Descriptive Study on Dietary Pattern and Health Status of Adolescents from Rural Bengaluru

Food habits and consumption pattern are changing globally on account of various factors like urbanization, income levels, socioeconomic status and so on de Lanerolle-Dias et al. (2015). Urbanization usually is considered as one of the major driving factors for the changes in eating and food habits amongst individuals in urban areas. However, with the recent scenario, these factors have not only influenced the food consumption pattern in urban areas, but has also modified the food choices of rural population. The diet including higher intakes of animal products, refined foods, fats and oil have been considered as urbanized diet (Pandey et al., 2020). These changing food consumption patterns have been associated with nutrition and health transition amongst the individuals. The modified food consumption pattern, increased intake of processed, convenience foods, coupled with sedentary life style, has ultimately increased the risk of non-communicable diseases (Abizari and Ali 2019). Along with the spiking risk of overnutrition, the burden of undernutrition and micronutrient deficiencies still prevails. Thereby making it vital to record the changing trends in adolescents’ food consumption.   
       
The changes in food consumption pattern can greatly influence the health status of the vulnerable groups, especially adolescents, children and expecting mothers. During adolescence (10-19 years) multiple factors like peer influence, social, cultural and demographic factors can affect the food choices; leading to foundation of unhealthy food habits. Thus, imparting proper nutrition knowledge and inculcating healthy eating habits during this age is essential to avoid the long-term health complications, especially for adolescent girls. Current statistics in India suggested that girls (40%) and boys (18%) fall prey to anemia (https://www.unicef.org/india/what-we-do/adolescent-nutrition#:~:text=Adolescence%20is%20a%20nutritionally% 20vulnerable,cent% 20of%20boys%20are%20anaemic accessed on 23-06-2022).

       
Changing food habits is a global phenomenon; thus, understanding the current trends in food intakes, dietary behavior, eating habits and food choices of adolescents can prove useful in planning improved food and nutrition interventions. Further, understanding the dietary pattern of adolescents can also help in correlating it with their health status or prevalence of any life style associated disorders like obesity, cardiovascular diseases and diabetes (Abizari and Ali 2019; Venkaiah et al., 2002). Therefore, this study aims at documenting the socio-demographic, anthropometric profile and dietary habits of the adolescent girls and boys in rural Bengaluru.
 

Sample selection and data collection
 
In this study purposive random sampling was done and 100 adolescent subjects were selected (50 boys and 50 girls) falling in the age group of 13-15 years from rural North Bengaluru. A standardized questionnaire was designed based on pre-tested questionnaire and pilot-study, to draw necessary information regarding their socio-economic status and dietary habits. Detailed information regarding sociodemographic and anthropometric measurements of the subjects were collected. The height, weight, mid upper arm circumference (MUAC), skin fold thickness (SFT) was measured using standard protocols (Jelliffee, 1966). Body Mass Index (BMI) was calculated using formula: weight (in kg)/ height (in m²); further it was categorized as underweight (<18.5 kg/m²), normal (18.5 to 24.9 kg/m²), pre-obesity (25 to 29.9 kg/m²) obesity class I (30 to 34.9 kg/m²), obesity class II (35 to 39.9 kg/m²) and obesity class III (> 40 kg/ m²) according to WHO (2010).
 
Socioeconomic status (SES)
 
Modified Kuppaswamy SES scale 2021 was used in this study to classify the respondents into five groups based on the total scores viz., upper class (I: 26-29), upper middle class (II: 16-25), lower middle class (III: 11-15), upper lower (IV: 5-10) and lower socio-economic class (V:<5). The scoring used in the scale is based on education and occupation of head of family along with total monthly income of the family (Saleem and Jan 2021).
 
Dietary survey and assessment
 
Dietary information was collected using 24-hour recall method for 3 days in a week. The consumption quantities of raw and cooked foods were recorded after showing the sets of pre-standard vessels. Dietary intake of different food groups (cereals and millets, pulses, milk and milk products, roots and tubers, green leafy vegetables, other vegetables, fruits, sugar) were quantified and based on the quantities consumed, individual nutrients were calculated using food compositional table (Longvah et al., 2017). Further the per cent adequacy for food intake and nutrients were calculated comparing to recommended dietary intake (RDI) and dietary allowances (RDA) (ICMR-NIN 2020). Following formula were used to calculate per cent intake and nutrient adequacy.
 

 
Research ethics
 
The study was approved by the institutional ethical committee for Human Research, University of Agricultural Sciences, GKVK, Bengaluru (No. DR/STA/Ethical Committee/2020-21) dated 05-04-2021. Informed consent was taken from the school management and authority, head master, parents and children before conducting the interview and asking the respondents to fill in the questionnaire. The respondents were made aware that their participation in the study is voluntary and can be withdrawn anytime.
 
Statistical analysis
 
The data was analyzed; necessary descriptive statistics was applied and the values were expressed as mean ± standard deviation (SD).
 

Socioeconomic status (SES) and anthropometric data
 
The socioeconomic and anthropometric data of the respondents is provided in Table 1 and 2. It was observed that amongst adolescents (50 girls and 50 boys) 32% respondents were studying in 8^th, 37% in 9^th and 31% in 10^th standard. Majority of the respondents belonged to the nuclear family (68% girls and 74% boys), followed by the joint family (28% girls and 24% boys) and only 4% of girls belonged to the extended family. Amongst the total respondent (n=100), 85% adolescents responded that their father was head of family, while only 15 % reported mother as the head of the family. Considering socioeconomic status, more than 80% of the respondents belonged to the lower middle class, while 12-16% were upper lower class and only 2% were upper middle class based on the education, occupation of head of the family and the total family income.




       
Anthropometric data suggested that on average the height, weight, SFT, MUAC and BMI were within the normal ranges. However, when the respondents were classified into BMI categories it was noted that 32% girls and 26% boys were underweight with BMI below 18.5. However, majority of the respondents i.e., 64% girls and 72% boys were having normal BMI and only 4% girls and 2% boys were falling under pre-obese BMI category. The results suggested that though majority respondents were normal, still there were cases of underweight and pre-obesity. This is an indicator that the burden of under and over nutrition co-exists. The results for anthropometric data correlated with a previous study conducted by Lakshmi (2021) and the standard values given by ICMR (2010); however, Lakshmi (2021) reported the highest number of adolescents being underweight, followed by normal and at risk of obesity. This difference could be due to the sample variation in the previous and present study.
 
Dietary pattern assessment
 
Food habits and meal consumption pattern
 
The food habits indicated that 56% of adolescents were non-vegetarian and 44% were vegetarian. Majority of the respondents (86%) consumed three meals a day, whereas 14% respondents were consuming only two meals a day. However, amongst the total sample, 8 girls and 5 boys reported about skipping meals. Detailed investigation suggested that from the 8 adolescent girls the breakfast and lunch was skipped once a week by half (4 girls) while dinner was skipped by 62.5%. Among the five boys, 60% skipped breakfast once a week, while 20% skipped twice and thrice a week. When compared, more girls skipped meals than boys. The reasons provided by girls and boys (n=13) for skipping meals included time shortage (37.5%, 40%), disliking a particular food (37.5%, 40%) and only a few reported that they skipped meals when they were not hungry (25%, 20%) respectively (Table 3). Results are concurrent with the study conducted by Durgannavar and Vijayalakshmi (2018) for school going adolescent girls and boys.


 
Food and nutrient intake adequacy
 
The food intake adequacy compared to recommended dietary intake (RDI) is denoted in Fig 1. It was observed that the food intake adequacy for cereal and pulses were above 70% for both boys and girls. In terms of GLVs, intake adequacy was above 70% for girls but only 62% for boys. For both boys and girls 50 % adequacy is met for milk, milk products and roots and tubers. The lowest adequacy was noted in terms of fruits as 46% (boys) while 36.3 (girls) in the study group. Moore et al., (2012) also indicted that majority adolescent girls have inadequate food intake for fruits. It is reported by previous study (Rodrigues et al., 2017) that skipping meals results in poor quality diets with reduced intake of fruits and vegetables. This was also observed in present study where the intake of fruits and vegetables were less than the RDI. The present results are also in line with those from Venkaiah et al., (2002) indicating that the food intake of 13-15 years children was less than the RDI.


       
Per cent nutrient adequacy for the adolescent girls and boys as presented in Fig 2, indicates that energy requirements were fulfilled up to 84.55% for boys and 81.98% for girls. Similarly, Venkaiah et al., (2002) also indicated that energy requirement of majority of 13-15-year children was fulfilled above 70% of RDA. The actual mean intake for protein was 35.33 g/day and 32.61 g/day for boys and girls, which was lower than the RDA of 45 g/day and 43 g/day, meeting the adequacy of 78.51% and 75.84% respectively. For dietary fiber, the daily recommended allowance is 40 g/2000 Kcal (ICMR-NIN 2020) and for the selected sample the data revealed that the actual intake of the adolescents was able to meet 72.23% (boys) and 70.97% (girls) adequacy. The requirements for calcium were satisfied to 85.53% (boys) and 81.58% (girls), this could be attributed to daily and regular consumption of finger millet (ragi) as staple cereal along with some quantities of milk and milk products. The actual iron consumption was recorded lower (boys: 14.15 mg/day; girls:17.66 mg/day) than the RDA (boys: 22 mg/day; girls: 30 mg/day) in both boys and girls thus, the per cent adequacy was 64.33% and 58.80% respectively. The requirements for vitamin B complex (thiamine, riboflavin, niacin and folate) ranged from 50.47% to 63.78% for boys and 52.21% to 61.19% for girls indicating that the actual nutrient intake was just enough to fulfill half of the RDA (ICMR-NIN 2020). Vitamin C adequacy was surprisingly meeting 80% in both boys and girls, because of daily intake of citrus fruits (e.g., lime); as they were informed about the health benefits of vitamin C (immunity boosting nutrient) and its regular consumption during pandemic period by anganwadi teachers. Overall, results indicated that nutrient intake of both girls and boys was lower than the RDA for their respective age group and these results were concurrent with the reports of Shafiee et al., (2015).


 

This study delineated information about the socioeconomic profile, dietary pattern and body composition of rural adolescents. It was concluded that in rural Bengaluru, majority of adolescents had micronutrient inadequacy, even though they belonged to normal BMI category. This may be due to their economic status and low intake of fruits and vegetables. This descriptive study could also provide basis to document, associate and plan nutritional interventions for understanding the relation between socioeconomic and nutritional status amongst adolescents residing in different areas viz. rural, urban and peri-urban.
 

None.