Abstract

The conditions in which adolescent girls mature shape their health, development and nutrition. Nutrient requirements increase to support growth during adolescence, but gaps between consumption and requirements exist in low‐ and middle‐income countries. We aimed to identify and quantify the relationship between dietary intake and diverse social determinants of nutrition (SDN) among a subset of adolescent girls 15–18.9 years (n = 390) enrolled within the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The primary outcome, dietary diversity score (DDS), was derived by applying the Minimum Dietary Diversity for Women 10‐item scale to 24‐h dietary recall data collected three times per participant. To examine the associations between the SDN‐related explanatory variables and DDS, we generated a hierarchical, causal model using mixed effects linear regression to account for the cluster‐randomized trial design. Using all data, diets lacked diversity (DDS mean ± SD: 3.35 ± 1.03 [range: 1–7; n = 1170]), and the minimum cut‐off for dietary diversity was infrequently achieved (13.5%; 95% CI: 11.6–15.6%). Consumption of starches was reported in all recalls, but micronutrient‐rich food consumption was less common. Of the SDN considered, wealth quintile had the strongest association with DDS (P < 0.0001). The diets of the sampled Pakistani adolescent girls were insufficient to meet micronutrient requirements. Poverty was the most important predictor of a diet lacking in diversity, indicating limited purchasing power or access to nutritious foods. Dietary diversification and nutrition education strategies alone are unlikely to lead to improved diets without steps to tackle this barrier, for example, through fortification of staple foods and provision of supplements.

Highlights

  • Adolescent girls' nutrient requirements are increased during puberty to support growth and development, making the availability and consumption of an adequate diet crucial (Patton et al, 2016)

  • Among late adolescent girls living in Matiari District, in rural Pakistan, we observed that the majority consumed monotonous diets and did not meet the cut-off for minimum dietary diversity (MDD)

  • Dietary diversity score (DDS) was low among those in the least poor wealth quintile. This is the first study to investigate the relationship between diverse social determinants of nutrition (SDN), TABLE 2 Nutritional status-related characteristics among participants at enrolment in the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial dietary assessment subgroup (n = 390)

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Summary

| INTRODUCTION

Adolescent girls' nutrient requirements are increased during puberty to support growth and development, making the availability and consumption of an adequate diet crucial (Patton et al, 2016). In Pakistan, diets are quantitatively inadequate, and micronutrient deficiencies are widespread among married women of reproductive age (WRA; 15–49 years) (UNICEF Pakistan, 2018) From limited data, this is suggested to be true for adolescent girls (10 to >19 years) (Global Alliance for Improved Nutrition, 2018; Global Alliance for Improved Nutrition & Aga Khan University, 2017). Among the late adolescent girls (15–18.9 years) surveyed in this rural setting in Pakistan, dietary diversity scores were poor, and dietary quality was generally inadequate, suggesting current consumption patterns are unlikely to meet nutrient requirements. Improving the dietary intake in this setting will require a two-pronged approach: (1) poverty alleviation strategies are needed to enhance purchasing power, as resource constraints affect many families' ability to access diverse and nutritious food; and (2) micronutrient intake improvement strategies could be of benefit because diet quality is generally poor. Literature and dietary intake among Pakistani late adolescent girls (15–18.9 years)

| METHODS
| RESULTS
Findings
| DISCUSSION
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