Burden and Predictors of Malnutrition Among Indian Adolescents (10-19 Years): Insights From Comprehensive National Nutrition Survey Data

Malnutrition and Anemia Among Particularly Vulnerable Tribal Groups of Odisha, India: Needs for Context-Specific Intervention

Background

As undernutrition and anemia persist to be prevalent in India, the socioeconomically disadvantaged groups continue to take the greater brunt. Odisha is home to the largest number of particularly vulnerable tribal groups (PVTGs) in India. The study aimed to provide a comprehensive report on the undernutrition and anemia status of all the PVTGs of Odisha.

Methods

A community-based cross-sectional study was conducted among (N = 1461, 683 males and 779 females) 13 PVTGs spread across 12 districts of Odisha from August 2018 to February 2019.

Results

Among the under-five children, the prevalence of underweight was observed in 75.26%, stunting in 55.42%, and wasting in 60.00% and all forms of undernutrition were higher among girls. Among children and adolescents belonging to the age group of 5 to 19 years, the prevalence of thinness was 46.7%. In individuals above the age of 20, the prevalence of underweight among males was 37.7% and females was 44.3% and severe anemia was present in 36.5% of females and 35.8% of males. Women in the reproductive age have a higher prevalence of anemia.

Conclusion

The study shows that undernutrition and anemia remain high in the PVTGs, especially among the under-five children and women in the reproductive age. As the country heads toward fulfilling Sustainable Development Goals (SDG) by 2030, national and state health policies need to be designed and implemented, giving special focus to these vulnerable groups.

Body weight modification experience among adolescents from Saudi Arabia

Background

Childhood malnutrition is a public health issue in developing countries, leading to a double burden of malnutrition, which is associated with both overweight and underweight.

Objective

To assess body weight satisfaction and perception as well as body weight modification experiences, among adolescents from Saudi Arabia.

Method

This study utilized a cross-sectional design targeting adolescents who attempted to modify their body weight. A questionnaire was constructed to measure their demographics, body weight satisfaction and perception, and experience concerning their weight modification attempts. The chi-square test was used to assess the association between the ability to modify weight and maintain the modification according to the ability to set an appropriate weight target based on the age and height of the adolescents, method of weight modification, and receipt of support to modify weight.

Results

A total of 285 adolescents were recruited. More than half of the sample were female (58%); most respondents were secondary school students (73%). Nearly 45% had abnormal body weight where 12.6% were underweight, and 32.3% were overweight or obese. Most of the recruited sample were unsatisfied with their body weight (63%). Although 52% of the adolescents had a normal BMI, only 35% perceived their body weight as normal. Nearly 75% of the sample were able to modify their body weight. However, a smaller proportion were able to maintain the modification they achieved. The most frequently selected body weight modification method was dieting (83%), followed by exercise (69%). Only 40 adolescents (14%) reported consulting a physician regarding their body weight modification attempts. The most frequently reported source of support for weight modification was the family (51%), while the lowest frequency of support was reported concerning schools' contribution (29%). Upon assessing factors associated with the ability to modify weight or maintain the modification, a higher frequency of adolescents who indicated they employed dieting behavior were able to maintain the modification compared to other weight modification practices (p < 0.05).

Conclusion

The findings highlight the importance of collaboration between families, schools, and healthcare services to improve adolescent body image and ensure the adoption of healthy body weight modification practices among adolescents.

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.

Stunting and Underweight among Adolescent Girls of Indigenous Communities in Telangana, India: A Cross-Sectional Study

India's indigenous groups remain vulnerable to malnutrition, despite economic progress, reflecting the reliance on traditional agriculture and the problems of poverty and inadequate education and sanitation. This mixed-methods study analyzed the incidence, causes and determinants of chronic malnutrition, measured through stunting, thinness and underweight among adolescent indigenous girls in Telangana. Using 2017 data on 695 girls aged 11-18 years from 2542 households, the analysis showed that 13% had normal nutritional status, while 87% were stunted, underweight or thin. Early adolescents (11-14 years) had higher underweight prevalence (24.4%), while late adolescents (15-18 years) showed greater stunting (30%). Regressions identified key influencing factors. Higher education levels of heads of households and the girls themselves alongside household toilet access significantly improved nutritional status and reduced stunting and underweight. The sociocultural emphasis on starchy staple-based diets and early marriage also impacted outcomes. Tackling this crisis requires mainstreaming nutrition across development agendas via comprehensive policies, education, communication and community participation. Further research can guide context-specific solutions. But, evidence-based investments in indigenous education, livelihoods, sanitation and women's empowerment are the first steps. Nutrition-sensitive development is indispensable for indigenous groups to fully participate in and benefit from India's progress.

The effect of the Mid-Day Meal programme on the longitudinal physical growth from childhood to adolescence in India

The study aims to examine the effect of the world's largest school-feeding programme, the Mid-Day Meal (MDM) programme, on the changes in the underweight prevalence among school-children in India. Data from the Indian Human Development Survey (IHDS) Rounds 1 (2004-05) and 2 (2011-12) were utilized. The sample included individual-level information of children aged 6 to 9 years in IHDS-1 who then turned 13 to 16 years in IHDS-2. The sample was categorised into four groups based on their MDM consumption history (Group 1: no MDM support in IHDS-1 and IHDS-2, Group 2: MDM support in IHDS-1, Group 3: MDM support in IHDS-2, Group 4: persistent MDM support in IHDS-1 and IHDS-2). The dependent variable was underweight status as defined by the World Health Organisation Child Growth Standards Body Mass Index for age (BMI Z-score) < -2 SD of the median. Bivariate analysis was used to examine the prevalence of underweight and establish associations between underweight status and socio-demographic characteristics. Logistic regression was performed to assess the strength of the association of socio-demographic characteristics and MDM consumption patterns with underweight across poor and non-poor asset groups. The findings suggest that early and persistent MDM support among respondents reduced the likelihood of low BMI Z-scores compared to those without MDM support. Respondents from the poor asset group who received MDM support in at least one of the two survey rounds had higher odds of being underweight in comparison with those who did not receive MDM support at all. Girls and adolescents residing in the Eastern region of India were less likely to be underweight. The study shows that the MDM programme was effective in reducing the rate of underweight among school children. However, continuous programme upscaling with a special focus on children from poor households will significantly benefit India's school-aged children.

Children's Educational Outcomes and Persistence and Severity of Household Food Insecurity in India: Longitudinal Evidence from Young Lives

BACKGROUND

Food insecurity is a pressing global challenge with far-reaching consequences for health and well-being. However, little attention has focused specifically on the experiences of children and adolescents over the age of 5 y in food insecure households.

OBJECTIVES

We examine whether the persistence and severity of household food insecurity are negatively associated with children's educational outcomes.

METHODS

We used data for the younger cohort of the longitudinal Young Lives data from rounds 3 (2009), 4 (2013), and 5 (2016), when children were aged 8 y, 12 y, and 15 y, respectively. Drawing on the Household Food Insecurity and Access Scale, we used descriptive statistics, graphical analysis, and multilevel regressions to document how the persistence and severity of household food insecurity are associated with children's educational outcomes (years of education, maths, and vocabulary [PPVT] test scores). We controlled for potentially confounding sociodemographic characteristics, including children's own baseline grade attained and test scores in "value-added" models, to provide robust estimates of household food insecurity in predicting children's educational outcomes.

RESULTS

Household food insecurity generally declined between 2009 and 2016. Fewer than 50% of households were food secure across the 3 rounds of data we examined. Our robust, multivariate, value-added models show that the persistence and severity of food insecurity are negatively associated with all 3 children's educational outcomes we examined.

CONCLUSIONS

We add to a small but growing literature exploring how household food insecurity is associated with children's educational outcomes in the Global South. Our findings on severity of food insecurity highlight the importance of understanding food insecurity along the severity continuum rather than as a dichotomous state, as previously done in existing literature. Addressing household food insecurity in childhood and adolescence may be a key factor to improve children's educational outcomes.

Sex-specific associations between markers of arterial stiffness and bone mineral density in Indian men and women

BACKGROUND

Osteoporosis and cardiovascular disease (CVD) share common risk factors, yet both are usually underdiagnosed in the absence of major complications. We investigated associations between arterial stiffness, cardiac workload, carotid intima media thickness (CIMT) and areal bone mineral density (aBMD) in Indian adults.

METHODS

Men and women aged >45 years from the Andhra Pradesh Children and Parents Study (APCAPS) were included for cross-sectional analysis (521 women and 696 men). Dual energy x-ray absorptiometry (DXA) measured aBMD at the whole body, total hip and lumbar spine. Supine blood pressure and heart rate were measured and used to calculate rate pressure product and pulse pressure; augmentation index, pulse wave velocity and CIMT were measured. Sex-interactions were tested (denoted as p-int); adjustments were made for confounders. Data were expressed as SD differences with 95 % confidence intervals.

RESULTS

There were significant negative associations between pulse pressure and aBMD at all sites in women only. In unadjusted analyses, for every 1SD increase in pulse pressure, women had greater negative differences in aBMD at the whole body (-0.13 vs 0.007), total hip (-0.20 vs -0.05) and lumbar spine (-0.12 vs 0.05) compared with men. After adjustments, sex differences remained. Similar negative associations were seen between pulse wave velocity and augmentation index with aBMD in women only. There were no sex differences between CIMT and rate pressure product with aBMD.

CONCLUSIONS

Markers of arterial stiffness are associated with poorer bone health in Indian women, but not in men. There is a need to identify the shared risk factors and markers of arterial stiffness and poor bone health to detect those who require co-management of these diseases to prevent cardiovascular events and fractures.

Undernutrition and anaemia among Indian adolescents: role of dietary diversity and hygiene practices

In 2021, the Lancet Commission on adolescent nutrition highlighted the need to prioritise the elimination of adolescent malnutrition to tap the human capital potential and break the intergenerational malnutrition trap. The nutritional requirement during adolescence reaches its peak. The present study aims to appraise the prevalence of undernutrition (stunting and thinness) and anaemia among adolescents (10-19 years) in India and the role of socioeconomic, individual-level hygiene behaviour and dietary diversity in nutritional outcomes. We have used the nationally representative Comprehensive National Nutrition Survey (CNNS-2016-18) that covers children and adolescents (0-19 years) in India. The prevalence of stunting, anaemia and thinness among adolescents was 27⋅2, 28⋅5 and 24⋅1 %, respectively. Bivariate and multivariable logistic regression models were applied to estimate the likelihood of undernutrition. The likelihood of stunting was higher for late adolescence (OR 1⋅21, 95 % CI 1⋅15, 1⋅27), low dietary diversity (OR 1⋅37, 95 % CI 1⋅26, 1⋅49) and low hygiene behaviour compliance (OR 1⋅53, 95 % CI 1⋅42, 1⋅64). Adolescents from the poorest quintile were more likely to be stunted (OR 3⋅20, 95 % CI 2⋅94, 3⋅48), anaemic (OR 1⋅66, 95 % CI 1⋅47, 1⋅87) and thin (OR 1⋅68, 95 % CI 1⋅54, 1⋅82). We found that lower hygienic compliance was significantly associated with undernutrition and anaemia. Therefore, promoting hygienic practices should be emphasised to tackle undernutrition and anaemia. Furthermore, dietary diversity and poverty were strong predictors of stunting and thinness, therefore targeting the poor and focusing on improving dietary diversity should be the priority.

Secular trends and sociodemographic determinants of thinness, overweight and obesity among Chinese children and adolescents aged 7-18 years from 2010 to 2018

Background

Most studies have focused on overweight/obesity and its secular trend, with insufficient studies on the factors influencing thinness and trends recently. To examine the trends of prevalence and sociodemographic determinants of thinness, overweight, and obesity among Chinese children and adolescents aged 7 to 18 years from 2010 to 2018.

Methods

This study was based on cross-sectional data of 11,234 children and adolescents aged 7 to 18 years from the Chinese Family Panel Studies (CFPS) in 2010, 2014, and 2018, including anthropometric and sociodemographic characteristics variables. The nutritional status of each individual was determined according to China and WHO criteria. The demographic characteristics of different subgroups were tested by chi-square, and log-binomial regression was used to analyze the trend of prevalence and the relationship between sociodemographic characteristics and different nutritional statuses.

Results

After adjusting for age, from 2010 to 2018, the overall prevalence of thinness decreased, and the prevalence of overweight increased in Chinese children and adolescents. The overall prevalence of obesity declined in boys and increased in girls, but in adolescents aged 16-18 years, it increased significantly. Log-binomial regression analysis showed that among all subjects, time (years), 16-18 years were negatively associated with thinness, while 13-15 years, walking to school, large family size, and paternal age at childbirth older than 30 years old were positively associated with thinness; 10-12/13-15/16-18 years, boarding at school, medium and large family sizes, and mother's education at junior middle school/junior high school and above were negatively associated with overweight/obesity, while time (years), boys were positively associated with overweight/obesity in the multivariate model by adjusting for the statistically significant factors (all p < 0.05).

Conclusion

Chinese children and adolescents are facing a double burden of malnutrition. Future public health policies and interventions should prioritize high-risk groups specifically young age groups, boys, larger family sizes and so on.