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A study on dietary intake among school going adolescent girls in rural and urban area of Jamnagar District, Gujarat.

INTRODUCTION

Adolescence is atumultuous time. The World Health Organization defines it as the time period between 10 years and 19 years of age. [1] In India, as per Census 2011, adolescent population (10-19) is 253.2 million constituting 20.9% of the total population. Today, every fifth person in India is an adolescent (10-19 years). Among them, 120 million are adolescent girls. [2]

Adolescence is a period of transition from childhood to adulthood. These are formative years during which maximum amount of physical, psychological, and behavioral changes take place. Rapid changes in physical growth and psychosocial development have placed these young adults in nutritionally vulnerable groups with poor eating habits that fail to meet essential dietary requirements. [3] Adolescents are the future generation of any country and their nutritional needs are critical for the well-being of society. The especially unhealthy diet of adolescents should be regarded as an important public health issue because it is one of the leading causes of pediatric obesity, which usually tracks into adulthood. Health of adolescent girls has intergenerational effect. A healthy adolescent girl becomes a healthy antenatal mother and gives birth to a healthy baby. [4] Good nutrition during adolescence is critical to cover the deficits suffered during childhood and should include nutrients required to meet the demands of physical and cognitive growth and development, provide adequate stores of energy for illnesses and pregnancy, and prevent adult onset of nutrition-related diseases. A large percentage of adolescents in India suffer from nutritional deficiencies. [5]

Diet plays a very important role in growth and development of adolescents, during which the development of healthy eating habits is of supreme importance. There is a dual burden of under nutrition and over nutrition in this age group. Pulses are one of the most important source of protein in vegetarian diet. Green leafy vegetables and fruits are good sources of vitamins, minerals, and fibers. Milk is a good source of calcium and Vitamin A which are crucial for human nutrition. All these food items are component of a balanced diet which is very important for adolescents, for their growth and development. According to the WHO, key causes of obesity are increased consumption of energy-dense foods high in saturated fats and sugars and reduced physical activity tea/coffee, fast food sweets/ice cream/pastries, etc., are energy-dense food having high-fat content. They contain empty calories and have no nutritional advantage.

Some dietary patterns appear quite common among adolescents, to mention a few: Snacking, usually on energy-dense foods, particularly breakfast or irregular meals, wide use of fast food, and low consumption of protein-rich food, fruits, and vegetables. [6]

To the best of our knowledge, very few researches were done which compare dietary intake of adolescent girls of rural and urban area.

Hence, the present study is done with objective of:

1. To assess the dietary intake of various food items and

2. To see the variation in dietary intake of girls from rural and urban area.

MATERIALS AND METHODS

A list of taluka wise distribution of the schools of Jamnagar district was obtained from the office of the District Education Officer. There are six talukas in study district. Using systematic random sampling, a sample of 12 schools (two schools from each taluka, one from urban area, and one from rural area) from this list was selected for the study. The study obtained approval from the school principal and was started after getting ethical clearance from Ethical Institutional Committee of Shree M. P. Shah Gov. Medical College, Jamnagar.

Sample Size

For estimating a population proportion with specified relative precision, formula used was, n=[Z.sup.2][sub.1-[alpha]/2]P [1-P)/[[epsilon].sup.2], according to this minimum required sample size was 662 with P = 0.40, [7] including 15% sample loss. A total of 670 samples were collected, 335 from rural and 335 from urban area schools.

Study Subjects

This was a school going girls of 9th-12th standard.

Study Period

The study period was 6 months, from October 2014 to March 2015.

Method of Collection of Data

Data were collected by interviewing the study participants using predesigned and pretested questionnaires. Data regarding the diet, food habits, and food consumption pattern were collected. After permission from the principal and lecturers, students were approached in the classroom after their lectures. They were asked to participate in this study voluntarily. Informed consent from school principal and assent from each participant were taken.

Data Entry and Analysis

The data entry was done using EPI INFO version 3.5.3 and data analysis was done using Microsoft Office Excel 2007 and MedCalc by applying appropriate statistical test.

Terminology:

* Early adolescence: 9-13 years old [8]

* Mid-adolescence: 14-15 years old [8]

* Late adolescence: 16-19 years old. [8]

RESULTS

Of total 670 subjects, 335 were from rural area schools and 335 from urban area schools.

Tables 1-4 summarized various sociodemographic characteristics of study subjects.

Table 1 summarizes age and standards wise distribution of adolescent girls. Majority of girls 76.72% (257) in rural area were from phase of mid-adolescents (14 and 15 years) and in standard 9th and 10th, whereas in urban area half of the girls, 51.94% (174) girls were from phase of late adolescents (16-19 years), and proportion of girls in all standard was almost same. The difference in age and standard distribution was highly statistically significant (P < 0.01).

91.3% of the respondents were Hindu. 57.4% of the adolescents came from nuclear families and the rest from joint families. 36.7% of the girls from rural area and 49.9% of girls from urban area belong to middle socioeconomic class (Class II and III), whereas 60.3% of the girls from rural area and 39.7% of girls from urban area belong to lower socioeconomic class (Class IV and V) family. Statistically significant difference was found in socioeconomic status of girls in rural and urban area (P = 0.000) [Table 2] (SEC according to AICPI 1143 of 2014) [9].

With regard to education of parents, nearly one-third of the parents were educated up to secondary standards, 9.5% of the fathers and 11.8% of the mothers were illiterate. Overall, literacy rate was, not surprisingly, better among fathers than among mothers. Highly statistically significant difference was present in education level of parents in rural and urban area (P = 0.000) [Table 3].

Occupational status of their mothers showed that 75% were housewives, and 2.7% were service class. Among the fathers, 9.7% were service class, 17.9% were businessmen, 27.6% were laborer, and 41% were engaged in agricultural activities. Statistically significant difference was found in occupation of father's in rural and urban area (P = 0.000) [Table 4].

Table 5 summarizes that more than 90% of girls in both rural and urban area were pure vegetarian. Only 2.7% in rural and 8.4% in urban area were consuming mix pattern of diet. This difference in type of diet among girls was statistically significant (P = 0.001).

Table 6 summarizes nearly 90% of adolescents had meals regularly (2-3 times a day). 83.1% of girls had habit of snacks 1-2 times a day.

Table 7 summarizes the frequency of intake of various nutritious food items among the adolescent girls of rural and urban area. Almost 77% of study participants consumed pulses <4 times a week, whereas 1.5% of rural and 9% of urban area girls consume pulses daily. 59.6% of study adolescents were taking green leafy vegetables 1-3 times a week, whereas 5.1% of girls from rural area and 14.9% of girls from urban area had daily serving of green leafy vegetables. Two-third (67%) of study participants had intake of fruits 1-3 times a week, whereas 4.5% of rural area and 11.9% of urban area girls had daily intake of fruits. One-third of adolescent girls had never consumed milk, and only 17.5% had daily intake of milk. Statistically significant difference was observed in intake of various nutritious food items, except for milk, in rural and urban area girls (P = 0.000).

Table 8 summarizes the frequency of intake of various non-nutritious food items among the adolescent girls of rural and urban area. Almost half of the study participants (48.4%) consumed tea/coffee 1-3 times a week. 16.7% of girls had habit of daily consumption of tea/coffee. On comparing the frequency of fast food and sweet, ice cream, and pastries, almost two-thirds had reported intake 1-3 times a week while 0.6% in fast food and 2.2% in sweet, ice cream, and pastries daily intake reported. Statistically significant difference was observed in intake of various non-nutritious food items except for fast food in rural and urban area girls (P = 0.001).

DISCUSSION

In the present study, in rural area, majority of girls (76.72%) were in mid-adolescent phase, whereas in urban areas, majority of girls (51.94%) were in late adolescent phase. 91.3% of respondent were Hindu and 57.4% came from nuclear family. 60.3% girls from rural area came from lower socioeconomic class and 49.9% girls from urban area were from middle socioeconomic class. Nearly one-third of the fathers and one-fifth of the mothers were graduates, 32% of the mothers and 23% of the fathers were educated up to class 10. 90% of girls were pure vegetarian. Mean number of meal was 2.85 in rural area and was 2.7 in urban area. Daily intake of all nutritious food items was very low (daily intake of pulses was 5.2%, green leafy vegetables was 10%, fruits was 16.9%, and milk was 17.5%). Almost half of the study participants (48.4%) consumed tea/coffee 1-3 times a week. Almost two-thirds had reported intake of fast food, sweets, ice creams, and pastries 1-3 times a week. The statistically significant differences were observed in age distribution, socioeconomic class, literacy of parents, mean number of meal, in intake of nutritious (pulses, green leafy vegetables, and fruits), and non-nutritious (tea/coffee, fast food, sweets, ice creams, and pastries) food items in rural and urban area (P < 0.05).

A study conducted by Kotecha et al. in urban area of Baroda, about one-third were in their early adolescence and the rest belonged to the late adolescence group, 93% Hindu and 65% from nuclear family. [10] Yadav et al. study also revealed same finding. [11] Census 2011, India, reports that adolescents in the age group of 10-14 years are contributing to more than half of the adolescent population. The differences observed in age distribution of the present study is because the study subjects are school students and census data reflect the general population. NFHS 3 findings in Gujarat revealed that 70% of women (aged 15-49 years) were vegetarians [12] According to the report of 61st round of NSSO, [13] the average number of meals consumed by females in urban population of the Gujarat was 2.07. A study on nutritional status of adolescent girls of Dongria Kondh tribe reported 62.36% girls had inadequate protein intake. [14] Daily intake of fruit was 17.3% and milk was 25% in a study conducted by Yadav et al. in college going adolescent of Belagavi. [11] According to NFHS-3, 74.1% of women in the Gujarat consumed milk at least once a week. [12] In Nepal, a study among schoolchildren revealed that fast foods were referred by more than two-thirds of them. [15] Study from school girls of rural West Bengal reported daily consumption of fast food was 8%. [16]

RECOMMENDATIONS

Based on the findings of the present study, adolescents must be educated about the importance of regular intake of healthy nutritious food and harmful effect of non-nutritious food. It is important that periodic talks on nutrition by specialist guest speakers should be arranged and parents should be invited to these lectures as well.

The present study was conducted with equal representative sample from rural and urban area and compare results but only school going girls were included in the study.

CONCLUSION

In the present study, it was observed that the majority of the adolescents had regular enough number of meals and snacks, but intake of nutritious food such as milk, protein-rich food, green leafy vegetables, and fruits was not enough according to ICMR standards. On the other hand, intake of non-nutritious food such as tea/coffee, fast food, sweets, ice cream, and pastries was observed in girls. On comparison, intake of nutritious food items was less in rural area, whereas non-nutritious food items were more in urban area.

DOI: 10.5455/ijmsph.2018.0412921052018

ACKNOWLEDGMENT

The authors would like to thanks all the girls for their enthusiastic participation and principals and teachers for cooperation throughout the study.

REFERENCES

[1.] Park K. Textbook of Preventive and Social Medicine. 21th ed. Jabalpur: Banarsidas Bhanot; 2011. p. 546, 113.

[2.] ORGI, UNFPA. A Profile of Adolescents and Youth in India. Available from: http://india.unfpa.org/en/publications/ profile-adolescents-and-youth-india.

[3.] Chandramouli C. Census of India 2013, Social and Cultural Tables-Age. Available from: http://www.censusindia. gov. in/2011 -Documents/Census_2011 _Age_data-ppt. [Last accessed on 2013 Sep 12].

[4.] WHO. Available from: http://www.who.int/child_adolescent_ health/topics/prevention_care/adolescent/en/index.html. [Last accessed on 2014 Jun 07].

[5.] WHO. Adolescent Nutrition: A Review of the Situation in Selected South-East Asian Countries. Geneva: WHO; 2006.

[6.] Dausch JG, Story M, Dresser C, Gilbert GG, Portnoy B, Kahle LL. Correlates of highfat/Lownutrientdense snack consumption among adolescents: Results from two national health surveys. Am J Health Promot 1995;10:85-8.

[7.] Joshi BN, Chauhan SL, Donde UM, Tryambake VH, Gaikwad NS, Bhandoria V. Reproductive health problems and help seeking behaviour among adolescents in Urban India. S.l. Indian J Pediatr 2006;73:509-13.

[8.] UNFPA. Adolescents in India: A profile, New Delhi: UNFPA; 2005.

[9.] Available from: http://www.cyberjournalist.org.in/majithia/ aicpi_2001.php.

[10.] Kotecha PV, Sangita V, Patel P, Baxi RK. Dietary pattern of school going adolescents in Urban Baroda, India. J Health Popul Nutr 2013;31:490-6.

[11.] Yadav H, Naidu S, Baliga SS, Mallapur MD. Dietary pattern of college going adolescents (17-19 years) in urban area of Belagavi. Int J Rec Sci Res 2015;6:3774-7.

[12.] International Institute for Population Sciences (IIPS) and Macro 2008. National Family Health Survey (NFHS-3), India, 2005-06: Gujarat. Mumbai: IIPS; 2005, 2006.

[13.] National Sample Survey Organization, Ministry of Statistics and Programme Implementation, GoI. Nutrition Intake in India 2004-05. NSSO 61st Round Report no 513. National Sample Survey Organization; 2007.

[14.] Nanda S, Dhar RN. A study on nutritional status of adolescent girls of Dongria Kondh tribe. Int J Community Med Public Health 2017;4:1573-6.

[15.] Sharma I. Trends in the intake of ready to eat food among urban school children in Nepal. SCN News 1998;16:21-2.

[16.] Manisha S, Manna N, Sinha S, Swapnodeep, Pradhan U. Eating habits and nutritional status among adolescent school girls: An experience from rural area of West Bengal.IOSR Journal of Dental and Medical Sciences 2015;14(12):6-12. Available from: www.iosrjournals.org. [Last accessed on 2015 Dec].

Trusha Kansagara (1), Dipesh V Parmar (1), Meet Chauhan (2), Prashant Dave (3)

(1) Department of Community Medicine, Shree M P Shah Government Medical College, Jamnagar, Gujarat, India, (2)Department of Community Medicine, Pacific Institute of Medical Science, Udaipur, Rajasthan, India, 3Senior Occupational Health Physician, Reliance Industries Limited, Dahej Manufacturing Division, Gujarat, India

Correspondence to: Dipesh V Parmar, E-mail: dpparmardipesh@gmail.com

Received: April 25, 2018; Accepted: May 21, 2018
Table 1: Age and standard wise distribution of
adolescent girl (n=670)

                                 n=335(%)

Characteristics        Rural        Urban         Total

Age
  Early              19 (5.67)     17 (5.07)     36 (5.37)
  adolescent
  Mid adolescent    257 (76.72)   144 (42.98)   401 (59.85)
  Late adolescent    59 (17.58)   174 (51.94)   233 (34.78)
Standard
  9                 135 (40.3)     87 (26)      222 (33.1)

  10                139 (41.5)     88 (26.3)    227 (33.9)
  11                 29 (8.7)      84 (25.1)    113 (16.9)
  12                 32 (9.6)      76 (22.7)    108 (16.1)

Characteristics         Remarks

Age
  Early             [chi square]=88.71,
  adolescent        P=0.0001
  Mid adolescent
  Late adolescent
Standard
  9                 [chi square]=4.31,
                    P=0.000
  10
  11
  12

Table 2: Sociodemographic characteristics of
adolescent girl (n =670)

Characteristics    Rural (%)    Urban (%)    Total (%)

Religion
  Hindu            313 (93.4)   299 (89.3)   616 (91.3)

  Muslim            14 (4.2)     19 (5.7)     33 (4.9)
  Other              8 (2.4)     17 (5.1)     25 (3.7)
Type of family
  Joint            134 (40)     152 (45.4)   285 (42.6)

  Nuclear          201 (60)     183 (54.6)   384 (57.4)
Socioeconomic
class
  I                 10 (3)       35 (10.4)    45 (6.7)

  II                51 (15.2)    87 (26)     138 (20.6)
  III               72 (21.5)    80 (23.9)   152 (22.7)
  IV               133 (39.7)    86 (25.7)   219 (32.7)
  V                 69 (20.6)    47 (14)     116 (17.3)

Characteristics   Remarks

Religion
  Hindu           [chi square]=4.31,
                  P=0.114
  Muslim
  Other
Type of family
  Joint           [chi square]=1.76,
                  P=0.184
  Nuclear
Socioeconomic
class
  I               [chi square]=37.96,
                  P=0.000
  II
  III
  IV
  V

Table 3: Distribution of adolescent girls according
to the education of parents (n=670)

                               n=335
                                                 Total n=670
Characteristics        Rural (%)      Urban          (%)

Father
  Do not know           41 (12.2)    12 (3.6)     53 (7.9)

  Illiterate            25 (7.5)     12 (3.6)     32 (9.5)
  Primary              104 (31.3)    10 (3)      174 (26)
  Secondary            105 (31.3)    70 (21)     238 (35.5)
  Higher secondary      42 (12.5)   133 (39.8)   120 (17.9)
  Graduate and above    18 (5.4)     78 (23.4)    50 (7.5)
Mother
  Do not know           43 (12.8)    13 (3.6)     56 (8.4)

  Illiterate            51 (15.2)    28 (30)      79 (11.8)
  Primary              117 (34.9)    82 (21)     199 (29.7)
  Secondary             75 (22.4)   123 (39.8)   198 (29.6)
  Higher secondary      29 (8.7)     57 (23.4)    86 (12.8)
  Graduate and above    20 (6)       32 (9.5)     52 (7.8)

Characteristics       Remarks

Father
  Do not know         [chi square]=147,
                      P=0.000
  Illiterate
  Primary
  Secondary
  Higher secondary
  Graduate and above
Mother
  Do not know         [chi square]=52.4,
                      P=0.000
  Illiterate
  Primary
  Secondary
  Higher secondary
  Graduate and above

Table 4: Distribution of adolescent girls according to
the occupation of parents (n =670)

                          n=335
                                            Total
Characteristics   Rural          Urban     (n =670)

Father
  Service          26 (7.5)     39 (11.6)    65 (9.7)

  Business         37 (11)      88 (24.8)   120 (17.9)
  Laborer         115 (34.3)    70 (20.9)   185 (27.6)
  Agriculture     145 (43.3)   130 (38.8)   275 (41.0)
  Other            12 (3.6)     13 (3.9)     25 (3.7)
Mother
  Service          10 (3)        8 (2.4)     18 (2.7)

  Business          2 (0.6)      1 (0.3)      3 (0.4)
  Laborer          36 (10.7)    21 (6.3)     57 (8.5)
  Agriculture      50 (14.9)    36 (10.7)    86 (12.8)
  Other             2 (0.6)      1 (0.3)      3 (0.4)
  Housewife       235 (70.1)   268 (80)     503 (75.1)

Characteristics   Remarks

Father
  Service         [chi square]=32.03,
                  P=0.0001
  Business
  Laborer
  Agriculture
  Other
Mother
  Service         [chi square]=9.28,
                  P=0.09
  Business
  Laborer
  Agriculture
  Other
  Housewife

Table 5: Distribution of adolescent girls according to the
type of diet (n=670)

                               n (%)
Type of
diet         Rural (n=335)   Urban (n=335)   Total (n=670)

Mix             9 (2.7)        28 (8.4)         37 (5.5)
Vegetarian    326 (97.3)      307 (91.6)       633 (94.5)
Total         335 (100)       335 (100)        670 (100)

[chi square]=10.3271 P=0.001

Table 6: Distribution of adolescents according to the
frequency of meal and snacks per day (n=670)

Characteristics   Frequency               Rural (%)

Meals             1 time                   9 (2.7)
                  2-3 time                300 (89.5)
                  More than 3              26 (7.8)
                  Mean [+ or -] SD   2.85 [+ or -] 0.59
Snacks            0 times                  33 (9.9)
                  1-2                     275 (82.1)
                  3 and 4                  27 (8.1)
                  Mean [+ or -] SD   1.67 [+ or -] 0.672

Characteristics   Frequency              Urban (%)

Meals             1 time                   4(1.2)
                  2-3 time               298 (88.9)
                  More than 3             33 (9.9)
                  Mean [+ or -] SD   2.7 [+ or -] 0.66
Snacks            0 times                 24 (7.2)
                  1-2                    282 (84.2)
                  3 and 4                 29 (8.7)
                  Mean [+ or -] SD   1.7 [+ or -] 0.642

Characteristics   Frequency               Total (%)        Remarks

Meals             1 time                   13 (1.9)        P=0.001
                  2-3 time                598 (89.2)
                  More than 3              59 (8.8)
                  Mean [+ or -] SD   2.78 [+ or -] 0.63
Snacks            0 times                  57 (8.5)        P=0.258
                  1-2                     557 (83.1)
                  3 and 4                  56 (8.4)
                  Mean [+ or -] SD   1.67 [+ or -] 0.657

SD: Standard deviation

Table 7: Distribution of adolescents according to the
frequency of eating various nutritious food per week (n=670)

                                       n (%)

Food items   Frequency      Rural        Urban        Total

Pulses       Never         2 (0.6)      5 (1.5)      7 (1.0)

             1-3         283 (84.5)   229 (68.4)   512 (76.4)
             4-6          45 (13.4)    71 (21.2    116 (17.3)
             Daily         5 (1.5)     30 (9.0)     35 (5.2)
Green        Never        20 (6.0)     41 (12.2)    61 (9.1)
leafy
vegetables   1-3         226 (67.5)   173 (51.6)   399 (59.6)
             4-6          72 (21.5)    71 (21.2)   143 (21.3)
             Daily        17 (5.1)     50 (14.9)    67 (10.0)
Fruits       Never        21 (6.3)     29 (8.7)     50 (7.5)

             1-3         237 (70.7)   215 (64.2)   452 (67.5)
             4-6          62 (18.5)    51 (15.2)   113 (16.9)
             Daily        15 (4.5)     40 (11.9)    55 (8.2)
Milk         Never       117 (34.9)   113 (33.7)   230 (34.3)

             1-3         154 (46.0)   135 (40.3)   289 (43.1)
             4-6          13 (3.9)     21 (6.3)     34 (5.1)
             Daily        51 (15.2)    66 (19.7)   117 (17.5)

                         Remarks

Food items   Frequency

Pulses       Never       [chi square]=17.36,
                         P=0.0001
             1-3
             4-6
             Daily
Green        Never       [chi square]=16.98,
leafy                    P=0.0001
vegetables   1-3
             4-6
             Daily
Fruits       Never       [chi square]=11.4,
                         P=0.0001
             1-3
             4-6
             Daily
Milk         Never       [chi square]=2.03,
                         P=0.15
             1-3
             4-6
             Daily

Table 8: Distribution of adolescents according to the
frequency of eating various non-nutritious food per week
(n=670)

                                       n (%)

Food item    Frequency      Rural        Urban        Total

Tea/coffee   Never        61 (18.2)   135 (40.3)   196 (29.3)

             1-3         204 (60.9)   120 (35.8)   324 (48.4)
             4-6          22 (6.6)     10 (3.0)     32 (4.8)
             Daily        48 (14.3)    64 (19.1)   112 (16.7)
Fast food    Never        80 (23.9)    86 (25.7)   166 (24.8)

             1-3         227 (67.8)   222 (66.3)   449 (67.0)
             4-6          27 (8.1)     24 (7.2)     51 (7.6)
             Daily         1 (0.3)      3 (0.9)      4 (0.6)
Sweet,       Never        53 (15.8)    58 (17.3)    111 (16.6)
ice cream,
pastries
             1-3         236 (70.4)   242 (72.2)   478 (71.3)
             4-6          44 (13.1)    22 (6.6)     66 (9.9)
             Daily         2 (0.6)     13 (3.9)     15 (2.2)

Food item    Frequency   Remarks

Tea/coffee   Never       [chi square]=38.4,
                         P=0.0001
             1-3
             4-6
             Daily
Fast food    Never       [chi square]=0.2,
                         P=0.6
             1-3
             4-6
             Daily
Sweet,       Never       [chi square]=15.7,
ice cream,               P=0.0001
pastries
             1-3
             4-6
             Daily
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Title Annotation:Research Article
Author:Kansagara, Trusha; Parmar, Dipesh V.; Chauhan, Meet; Dave, Prashant
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Sep 1, 2018
Words:3904
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