Association of Iron Supplementation and Dietary Diversity With Nutritional Status and Learning Outcomes Among Adolescents: Results From a Longitudinal Study in India

Abstract

Abstract Objectives Health and nutrition are strongly associated with educational outcomes and future life productivity. Using longitudinal data, we studied the associations of sex, iron & folic acid (IFA) supplementation, deworming, and dietary diversity with nutritional status and learning outcomes among Indian adolescents. Methods Data of 12,035 adolescents were analyzed from two rounds of the UDAYA project surveys in Uttar Pradesh and Bihar, India. Multivariate linear and logistic regression models were used to estimate the prospective relationships of explanatory variables in the 1st round of the survey on nutritional status (i.e., hemoglobin, BMI − and height − for − age z − scores (BAZ, HAZ), and incidence of anemia, stunting, and underweight) and learning outcomes (i.e., reading and math skills, and school dropout) in the 2nd round of the survey. Results Girls had a lower hemoglobin (adjusted mean difference (aMD) −2.07; 95% CI: −2.20, −1.94) and HAZ (aMD −0.45; 95% CI: −0.53, −0.38) and higher BAZ (aMD 0.36; 95% CI: 0.27, 0.44) than boys. Girls had poorer reading (adjusted odds ratio (aOR) 0.81; 95% CI: 0.70, 0.95) and math skills (aOR 0.36; 95% CI: 0.31, 0.42), and a higher risk of school dropout (aOR 1.65; 95% CI: 1.40, 1.95) than boys. Overall, IFA supplementation had no significant association with adolescents’ hemoglobin, but we noted a favorable association for girls (aMD 0.41; 95% CI: 0.00, 0.82) and not for boys (aMD 0.02; 95% CI: −0.38, 0.43; P for interaction = 0.09). IFA supplementation was associated with higher reading (aOR 1.47; 95% CI: 1.07, 2.01), and math skills (aOR 1.51; 95% CI: 1.16, 1.98) and a lower risk of school dropout (aOR 0.72; 95% CI: 0.54, 0.96). High dietary diversity was positively associated with hemoglobin (P = 0.003), HAZ (P < 0.001), math skills (P = 0.05), and a lower risk of school dropout in adolescents (P = 0.02). Conclusions Beneficial associations of IFA supplementation and a diverse diet with adolescent nutrition and learning outcomes underscore the importance of integrated nutritional and health interventions to address adolescents’ nutritional needs and improve educational outcomes. Funding Sources The B & M Gates Foundation and the D & L Packard Foundation supported the UDAYA project through a grant to the Population Council. This analysis did not receive any fiscal support.