Nutritional status of adolescents in rural Wardha
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《美国医学杂志》
Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
Abstract
Objective : The objective of the study was to study the nutritional status of adolescents in rural area of Wardha. Methods : The cross-sectional study was carried out in two PHC areas of Wardha district with two stage sampling method. In the first stage, cluster-sampling method was used to identify 30-clusters in each Rural Health Training Centre (RHTC) area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study. The mean body mass index (BMI) for age was used for classifying the nutritional status with CDC 2000 reference. Data thus generated was entered and analyzed using epi_info 2000. Results : Overall, 53.8% of the adolescents were thin, 44% were normal and 2.2% were overweight. The mean body mass index (BMI) for boys and girls was 16.88 and 15.54 respectively. The difference was statistically significant (p<0.05). The prevalence of thinness was significantly (p<0.05) higher in early adolescence, girls, lower education (< 8th standard) and lower economic status. Conclusion : Majority (53.8%) of the adolescents in this study area are thin and only 2.2% were overweight.
Keywords: Thinness; BMI; Chronic energy deficiency; Stunting; Underweight; Obesity,
Adolescence - a period of transition between childhood and adulthood is a significant period of human growth and maturation. The health of adolescents attracted global attention in the past two decades. Poor nutritional status during adolescence is an important determinant of health outcomes. Short stature in adolescents resulting from chronic undernutrition is associated with reduced lean body mass and deficiencies in muscular strength and working capacity.[1] In adolescent girls, short stature that persists into adulthood is associated with increased risk of adverse reproductive outcomes.[2],[3],[4] Overweight and obesity during adolescent period are associated with risk factors for obesity-related diseases in adulthood.[1]
As health systems have accepted life-cycle approach, the proximity to biological maturity and adulthood may provide final opportunities to implement certain activities designed to prevent adult health problems.[1] Though the health issues of adolescents like sexually transmitted diseases and reproductive health have been given due importance, limited research work has been done on their nutritional status. Hence the present study was undertaken to study the nutritional status of adolescents in rural area of Wardha.
Materials and Methods
A cross-sectional study was carried out in the areas of two Rural Health Training Centers (RHTC) of Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram (namely Bhidi and Anji with a total population of 19000 and 40000 respectively) through house-to-house visits. Two-stage sampling method was used to reach the respondents' households. In the first stage, cluster-sampling method was used to identify 30-clusters in each RHTC area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study.
Data on socio-demographic and anthropometric variables was collected on pre-designed and pre-tested questionnaire. Data thus generated was entered and analyzed using epi_info 2002 v 3.3. BMI for age was used for classifying the nutritional status. CDC 2000 reference was used to assess the nutritional status.[1] Chi-square was used for testing statistical significance. All tests of significance were two-tailed and level of significance was taken at p-value < 0.05.
Results
Total of 764 adolescents participated in the study. Out of them 420 (54.9%) were boys and 344 (45.1%) were girls. Overall 53.8% of the adolescents were thin; 44% were normal, and 2.2% were overweight table1. The mean BMI was significantly higher among boys (16.88 + 3.09) as compared to girls' (15.54 + 3.25). The prevalence of thinness was significantly higher (57.0%) in early adolescence than in late adolescence (48.6%). Similarly, the prevalence of thinness was significantly higher (69.8%) in girls than boys (40.7%). The prevalence of thinness was significantly (p<0.05) higher (60.3%) in those having education less than 8th standard than those who have education of at least 8th standard (49.6%). Among adolescents doing housework, there was 49.1% thinness; among the students it was 54.7% and in laborers it was 53.3%. The difference was not statistically significant (p>0.05). It was significantly (p<0.05) higher among the adolescents from lower family income (63.2%) than those from higher family income (38.1%) table1.
It was noted that three different criteria are used to assess the nutritional status of adolescents. They are BMI for age, BMI and Z score. When BMI for age was used, thinness (< 5th percentile) was 53.8%. But when BMI classification was used, chronic energy deficiency (CED) (< 18.5 kilogram per square meter) was found to be 75.3%, and when weight for height was used, wasting was found to be only 20.3% table2. 50.7% adolescents were stunted table2.
Discussion
In the present study, majority (53.8%) of the adolescents were thin, only 2.2% were overweight while 44.0% were normal. The high prevalence of thinness is commonly reported from the developing world. Choudhary et al[5] reported 68.52% of adolescents had BMI less than 18.5 kg/square meter in rural area of Varanasi. Shahabuddin et al[6] reported 67.0% prevalence of thinness in Bangladesh. The situation is serious and may prove an obstacle in achieving RCH (Reproductive and Child Health) program targets, like reduction in proportion of low birth-weight babies and in improving other reproductive outcomes.[3] Over the years, the programs directed towards this have failed to achieve targets, and one of the major reasons may be poor nutritional status of adolescents.
In the present study, thinness was significantly higher in early adolescence (57.0%) than in late adolescence (48.5%). Shahabuddin et al[6] also reported that as age increased, thinness decreased. National Nutrition Monitoring Bureau (NNMB)[7] also reported that undernutrition decreased from 78% in 10-13 years to 66% in 14-17 years.
In the present study, thinness was significantly more prevalent in girls than boys. But, Shahabuddin et al[6] reported that boys were affected more (75%) than the girls (59%). Chaturvedi et al[8] reported prevalence of chronic energy deficiency to be 93.5% among adolescent girls of rural Rajasthan. de Onis et al[9] reported prevalence of thinness to be 50.5% among Indian adolescent boys. NNMB[7] reported no sex difference in undernutrition in age group 10-13 years, but in age group 14-17 years, undernutrition was more (73%) prevalent in boys than their female counterparts (60.4%).
The significantly higher prevalence of thinness among adolescents from lower family income group was observed. Hesketh et al[10] also reported that lower family income is an important predictor of underweight. NNMB[11] reported that low-income group adolescents had height, weight and growth rates about 70-80% than those of high-income group.
In the present study, the stunting was present in 50.7% adolescents; Venkaiah et al[12] reported stunting of 39% from NNMB data; Yadav and Singh[13] reported it to be 60%. Shahabuddin et al[6] also reported stunting to be as high as 48% in Bangladesh.
The basic objective of anthropometric assessment at the community level is to provide an estimate of prevalence and severity of malnutrition. This information is of obvious importance for the formulation of health and development policies. In the present study, the prevalence of thinness (<5th percentile of BMI for age) was observed to be 53.8%, chronic energy deficiency (BMI < 18.5) 75.3% and wasting (< -2 Z-value of weight for height) was observed to be only 20.8%. These are the three different terminologies (thinness, chronic energy deficiency and wasting) and definitions/classifications used for assessing undernutrition, thus providing three different proportions of undernutrition in the same population, which is confusing to health managers and planners. Though weight for height (wasting) reference data has the advantage of requiring no knowledge of chronological age, available distributions of weight within categories of height have not been smoothed properly. Weight for age (underweight) has been considered uninformative and even misleading in absence of corresponding information on height for age. Conventional approaches to the combined use of height for age and weight for age are awkward and give biased results. BMI itself does not consider age, which is important in adolescence. Because of these various limitations, WHO has recommended BMI for age as the best indicator for use in adolescence as it incorporates the required information on age; it has been validated as an indicator of total body fat at the upper percentiles, and it provides continuity with recommended adult indicator.[1],[14] But most of the studies used BMI[5],[8] (chronic energy deficiency) and < -2 Z-value of weight for height[7],[10] (wasting) indicators for assessing nutritional status in adolescents. Hence, it is recommended that WHO criteria and terminology should be used to assess the nutritional status of adolescents to avoid the unnecessary confusion.
References
1. Physical status: The use and interpretation of anthropometry. Technical report series. Geneva; World Health Organization; 1995. Report No.: 854.
2. Thame M, Wilks RJ, McFarlane-Anderson N, Bennett FI, Forrester TE. Relationship between maternal nutritional status and infant's weight and body proportions at birth. Eur J Clin Nutr 1997 Mar; 51(3) : 134-138.
3. Kirchengast S, Winkler EM. Nutritional status as indicator for reproductive success in !Kung San and Kavango females from Namibia. Anthropol Anz 1996 Sep; 54(3) : 267-276.
4. Ravindra C. Correlation between adolescent nutrition during pregnancy and outcome of low birth-weight babies. J Fla Med Assoc 1989 Jun;76(6) : 523-525.
5. Choudhary S, Mishra CP, Shukla KP. Nutritional status of adolescent girls in rural area of Varanashi. Indian J Prev Soc Med. 2003; 34 (1): 53-61.
6. Shahabuddin AK, Talukdar K, Talukdar MK, Hassan M, Seal A, Rahman Q, Mannan A, Tomkins A, Costello A. Adolescent nutrition in a rural community in Bangladesh. Indian J Pediatr 2000 Feb; 67(2) : 93-98.
7. National Nutrition Monitoring Bureau. Diet and nutritional status of rural population. NNMB Technical Report No. 21. National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, 2002.
8. Chturvedi S, Kapil U, Gnanasekaran N, Sachadev HP, Pandey RM, Bhanti T. Nutrient intake amongst adolescent girls belonging to poor socioeconomic group of rural area of Rajasthan. Indian Pediatr 1996 Mar; 33(3): 197-201. Comments in Indian Pediatr 1997 Jan; 34(1): 70-71.
9. de Onis M, Dasgupta P, Saha S, Sengupta D, Blossner M. The National Centre for Health Statistics reference and the growth of Indian adolescent boys. Am J Clin Nutr 2001 Aug; 74(2): 248-253.
10. Hesketh T, Ding QJ, Tomkins AM. Disparities in economic development in Eastern China: impact on nutritional status of adolescents. Public Health Nutr 2002 Apr; 5(2): 313-318.
11. Kanani S, Consul P. Nutrition health profile and intervention strategies for underprivileged adolescent girls in India: a selected review. Indian J Matern Child Health 1990 Oct-Dec; 1(4): 129-133.
12. Venkaiah K, Damayanti K, Nayak MU, Vijayaraghvan K. Diet and nutritional status of rural adolescents in India. Eur J Clin Nutr 2002 Nov; 56(11): 1119-1125.
13. Yadav RJ, Singh P. Nutritional status and dietary intake in tribal children of Bihar. Indian Pediatr 1999 Jan; 36(1): 37-42.
14. WHO working group. Use and interpretation of anthropometric indicators of nutritional status. Bulletin of the World Health Organization 1986; 64(6) : 929-941.(Deshmukh PR, Gupta SS, Bh)
Abstract
Objective : The objective of the study was to study the nutritional status of adolescents in rural area of Wardha. Methods : The cross-sectional study was carried out in two PHC areas of Wardha district with two stage sampling method. In the first stage, cluster-sampling method was used to identify 30-clusters in each Rural Health Training Centre (RHTC) area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study. The mean body mass index (BMI) for age was used for classifying the nutritional status with CDC 2000 reference. Data thus generated was entered and analyzed using epi_info 2000. Results : Overall, 53.8% of the adolescents were thin, 44% were normal and 2.2% were overweight. The mean body mass index (BMI) for boys and girls was 16.88 and 15.54 respectively. The difference was statistically significant (p<0.05). The prevalence of thinness was significantly (p<0.05) higher in early adolescence, girls, lower education (< 8th standard) and lower economic status. Conclusion : Majority (53.8%) of the adolescents in this study area are thin and only 2.2% were overweight.
Keywords: Thinness; BMI; Chronic energy deficiency; Stunting; Underweight; Obesity,
Adolescence - a period of transition between childhood and adulthood is a significant period of human growth and maturation. The health of adolescents attracted global attention in the past two decades. Poor nutritional status during adolescence is an important determinant of health outcomes. Short stature in adolescents resulting from chronic undernutrition is associated with reduced lean body mass and deficiencies in muscular strength and working capacity.[1] In adolescent girls, short stature that persists into adulthood is associated with increased risk of adverse reproductive outcomes.[2],[3],[4] Overweight and obesity during adolescent period are associated with risk factors for obesity-related diseases in adulthood.[1]
As health systems have accepted life-cycle approach, the proximity to biological maturity and adulthood may provide final opportunities to implement certain activities designed to prevent adult health problems.[1] Though the health issues of adolescents like sexually transmitted diseases and reproductive health have been given due importance, limited research work has been done on their nutritional status. Hence the present study was undertaken to study the nutritional status of adolescents in rural area of Wardha.
Materials and Methods
A cross-sectional study was carried out in the areas of two Rural Health Training Centers (RHTC) of Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram (namely Bhidi and Anji with a total population of 19000 and 40000 respectively) through house-to-house visits. Two-stage sampling method was used to reach the respondents' households. In the first stage, cluster-sampling method was used to identify 30-clusters in each RHTC area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study.
Data on socio-demographic and anthropometric variables was collected on pre-designed and pre-tested questionnaire. Data thus generated was entered and analyzed using epi_info 2002 v 3.3. BMI for age was used for classifying the nutritional status. CDC 2000 reference was used to assess the nutritional status.[1] Chi-square was used for testing statistical significance. All tests of significance were two-tailed and level of significance was taken at p-value < 0.05.
Results
Total of 764 adolescents participated in the study. Out of them 420 (54.9%) were boys and 344 (45.1%) were girls. Overall 53.8% of the adolescents were thin; 44% were normal, and 2.2% were overweight table1. The mean BMI was significantly higher among boys (16.88 + 3.09) as compared to girls' (15.54 + 3.25). The prevalence of thinness was significantly higher (57.0%) in early adolescence than in late adolescence (48.6%). Similarly, the prevalence of thinness was significantly higher (69.8%) in girls than boys (40.7%). The prevalence of thinness was significantly (p<0.05) higher (60.3%) in those having education less than 8th standard than those who have education of at least 8th standard (49.6%). Among adolescents doing housework, there was 49.1% thinness; among the students it was 54.7% and in laborers it was 53.3%. The difference was not statistically significant (p>0.05). It was significantly (p<0.05) higher among the adolescents from lower family income (63.2%) than those from higher family income (38.1%) table1.
It was noted that three different criteria are used to assess the nutritional status of adolescents. They are BMI for age, BMI and Z score. When BMI for age was used, thinness (< 5th percentile) was 53.8%. But when BMI classification was used, chronic energy deficiency (CED) (< 18.5 kilogram per square meter) was found to be 75.3%, and when weight for height was used, wasting was found to be only 20.3% table2. 50.7% adolescents were stunted table2.
Discussion
In the present study, majority (53.8%) of the adolescents were thin, only 2.2% were overweight while 44.0% were normal. The high prevalence of thinness is commonly reported from the developing world. Choudhary et al[5] reported 68.52% of adolescents had BMI less than 18.5 kg/square meter in rural area of Varanasi. Shahabuddin et al[6] reported 67.0% prevalence of thinness in Bangladesh. The situation is serious and may prove an obstacle in achieving RCH (Reproductive and Child Health) program targets, like reduction in proportion of low birth-weight babies and in improving other reproductive outcomes.[3] Over the years, the programs directed towards this have failed to achieve targets, and one of the major reasons may be poor nutritional status of adolescents.
In the present study, thinness was significantly higher in early adolescence (57.0%) than in late adolescence (48.5%). Shahabuddin et al[6] also reported that as age increased, thinness decreased. National Nutrition Monitoring Bureau (NNMB)[7] also reported that undernutrition decreased from 78% in 10-13 years to 66% in 14-17 years.
In the present study, thinness was significantly more prevalent in girls than boys. But, Shahabuddin et al[6] reported that boys were affected more (75%) than the girls (59%). Chaturvedi et al[8] reported prevalence of chronic energy deficiency to be 93.5% among adolescent girls of rural Rajasthan. de Onis et al[9] reported prevalence of thinness to be 50.5% among Indian adolescent boys. NNMB[7] reported no sex difference in undernutrition in age group 10-13 years, but in age group 14-17 years, undernutrition was more (73%) prevalent in boys than their female counterparts (60.4%).
The significantly higher prevalence of thinness among adolescents from lower family income group was observed. Hesketh et al[10] also reported that lower family income is an important predictor of underweight. NNMB[11] reported that low-income group adolescents had height, weight and growth rates about 70-80% than those of high-income group.
In the present study, the stunting was present in 50.7% adolescents; Venkaiah et al[12] reported stunting of 39% from NNMB data; Yadav and Singh[13] reported it to be 60%. Shahabuddin et al[6] also reported stunting to be as high as 48% in Bangladesh.
The basic objective of anthropometric assessment at the community level is to provide an estimate of prevalence and severity of malnutrition. This information is of obvious importance for the formulation of health and development policies. In the present study, the prevalence of thinness (<5th percentile of BMI for age) was observed to be 53.8%, chronic energy deficiency (BMI < 18.5) 75.3% and wasting (< -2 Z-value of weight for height) was observed to be only 20.8%. These are the three different terminologies (thinness, chronic energy deficiency and wasting) and definitions/classifications used for assessing undernutrition, thus providing three different proportions of undernutrition in the same population, which is confusing to health managers and planners. Though weight for height (wasting) reference data has the advantage of requiring no knowledge of chronological age, available distributions of weight within categories of height have not been smoothed properly. Weight for age (underweight) has been considered uninformative and even misleading in absence of corresponding information on height for age. Conventional approaches to the combined use of height for age and weight for age are awkward and give biased results. BMI itself does not consider age, which is important in adolescence. Because of these various limitations, WHO has recommended BMI for age as the best indicator for use in adolescence as it incorporates the required information on age; it has been validated as an indicator of total body fat at the upper percentiles, and it provides continuity with recommended adult indicator.[1],[14] But most of the studies used BMI[5],[8] (chronic energy deficiency) and < -2 Z-value of weight for height[7],[10] (wasting) indicators for assessing nutritional status in adolescents. Hence, it is recommended that WHO criteria and terminology should be used to assess the nutritional status of adolescents to avoid the unnecessary confusion.
References
1. Physical status: The use and interpretation of anthropometry. Technical report series. Geneva; World Health Organization; 1995. Report No.: 854.
2. Thame M, Wilks RJ, McFarlane-Anderson N, Bennett FI, Forrester TE. Relationship between maternal nutritional status and infant's weight and body proportions at birth. Eur J Clin Nutr 1997 Mar; 51(3) : 134-138.
3. Kirchengast S, Winkler EM. Nutritional status as indicator for reproductive success in !Kung San and Kavango females from Namibia. Anthropol Anz 1996 Sep; 54(3) : 267-276.
4. Ravindra C. Correlation between adolescent nutrition during pregnancy and outcome of low birth-weight babies. J Fla Med Assoc 1989 Jun;76(6) : 523-525.
5. Choudhary S, Mishra CP, Shukla KP. Nutritional status of adolescent girls in rural area of Varanashi. Indian J Prev Soc Med. 2003; 34 (1): 53-61.
6. Shahabuddin AK, Talukdar K, Talukdar MK, Hassan M, Seal A, Rahman Q, Mannan A, Tomkins A, Costello A. Adolescent nutrition in a rural community in Bangladesh. Indian J Pediatr 2000 Feb; 67(2) : 93-98.
7. National Nutrition Monitoring Bureau. Diet and nutritional status of rural population. NNMB Technical Report No. 21. National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, 2002.
8. Chturvedi S, Kapil U, Gnanasekaran N, Sachadev HP, Pandey RM, Bhanti T. Nutrient intake amongst adolescent girls belonging to poor socioeconomic group of rural area of Rajasthan. Indian Pediatr 1996 Mar; 33(3): 197-201. Comments in Indian Pediatr 1997 Jan; 34(1): 70-71.
9. de Onis M, Dasgupta P, Saha S, Sengupta D, Blossner M. The National Centre for Health Statistics reference and the growth of Indian adolescent boys. Am J Clin Nutr 2001 Aug; 74(2): 248-253.
10. Hesketh T, Ding QJ, Tomkins AM. Disparities in economic development in Eastern China: impact on nutritional status of adolescents. Public Health Nutr 2002 Apr; 5(2): 313-318.
11. Kanani S, Consul P. Nutrition health profile and intervention strategies for underprivileged adolescent girls in India: a selected review. Indian J Matern Child Health 1990 Oct-Dec; 1(4): 129-133.
12. Venkaiah K, Damayanti K, Nayak MU, Vijayaraghvan K. Diet and nutritional status of rural adolescents in India. Eur J Clin Nutr 2002 Nov; 56(11): 1119-1125.
13. Yadav RJ, Singh P. Nutritional status and dietary intake in tribal children of Bihar. Indian Pediatr 1999 Jan; 36(1): 37-42.
14. WHO working group. Use and interpretation of anthropometric indicators of nutritional status. Bulletin of the World Health Organization 1986; 64(6) : 929-941.(Deshmukh PR, Gupta SS, Bh)