Dietary patterns close socioeconomic disparity in adolescents’ height and adiposity level in urban Gambia

Abstract

BackgroundThere is great disparity in adolescents’ nutritional status between public and private schools in urban Gambia. The present study examined the disparity of adolescents’ hunger experiences and dietary patterns between public and private schools in urban Gambia.MethodsThis school‐based cross‐sectional study took place in six private and six public middle schools in Banjul and Kanifing, the Gambia. In total, 960 students (13–15 years old) were recruited. Standing height and body mass index (BMI) were converted to Z‐score using the WHO growth references. Main outcomes of interest included height‐for‐age Z score (HAZ), BMI‐for‐age Z score (BMIAZ), and percent of body fat (BF%). BF% was measured on Tanita BIA UM‐076. Information on family socioeconomic status were based on parent/guardian's response. Hunger experience was based on participants’ self‐report on ever feeling hungry both at home and in school in the past 30 days. A food frequency questionnaire of 14 common food groups in the Gambia was administered to collect adolescents’ dietary habit in the past 7 days of interview. Factor analysis extracted the dietary patterns by analyzing the commonality of the consumption of 14 food groups.Results52.6% of public school students and 7.7% of private school students reported ever feeling hungry at home and school in the past 30 days. The differences in HAZ, BMIAZ, and BF% by family socioeconomic status were not significant after hunger experience was taken into account, while hunger experience itself was significantly associated with lower HAZ (by −0.17, 95% CI: −0.34, 0.00), BMIAZ (by −0.34, 95% CI: −0.57, −0.11), and BF% (by −1.85%, 95% CI: −3.00%, −0.70%). Factor analysis identified 4 independent dietary patterns. The 1st pattern includes red meat, egg, milk, dairy and sweetened beverage. The 2nd pattern includes vegetables, tubers, fruits and juices. The 3rd pattern includes whole grain and poultry. The 4th pattern is fried foods and seafood. Adolescents in private schools had higher HAZ than those in public schools, but the difference was no longer significant after dietary patterns were adjusted. Meanwhile, hunger was no longer associated with HAZ after dietary patterns was controlled. As for adiposity, disparity in BF% between public and private schools disappeared after dietary patterns were controlled, but hunger was still associated with a lower BF% (−1.38%, 95% CI: −2.49%,−0.26%). However, disparity in BMI‐for‐age between public and private schools remained significant after dietary patterns were taken into account.ConclusionThe observed disparity in nutritional status between public and private schools in the urban Gambia may be eliminated when children have comparable dietary quality.