language for easy understanding. These emerging findings underscore the need to design school-based food literacy programs for vulnerable Indian adolescents to address obesity and diet-related complications in early adulthood.

Determinants of dietary patterns in school going adolescents in Urban Zambia

Background

Understanding dietary patterns in a population is critical for decision making. This study aimed to identify the prevailing dietary patterns and their associated individual and school environment factors among school going adolescents in Lusaka, Zambia.

Method

A cross-sectional study involving 404 Grade 10 pupils from 10 secondary schools in Lusaka district was conducted. A 108-item unquantified Food Frequency Questionnaire (FFQ) was used to assess the learner's food intake practices. Principal component analysis (PCA) was used to derive dietary patterns from the 108 food items. In addition, a mapping of food vendors and types of food sold was conducted in the same 10 schools using a semi-structured observation checklist. Bivariate and multivariate multilevel regression was used to analyse the individual and school level determinants of the adolescent dietary patterns.

Results

The average age of learners was 16.1 years (SD 1.4 years); 234 (58%) were female while 170 (42%) male. “Snacking,” “vegetarian,” “health conscious,” and “traditional” dietary patterns accounting for 54.5% of variability in learner's diets were identified using PCA. At individual level, having weekly pocket money was significantly associated with snacking (p ≤ 0.0001). Self-identified poverty was associated with snacking (p ≤ 0.0001), vegetarian (p = 0.009) and traditional (p = 0.009) dietary patterns. School level factors like a school tuckshop (similar to canteen) that sells fast foods or a kantemba (semi-permanent makeshift store) within the school vicinity (p = 0.023) were significantly associated with a snacking dietary pattern. School tuckshop selling nshima (a thick maize based porridge) was significantly associated with vegetarian (p = 0.007), health conscious (p = 0.02) and traditional dietary patterns (p=0.01) while a tuckshop with fruit significantly predicted traditional (p ≤ 0.0001), vegetarian (p = 0.041), and snacking (p = 0.002), dietary patterns. Having a supermarket or fast food restaurants in the school vicinity did not significantly influence any dietary pattern.

Conclusion

Both individual behavioral and school environment level factors were found to be significant determinants of the four dietary patterns identified in this study.

A School-based survey among adolescents on Dietary pattern, Exercise, and Knowledge of Cardiovascular risk factors (ADEK) Study

Background. Cardiovascular disease is a global emerging problem and its risk starts in children and adolescents. Adolescents have modifiable cardiovascular risk factors that have been found globally, and nationally, and early intervention programs may be able to lower these risks for both individuals and populations. Accurate risk factor evaluation at the individual level is crucial in this situation for the prevention of cardiovascular disease. Objective. The study aimed to investigate cardiovascular disease knowledge and to determine physical activity, and dietary patterns among school-going adolescents in Arakkonam, Tamil Nadu, India. Methods. A school-based cross-sectional survey was conducted to assess cardiovascular disease knowledge among 500 adolescents aged 10-18 from public schools. The study period was from September 2021 to February 2022. The measurement taken on anthropometrics such as height, weight, body mass index, and bio-physiological measurement as blood pressure, structured questionnaire assessed for knowledge, dietary questionnaire assessed previous week food consumption which the investigator developed, and physical activity standard questionnaire assessed the past week’s exercise level. Data were analyzed using IBM Statistical Package for Social Sciences version 20. Results. The mean study population age was 13.7±1.7, 53% were boys, and 47% were girls. Factors like age 16-18 years (p=0.01), site of residence from urban (p=0.001), education of teenagers (p=0.01), and family history of cardiovascular disease (p=0.001) are significantly correlated with the level of knowledge score, with better-educated adolescents having fair knowledge score than others. Level of knowledge score and demographic traits are associated with physical activity, such as 16 to 18 years (p=0.03), living in an urban region (p=0.03), being in a joint household (p=0.001), adolescents who are at higher secondary (p=0.02), and having a family history contribute more to cardiovascular disease (p=0.001) than other variables. Mean days eating diets were egg (4.18±2.27), vegetables (3.92±0.93), milk products (3.85±1.87), fried foods (3.75±1.25), toffees, and chocolates (3.35±1.81) all had higher percentages of consumed foods than others. Conclusion: There is a risk of cardiovascular disease higher among adolescents. Still a need for school-based primordial preventive educational approaches needed to improve to curb this burden.

Co-occurrence of non-communicable disease risk factors and its determinants among school-going adolescents of Kathmandu Metropolitan City

Background

Adolescence is a critical transition in human growth and adolescents tend to engage in various risky behaviors which are likely to continue into adulthood. Co-occurrence of non-communicable disease risk factors has the potential to increase risks of chronic disease comorbidity and increased mortality in later life. Behavioral risk factors are adopted due to changes in lifestyle and adolescents are more prone to acquire them. This study aimed to determine the prevalence and associated factors of co-occurrence of non-communicable disease risk factors among school-going adolescents of Kathmandu Metropolitan City.

Methods

We conducted a cross-sectional study among school-going adolescents of Kathmandu Metropolitan City in January/February 2020. We used stratified random sampling to select 1108 adolescents studying in 9, 10, 11, and 12 grades. We used Global Schools Health Survey tools to collect data. We entered data in EpiData 3.1 and exported it into Statistical Package for Social Science (SPSS) version 20 for statistical analysis. We estimated prevalence of NCDs risk factors and co-occurrence of risk factors. We applied multivariate multinomial logistic regression analysis adjusting for age, gender, ethnicity, religion, education, type of school, and parental education to determine factors associated with co-occurrence of NCDs risk factors.

Results

The prevalence of physical inactivity, unhealthy diet, harmful use of alcohol and tobacco among school-going adolescents were 72.3% (95%CI: 69.6–74.9), 41.1% (95%CI: 38.2–44.0), 14.8% (95%CI: 12.8–17.0) and 7.8% (95%CI:6.3–9.5) respectively. The adolescent with co-occurrence of two or more risk factors was 40.7% (95%CI: 37.8–43.7). The school-going adolescents who were in higher age group (AOR = 1.72, 95% CI- 1.06, 2.77), Hindus (AOR = 1.78, 95% CI-1.09, 2.89), other than Brahmin/Chhetri by ethnicity (AOR = 2.11, 95% CI-1.39, 2.22) and with lower education level of mothers (AOR = 2.40, 95% CI- 1.46,3.98) were more likely to have co-occurrence of NCDs risk factors after adjusting for all socio-demographic variables.

Conclusion

The co-occurrence of non-communicable disease risk factors was high among school going adolescents and was associated with age, religion, ethnicity and mother’s education. Integrated and comprehensive interventional programs should be developed by concerned authorities.

Psychological distress and unhealthy dietary behaviours among adolescents aged 12-15 years in nine South-East Asian countries: a secondary analysis of the Global School-Based Health Survey data

It is unclear whether there is any association between psychological distress and unhealthy dietary habits among adolescents in low- and middle-income countries. We aimed to estimate the prevalence of these factors in South-East Asia region and investigate their associations. We used data from the Global School-based Health Survey for nine South-East Asian countries. Psychological distress was defined by presence of ≥ 2 factors from loneliness, anxiety, suicide ideation, suicide planning and suicide attempt. We assessed inadequate fruit intake, inadequate vegetable intake, daily soft drink and weekly fast-food consumption. We used random-effects meta-analysis to estimate pooled prevalence. Logistic regressions were used to estimate OR of unhealthy dietary behaviours for psychological distress. Among 30 013 adolescents (56 % girls) aged 12-15 years, the prevalence of psychological distress was 11·0 %, with girls reporting slightly higher than boys (11·8 % v. 10·1 %). The prevalence of inadequate fruit intake, inadequate vegetable intake, daily soft drink consumption and weekly fast-food consumption was 42 %, 26 %, 40 % and 57 %, respectively. Psychological distress was associated with inadequate fruit intake (pooled OR = 1·20, 95 % CI 1·03, 1·40), inadequate vegetable intake (pooled OR = 1·17, 1·05, 1·31) and daily soft drink consumption (pooled OR = 1·14, 1·03, 1·26); but not with weekly fast-food consumption (pooled OR = 1·13, 0·96, 1·31). We observed substantial cross-country variations in prevalence and OR estimates. In conclusion, South-East Asian adolescents have significant burden of psychological distress and unhealthy dietary behaviours, with those having psychological distress are more likely to have unhealthy dietary behaviours. Our findings will guide preventative interventions and inform relevant policies around adolescent nutrition in the region.

Effectiveness of structured interventional strategy for middle-aged adolescence (SISMA-PA) for preventing atherosclerotic risk factors—A study protocol

Background

Atherosclerotic risk starts at an early stage in adolescents and interventions on adolescents’ lifestyles are most important. The pandemic of obesity-related morbidities like atherosclerosis among young adults and atherosclerotic risk factors for middle-aged adolescents in India is known. Yet, there is a lack of cost-effective and integrated intervention programs to treat this important health problem.

Objective

The main objective of this study is to evaluate the effect of a 12-week structured interventional strategy program, containing integrated education and supervised physical activity interventions for middle-aged adolescents.

Methods/design

This will be a school-based pre-experimental one-group pre-post time-series research design. The sample size is estimated to include 154 adolescents of 10^th to 12^th grade; aged 15–17 years will be grouped as a single arm. Data will be collected from July 2021 to January 2022. The intervention duration will be 3 months. The following measures will be evaluated before, during, and after intervention: knowledge, body mass index, level of physical activity, dietary habits, and sedentary activity.

Discussion

We believe that the structured interventional strategy approach which includes education related to atherosclerosis, physical activity, dietary habits, and sedentary activity, and cost-effective physical activity training will be more effective in preventing atherosclerotic-related changes among middle-aged adolescents. Further, this kind of approach may be applied in similar study areas elsewhere in India.

Trial registration

Clinical Trials Registry—India (Registered Number: CTRI/2021/03/032271).

School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.

Socioeconomic, intrapersonal and food environmental correlates of unhealthy snack consumption in school-going adolescents in Mumbai

Background

Unhealthy snacking habits in adolescents are typically triggered by obesogenic food environments and possibly perpetuated through interactions between socio-environmental factors and personal perceptions, attitudes, and motivations to change eating behaviors. This study attempted to address the knowledge gap regarding the association of intrapersonal, socioeconomic, and food environmental characteristics with unhealthy snack consumption in Indian adolescents, presenting several targets for effective interventions.

Methods

A representative sample of 10–12 years old adolescents (n 712) completed a cross-sectional survey including eating habits, characteristics of school and home food environments, and perceptions related to affordability, convenience, and barriers within the food environments. The frequency of unhealthy snack consumption was assessed using a validated qualitative food frequency questionnaire. Multivariate regression analyses determined the associated factors of unhealthy snack consumption in adolescents attending private and public schools.

Results

The mean age of adolescents was 10.9 (1.1) years, 48.2% were girls and 53.9% attended private schools. The most frequently consumed unhealthy snacks were biscuits/ cookies (5.2d/wk) followed by wafers (3.4d/wk) and Indian fried snacks- samosa/ vada pav (2.8 d/wk). Among the public-school adolescents, the odds of unhealthy snack consumption were 0.89 times lower when meals were had frequently at the dinner table and 4.97 times higher when the perceived barriers related to the affordability of healthy snacks were greater. Maternal education (OR 0.78, 95% CI 0.66–0.82, p < 0.001), family income (OR 2.15, 95% CI 1.98–2.32, p < 0.001), availability of unhealthy snacks (OR 2.98, 95% CI 1.36–3.46, p < 0.001) and fruits (OR 0.57, 95% CI 0.49–0.69, p < 0.001) at home, having evening meals together (OR 0.71, 95% CI 0.63–0.81, p 0.031), and perceived parental control during mealtimes (OR 0.67, 95% CI 0.62–0.72, p < 0.001) were associated with unhealthy snack consumption in adolescents attending private schools.

Conclusions

The results highlighted a pervasiveness of unhealthy snacks in adolescents’ food environments. Improving provisions and affordability of fruits and healthy snacks at schools, encouraging family mealtimes, and limiting the availability of unhealthy snacks at home whilst addressing the perceived barriers within food environments, and inculcating self-efficacy skills can improve snacking habits in Indian adolescents, irrespective of socioeconomic backgrounds.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13449-6.

Evolving Food Choices Among the Urban Indian Middle-Class: A Qualitative Study

One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.

A cross-sectional study to assess the prevalence of health behaviors and protective factors among schoolchildren in a rural area in West Bengal

Background:

Adolescence is the most vulnerable developmental period in one’s life. In low to middle-income countries like ours, adolescence living in the rural area face increasing physical and mental health challenges that are not addressed due to ignorance or resource limitation. This study is conducted with the aim of assessing the magnitude of health behavior and protection factor among school children in the study area and to compare the same between boys and girls.

Materials and Methods:

An explanatory sequential mixed method descriptive observational study with cross-sectional study design was conducted on 102 students aged 15-19 years studying in a government school in Amdanga block, West Bengal. Purposive sampling was done for the quantitative part. Global school health survey questionnaire was used. Qualitative study with FGD was done after the quantitative part.

Results:

Out of 102 students, 58 (56.66%) re females and 44 (43.13%) are males, only 10 (9.8%) have consumed alcohol and 14 (13.72%) have consumed tobacco of some form. 15 (14.8%) students were bullied last year. Around 11 (10.8%) students had suicidal thoughts in the last 1 year. Most of them have proper hygiene behavior. Qualitative analysis revealed issues amongst both males and females regarding body image perception etc.,

Conclusion:

It is seen that males have more addictive behavior and gets into fighting easily then females. It is found that there are many issues regarding mental and physical health of the adolescents. That needs to be addressed and measure should be taken seriously and proper services like counseling, monitoring, parent’s support should be given.

Assessing Dietary Intake Patterns Through Cluster Analysis Among Adolescents in Selected Districts of Bihar and Assam From India: A Cross-Sectional Survey

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.

Food consumption patterns of the urban adult population in the field practice area of a teaching hospital in Kolkata, using food frequency questionnaire

Background:

Nutrition transition has replaced homemade foods with processed items that increased the prevalence of noncommunicable disease in adult population. But we know little about the food intake pattern of adults specially in urban sector.

Aims:

The study aimed at describing the food-consumption patterns in a sample of adults residing in urban area.

Settings and Design:

An observational cross-sectional study was done from April to June, 2019 at urban field practice area of a teaching hospital of Kolkata.

Methods and Material:

A prevalidated, pretested, 51-item, food-frequency questionnaire was applied to assess the food-consumption pattern of 110 participants.

Results:

Adults reported poor dietary intakes; more than half reported no consumption of green-leafy vegetables (GLV) (66.4%), other vegetables (52.8%), and fruits (63.6%). Whereas 72.7% reported consumption of three or more servings of energy-dense foods and 90.9% reported consumption of three or more servings of energy-dense beverages on previous day. Mean intake of food varied from 0.34 (SD = 0.47) for GLV to 8.19 (SD = 2.39) for cereals. Females consumed more servings of GLV, other vegetables, roots-tubers, and fruits than males. Fruit consumption was low in all age groups. Higher socioeconomic class people strikingly consumed no GLV.

Conclusions:

Study participants reported consumption of more energy-dense snacks, beverages than healthy food like GLV, fruits. Study findings highlight to design strategies to promote nutrition education and practical application of healthy food habits in target population group.

Assessment of macronutrients consumption in the diet of adolescent school children in four seasons: a longitudinal study from an urban city in Pakistan

BACKGROUND

A healthy diet in the adolescence period is essential for physical, mental, and immunological development. We aimed to assess macronutrient consumption in the diet of adolescent school children using 24 h recalls in four seasons of the year.

METHOD

This was a longitudinal study conducted from February 2014 to June 2015. The study population included 155 school children aged 7-14 years from an urban school in Karachi. 24HR recall was conducted on 4 random days of the 4 main seasons. A food composition table was developed where the weight, calories, carbohydrate, fat, and protein content of the food items were listed. Macronutrients quantification was calculated by using proportional weight from the food composition table. Food groups were also assigned to each food item including vegetables, fruits, grains, protein foods, dairy products, and oils.

RESULTS

A total of 155 adolescent children aged between 7 and 14 years were approached. Out of the 155 preadolescents and adolescents, 150 (96.7%) agreed to participate. The mean (SD) age of the children was 11.31 (1.6) years, and 59% of all the children were males. Overall mean (SD) daily intake for all seasons was 195.31 (86.87) grams of carbohydrates, 94.77 (71.87) grams of proteins, and 55.87 (30.79) grams of fats. Carbohydrates formed 48.16%, protein 21.92%, and fat 29.93% of the total caloric intake. The mean (SD) daily caloric intake was 1517 (644) grams. Overall, the highest source of calories was from carbohydrate 781 (347) Kilocalories (Kcal), followed by fat 502 (277) Kcal and protein 379 (287). The Carbohydrate intake in 24 h was highest in the autumn; 212.81 (85.37), and there was a significant difference in carbohydrate intake in all seasons (p value 0.003). Consumption of discretionary food group was high (31.3%), and consumption of fruits and vegetables was low (29%).

CONCLUSION

The study reports a suboptimal caloric intake of fewer than 2000 cal/day among the adolescents from school. The highest source of calories was from carbohydrates.The highest consumption of food was in autumn and the least in summer. Fruits and vegetable intake was low, and discretionary food intake was high.

Prevalence of Excessive Weight and Underweight and Its Associated Knowledge and Lifestyle Behaviors among Urban Private School-Going Adolescents in New Delhi

With rapid urbanization and the Indian nutrition transition, Indian adolescents face a high risk of developing an energy imbalance. This study aims to assess the prevalence of excessive weight, underweight, and associated knowledge and lifestyle behaviors among private school-going adolescents in Delhi. A cross-sectional study was conducted in students (6th–7th grades) of eight randomly selected private schools in Delhi, India in 2019. A self-administered survey was used to assess students’ dietary-and-physical-activity-related knowledge and behavior. Anthropometric measurements (height, weight, and waist circumference) were also conducted. Out of 1567 participants, 7.2% were underweight, 61.3% normal, and 31.5% excess in weight. Underweight was associated with significantly more eating whilst studying for exams (relative risk ratio (RRR) 1.7 (1.0–2.9)). Excessive weight was associated with less incorrect knowledge on behaviors causing overweight (RRR 0.7 (0.5–0.9)), more often reading nutritional labels of packed food items (RRR 0.6 (0.4–0.9)), and less frequent vegetable-intake (RRR 0.7 (0.4–0.9)). Underweight students showed more suboptimal knowledge and unhealthy behaviors, whilst students with excessive weight showed more correct knowledge and healthy behaviors. This study highlights the immediate need for effective health-promoting interventions focused on the importance of healthy lifestyle at least in underweight adolescents.

Association between Food Preferences and Food Habits in a Polish Adolescents' COVID-19 Experience (PLACE-19) Study

Food preferences are among the most influential factors of food habits in the vulnerable period of adolescence; in addition, gender-dependent differences in food preferences are also observed. The aim of the present study was to analyze differences in food habits between individuals stratified based on their food preferences in a population-based sample of adolescents aged 15–20. The study was conducted within the Polish Adolescents’ COVID-19 Experience (PLACE-19) Study population in a group of 2419 secondary school students who were randomly chosen to participate in the study using a random quota sampling procedure. The food preferences were determined on the basis of a validated Food Preference Questionnaire (FPQ) (which enables assessing preference of vegetables, fruit, meat/fish, dairy, snacks, and starches), whereas food habits were determined on the basis of the Adolescents’ Food Habits Checklist (AFHC) (which enables assessing food purchase, preparation, and consumption habits). The analysis involved three homogenous clusters (‘low-preferring’, ‘hedonists’, and ‘high-preferring’), which were identified using the k-means algorithm. It was found that for a number of the assessed food purchase, preparation, and consumption habits, there were statistically significant differences between the ‘low-preferring’, ‘hedonists’, and ‘high-preferring’ clusters. Within food purchase habits, the food preference influenced frequency of buying pastries/cakes and frequency of eating takeaway meals for all the respondents, while for female respondents, it influenced also choice of desserts in restaurants, and for male respondents, it influenced choosing a low-fat lunch away from home (p < 0.05). Within food preparation habits, the food preference influenced the fat content in desserts at home, the frequency of eating at least one serving of vegetables/salad with an evening meal, the frequency of spreading butter/margarine on bread thinly, and the frequency of having cream on desserts for all the respondents; meanwhile, for female respondents, it also influenced the frequency of avoiding fried foods and the frequency of including chocolate/biscuits in their packed lunch (p < 0.05). Within food consumption habits, the food preference influenced the frequency of eating a dessert/pudding, eating at least one serving of fruit a day, eating at least one serving of vegetables/salad a day, avoiding sausages/burgers, trying to ensure they eat plenty of fruit and vegetables, and frequency of choosing fruit as a snack for all the respondents; meanwhile, for male respondents, it also influenced the frequency of eating sweet snacks and eating at least three servings of fruit most days (p < 0.05). Taking into account that some improper food habits may be typical for the specific clusters, there is an urgent need to analyze and address them for the purposes of public health and to bear in mind that some of those habits are gender-dependent.

Effect of Almond Consumption on Metabolic Risk Factors-Glucose Metabolism, Hyperinsulinemia, Selected Markers of Inflammation: A Randomized Controlled Trial in Adolescents and Young Adults

A large percentage of the Indian population has diabetes or is at risk of pre-diabetes. Almond consumption has shown benefits on cardiometabolic risk factors in adults. This study explored the effect of almond consumption on determinants of metabolic dysfunction—blood glucose, lipids, insulin and selected inflammatory markers in adolescents and young adults aged 16–25 years from Mumbai city. This randomized controlled trial was conducted for a period of 90 days on individuals with impaired levels of fasting glucose levels between 100–125 mg/dL (5.6–6.9 mmol/L) and 2-h post-glucose value 140–199 mg/dL (7.8–11.0 mmol/L) and/or fasting insulin (≥15 mIU/ml)/stimulated insulin (≥80 mIU/ml). Of 1,313 individuals screened, 421 met the inclusion criteria, of which 275 consented to participate and 219 completed the trial. The trial was registered with Clinical Trials Registry India (CTRI) CTRI/2018/02/011927. The almonds group (n = 107) consumed 56 g almonds daily, the control group (n = 112) was provided an iso-caloric cereal-pulse based snack. At baseline and endline, blood glucose, insulin, HbA₁c, LDL-c, HDL-c, total and ox-cholesterol, triglycerides, hs-CRP, IL-6, TNF-α, adiponectin, leptin were measured and HOMA-IR and FG:FI ratios were calculated. Dietary intakes were assessed. The anthropometric measurements, biochemical markers as well as macronutrient intakes did not differ significantly between the two groups at baseline. Almond consumption significantly decreased HbA₁c, total cholesterol and LDL-c. Stimulated insulin decreased post-intervention in both groups, but the decrease was greater in the almonds group. Fasting glucose was reduced post intervention in the controls with no change in the almonds group. FG:FI ratio decreased in the almonds group. TNF-α and IL-6 decreased in the almonds group, while it increased in the control group. Our results showed that almonds reduced HbA1c, LDL-c and total cholesterol levels in just 12 weeks of consumption in these adolescents and young adults who were at risk for developing diabetes. Almonds can be considered as part of food-based strategies for preventing pre-diabetes.

Clinical Trial Registration:ClinicalTrials.gov, identifier: CTRI/2018/02/011927.

Factors Affecting Fast Food Consumption among College Students in South Asia: A Systematic Review

Unhealthy dietary practices have increased among college students in South Asia. Higher intakes of energy-dense foods may increase health risks such as weight gain in college students. The purpose of the study was to gather evidence on fast food consumption patterns and factors that influenced fast food consumption among college students in South Asia. Electronic databases (CINAHL, PsycINFO, PubMed, and ScienceDirect) were used to find relevant potential English-written articles. We followed the standard process of identification, screening, eligibility assessment, study quality assessment, and data extraction from the included articles in this review. In total, data were synthesized from 28 articles. Factors such as gender, being younger, higher socio-economic class, higher body mass index (being overweight or obese), study groups such as students from Humanities, low nutrition knowledge, and the internet addiction played the roles as positive determinants (all P values < 0.05) of consuming fast food frequently. Furthermore, taste, brand reputation, accessibility, location, price, ambiance, hygiene practice, variety, promotional offers, and timely service significantly (all P values < 0.05) increased intakes of fast food in college students. Engaged institutional nutrition education intervention and multisectoral approaches are necessary to reduce fast food consumption in college students along with enabling them to make healthy food choices.Key teaching pointsFrequency of fast food consumption (daily to several times a week) has increased among college students in recent years in South Asia.This systematic review shows that a number of socio-economic, physiological, and behavioral factors influence fast food consumption in college students.Commonly, male students and persons with higher body mass index consume fast food more often. Taste, price, and convenience, accessibility, availability, ambiance, and location also promote fast food consumption in college students.Nutrition interventions are needed to promote healthy dietary intake behavior among college students in South Asia.

Promoting healthy foods among urban school children in Bangladesh: a qualitative inquiry of the challenges and opportunities

BACKGROUND

In Bangladesh overweight and obesity among urban school children are on the rise. Urban school children tend to consume foods dense in calories and few fruits and vegetables which is associated with overweight and obesity. The current study explored the barriers and opportunities for promoting healthy diets among school children from the perspective of teachers and parents in Dhaka, Bangladesh.

METHODS

We conducted 14 key informant interviews with teachers and principals, six focus group discussions with 31 mothers of school children (5 to 15 year old) and 14 structured observations of the school food environment. Inductive thematic analysis was performed manually.

RESULTS

Schools were important for development of food preferences of children, however, most school cafeterias provided foods based on profit rather than health considerations. A shift in food culture resulted in making eating out acquire many meanings beyond convenience. Mothers, especially those who were employed, struggled to prepare healthy foods due to time pressure. Mothers were generally concerned about chemicals added to raw foods in markets which led to limited fruit and vegetable consumption.

CONCLUSIONS

There were many challenges to promoting healthy foods to school children within and outside the school. It is important to formulate policies and guidance to create a supportive environment for healthy foods in and in the proximity of schools. It is also important to educate consumers about identifying and choosing healthy foods. Laws related to food safety should be adequately implemented to boost the population's confidence in safety of available healthy foods in the food system.

Structured, multifactorial randomised controlled intervention to investigate physical activity levels, body composition and diet in obese and overweight adolescents

INTRODUCTION

There has been a steep increase in the prevalence of adolescent overweight and obesity globally and in India, demonstrating that present prevention strategies are insufficient. Available evidence suggests that multifactorial interventions may improve short-term physical activity (PA), nutrition and psychological behaviour of overweight and obese adolescents but long-term follow-ups and strategies are needed. This study will investigate the effects of a structured multifactorial (school-based and family-based) intervention on adolescent obesity, compared with a single or no intervention.

METHODS AND ANALYSIS

A pragmatic, clustered randomised controlled trial with 12 weeks of interventions and 3-month, 6-month and 12-month follow-ups will be conducted at multiple participating schools in Karnataka, India. The participants will be overweight and obese male and female adolescents aged 11-16 years and will be randomly assigned by school into three groups: group A (multifactorial intervention, exercise and dietary advice); group B (exercise only); and group C (controls, no interventions). Primary outcome measures are the level of PA and body composition. Secondary outcomes are dietary change, behaviour change, food behaviours, cardiovascular and muscular fitness, quality of life, parental behaviours (physical and mental) and family functioning. Positive intervention results may reduce obesity in adolescents and promote a healthier lifestyle for students and families. A larger, culturally diverse population can benefit from a similar methodology.

ETHICS AND DISSEMINATION

The study has been approved by the Institutional Research and Ethics Committee (IEC 536-2018), Kasturba Hospital, Manipal, Udupi District, Karnataka, India. A written and verbal informed consent (supplemental material) will be provided to the participants prior to participation. On completion of the trial, the results can be communicated to adolescents and their parents on request, and will be published at national and international conferences and in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

CTRI/2019/04/018834.

Medical nutrition therapy of pediatric type 1 diabetes mellitus in India: Unique aspects and challenges

Medical nutrition therapy (MNT) is a vital aspect of management of type 1 diabetes mellitus (T1DM) and should be tailored to ethnic and family traditions and the socioeconomic and educational status of the patient. In this article, we discuss the unique aspects of MNT in children and adolescents with T1DM in the Indian setting, with focus on the challenges faced by patients, dieticians and physicians and how these can be overcome. The authors reviewed the available literature on MNT in T1DM from India and prepared the document based on their vast collective clinical experience in treating patients with T1DM from different regions in India. Indian diets are predominantly carbohydrate-based with high glycemic index (GI) and low protein content. Various methods are available to increase the protein and fiber content and reduce the GI of food in order to limit glycemic excursions. Insulin regimens need to be tailored to the child's school timings, meal schedule, and the availability of a responsible adult to supervise/administer insulin. All patients, irrespective of economic and education background, should be taught the broad principles of healthy eating, balanced diet and carbohydrate counting. There are various barriers to dietary compliance, including joint family system, changing lifestyles, and other factors which need to be addressed. There is a need to customize dietary management according to patient characteristics and needs and develop standardized patient educational material on principles of healthy eating in various regional languages.

Does diet play a role in the prevention and management of depression among adolescents? A narrative review

BACKGROUND

Depression is one of the major causes of illness and disability, while suicide is the second leading cause of death amongst adolescents. Although many factors determine the mental health of an individual, diet has been gaining popularity as a key modifiable factor in the prevention and management of depression. Nutritional Psychiatry is an emerging field where researchers suggest that the food we consume influences our mental well-being.

AIM

This review aims to explore the significance of diet, nutrient deficiencies, imbalances, and unhealthy dietary patterns in the prevention and management of unipolar depression or major depressive disorder among adolescents.

METHODS

Electronic databases such as PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE were searched using keywords such as "mental health," "depression," "adolescents," "diet," "dietary pattern," and pertinent articles (N = 68) were retrieved and reviewed.

RESULTS

The Mediterranean and traditional diets rich in complex carbohydrates, omega-3 fatty acids, B-group vitamins and several amino acids have shown negative correlation with the incidence of depression. On the other hand, Western dietary patterns (sweetened beverages, processed/ junk food, and foods rich in saturated fatty acids), along with low consumption of fruits and vegetables have been linked to an increased risk of depression among adolescents.

CONCLUSION

Dietary modification can prove to be a cost-effective strategy for the prevention and treatment of depression among adolescents. Diet and nutrition need to be recognized as key modifiable targets for the prevention of mental disorders and nutritional medicine should be considered as an integral part of psychiatric treatment.

Challenges to lifestyle modification of chronic disease patients attending primary health care centers in Riyadh

BACKGROUND

The rate of chronic diseases is increasing due to the global pandemic of inactivity and an unhealthy diet.

OBJECTIVE

We aimed to determine the dietary habits, physical activities of the participants, and challenges facing them to adapt to a healthy lifestyle.

METHODOLOGY

The researchers conducted a cross-sectional study on chronic disease patients attending primary health care centers in Riyadh from January to March 2018. The estimated sample size was 250 patients. The participants completed a self-administered questionnaire.

RESULT

The mean age of the 250 participants was 35.3 years old. The Overweight and obese participants accounted for 67.2% of the sample (mean BMI = 28.0). Two-thirds of the participants depend mainly on rice or pasta for their diet, and 48.4-52.0% eat fruits and vegetables less than three times a week. About 50% of the participants perceived a lack of information, skills, motivation, and family or friends support as a barrier to a healthy diet. Also, (56.4%) of males and (67.8%) of females are physically inactive. Accessibility, cost, and the hot climate were physical activity obstacles in more than 60% of the respondents. Optimal BMI showed a significant association with increased physical activity P = 0.04.

CONCLUSION

Physical inactivity and consuming a non-balanced diet are common. So awareness campaigns of the benefit of a healthy lifestyle besides increasing physical exercise facilities, installing environmental changes, and subsidizing sports gyms would encourage people to be more physically active.

High dietary micronutrient inadequacy in peri-urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation

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.

Study on Breakfast Consumption Pattern and Its Outcomes in Relation to Hematological and Body Composition Indices among Adolescent Girls

Breakfast consumption is of utmost importance for adolescents to attain nutritional adequacy. The association of breakfast skipping with overall nutritional status has been supported with little causal evidences. Therefore, the present investigation was undertaken to examine this conjecture. A total of 500 adolescent girls from rural and urban government schools of Ludhiana District in the Punjab State of India in the age group of 16-18 years were randomly interviewed to assess their breakfast consumption pattern. Based on their breakfast consumption pattern, 90 subjects out of 500 interviewed girls were selected and categorized in three groups of regular, occasional, and never breakfast consumers. They were further assessed for body composition and hematological profile including hemoglobin level, red blood cell count, packed cell volume to evaluate the association with breakfast consumption. Consequently, a higher percentage of regular breakfast (83%) consumers were found in the normal category of BMI as compared to occasional (30%) and never (27%) consumers. There was a significant (p ≤ 0.05) association of body mass index and muscle mass with breakfast consumption. Similarly, a higher percentage of regular breakfast consumers (60%) were found non-anemic in comparison to occasional (13%) and never (3%) and showed a significant association with breakfast consumption.

Fruit and vegetable consumption among South Asians: A systematic review and meta-analysis

BACKGROUND AND AIMS

Low consumption of fruit and vegetables is associated with high prevalence of non-communicable diseases, especially among South Asians. The aim of our study was to systematically review data published on fruit and vegetable intake among South Asian countries.

METHODS

This review included 43 studies conducted from December 1999 to 2019 among South Asians. Literature searching was undertaken in PubMed® database and World Health Organization website. The main outcomes were pooled using random effect meta-analysis.

RESULTS

The highest fruit consumption by both men and women (2.4 servings/day) was found in Bhutan (2004) while the lowest reports (0.43 servings/day) were from Sri Lanka (2011) and Bangladesh (2002). With regard to vegetable consumption, Indians (2007) had the lowest reported intake (0.9 servings/day), while the highest value, 3.8 servings/day, was reported in Bhutanese adults (2014). When both intakes were considered, the highest (4.28; 95% CI, 4.02 to 4.55; p=0.15; I²=51%, p<0.001) and the lowest (1.83; 95% CI, 1.41 to 2.25; p<0.001; I²=100%, p<0.001) pooled mean values, were attained for Bhutan and Bangladesh, respectively. The highest percentage of respondents (86.2%) achieved the World Health Organization recommendation of five fruit and vegetables (400 g) per day in Afghanistan (2013) whereas the lowest (0%) reported in Bangladesh (2005).

CONCLUSIONS

Residents of almost all South Asian countries appear to consume extremely low quantities of fruit and vegetables, lower than the World Health Organization recommendation. Hence, immediate initiatives should be implemented to enhance the intake of fruit and vegetables across the region.

Predictors of the diets consumed by adolescent girls, pregnant women and mothers with children under age two years in rural eastern India

Adolescents, pregnant women and mothers of children under 2 years of age are in stages of life characterized by higher nutritional demands. The study measured the dietary diversity of 17,680 adolescent girls, pregnant women and mothers of children under age 2 years in the eastern Indian states of Bihar, Chhattisgarh and Odisha using data from the Swabhimaan baseline survey conducted in 2016. The association of women's mean Dietary Diversity Scores with socioeconomic, health and nutrition service indicators was assessed. The sampled population was socioeconomically more vulnerable than the average Indian population. There was not much variation in the types of foods consumed daily across target groups, with diet being predominantly cereal (98%) and vegetable (83%) based. Nearly 30% of the mothers had low Dietary Diversity Scores, compared with 25% of pregnant women and 24% of adolescent girls. In each target group, more than half of the respondents were unable to meet the Minimum Dietary Diversity score of at least five of ten food groups consumed daily. Irrespective of their background characteristics, mean Dietary Diversity Scores were significantly lower in Bihar than in Chhattisgarh and Odisha for all target groups. Having at least 6 years of education, belonging to a relatively rich household and possessing a ration card predicted mean dietary diversity. Project interventions of participatory women's group meetings improved mean Dietary Diversity Scores for mothers and adolescent girls. Considering the association between poverty and dietary diversity, the linkage between girls and women and nutrition-focused livelihoods and supplementary nutrition programmes needs to be tested.

Psychosocial Determinants of Fruit and Vegetable Intake in Japanese Adolescents: A School-Based Study in Japan

A few studies in Japan have demonstrated positive attitudes, self-efficacy, social support, and perceived barrier were associated with fruit and vegetable (F&V) intake in adults; however, limited evidence addresses the association of psychosocial factors with F&V intake in adolescents. A cross-sectional study through a questionnaire survey was conducted at junior and senior high schools, and 933 students completed the questionnaire. Data were analyzed by X² test and Student t-test. The findings demonstrated 2.7% of participants were aware of the current recommendations for vegetable and 2.0% for fruit. Only 4% and 8.1% of participants reported they consumed recommended amount of vegetables and fruits. In comparison with males, females showed higher scores of attitude (p < 0.01), responsibility (p < 0.01), and social support (p < 0.01). The barriers to vegetable intake were "I'm eating enough now", "not always available when eating away from home"; the barriers to fruit intake were "don't have a habit of having 100% juice or fruit in the morning", and "cost too much". The findings suggest the change of adolescents' knowledge about what they should eat is needed in boosting F&V consumption. The development of an intervention program for adolescents needs to target socio-environmental factors such as family support, and nutritional education for early healthy habit formation.

"Do you think adolescents' food intake is satisfactory?" - Views of Indian parents and teachers

Adolescents develop food habits that affect both their present and future health. Underpinned by the stakeholder theory, this study was designed to explore the perspective of parents and nutrition educators regarding urban Indian adolescents' food habits. Thirty-two educators and 280 parents from five independent, English-speaking, secondary schools in Kolkata, India completed a paper-based instrument consisting of both closed and open-ended measures. Qualitative data were subjected to thematic analysis informed by the Template Analysis Technique. Descriptive and cross-tabulation analyses were employed to assess quantitative data. Three quarters (75%) of the respondents were dissatisfied with the ubiquitous consumption of energy-dense, nutrient-poor foods and sugar-sweetened beverages as well as the low intakes of healthy foods like fruits and vegetables among urban Indian adolescents. Six reasons were advanced for such unhealthy consumption including i) Proliferation of fast food retail outlets; ii) Hyper-palatability of fast food; iii) Marketing of fast food on electronic and social media; iv) Diminished household cooking practices; v) Lack of food knowledge; vi) Tendency to seek peer group acceptance. Both parents and educators suggested some healthy eating strategies aimed at improving the food and nutrition situation in Indian secondary schools to foster healthy eating among pupils. These included: i) Restrictions on the sale of unhealthy foods in school canteens; ii) Increased availability of attractive and palatable nutritious foods; iii) Discussion of the advantages of consuming healthy foods and inclusion of food preparation techniques in the school curriculum; iv) Home Economics coursework to be made mandatory for students. The findings suggest that Indian parents and teachers are likely to support changes to the food and nutrition curricula and to school food provision to foster healthy eating among adolescents.

Are our rural adolescents eating healthy?: Implications for redesigning school health interventions - A cross sectional study in rural Coimbatore

Background

Adolescence is a period of transition where independence in thinking and behavior is established and food choices that are made are followed for several years, and this can influence their health in adulthood. Hence, understanding the eating habits are necessary to plan effective nutritional interventions in adolescents.

Objectives

The main objective of the study is to find out the extent of malnutrition among rural adolescents as well as evaluate their eating habits against recommended dietary food groups and to compare eating habits across gender and age groups.

Methods

A cross-sectional study was done among 1425 adolescents from 13 rural schools from 2014 to 2015, and the variables considered in this study were age, sex, body mass index (BMI), and the eating habits of the adolescents.

Results

Undernutrition was seen among 23% and overweight/obesity among 8% of adolescents. The habit of taking milk and milk products, fruits, and green leafy vegetables were very poor among the adolescents. Significant association was found between eating habits and BMI. Furthermore, late adolescents had better eating habits, and significant gender difference was seen in certain eating habits.

Conclusions

The study shows that it is possible to understand the gaps in eating habits of adolescents, and this can be used to plan tailor-made nutritional interventions to adolescent groups as their eating habits are different and have long-term nutritional and health implications.

Associations of obesity and serum leptin level with elevated blood pressure among urban secondary school students of a northeastern city of India: A baseline observation

BACKGROUND

Elevated blood pressure has been found to be associated with body mass index (BMI) and serum leptin levels among adults. But there is a paucity of reports regarding such associations among adolescents.

OBJECTIVES

To estimate the prevalence of prehypertension and hypertension and its associations with BMI and serum leptin levels among the secondary school going students of the Agartala Municipal Corporation area.

MATERIALS AND METHODS

This school-based cross-sectional study was conducted from 1st April 2018 to 31st December 2018, among 1,000 students studying in different secondary level schools located in Agartala municipal corporation area chosen by multistage sampling ensuring proportionate representation in the sample.

RESULT

Prevalence of prehypertension and hypertension were found to be 42.40% and 15.70%, respectively, 55.20% had normal, 22.80% had low, and 22.00% had high BMI. Serum leptin levels were found to be normal among 54.70% of the students, whereas, 36.70% had high and 8.60% had low levels, respectively. Logistic regression analysis has identified male sex (OR = 0.231, 95% CI = 0.172-0.310, P = 0.000) and high BMI (OR = 4.289, 95% CI = 2.857-6.440, P = 0.000) as the significant determinants of elevated blood pressure, but the effect of serum leptin level and family history of hypertension did not attain the level of statistical significance.

CONCLUSION

Prevalence of prehypertension and hypertension among urban school-going adolescents were found to be 42.40% and 15.70%, respectively and were significantly associated with their sex and BMI and serum leptin level, but regression analysis failed to detect any significant effect of serum leptin level in determining the blood pressure of the study subjects.

Parents’ and teachers’ critique of nutrition education in Indian secondary schools

Purpose

Nutrition education plays a significant role in inculcating lifelong healthy dietary behaviours among adolescents. The purpose of this paper is to understand the opinions of parents and teachers regarding nutrition education in private Indian secondary schools.

Design/methodology/approach

A cross-sectional, self-administered, paper-based survey comprising both closed- and open-ended questions was completed by 32 teachers and 280 parents who were recruited from five private English-speaking secondary schools in Kolkata, India. Descriptive and cross-tabulation analyses were conducted to compare the responses of teachers and parents. Thematic data analysis informed by template analysis technique was performed to evaluate the qualitative data.

Findings

While the curriculum was considered interesting and easy to understand, the gendered nature of the curriculum, excessive rote learning and lack of synchrony between the curriculum and school food services were highlighted as shortcomings of the existing curriculum. The need for the dissemination of food skills either through a compulsory food and nutrition curriculum or through extra-mural activities was expressed by most respondents. Both these ideas were indicative of strong support and motivation for modification in the current curriculum.

Practical implications

These findings emphasise the support for a skills-focussed food and nutrition curriculum to inculcate experiential culinary skills and comprehensive nutrition knowledge in Indian adolescents, thus improving their nutritional and health profiles.

Originality/value

This is the first cross-sectional survey to investigate the views of parents and teachers about the status of food and nutrition education in private Indian secondary schools.

Changes in diet, and the relationship between diet and physical activity within and across the lifetime of current ultra-endurance exercisers

BACKGROUND

There is currently no information on the lifetime diet of ultra-endurance exercisers. This study describes changes in diet across the lifetime of current ultra-endurance exercisers and the relationship between diet and physical activity (specifically ultra-endurance exercise [UEE]).

METHODS

Lifetime physical activity and diet were assessed in current ultra-endurance exercisers (N.=120; ages 21-74 years) over six life periods (5-12, 13-18, 19-30, 31-45, 46-60, 61-75 years). Using the life period having the largest absolute increase in UEE (IUEE), diet was assessed according to food category scores and dietary patterns. Changes in lifetime diet were described by comparing food category scores between adjacent life periods. Differences in food category scores were investigated between the life period for each IUEE group and the preceding life period and associations between dietary patterns and UEE were investigated within each IUEE group. Relationships between lifetime diet and UEE were investigated by examining associations between lifetime food category scores and lifetime UEE.

RESULTS

The participant group had significant increases in all food category scores from 13-18 to 19-30 years and significant decreases in all food category scores from 19-30 to 31-45 years. UEE correlated negatively with the Western style dietary pattern in the IUEE19-30 group and positively with the fruit and vegetable dietary pattern in the IUEE31-45 group. There was a positive correlation between lifetime UEE and lifetime vegetables and fruit category scores.

CONCLUSIONS

The ultra-endurance exercisers in this study exhibited changes in diet similar to general populations, which appear to reflect typical nutritional requirements across the lifespan.

Obesity Prevention Behaviors in Asian Indian Adolescent Girls: A Pilot Study

PURPOSE

The purpose of this pilot study was to evaluate obesity prevention behaviors of Asian Indian adolescent females and determine the relationship of these behaviors to cardiovascular risk factors.

DESIGN AND METHODS

A purposive sample of twenty females, 14-18 years of age, was enrolled. Body mass index, percent body fat, waist circumference, and blood pressure were measured to assess cardiovascular risk. Measures of obesity prevention behaviors were physical activity, dietary and sleeping behaviors. To quantify engagement in physical activity, participants wore an accelerometer. The dietary intake was assessed using the web based SuperTracker. Pittsburgh Sleep Quality Index was used to assess sleep behaviors. For data analysis, descriptive statistics was used for demographic characteristics. Correlations were calculated to evaluate the relationship between cardiovascular risk factors and obesity prevention behaviors.

RESULTS

The majority of the adolescents did not meet recommended physical activity levels. Most reported unhealthy eating behaviors with higher saturated fat intake correlating with higher percent body fat. The cardiovascular risk measures fell below normative values. However, more time spent in sedentary behaviors was related to higher systolic blood pressure, while poor sleep quality was associated with higher diastolic blood pressure and greater BMI.

CONCLUSIONS

The findings support the unhealthy patterns of physical activity, dietary and sleep behaviors in Asian Adolescent girls and the need for promoting healthy behaviors in this at risk population.

PRACTICE IMPLICATIONS

The study findings provide a basis for education on healthy behaviors and development of culturally appropriate interventions to prevent obesity.

Parents' and Teachers' Views of Food Environments and Policies in Indian Private Secondary Schools

School food environments and policies can play a pivotal role in inculcating healthy food habits among young people. This cross-sectional survey explored teachers’ and parents’ views of the role of school food environments and policies in promoting healthy food consumption among Indian adolescents. Thirty-two teachers and 280 parents from five private, English-speaking, secondary schools in Kolkata, India took part in a short questionnaire survey which included closed and open answer questions. Descriptive and chi-square analyses were performed to compare the responses of parents and teachers. Thematic data analysis underpinned by Template Analysis Technique was employed to examine the qualitative responses. The easy availability and accessibility of energy-dense, nutrient-poor foods, the limited availability of nutritious foods, the absence of written food policies, and inflated prices of nutritious foods were reported as problems in the Indian school food environment. However, the respondents also noted that schools restricted the sale of sugar-sweetened beverages and adopted hygienic food practices. Novel ideas for creating healthy school food environments and effective school canteen policies were also captured during the survey. These findings point to the need to create effective school food policies in Indian secondary schools to help adolescents eat healthily at school. Future research is required to test the feasibility of the implementation of school food policies.

Barriers to Nutrition Promotion in Private Secondary Schools in Kolkata, India: Perspectives of Parents and Teachers

School-based nutrition promotion is critical to the development of healthy eating habits in adolescents. Unfortunately, most Indian secondary schools do not support healthy eating among adolescents. Therefore, this study was designed to understand the perspectives of teachers and parents regarding the potential barriers to nutrition promotion in Indian secondary schools. Thirty-two teachers and 280 parents from five private English-speaking secondary schools in Kolkata, India took part in a cross-sectional survey. The paper-based survey instrument included both quantitative and qualitative items which were derived from previously published evidence. Descriptive and chi-square analyses were conducted on the quantitative data. Qualitative data were evaluated by thematic data analysis underpinned by the template analysis technique. Five main barriers to nutrition promotion emerged from the study. These included the perceived strong preference for energy-dense, nutrient-poor foods among students; lack of government canteen guidelines; limited engagement of parents, teachers, and adolescents in canteen operations; the widespread display of eye-catching food advertisements; and poor knowledge among canteen personnel with regards to healthy food preparation. These findings about the potential barriers to nutrition promotion provide useful directions for healthy school food policy implementation. Successful implementation of healthy school food policies can inculcate lifelong healthy eating habits among adolescents.