Food Security, Dietary Diversity, Dietary Patterns and the Double Burden of Malnutrition among School-Aged Children and Adolescents in Two Nigerian States

What influences Indian primary school children's food behaviors? - Perceptions of children, mothers and teachers

BACKGROUND

Development of healthy food behaviors in childhood is significant for optimum growth and development of children as well as future health. However, many Indian children display unhealthy dietary habits including poor intakes of fruits and vegetables and excessive consumption of calorie-dense, nutrient-poor foods and sugar-sweetened beverages. Therefore, the factors that influence their daily diet need to be explored for developing future interventions and policies. In this light, the present inquiry was designed to examine the various influences on the food behaviors of Indian primary school children.

METHODS

Informed by the socio-ecological framework, this study used an exploratory qualitative research approach to conduct semi-structured interviews with 22 primary school children, 19 mothers, and 18 teachers residing in Varanasi, India. For children, the interviews were preceded by a drawing session where the interviewees were asked to draw their preferred and non-preferred food and beverage items. Interviews were carried out in English or Hindi and digitally recorded. Interviews were conducted until data saturation was achieved. Digital recordings were transcribed verbatim and translated to English (where necessary) for the purpose of thematic analysis. The transcripts were coded both deductively and inductively using the NVivo software program.

RESULTS

Individual level influences included taste and nutritional knowledge. At the interpersonal level, the family food environment and peers emerged as key determinants. The physical environment also played a pivotal role in determining food behaviors, with the school food environment and food availability in the marketplace being significant. Lastly, at the societal level, television and internet advertisements were frequently cited as important determinants of children's food behavior.

CONCLUSIONS

The collective insights from the three stakeholder groups have the potential to inform public health nutrition policies and interventions targeting the different socio-ecological factors to encourage healthy eating in Indian primary school children.

Child-report food insecurity assessment measures: A scoping review

BACKGROUND

Experiences of household food insecurity are associated with a wide range of deleterious nutritional, developmental, psychological and social consequences for children. Children's distinct experiences of food insecurity, compared to adults, have been identified in diverse economic and cultural contexts. Yet historically, measurement of food insecurity in children has been predominantly reported by adult respondents on behalf of children, potentially underestimating prevalence and neglecting their unique perspectives. In response to this, child-report measures have been developed to assess food security status at both the individual and household level.

OBJECTIVES

To identify and characterise child self-report food insecurity assessment tools used globally, with particular interest in how children's perspectives have been included in measure development processes.

METHODS

A scoping systematic literature review was conducted using PRISMA-ScR. Searches were conducted in four databases in January 2024 using keywords and MeSH terms. Data were extracted and synthesised relating to population and measure characteristics, validity and reliability metrics, and child involvement in measure development.

RESULTS

A total of 169 papers employing child-report measures were included after screening. Most papers originated in North America, used a single-item and included children aged >12 years. Of the child-report measures identified (n = 33), most were not specifically validated in the population of use. Only a small number of included papers (n = 13) had the aim to specifically evaluate measure validity. The Child Food Insecurity Experiences Scale and Child Food Assessment Scale emerged as child-centred measures with comprehensive validity evidence.

CONCLUSIONS

Further child-centred validity testing, particularly with younger children (<12 years) is necessary to ensure validity of measures across age-groups and contexts. Ethical considerations when employing child-report measures, including how to best use tools across different child settings also warrant further exploration.

"Are you sure you want to go to that village"; a qualitative review of the challenges, experiences and lessons learnt from a nutritional survey in rural and urban communities in Nigeria

INTRODUCTION

The importance of community-based studies is not in doubt, however only few exist because of the complexity and challenges associated with them. Little data exists on these complexities and challenges in West Africa. This study aimed to describe the experiences, challenges and lessons learnt from a community-based Nutritional survey carried out in Nigeria. This was a qualitative review of the experiences and challenges involved in a community-based research project. A thematic content analysis was done and the findings were presented as themes and sub-themes, with the inclusion of quotes that accurately depicted the themes/sub-themes.

RESULTS

Two broad themes emerged from the study. For observations and experiences with community entry, sub-themes include the finding that community structure in the books were different from community structure on the ground, there was a general mistrust among community members, poor access to some communities and/or houses, there was a poor perception of need for the research, there was concern about risk to study participants and about benefit to the participants. The five sub-themes that pertained to the data collection process include the issues with timing, gender, data quality, men being at home and safety of the research team. Guided community engagements are recommended.

Dietary diversity and development among early childhood children in rural China

Background

Early childhood is a critical period for cognitive development, heavily influenced by nutrition. Despite significant economic advancements, malnutrition and micronutrient deficiencies persist in many low- and middle-income countries, including China, where dietary diversity remains suboptimal. Existing research predominantly relies on correlational data, underscoring the need for more rigorous empirical evidence. This study aims to fill that gap by providing stronger empirical evidence on the relationship between dietary diversity and developmental outcomes in rural Chinese children.

Methods

We conducted a longitudinal cohort study of 1,207 children aged 6-23 months, drawn from 100 villages across 22 counties in rural China, with three follow-up rounds extending until the children reached 51-83 months of age. Cognitive and non-cognitive development, as well as key health indicators, were evaluated. Cognitive development was measured using the Bayley Scales of Infant and Toddler Development and the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition. Non-cognitive development was assessed via the Ages and Stages Questionnaire: Social-Emotional and the Strengths and Difficulties Questionnaire. Health indicators included anemia, frequency of illness in the past 2 weeks, and four key anthropometric measures (height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, and body mass index-for-age z-scores). Multiple linear regression models were applied to analyze the relationship between dietary diversity scores (DDS) and developmental outcomes, incorporating child fixed effects and adjustments for time-variant confounders. We accounted for the hierarchical structure of the data by clustering standard errors at the village level, which also reflects the township level.

Results

The regression analysis identified significant positive associations between DDS and cognitive (p < 0.01), as well as reduced illness incidence (p < 0.001) in children aged 6-54 months. Additionally, DDS demonstrated a strong positive effect on non-cognitive development (p < 0.001) in children 2 years and older. The associations between DDS, non-cognitive development (p < 0.01), and illnesses reduction (p < 0.001) remained robust under two-way fixed effects models.

Implications

To promote sustainable improvements in child development and health, policymakers should prioritize nutrition-focused interventions in rural areas. Community-based programs offering caregivers training and nutritional support, integrated within healthcare and social services infrastructures, are vital for ensuring families have the necessary resources enhance child wellbeing and long-term developmental outcomes.

Nutritional status of tribal and non-tribal school-going children in rural Bangladesh: A comparative study

BACKGROUND

Inadequate nutrition of school-going children is a major concern in Bangladesh, and it can negatively affect their productivity. It is important to consider the food pattern, socio-cultural, and economic differences between tribal (T) and non-tribal (NT) communities in Bangladesh when evaluating their nutritional status. This study aimed to investigate the nutritional status of school-going children in the rural area of Rajshahi district's High Barind Tract (HBT) region of Bangladesh. Additionally, we compared the nutritional status between T and NT school-going children in the same area.

METHODS

This was a cross sectional household study. Data were collected from T and NT households in the HBT region in the Rajshahi district of Bangladesh, from January to June of 2019. A total of 500 (T 81, NT 419) school-going children aged 6-13 years were selected as samples using mixed sampling, including convenience sampling (non-probability) and simple random sampling (probability) methods. Nutritional status was assessed using body mass index-for-age z-score (BAZ) and height-for-age z-score (HAZ) according to WHO guidelines. Thinness was defined as BAZ < -2SD and stunting as HAZ < -2SD. Descriptive statistics, Z-proportional test, and logistic regression model were used to analyze the effect of selected independent variables on nutritional status of T and NT children.

RESULTS

Among school-going children, 15.20% were suffering from thinness (T 12.30% and NT 15.80%) and 17.80% stunting (T 13.60% and NT 18.60%), respectively. The difference in thinness (p > 0.05) and stunting (p > 0.05) were not significant between T and NT. The distribution of BAZ and HAZ of T and NT children were normally distributed, and were positioned negatively compared to the WHO standards. The logistic model identified the following factors for thinness: (i) mother with non-or-primary education (aOR = 1.89, 95% CI: 1.05-3.43, p < 0.05), (ii) underweight mother (aOR = 3.86, 95% CI: 1.48-10.06, p < 0.01), and (iii) underweight father (aOR = 4.12, 95% CI: 1.50-11.29, p < 0.01). For stunting, the factors were: (i) mother as a housewife (aOR = 2.79, 95% CI: 1.16-6.71, p < 0.05), (ii) father working as labour (aOR = 1.77, 95% CI: 1.01-3.278, p < 0.05), (iii) severe food insecurity in the household (aOR = 2.37, 95% CI: 1.23-4.54, p < 0.05), and (iv) children playing outside regularly more than 2 h (aOR = 2.19, 95% CI: 1.31-3.67, p < 0.01).

CONCLUSION

In rural Bangladesh, the nutritional status of T and NT school-going children did not show significant defferences. However, the mean z-score values for both groups of children were lower than the WHO standard, indicating that both communities have poor nutritional status.

Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: The Comprehensive National Nutrition Survey

BACKGROUND

Limited information on the co-prevalence of undernutrition, micronutrient deficiencies, overnutrition, and abnormal levels of noncommunicable disease biomarkers at the same time in children and adolescents in India hinders efforts to comprehensively address their health.

OBJECTIVES

This study aimed to examine the prevalence and correlates of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among children and adolescents (5-19 y) to inform policies and programs.

METHODS

A total of 17,599 children (5-9 y) and 16,184 adolescents (10-19 y) with available biomarker data from the Comprehensive National Nutrition Survey were included. Malnutrition was defined based on either undernutrition based on anthropometry, overnutrition/abnormal metabolic markers, and anemia/micronutrient deficiency. DBM was defined as the coexistence of any 2 forms of malnutrition. DBM+ was defined as the coexistence of undernutrition and/or micronutrient deficiency along with overnutrition. TBM was defined as having the coexistence of all 3 forms of malnutrition. The prevalence of DBM, DBM+, and TBM was estimated accounting for probabilistic selection. We used mixed-effect binomial regression to determine correlates of DBM/TBM in children and adolescents separately.

RESULTS

The prevalence of DBM, DBM+, and TBM was 50.8%, 37.2%, and 14.4%, respectively, in children and 53.4%, 36.1%, and 12.7%, respectively, in adolescents. The prevalence of DBM+ was significantly higher in girls compared to in boys in the 5-9 y age group. In children, being in a disadvantaged caste group, having a lower wealth index, having inadequate diet diversity, having no maternal schooling, and having a recent history of acute illness were associated with DBM. In adolescents, being in a disadvantaged caste group, maternal occupation, and lower paternal age were correlated with DBM. A similar set of variables was associated with TBM in both age groups.

CONCLUSIONS

The prevalence of DBM and TBM is substantial in children and adolescents in India and varies across states. Socioeconomic factors and acute illness were the main correlates for DBM and TBM.

Adolescent nutrition in Nigeria: a systematic review

In this systematic review, we scrutinise adolescent nutrition in Nigeria, focusing on dietary patterns, intake, and nutritional status. Through a systematic examination of observational studies across three major databases, we analysed data from 67,844 adolescents. Our exploration revealed 102 studies, predominantly cross-sectional, addressing various nutritional dimensions. However, only 13% of these studies demonstrated low risk of bias, with none offering national representation and most concentrated in specific, school-based regions. The findings underscore a complex nutritional landscape with widespread malnutrition and highlight the critical need for high-quality, comprehensive data. The dominance of cross-sectional designs and regional biases in existing research calls for cautious interpretation and suggests a pressing need for more robust, nationally representative studies to guide future nutritional interventions and policy-making in Nigeria.

Nutritional status and dietary intake among Nigerian adolescent: a systematic review

INTRODUCTION

The prevailing nutritional conditions and the triple challenge of malnutrition faced by adolescents have adverse consequences for both the present and future generations' health and nutrition. Summarizing the available research on the nutritional status and dietary habits of adolescents in Nigeria is crucial.

OBJECTIVE

This study aims to systematically evaluate available literature on the nutritional status of adolescent aged 10 to 19years in Nigeria.

METHODOLOGY

A systematic search using PRISMA guideline was conducted. Three electronic databases were searched i.e., PubMed, Web of Science and Scopus using specific terms and keywords for online articles published between 2013 and 2023. After applying specified inclusion and exclusion criteria, 51 articles were selected for data extraction, synthesis and quality assessment.

RESULTS

Of the 51 included studies, 78.4% were conducted in the Southern Nigeria, 11.8% in the Northern Nigeria and 9.8% included both regions. The prevalence of overweight ranged between 0.8 and 31% and obesity ranged between 0.1 and 14%. The prevalence of thinness, stunting and underweight ranged between 3 and 31%, 0.4 to 41.6%, 0.3 to 73.3% respectively. The review also identified an inadequate intake of essential nutrients including iron, zinc, calcium, vitamin A, C, D, niacin, thiamin, riboflavin, cobalamin, and folate, with vitamin A deficiency prevalence ranges from 44 to 96%. The dietary patterns were characterized by a high consumption of cereals grains and starchy foods, low animal proteins, fast-food with soft drinks, and limited consumption of fruits and vegetables along with meal skipping.

CONCLUSION

These findings portray a complex picture of the nutritional challenges faced by this demographic group, highlighting both undernutrition and overnutrition, poor eating behaviour and micronutrient deficiency as significant concerns. The review revealed regional disparities in research representation, with a concentration of studies in Southern Nigeria. This highlights the importance of directing research efforts toward the northern regions, where the prevalence of nutritional issues is equally severe, but less studied.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023481095.

Dietary Patterns, Socio-Demographic Predictors Thereof, and Associations of Dietary Patterns with Stunting and Overweight/Obesity in 1-<10-Year-Old Children in Two Economically Active Provinces in South Africa

A review of the literature showed that there were only a few studies that reported on the dietary patterns of children in South Africa. The aim of the present study was to characterise the dietary patterns of children aged 1-<10 years who were studied during the Provincial Dietary Intake Survey (PDIS) in 2018 and to investigate the socio-demographic predictors thereof, as well as the associations with stunting and overweight/obesity. Dietary pattern analysis was conducted within three age groups, namely 1-<3-year-olds, 3-<6-year-olds, and 6-<10-year-olds using iterated principal factor analysis with varimax rotation and 24 h recall data from the PDIS. The dietary patterns that emerged seem to be far from ideal. Energy-dense, nutrient-poor patterns were included in the top three strongest patterns in all three age groupings that were investigated. Few of the dietary patterns included vegetables other than starchy vegetables, fruit, dairy, quality proteins, and unrefined carbohydrates. There were no associations between any of the dietary patterns and stunting or overweight/obesity in the children. Key predictors of greater adherence to the mostly unhealthy patterns included indicators of a higher socio-economic status in all three age groups, as well as having an obese mother in the 6-<10-year-old group. Key predictors of greater adherence to the mostly healthy patterns were a higher wealth index and having an obese mother in the two younger groups, with no predictors in the 6-<10-year-old group. We conclude that the dietary patterns of children in the Western Cape contain strong elements of the energy-dense, nutrient-poor dietary patterns. Interventions to improve the dietary intake of children should be directed at both poorer and higher income communities.

Exploring the double burden of malnutrition at the household level in the Philippines: Analysis of National Nutrition Survey data

BACKGROUND

In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking.

METHODS

Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM.

RESULTS

The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age.

CONCLUSIONS

The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.

A systematic review and meta-analysis of the association of dietary diversity with undernutrition in school-aged children

BACKGROUND

Malnutrition in childhood has lasting consequences; its effects not only last a lifetime but are also passed down from generation to generation such as short stature, school-aged children are the most vulnerable section of the population and require special attention, including nutrition.

METHOD

We searched Medline through PubMed, Scopus, and Web of Science to identify all observational studies published before Jun 2022. Observational studies with a pediatric population aged 5-18 years that evaluated risk estimate with 95% confidence intervals the relationship between dietary diversity and undernutrition (wasting, stunting, and thinness) were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed.

RESULTS

This is a first systematic review and meta-analysis with a total of 20 studies were eligible (n = 18 388). Fourteen data evaluated stunting resulting in a pooled effect size estimated odds ratio of 1.43 (95% CI: 1.08-1.89; p = 0.013). Ten data evaluated Thinness resulting in a pooled effect size estimated odds ratio of 1.10 (95% CI: 0.81-1.49; P = 0.542). Two studies were revealed wasting with a odds ratio of 2.18 (95% CI: 1.41-3.36; p-value < 0.001).

CONCLUSION

According to the conclusions of this meta-analysis of cross-sectional studies, inadequate dietary diversity increases the risk of undernutrition in growth linear but not in thinness in school-aged children. The findings of this analysis suggest that initiatives that support improvements to the diversity of children's diets to reduce the risk of undernutrition may be warranted in LMICs.

Evaluation and Management of Reduced Dietary Diversity in Children with Pediatric Feeding Disorder

Pediatric Feeding Disorder, a common problem in children, is commoner in children with various developmental disorders. Children with pediatric feeding disorder can have food selectivity and lack dietary diversity (DD). In this paper, an understanding of DD in these children is provided along with a dietary diversity index that can be helpful in measuring and understanding the risks posed by this lack of DD. An overview of a management strategy to address decreased DD is proposed. In these children, improving DD can improve growth, micronutrient status, long-term metabolic health, and potentially quality of life.

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.