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Choedon T, Brennan E, Joe W, Lelijveld N, Huse O, Zorbas C, Backholer K, Murira Z, Wrottesley SV, Sethi V. Nutritional status of school-age children (5-19 years) in South Asia: A scoping review. Matern Child Nutr 2024; 20:e13607. [PMID: 38095279 PMCID: PMC10981491 DOI: 10.1111/mcn.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 04/01/2024]
Abstract
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.
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Affiliation(s)
| | | | - William Joe
- Institute of Economic Growth (IEG)DelhiIndia
| | | | - Oliver Huse
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Christina Zorbas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | | | | | - Vani Sethi
- UNICEF South Asia Regional OfficeKathmanduNepal
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Vastrad P, Neelopant S, Prasad UV, Kirte R, Chandan N, Barvaliya MJ, Hatnoor S, Shashidhar SB, Roy S. Undernutrition among rural school-age children: a major public health challenge for an aspirational district in Karnataka, India. Front Nutr 2023; 10:1209949. [PMID: 37502723 PMCID: PMC10368874 DOI: 10.3389/fnut.2023.1209949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Background For school-age children, a healthy transition from childhood to adolescence and adulthood depends on proper nutrition. Globally, most nutritional surveys focus on preschool and adolescents, neglecting school-age children. Recent studies have shown the prevalence of thinness among adolescents to be 26.5% in Karnataka. Similarly, among children aged < 5 years in the Raichur district, the prevalence of stunting, wasting, and being underweight was 39.8, 23.2, and 40.7%, respectively. The present study aimed to bridge the data gap between < 5 years of children and adolescents through a nutritional survey of school-going children in Raichur, one of the aspirational districts of India. Materials and methods A cross-sectional survey was conducted from January to March 2020 among rural school-age children (n = 2700) in 30 villages of the Raichur district of Karnataka, India. The school children were selected through a multi-stage cluster sampling technique. The WHO Anthro-plus software was used for calculating the age and sex-specific Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and BMI-for-age (BAZ). Results Of the 2,700 school-age children surveyed, the mean weight and height were 22.2 kg (+5.8) and 124.9 cm (+11.6), respectively. The prevalence of children having weight-for-age Z-scores < -2 SD (Underweight) was 45.3% (95% CI: 42.7%-47.8%). The magnitude of stunting and severe stunting was 19.5% (95% CI: 18.0%-21.0%) and 7.6% (95% CI: 6.6%-8.6%), respectively. The proportion of children with BMI for age Z-scores < -2SD (thinness) was 43% (95% CI: 41.1%-44.9%), with sub-district Sindhanur having a dual burden of malnutrition. Conclusion Despite many flagship programs, the prevalence of undernutrition in school-age children remains a considerable public health problem in the aspirational district of Raichur, India. Furthermore, exploratory studies are recommended to identify the factors associated with undernutrition among school-age children and strategize evidence-based intervention.
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Affiliation(s)
- Phaniraj Vastrad
- Model Rural Health Research Unit, Department of Health Research (Government of India), Sirwar, Raichur, Karnataka, India
| | | | - U. Venkateswara Prasad
- Model Rural Health Research Unit, Department of Health Research (Government of India), Sirwar, Raichur, Karnataka, India
| | - Rahul Kirte
- Model Rural Health Research Unit, Department of Health Research (Government of India), Sirwar, Raichur, Karnataka, India
- Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - N. Chandan
- National Institute of Traditional Medicine, Indian Council of Medical Research (ICMR), Belagavi, Karnataka, India
| | - Manish J. Barvaliya
- National Institute of Traditional Medicine, Indian Council of Medical Research (ICMR), Belagavi, Karnataka, India
| | - Shivappa Hatnoor
- Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - S. B. Shashidhar
- Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Subarna Roy
- Model Rural Health Research Unit, Department of Health Research (Government of India), Sirwar, Raichur, Karnataka, India
- National Institute of Traditional Medicine, Indian Council of Medical Research (ICMR), Belagavi, Karnataka, India
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Verma M, Aditi A, Kapoor N, Sharma P, Kakkar M, Kakkar R, Kalra S. Childhood Obesity and Essential Micronutrients: Insights from India's Comprehensive National Nutrition Survey (2016-18). Diabetes Ther 2023:10.1007/s13300-023-01424-2. [PMID: 37264296 PMCID: PMC10299976 DOI: 10.1007/s13300-023-01424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Based on the long-term impact of childhood obesity, there is a compelling need to assess the burden of obesity and micronutrient deficiency and the interactions between the two. Thus, the aims of the study were to estimate the prevalence of overweight and obese children and adolescents to compare micro-nutrient levels in these children with normal and underweight categories and explore the factors affecting overweight and obesity in the presence of micronutrient deficiencies. METHODS Secondary data analysis of the Comprehensive National Nutrition Survey-India (2017-2018) was done. The survey recorded information from 112,245 preschool children (6-60 months), school age children (5-9 years), and adolescents (10-19 years). Half of these participants were invited for biochemical testing and were included in our analysis. The presence of overweight or obesity and micronutrient (serum erythrocyte folate; vitamin B12, A, and D; ferritin; zinc; and urinary iodine) deficiencies were the primary outcomes. The secondary outcome included the mean serum levels and predictors of overweight and obesity in the presence of micronutrient deficiencies. RESULTS Of the 38,060, 38,355, and 35,830 preschool, school-age, and adolescent study participants, about 2.69, 4.18, and 4.99% were overweight or obese. We observed significant variations in the mean folate and vitamin B12 levels among the overweight and obese preschool and school-age children compared to the normal weight group. School-age children exhibited significant differences in all micronutrient levels. In contrast, adolescents only showed substantial differences in vitamin D and A and serum ferritin levels. The predictors of overweight and obesity included geographical locations, wealth quintiles, and societal castes. Iron, folate, vitamin D, and zinc levels significantly affect the odds of developing childhood overweight and obesity. CONCLUSIONS It is vital to halt the growing burden of childhood overweight and obesity. Addressing micronutrient deficiencies can help us bring a sustainable and feasible approach to managing this menace.
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Affiliation(s)
- Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, India.
| | - Aditi Aditi
- International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, 400088, India
| | - Nitin Kapoor
- Department of Endocrine, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, 632004, India
- Non-Communicable Disease Unit, The Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Priyanka Sharma
- Department of Preventive Oncology, MPMMCC, and HBCH, TMC, Varanasi, Uttar Pradesh, India
| | - Monica Kakkar
- Department of Biochemistry, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, 151001, India
| | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India.
- University Centre for Research and Development, Chandigarh University, Mohali, Punjab, India.
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Verma M, Aggarwal R, Nath B, Kakkar R. Exploring the influence of food labels and advertisements on eating habits of children: a cross-sectional study from Punjab, India. BMC Public Health 2023; 23:311. [PMID: 36774475 PMCID: PMC9919747 DOI: 10.1186/s12889-023-15058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/16/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Maintaining healthy eating habits among children is challenging due to industrial tactics. There is little research on the effect of nutritional labels and tv ads on the eating habits of children. So the primary aim of the study was to explore the noticeability of the food packaging labels by the children, the information retrieved from the food nutrition labels, and their role in increased frequency of eating out in addition to the perceptions of their parents about the television ads. METHODS A cross-sectional study was conducted at schools in Punjab, India. Using multi-stage stratified random sampling, we included 722 school-going children aged 14-18 and their parents. A structured predefined questionnaire collected data using a four-point Likert scale. Descriptive statistics and binary logistic regression were used to draw our inferences. RESULTS About 46% of children were eating out > 3 times a week. Nearly 49% said they never looked at the expiry dates on the food packet, and 40% have yet to notice the quality certification. Nearly half do not understand the components of the food label, and 59% said they never changed their buying behavior because of the label. Only 37% of parents expressed their concerns about the timing of the ads when children watch television, while only 25.5% were concerned about the accuracy of the information. Concerns of the parents regarding the timing of the ads, and celebrity endorsements, were potential predictors for the increased frequency of eating out by the children. CONCLUSIONS Low awareness regarding the utility of nutrition labels and minimal concerns of the parents increase the frequency of eating out. Unification of our existing policies regarding food labels and tv advertisements to develop family-centric interventions will bring us one step closer to improving the enabling environment to curb the growing menace of childhood obesity.
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Affiliation(s)
- Madhur Verma
- grid.413618.90000 0004 1767 6103Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
| | - Ramnika Aggarwal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Bhola Nath
- grid.413618.90000 0004 1767 6103Departmentof Community and Family Medicine, All India Institute of Medical Sciences, Raebarely, Uttar Pradesh 229405 India
| | - Rakesh Kakkar
- grid.413618.90000 0004 1767 6103Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
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Parida J, Jena Samanta L, Badamali J, Singh PK, Patra PK, Mishra BK, Pati S, Kaur H, Acharya SK. Prevalence and determinants of undernutrition among adolescents in India: A protocol for systematic review and meta-analysis. PLoS One 2022; 17:e0263032. [PMID: 35073386 PMCID: PMC8786165 DOI: 10.1371/journal.pone.0263032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Undernutrition is one of the serious health problems among adolescents in India where 253 million adolescents are in the age group of 10-19 years. Since adolescents represent the next generation of adults, it is important to understand the nutritional status of adolescents. Even though several studies have been carried out in different states in India on adolescent undernutrition (stunting, wasting /underweight), there is no study or review that estimated the national pooled prevalence of adolescent undernutrition and its determinants. Therefore, this review aims to determine the pooled prevalence and determinants of undernutrition (stunting, underweight/wasting) among Indian adolescents. METHODS A systematic review of eligible articles will be conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive searching of the literature will be made in Pub Med, EMBASE, SCOPUS, Google, Google Scholar, and Cochrane databases. The quality of the articles included in the review will be evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies in meta-analyses. The pooled prevalence and odds ratio of the associated risk factors or determinants with their 95% confidence interval will be computed using STATA version 16 software. The existence of heterogeneity among studies will be assessed by computing p-values of Higgins's I2 test statistics and Cochran's Q-statistics based on chi-square with a 5% level of significance among reported prevalence. Sensitivity analysis and subgroup analysis will be conducted based on study quality to investigate the possible sources of heterogeneity. Publication bias will be assessed through visual examination of funnel plots and objectively by Egger's regression test. This review protocol has been registered at PROSPERO (CRD42021286814). DISCUSSION By collecting and summarizing information on adolescent undernutrition can be a step towards a better understanding of the prevalence of nutritional status of Indian adolescents and how the associated factors influence the prevalence of undernutrition. This review will provide directions for further research and healthcare practitioners. This summarized finding at the national level will provide impetus to build nutritional strategies and proper healthcare services to fight against undernutrition among the most ignored population.
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Affiliation(s)
- Jayashree Parida
- Indian Council of Medical Research -Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Lopamudra Jena Samanta
- Indian Council of Medical Research -Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jagatdarshi Badamali
- Indian Council of Medical Research -Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Prasant Kumar Singh
- Indian Council of Medical Research–National Institute of Cancer Prevention and Research, New Delhi, India
| | | | - Bijay Kumar Mishra
- Indian Council of Medical Research -Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Indian Council of Medical Research -Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Harpreet Kaur
- Division of Tribal Health, Indian Council of Medical Research, New Delhi, India
| | - Subhendu Kumar Acharya
- Indian Council of Medical Research -Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Bhattacharyya M, Roy S, Sarkar A, Sinha RN, Mallick AK, Bandyopadhyay S. Burden of malnutrition among school-going children in a slum area of Kolkata: A matter of concern. J Family Med Prim Care 2021; 10:2940-2946. [PMID: 34660428 PMCID: PMC8483088 DOI: 10.4103/jfmpc.jfmpc_2472_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background Malnutrition is still a great barrier to the growth and development of children, especially in India. Children from the underprivileged sections of the society like slum children are more vulnerable to both undernutrition and overnutrition. This study aimed to estimate the magnitude of malnutrition among school-going children in a slum area of Kolkata and to elicit the association of nutritional status with parental education. Methods A cross-sectional observational study was conducted from November 2017 to May 2018 among 508 school-going children of 6 years to 19 years of age in slums of Chetla, Kolkata. Out of three coeducation high schools catering to those children, two schools were randomly selected. 254 participants from each school were selected using systematic random sampling. Students, unwilling to participate and/or whose parents denied providing informed written consent were excluded. After the interview by a predesigned, pretested schedule, their anthropometric examination was conducted. Results Prevalence of stunting and severe stunting was present in 9.4% and 1.2% of subjects whereas the prevalence of thinness was 23.6% among them. The prevalence of overnutrition was 11%. Boys are more stunted (OR = 2.13, P = 0.013) and thin (OR = 1.73, P = 0.011) than girls. Poor parental education was significantly associated with both undernourishment (stunting and thinness) as well as overweight and obesity. Conclusion Substantial burden of double malnutrition was observed among school-going slum children. Parental education had an important role to prevent malnutrition of their children. Thus, periodic growth monitoring with the strengthening of the Mid-Day Meal program and awareness generation campaigns regarding malnutrition among parents of slum children are highly needed.
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Affiliation(s)
- Madhumita Bhattacharyya
- Associate Professor, Department of Maternal and Child Health, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Soumit Roy
- Senior Resident, Department of Community Medicine, IQ City Medical College, Durgapur, West Bengal, India
| | - Asim Sarkar
- Assistant Professor, Department of Maternal and Child Health, All India Institute of Hygiene and Public Health, Kolkata, India
| | - Rabindra N Sinha
- Director Professor, Department of Maternal and Child Health, All India Institute of Hygiene and Public Health, Kolkata India
| | - Ashok K Mallick
- Director Professor, Department of Maternal and Child Health, All India Institute of Hygiene and Public Health, Kolkata India
| | - Sayanti Bandyopadhyay
- Senior Resident, Department of Community Medicine, IQ City Medical College, Durgapur, West Bengal, India
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Rawal T, Willeboordse M, Arora M, Sharma N, Nazar GP, Tandon N, van Schayck CP. Prevalence of Excessive Weight and Underweight and Its Associated Knowledge and Lifestyle Behaviors among Urban Private School-Going Adolescents in New Delhi. Nutrients 2021; 13:3296. [PMID: 34579174 DOI: 10.3390/nu13093296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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