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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 17
| Issue : 4 | Page : 864-870 |
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A cross-sectional study to assess nutritional status of adolescent girls using body mass index
Ashutosh Jain, Vaishali Vinayak Raje, Satish V Kakade
Department of Community Medicine, KIMSDU, Karad, Maharashtra, India
| Date of Submission | 23-Apr-2021 |
| Date of Acceptance | 06-Oct-2021 |
| Date of Web Publication | 10-Feb-2023 |
Correspondence Address:
Dr. Vaishali Vinayak Raje
Department of Community Medicine, KIMSDU, Karad, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_180_21
Background: Malnutrition continues to be a major public health problem worldwide. World's attention is now toward malnourished girls who are more likely to remain undernourished during adolescence and adulthood, and when pregnant, they are more likely to deliver low birth-weight babies creating a vicious cycle. Objectives: (1) To study sociodemographic profile of adolescent girls and (2) to study the association of undernutrition with sociodemographic status. Materials and Methods: This school-based cross-sectional study was conducted among 268 adolescent girls of 7th and 8th standard, from government high school of Karad. Quantitative data were analyzed using SPSS version 20 for calculating mean with standard deviation and Chi-square test was applied. Results: According to body mass index for age, the prevalence of undernutrition was 32.85%. Similarly undernutrition was found high among rural girls (35.4%), among girls of age group 12 (34.85%) and those who were pure vegetarian (37.3%). It was found very much high among three generation type family (45%). Significantly high proportion of girls with first birth order (38.3%), below poverty line (BPL) families (71.4%), and the girls taking <3 meals per day (76.1%), were found to be undernourished. Skipping breakfast for 1-3 days per week (27.3%) and the girls using fast food (98.9%) as well as soft drinks (56.8%) showed high rate of undernutrition. Conclusion: Undernutrition was found to be prevalent among the rural adolescent girls with first birth order belonging to BPL families and associated with poor dietary habits.
Keywords: Adolescents, below poverty line, fast food, nutrition, pure vegetarians
How to cite this article:
Jain A, Raje VV, Kakade SV. A cross-sectional study to assess nutritional status of adolescent girls using body mass index. J Datta Meghe Inst Med Sci Univ 2022;17:864-70 |
How to cite this URL:
Jain A, Raje VV, Kakade SV. A cross-sectional study to assess nutritional status of adolescent girls using body mass index. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Mar 28];17:864-70. Available from: http://www.journaldmims.com/text.asp?2022/17/4/864/369482 |
| Introduction | |  |
Malnutrition is a major public health problem worldwide. Undernutrition in girls' starts before the birth and continues even in adolescence, pregnancy and can go further generations to generations.[1],[2],[3] The global prevalence of underweight in adolescent girls is 8.4%. - The National Family Health Survey in India reported 41.9% thinness among adolescent girls and in Maharashtra 13.9%.[4],[5],[6] The WHO defines adolescence age from 10 to 19 years.[7] About one-fifth of the world's population is adolescents.[8] India (2011 census) accounts for 253.2 million (20.9%) adolescents.[9]
Poor feeding and early marriage increase complications in child birth. Breaking of intergeneration cycle of undernutrition is important.[10],[11],[12] The current study aimed to assess nutritional status of adolescent girls and to find risk factors associated with undernutrition.
| Materials and Methods | | |
The present cross-sectional study was carried out to assess nutritional status of adolescent girls during November 2018 to December 2020.
Design of study
This was a school-based cross-sectional study conducted among middle school population.
Study population
The study was carried out on adolescent girls attending middle school, i.e., 7th and 8th standard.
Study subjects
A total of 293 students from 7th standard and 8th standard comprised the study population. Students enrolled in this study were from government high school, Karad, Satara District, Maharashtra, which was selected randomly by lottery method from 8 government high schools. Girls from urban as well as rural areas were admitted in this school. It was decided to study middle school girls to cover early adolescent girls, i.e., of age 12–14 years.
Sample size
Sample size (203) was estimated by considering prevalence of undernutrition 4.8% with precision level 3.[13]
The nonresponse rate of 10% was anticipated. Thus the whole strength of 7th and 8th standard, which came to be 293 students (100%) were considered as study subjects.
Inclusion criteria
Adolescent school-going girls of 7th and 8th standard were enrolled whose parents had given consent and the girls who had signed ascent form to include in the study.
Exclusion criteria
The study subjects with history of chronic illnesses and those who did not furnish required information or provided inadequate information as per the pro forma were excluded from the study.
Ethical clearance
Permission from the school principal was obtained on explaining the purpose and process of the study. Written informed consent was obtained from the parents of each adolescent girl in vernacular language, i.e., in Marathi. Assent was signed voluntarily by the study subjects in Marathi. Ethical clearance was obtained from the institutional ethical committee prior to the commencement of the study.
Data collection
All the study subjects were assured for anonymity, voluntary involvement, and freedom to give up the study anytime during the data collection process. A total of 14 subjects' parents did not respond to consent form and 11 subjects did not complete data collection process. A structured pro forma was used to record information of 268 study subjects, regarding student's personal data and family data. Information related to food preferences, food habits, like fast food and carbonated drinks consumption, time spent for physical activities including exercise, and outdoor games were recorded.
Anthropometric measurements were recorded. Weight was measured using a standard portable weighing scale.[13] Height was measured using a portable stadiometer nearest to 0.5 cm, in erect posture without shoes, ensuring a parallel Frankfurt plane.[13] Both height and weight were taken thrice, and the average value was recorded.
Nutritional status was assessed using body mass index (BMI) for age. According to BMI, undernutrition is considered when the BMI for age is below 5th percentile, which corresponds to 14.8 kg/m2 for age 12 years, 15.2 kg/m2 for the age 13 years, and 15.6 kg/m2 for the age 14 years. Thus, in the study, the CDC classification of BMI has been considered to assess nutritional status.[14],[15]
Per capita per monthly income of Rs. 447 per month and above in the household was considered as above poverty line (APL) and the household with per capita per month income of Rs. <447 was considered a family below poverty line (BPL).[16] Early adolescence is considered to stretch between 10 and 14 years of age whereas late adolescence embraces the later years of teenage from 15 to 19 years.[17]
Statistical analysis
Data were entered using Microsoft Excel 2010 for windows. Summarization and analysis of data was carried out using Software Statistical Package for the Social Sciences (SPSS version 20 (SPSS South Asia Pvt. Ltd, Bangalore, India)). For quantitative variable, mean and standard deviation (SD) was calculated. Chi-square test was applied to study the association of sociodemographic variables with BMI. Level of significance was considered when P value was equal or less than 0.05.
| Results | | |
A total of 293 students of 7th and 8th standards were studied. However, 268 students were responded completely.
The mean age of study subjects was 12.86 years with SD of ± 0.729 years. Regarding anthropometric measurement, the mean weight was 39.3 kg with SD ± 8.4 kg and mean height was 152 cm with SD ± 6.5 cm. The nutritional status of all the subjects was assessed by calculating BMI. The mean BMI was noted 16.8 kg/m2 with SD ± 3 kg/m2.
It was seen that nearly one-third (32.85%) study subjects were undernourished. Majority of study subjects were belonged to urban area (69.4%), Hindu by religion (82.1%), first birth order (60.4%), from nuclear family (47%), and in the age group of 13 years (45.1%). However, undernutrition was observed predominantly in girls from rural area (35.4%), first birth order (38.3%), girls from broken (50%) and third-generation family (45%), BPL family (71.4%), and in age group of 12 years (34.8%). Undernutrition was significantly associated with first birth ordered girls and girls from families BPL (P = 0.052 and 0.040, respectively). It reflects that the first female child might have got neglected their nutrition by their parents may be due to poverty or unaffordability. However, the risk of undernutrition was almost similar (odds ratio [OR] = 1.105) in adolescent girls with the first birth order and the second birth order.
The adolescent girls who belong to BPL were at 5 times (OR = 5.361) higher risk of undernutrition than those belonged to APL [Table 1].
Majority of study subjects had mixed diet (81%) with 3 meals per day (83.2%). More than half of the girls (54%) did not take breakfast. Majority of them skip their breakfast for more than 4 days (28.4%). Most of the study subjects (97%) consume fast food like kurkure, wada-pav, wafers, etc., and 62% of girls were consuming carbonated soft drinks, minimum of 2 day per week. Regarding undernutrition, high rate was observed in girls consuming pure vegetarian diet (37.3%), who consume more than 4 meals (46.7%), those who did not take breakfast (36.6%), and who consume fast food more than 2 days per week (39%) [Table 2]. | Table 2: Association of nutritional status of study subjects with their dietary habits
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Almost all girls were involved with one or the other form of physical activity except one. All the undernourished girls were found to follow exercise minimum 30 min to maximum of more than 2 h. There was no much difference found in the risk of undernutrition among adolescent girls performing <1 h and >2 h physical activities (OR = 1.088).
Majority (60.4%) of girls exercise for ≤1 h per day and more than 1/3rd (39.6%) girls exercise ≥2 h per day.
More than half of undernourished girls (59.1%) follow exercise ≤1 h per day daily, while 40.9% of undernourished girls performed ≥2 h per day physical activity. However, the association between the hours of exercise per day and nutritional status by BMI for age was not found significant [Table 3].
| Discussion | | |
The present study aimed to assess the nutritional status of adolescent girls.
The mean age of girls found to be 12.86 ± 0.729 years with mean weight of 39.26 ± 8.36 kg and mean height of 152.17 ± 6.45 cm. The mean BMI was 16.83 ± 3.04 kg/m2.
Similar to the present study Uddin et al.,[18] Pavithran and Bant,[19] and Rani and Rani[20] considered adolescents of age group 12 -14 years in their study, whereas Meena and Varma[21] studied adolescents of 14–16 years age group. ALFaris et al.[22] and Vicente-Rodríguez et al.[23] studied 13–18.5 years of age girls.
Sachan et al.,[24] Pavithran and Bant,[19] and Rani and Rani[20] reported mean weight similar to the present study (41.38 ± 8.03 kg, 40.75 ± 6.9 kg, and 42.37 ± 6.54 kg, respectively). This similarity might be due to similar age group studied by these authors. Similarly, ALFaris et al.[22] and Vicente-Rodríguez et al.[23] reported higher mean weight, that is, 55.7 ± 11.3 kg and 56.4 ± 9.6 kg, respectively. This difference with the present study might be due to the reference studies conducted in affluent countries.
Regarding mean height, similar findings to the present studies have been reported by Rani and Rani,[20] 152.91 ± 5.39 cm. Uddin et al.,[18] Maiti et al.,[25] Sachan et al.,[24] and Pavithran S et al.[19] have reported less mean height than the present study. This difference might be due to the lesser age group involvement in the study as well as some of these studies were conducted in urban slum areas. Although Meena and Varma,[21] ALFaris et al.,[22] and Vicente-Rodríguez et al.[23] studied similar age group as in the present study, the mean height reported was higher. Moreover, this difference might be because the study subjects belonged to well-to-do families, where adequate growth and development of adolescent population was achieved.
The mean BMI of present study was almost similar with the findings of Uddin et al.,[18] Srivastav et al.,[26] and Deshmukh et al.,[27] (16.08 ± 2.36 kg/m2, 16.75 kg/m2, and 15.54 ± 3.25 kg/m2, respectively as they also have studied nutritional status among similar age group Indian adolescents. Higher BMI among adolescent girls was reported by Omobuwa et al.[28] from Nigeria, ALFaris et al.[22] from Saudi, and Vicente-Rodríguez et al.[23] from Spain (20.58 ± 3 kg/m2, 22.4 ± 4.4 kg/m2, and 21.6 ± 3.8 kg/m2 for the similar age groups respectively).
In the present study, the prevalence of undernutrition was 32.8% in the presents study. In the present study, the prevalence of undernutrition was 32.8%. Similar proportion was reported by Srivastav et al.[26] (30.6%), Akhter and Sondhya[29] (32.7%), Sachan et al.[24] (28.4%), and Omobuwa et al.[28] (23.4%). Very less prevalence of undernutrition was reported by Jeyakumar et al.[13] from Pune, Maharashtra, that is 4.8%. However, the age group of study subjects was 16–18 years. Rani and Rani[20] from Haryana, India, (24%) and Smetanina et al.[30] from Lithuania, Europe, reported 12.7% and 14.6% undernutrition among 10–13 years and 14–17 years age adolescents. This suggests that their nutritional status was quite good in these study settings. The prevalence of undernutrition reported from 41.33% to the highest of 76.2%.[2],[27],[18],[31],[32] Majorities of all these studies were conducted in slum and rural areas of India.
Proportionately high prevalence of undernutrition was seen in the age group of 12 years (34.8%). Very less prevalence of low BMI was reported in early adolescent age of 13-14 years (5.1%) by Pavithran and Bant[19] from Karnataka.
In the present study, vegetarian girls showed higher prevalence of undernutrition than the girls consuming mixed diet (37.3% vs. 31.8%) [Table 2]. Similar response was noted by Pavithran and Bant,[19] showing that the vegetarian school girls had higher prevalence of undernutrition than that of mixed vegetarian.[19] This may be due to the families might have not afforded quality protein diet due to their poverty status as in the present study.
In the present study, 54% of adolescent girls used to miss their breakfast one or the other day and 46% girls used to have their breakfast daily. Undernutrition was observed among 1/4th of girls (25%) who used to skip breakfast for > 4 days, however high proportion of undernutrition was observed among girls (34.8%) skipping breakfast for 1 -3 days.
Significantly high prevalence of undernutrition was observed among girls who were taking ≤3 meals in a day.
One of the Indian studies[19] reported that 25.6% school girls miss their breakfast every day and 41.8% girls miss their breakfast for 1-2 times per week. Similarly, Vik et al.[33] reported 17% girls missing their breakfast. The practice of skipping breakfast or meal by the school going girls might be due to their focus on studies and other physical activities.
The overall prevalence of consumption of fast food was found to be very much high in the present study. The fast foods like crackers, wafers, wada-pav, pizza, and burger were preferred by them. ALFaris et al.[22] reported that 52.8% of girls consumed fast food once per week, whereas 25.2% girls consumed fast food for more than 2 days per week. This might be due to easy access to the fast food nearby school.
Usually, the fast food consumption has been correlated with obesity and overweight.[34] However, in the present study, undernutrition was found to be proportionately higher among the girls consuming fast food at least 1 day per week and more than 2 days per week. This low nutritional status among fast food consumers might be due to deprivation of proteins and other micronutrients necessary for the growth and development.
It was observed that undernutrition was proportionately high among the girls consuming cold drinks than who did not. The similar higher prevalence of carbonated drink consumption or soft drink consumption was reported among Saudi adolescent girls (89%).[22] The study conducted by Smetanina et al.[30] and Meena and Varma[21] reported low consumption of soft drinks by the adolescent girls (10–13 years 12.6%, 14-17 years 10.8%, and 14–-16 years 9.65%, respectively).
| Conclusion | | |
It was concluded that undernutrition was prevalent among the rural adolescent girls with first birth order belonged to BPL families. Poor dietary habits like skipping meals, breakfasts and replacing it with junk foods were found to be the cause of undernutrition. Physical activity helps maintain normal nutritional status; however, overexertion leads to undernutrition.
Recommendations
Even though personal hygiene, balance diet has got included in the health educational activities in the school, now there is a need to create awareness about cardiovascular diseases and lifestyle related diseases their risk factors like excess fat and sugar intake in the form of junk food. The change in their behaviour towards their own health is to be bring about through regular physical activity, health education, periodic health check-up and proper implementation of mid-day meal programme in schools.
Limitations
- Physical activity status was asked verbally and could not be cross checked or verified
- The quantity and quality of food intake by the girls could not be observed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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