Stunting and its determinants among adolescents in four schools of Bangalore city: Height for age- a vital metric for nutritional assessment

Published

2022-03-31

DOI:

https://doi.org/10.47203/IJCH.2022.v34i01.021

Keywords:

Stunting, Adolescent Nutrition, Nutritional Status, Iron Folic Acid Supplements, Schools

Dimensions Badge

Issue

Section

Original Article

Authors

Abstract

Background: National Family Health Surveys in India have not included nutritional status of the crucial age group of 10-14 years, when pubertal growth spurt typically occurs. BMI-for-age is commonly used to assess adolescent nutritional status which may misclassify stunted adolescents as normal or overweight. Objectives: To estimate prevalence and determinants of stunting among adolescents (10 to 19 years) in Bangalore city and to estimate the proportion of adolescents who are stunted, but otherwise assessed as normal or overweight using BMI-for-age. Methods: Cross sectional study conducted in four schools of Bangalore city using a self-administered questionnaire to capture socio-demographic details, dietary patterns and physical activity. WHO Anthroplus software was used to classify nutritional status based on height-for-age and BMI-for-age. Multiple logistic regression analysis was done to calculate adjusted odds ratios of independent co-variates associated with stunting. Results: Overall prevalence of stunting was 14% (95%CI:11.5-16.5%); 14.3% among females (95%CI:10.7-17.9%) and 13.6% among males (95%CI: 10.2-17.0%). Determinants of stunting were late adolescence [AOR=1.90(1.24-2.90),P=0.03], lower socio-economic class [AOR=2.75(1.39-5.41),P=0.03] and not taking weekly iron and folic acid supplements [AOR=2.78(1.48-5.21),P=0.001] Four of every five stunted children (81%) were classified as normal/ overweight/ obese using BMI-for-age. Conclusion: Stunting is a problem among urban adolescents in Bangalore. Height-for-age is a vital metric for assessing nutritional status of adolescents along with other metrics. We recommend strengthening of weekly iron and folic acid supplementation in schools and culturally specific targeted nutritional interventions for adolescents from economically weaker sections of society using a multi-sectoral and participatory approach.

How to Cite

1.
Johnson AR, Balasubramanya B, Thimmaiah S. Stunting and its determinants among adolescents in four schools of Bangalore city: Height for age- a vital metric for nutritional assessment. Indian J Community Health [Internet]. 2022 Mar. 31 [cited 2022 Oct. 6];34(1):111-7. Available from: https://iapsmupuk.org/journal/index.php/IJCH/article/view/2279

Downloads

Download data is not yet available.

Author Biography

Sulekha Thimmaiah, St. John’s Medical College, Bangalore

Professor,

Department of Community Health

References

Adolescent Health. South East Asia. World Health Organization; 2020. Available from: https://www.who.int/southeastasia/health-topics/adolescent-health. (Accessed on 20/03/2022).

Wahl R. Nutrition in the adolescent. Pediatr Ann. 1999;28(2):107-11. doi: 10.3928/0090-4481-19990201-07. PMID: 10036686

https://doi.org/10.3928/0090-4481-19990201-07

Soliman A, De Sanctis V, Elalaily R, Bedair S. Advances in pubertal growth and factors influencing it: Can we increase pubertal growth? Indian J Endocrinol Metab 2014;18(S1):S53-62. doi: 10.4103/2230-8210.145075. PMID: 25538878; PMCID: PMC4266869.

https://doi.org/10.4103/2230-8210.145075

de Onis M. Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization 2007;85(9):660–7. doi: 10.2471/blt.07.043497. PMID: 18026621; PMCID: PMC2636412.

https://doi.org/10.2471/blt.07.043497

Christian P, Smith ER. Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks. Ann Nutr Metab. 2018;72(4):316-328. doi:10.1159/000488865

https://doi.org/10.1159/000488865

Riley AP. Determinants of adolescent fertility and its consequences for maternal health, with special reference to rural Bangladesh. Ann N Y Acad Sci. 1994;709:86-100. doi:10.1111/j.1749-6632.1994.tb30390.x

https://doi.org/10.1111/j.1749-6632.1994.tb30390.x

Belachew, T., Hadley, C., Lindstrom, D. et al. Food insecurity, school absenteeism and educational attainment of adolescents in Jimma Zone Southwest Ethiopia: a longitudinal study. Nutr J 10, 29 (2011). https://doi.org/10.1186/1475-2891-10-29

https://doi.org/10.1186/1475-2891-10-29

Empowering adolescent girls and boys in India. UNICEF. Available from: https://www.unicef.org/india/what-we-do/adolescent-development-participation. (Accessed on 20/03/2022)

Bhargava M, Bhargava A, Ghate SD, Rao RSP. Nutritional status of Indian adolescents (15-19 years) from National Family Health Surveys 3 and 4: Revised estimates using WHO 2007 Growth reference. PLoS One. 2020;15(6):e0234570. doi: 10.1371/journal.pone.0234570. Erratum in: PLoS One. 2020 Sep 24;15(9):e0239923. PMID: 32569312; PMCID: PMC7307767.

https://doi.org/10.1371/journal.pone.0239923

World Bank Open Data: Urban Population. The World Bank;2018. Available from: https://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS (Accessed on 20/03/2022).

Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad’s Socio-economic classification – 2018: The need of an update in the present scenario. Indian J Community Health. 2018; 30(1): 82-4.

WHO AnthroPlus for personal computers manual: Software for assessing growth of the world's children and adolescents. Geneva: World Health Organization, 2009. Available from: http://www.who.int/growthref/tools/en/. (Accessed on 20/03/2022)

Growth reference: Height-for-Age (5-19 years). World Health Organization; 2007. https://www.who.int/growthref/who2007_height_for_age/en/. (Accessed on 20/03/2022)

Early and late adolescence. UNICEF; 2011. Available from: https://www.unicef.org/sowc2011/pdfs/Early-and-late-adolescence.pdf Accessed on 04/03/2022.

Lange SJ, Moore LV, Harris DM, et al. Percentage of Adolescents Meeting Federal Fruit and Vegetable Intake Recommendations — Youth Risk Behavior Surveillance System, United States, 2017. MMWR Morb Mortal Wkly Rep 2021;70:69–74. Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7003a1.htm. (Accessed on 20/03/2022)

https://doi.org/10.15585/mmwr.mm7003a1

Physical Activity. Fact Sheets. Geneva: World Health Organization, 2020. https://www.who.int/news-room/fact-sheets/detail/physical-activity . (Accessed on 20/03/2022).

Pal A, Pari AK, Sinha A, Dhara PC. Prevalence of undernutrition and associated factors: A cross-sectional study among rural adolescents in West Bengal, India. Int J Pediatr Adolesc Med. 2017;4(1):9-18. doi: 10.1016/j.ijpam.2016.08.009. Epub 2016 Sep 13. PMID: 30805494; PMCID: PMC6372453.

https://doi.org/10.1016/j.ijpam.2016.08.009

Singh S, Srivastava S, Upadhyay AK. Socio-economic inequality in malnutrition among children in India: an analysis of 640 districts from National Family Health Survey (2015-16). Int J Equity Health. 2019;18(1):203. doi: 10.1186/s12939-019-1093-0. PMID: 31881899; PMCID: PMC6935164.

https://doi.org/10.1186/s12939-019-1093-0

Al-Mansoob MAK, Masood MSA. The relationship between stunting and some demographic and cocioeconomic factors among Yemeni children and adolescents. Advances in Public Health. 2018: 5619178. doi: 10.1155/2018/5619178. Available from: https://www.hindawi.com/journals/aph/2018/5619178/. (Accessed on 20/03/2022)

https://doi.org/10.1155/2018/5619178

Kumar P, Srivastava S, Chauhan S, Patel R, Marbaniang SP, Dhillon P. Associated factors and socio-economic inequality in the prevalence of thinness and stunting among adolescent boys and girls in Uttar Pradesh and Bihar, India. PLoS One. 2021;16(2):e0247526. doi: 10.1371/journal.pone.0247526. PMID: 33626097; PMCID: PMC7904204.

https://doi.org/10.1371/journal.pone.0247526

Rao KM, Balakrishna N, Laxmaiah A, Venkaiah K, Brahmam GN. Diet and nutritional status of adolescent tribal population in nine states of India. Asia Pac J Clin Nutr. 2006;15(1):64–71. PMID: 16500880.

Kimmons J, Gillespie C, Seymour J, Serdula M, Blanck HM. Fruit and vegetable intake among adolescents and adults in the United States: percentage meeting individualized recommendations. Medscape J Med. 2009;11(1):26. Epub 2009 Jan 26. PMID: 19295947; PMCID: PMC2654704.

https://doi.org/10.1096/fasebj.22.1_supplement.868.8

Diethelm K, Jankovic N, Moreno LA, Huybrechts I, De Henauw S, De Vriendt T, et al; HELENA Study Group. Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2012;15(3):386-98. doi: 10.1017/S1368980011001935. Epub 2011 Sep 22. PMID: 21936969.

https://doi.org/10.1017/s1368980011001935

Keats EC, Rappaport AI, Shah S, Oh C, Jain R, Bhutta ZA. The Dietary Intake and Practices of Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review. Nutrients. 2018;10(12):1978. doi: 10.3390/nu10121978. PMID: 30558128; PMCID: PMC6315365.

https://doi.org/10.3390/nu10121978

Operational Framework: Weekly Iron and Folic acid supplementation programme for adolescents. RCH-DC Division, Ministry of Health and Family Welfare, Government of India. 2012. http://nhm.gov.in/images/pdf/programmes/wifs/operational-framework-wifs/operational_framework_wifs.pdf (Accessed on 20/03/2022)

https://doi.org/10.9734/ejnfs/2015/20933

Soliman AT, De Sanctis V, Kalra S. Anemia and growth. Indian J Endocrinol Metab. 2014;18(Suppl 1):S1-5. doi: 10.4103/2230-8210.145038. PMID: 25538873; PMCID: PMC4266864.

https://doi.org/10.4103/2230-8210.145038

Soliman AT, Eldabbagh M, Adel A, Sabt A. Linear growth and circulating IGF-I concentrations in children with Iron deficiency anemia after treatment. Arch Dis Child. 2012;97:A220. doi:10.1136/archdischild-2012-302724.0765

https://doi.org/10.1136/archdischild-2012-302724.0765

Pettifor JM. Combined stunting and overweight in young children - a paradox? South Afr J Clin Nutr. 2006;19(3):98-100. doi: 10.1080/16070658.2006.11734101. PMID: 20396610; PMCID: PMC2854810.

https://doi.org/10.1080/16070658.2006.11734101

de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12(Suppl 1):12-26. doi: 10.1111/mcn.12231. PMID: 27187907; PMCID: PMC5084763.

https://doi.org/10.1111/mcn.12231

Proos LA, Hofvander Y, Tuvemo T. Menarcheal age and growth pattern of Indian girls adopted in Sweden. I. Menarcheal age. Acta Paediatr Scand. 1991;80(8-9):852-8. doi: 10.1111/j.1651-2227.1991.tb11960.x. PMID: 1957606.

https://doi.org/10.1111/j.1651-2227.1991.tb11960.x

Martorell R, Khan LK, Schroeder DG. Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr. 1994;48 Suppl 1:S45-57. PMID: 8005090.

Most read articles by the same author(s)