Abstract
In India, 66% of 8 million married adolescents (~5.3 million) are nulliparous and likely to conceive soon. Among married young women aged 20–24 years about 9.1 million are nulliparous. This group remains relatively less reached in maternal nutrition programs. Current estimates of their nutritional status and predictors of body mass index (BMI) are unavailable. Thinness (BMI <18.5 kg/m2), severe thinness (BMI <16 kg/m2), overweight or obesity (BMI ≥ 23kg/m2) prevalence estimates are presented based on a sample of 11,265 married nulliparous adolescents (15–19 years, married, no parity) and 15,358 young women (20–24 years, married, no parity) drawn from the National Family Health Surveys 2005–06 and 2015–16. Trends by age, time and state were analysed. Predictors of BMI were investigated using linear regression. Using BMI for age z score (BAZ) as standard reference, BMI cut-off was calculated for thinness (-2SD) and overweight or obesity (+1SD) among married nulliparous adolescents as recommended for population under 19 years. 35% sampled adolescents and 26% young women were thin; 4%-5% severely thin. Overweight or obesity was higher among married nulliparous young women than married nulliparous adolescents (21% versus 11%). Eight in 1000 were short, thin and young and six in 1000 were short, thin, anemic and young. At 15 years of age, prevalence of thinness based on BMI was 46.5% while based on BAZ, 7.6%. At 24 years of age thinness was 22.5%. Decadal reduction in thinness was half among married nulliparous adolescents (4% points) compared with married nulliparous young women (8% points). Decadal increase in overweight/ obesity ranged from 4% to 5% in both age groups. Western states had high prevalence of thinness; Tamil Nadu had highest prevalence of overweight or obesity. Incremental increase in age and wealth increased BMI among young women more than adolescents. BMI was lower among adolescents and young women wanting a child later than soon [β -0.28 (CI -0.49- -0.07), β -0.33(CI -0.56- -0.093), respectively]. BMI cut-off 16.49 kg/m2 and 24.12 kg/m2 had a high sensitivity (100%, 99.7%) and specificity (98.9%, 98.5%) to screen thin and overweight or obese adolescents, respectively. Owing to the high prevalence of both thinness and overweight/obesity among nulliparous married adolescents and women, nutritional anthropometry based screening should be initiated for this target group, along with a treatment package in states with high and persistent malnutrition. Family planning services should be integrated in nutrition programs for this target group to achieve normal nutritional status before conception.
Highlights
Poor nutrition of women before and during pregnancy has profound effect on fetal growth and development as well as mother’s own health and well-being [1]
With the NFHS 2015–16 data sets available, this paper presents 1) prevalence of thinness, severe thinness and overweight or obesity among married nulliparous adolescents (15–19 years) and married nulliparous young women (20–24 years), 2) determine proportion of most at risk married adolescents (MARA) or those short and thin, with or without anemia, 3) age, time and state-wise trends in prevalence of thinness and overweight or obesity and 4) predictors of both body mass index (BMI) and BMI for age z scores (BAZ) for adolescents and of BMI for young women
While the proportion with no schooling was under 15% in both age-groups, 38% had 12 years or more of education among married nulliparous young women opposed to 15% among married nulliparous adolescents
Summary
Poor nutrition of women before and during pregnancy has profound effect on fetal growth and development as well as mother’s own health and well-being [1]. India witnesses 30 million pregnancies each year [10]. Most Indian women enter pregnancy with poor nutrition. In India, the median age at marriage is 18.6 years and median age at first birth is 21 years [11]. Among married women in India, about 66% of 8 million (~5.3 million) aged 15 to 19 years and 26% of 35 million (~9.1 million) aged 20–24 years are nulliparous, presenting an opportunity to meet any health and nutrition gaps before conception if family planning services are used [11, 15]. Delaying age at first birth is likely to improve woman’s nutritional status [16]
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