Nutritional status of Indian adolescents (15-19 years) from NationalFamily HealthSurveys 3 and 4: Revised estimates using WHO 2007 Growth reference.

Madhavi Bhargava,Sudeep D Ghate,Anurag Bhargava,R Shyama Prasad Rao,Vijayaprasad Gopichandran

doi:10.1371/journal.pone.0234570

Abstract

The National Family Health Surveys (NFHS) in India apply adult cutoffs of nutritional status for the estimation of undernutrition/overweight in the 15-19 age group. The prevalence of thinness in boys and girls thus estimated is 58.1% and 46.8% in NFHS-3, and 45% and 42% in NFHS-4 respectively. But the WHO recommends using age and sex-specific reference for adolescents. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles. Demographic information, anthropometric data, and wealth index were accessed from the Demographic and Health Survey (DHS) database. We re-analyzed the anthropometric data using WHO AnthroPlus software which uses the WHO 2007 Growth reference. The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% (95%CI: 21.6, 23.0) and 9.9% (95%CI: 9.5, 10.3) in NFHS-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively. Stunting was found to be 32.2% (95% CI: 31.6, 32.9) in boys and 34.4% (95% CI: 34.2, 34.7) in girls in NFHS-4. This was higher than that in NFHS-3; 25.2% (95% CI: 24.4, 26) in boys and 31.2 (95% CI: 30.6, 31.8) in girls. There was a clear socioeconomic gradient as there were higher thinness and stunting in rural areas. There was wide variation among the states with pockets of a double burden of malnutrition. Using the adult cutoffs significantly overestimates thinness in adolescents in the age group of 15-19 years old in India. Stunting, which is an indicator of long term nutrition is also widely prevalent in them. Future editions of DHS and NFHS should consider adolescents as a separate age group for nutritional assessment for a better understanding of nutritional transition in the population.

Highlights

The World Health Organization (WHO) defines adolescence as 10–19 years [1]
The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% and 9.9% (95%confidence intervals (CI): 9.5, 10.3) in National Family Health Surveys (NFHS)-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively
In the NFHS-3, the mean BMI-for-age z-scores (BAZ) and Height-for-age z-scores (HAZ) scores were significantly lower in the rural adolescents and those in the poorer quintiles, and the mean HAZ score was significantly lower in the girls

Summary

Introduction

The World Health Organization (WHO) defines adolescence as 10–19 years [1]. It is a key decade in the life course with implications on adult health, socio-economic well-being of a country and even the health of the future children. Adolescence is a period of rapid growth and development, second only to infancy, with dramatic biological, psychological changes often shaped by socio-cultural factors. It is usually divided into two phases: early adolescence (10–14 years) and late adolescence (15–19 years) [5]. The nutritional issues in this age group have commonalities with children and adults with some added dimensions of puberty, psychological changes, and growth spurt which are crucial for current, future and intergeneration health [6]. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles.

Methods

Results

Conclusion