Dietary Pattern and Nutritional Status of In-School Adolescents in Abeokuta South and Abeokuta North Local Government Areas of Ogun State
Adolescents are considered as a nutritionally vulnerable subgroup. A rapid growth rate combined with marginal nutrient intakes increases the risk of nutritional deficiencies in this population. Poor nutritional status in adolescence compounds the risk of adolescent pregnancy and it is an important determinant of health outcomes at a later stage of life. A knowledge of an healthy dietary pattern in adolescence is an Investment in Present and Future Health. The objective of this study was to Characterize the dietary pattern and Assess the Nutritional status of in-School Adolescents in Abeokuta South and Abeokuta North local Government Areas of Ogun State. The study was descriptive cross-sectional in design. A multi-stage sampling technique was used to select 775 in-school adolescent boys and girls aged 10 -19 years in 10 public secondary schools each in Abeokuta South and North local Government Areas. Anthropometric measurements were taken using Standard Procedures, Socio demographic Data were obtained through a self- administered questionnaire while usual nutrient intakes were determined through a 24 hour dietary recall. Dietary pattern was determined by factor analysis of data obtained from the self administered food frequency questionnaire. Additional structured questions on eating habits were answered on a different questionnaire to serve as correlates of dietary pattern. Statistical analysis included descriptive, inferential and dimension reduction statistics.
More than one-third (35.4%) of the subjects were boys while 64.6% were girls. About half (50.3%) were in junior secondary school, while 49.7% were in senior secondary school. The boys and girls had a mean weight of 45.68 and 45.05 kg respectively, a mean height of 155.84 and 155.08 cm respectively and a mean BMI of 18.84 and 18.68 kg/m2 respectively. The Mean NAR for Energy, Carbohydrate and Protein were 0.83, 2.47 and 1.61 respectively while Mean NAR for Calcium, Folate, Zinc and Iron were 0.23, 1.14, 0.44 and 0.73 respectively. Factor analysis revealed 2 distinct dietary patterns labelled a “western” pattern highly loaded in Pastries, beverages, Dairy, Canned foods, Sugared drinks and Poultry and a “mixed” pattern which loaded highly in Cereals, Legumes, Roots and tubers, Fruits, Vegetables and Processed Cereals. Both patterns explained 38.18 and 31.46% of the variation of food intakes respectively. More than one-third (39.9%) of the subjects had irregular breakfast, 52.6% had irregular lunch and 19.7% had irregular dinner. Majority (90.3%) of the subjects snacks on a daily basis, 67.2% eats out or order food at varying degrees.
The prevalence of stunting for boys and girls were 10.7% and 9.5% respectively. The prevalence of underweight was 13.7% for boys and 16% for girls. The prevalence of overweight was 2.7% for boys and 3.8% for girls, while 2.7% of boys and 1.1% of girls were obese.
The “western” dietary pattern was significantly associated with snacking (p<0.05), and higher sodium intake (P<0.005). The “mixed” pattern was significantly associated with breakfast consumption (P<0.05). Stunting was significantly associated with school level (P<0.05), snacking (P<0.05) and eating out/food order (P<0.05). Underweight was significantly associated with the method of refuse disposal (p<0.005) and lunch consumption (p<0.05).
Key words: Adolescents, Dietary pattern, Factor analysis, Nutritional Status.
Word Count: 497
TABLE OF CONTENTS
Title page i
List of Tables x
List of Figures xi
List of Acronyms xii
Chapter One: Introduction
1.1 Statement of the problem 3
1.2 Justification for the study 4
1.3 Objectives of the study 5
1.3.1 General objective 5
1.3.2 Specific objectives 5
1.4 Research questions 5
Chapter Two: Literature Review
2.1 Adolescents 6
2.1.1 Nutritional Needs of Adolescents 8
2.1.2 Energy and Nutrients Needs 9
2.2 Adoption and Consolidation of Sound Dietary habits in Adolescence 12
2.3 Improving Adolescents’ Nutrition Behaviours is an Investment in Adult Health. 12
2.4 Is there a Potential for Correcting Nutritional Inadequacies and Perhaps even for Catch
up Growth in Adolescence? 13
2.5 Adolescence is a Period of Nutritional Vulnerability 16
2.6 Over view of Nutritional Status in Adolescence 17
2.6.1 Poor Nutritional Status Compounds the Risk of Adolescent Pregnancy 19
2.6.2 Malnutrition Reduces Adolescents’ Work Capacity 19
2.6.3 Major threats to Adolescents’ Nutritional Status 20
2.7 Typical Eating Patterns and Intakes of Adolescents 21
2.7.1 Commercial, Cultural and Psychosocial Influences on eating Patterns 24
2.8 Dietary Pattern Analysis 26
2.8.1 Methods for Defining Dietary Pattern 27
2.8.2 Factor Analysis 28
2.8.3 Cluster Analysis 28
2.8.4 Dietary Indices 28
2.9 The Reproducibility and Validity of Dietary Pattern 29
2.9.1 Limitations of Dietary Pattern Analysis 30
2.9.2 New Approaches to the Study of Dietary Pattern 32
2.9.3 Empirical Findings 34
Chapter Three: Methodology
3.1 Study design 42
3.2 Study area 42
3.3 Study subjects 42
3.4 Sample size calculation 42
3.5 Sampling 43
3.6 Data collection 43 3.7 Data Analysis 41
3.8 Ethical considerations 42
Chapter Four: Results
4.1 Socio demographic characteristics of the subjects 43
4.2 Dietary Pattern of the Respondents 47
4.3 Anthropometric Characteristics of the Respondents 56
4.4 Mean Nutrient Intakes of the Respondents 56
4.5 Nutritional Status of the Respondents 62
4.6 Association of Dietary Pattern with Socio-demographic Variables 68
4.7 Association of Dietary Pattern with Nutritional Status 69
4.8 Association of Dietary Pattern with Nutrient Adequacy 69
4.9 Association of Dietary Pattern with Eating habits 69
4.9.1 Association of Nutritional Status with Socio-demographic Variables 69
4.9.2 Association of Nutritional Status with Eating Habits 90
Chapter Five: Discussion and Conclusion 71
Adolescents are considered to be a nutritionally vulnerable subgroup of the population, a rapid growth rate combined with marginal nutrient intakes increases the risk of nutritional deficiencies in this population. The nutritional demands associated with rapid physical and cognitive development and maturation are substantial (Rogol et al., 2002, spear et al., 2002). Poor nutritional status during adolescence is an important determinant of health outcomes at a later stage of life (kabir et al., 2010).
Adolescence represents an important life stage for the development of healthy nutrition behaviours (Mcnaughton et al., 2008). There is evidence that nutrition behaviors track from adolescence into adulthood (Lake et al., 2004). Therefore, the promotion of healthy nutrition during adolescence has the potential to confer significant long-term health benefits.
Despite the importance of nutrition for adolescents’ current and future health,Many adolescents consume diets that may not be adequate for their requirements. For example, studies from the US, Europe, and Australia demonstrated that adolescents tend to have lower than desirable intakes of fruits, vegetables, dairy products, and whole grains but higher than desirable intakes of soft drinks, confectionery, and fast foods (Harnack et al., 2003, Yngve et al., 2005). Consequently, many adolescents fall short of achieving optimal nutrient intakes for good health and development.
Diet is a complex exposure variable, which calls for multiple approaches to examine the relationship between diet, nutritional status and disease risk, dietary pattern analysis is one of these approaches (Hu 2002). Previous investigations of adolescents’ diet have tended to focus on intakes of individual foods or individual nutrients. However, in recent years, the use of dietary pattern analysis has become popular for characterizing the whole diet in combination, because this approach captures complex behaviours and potentially interactive and antagonistic effects among nutrients that might impact health outcomes (Mishra et al., 2002, Newby et al., 2006).
Dietary patterns can be measured by means of statistical methods using collected dietary information. The methodology for defining dietary patterns is relatively new and is still in development. However, three approaches have been used in the literature: factor analysis, cluster analysis, and dietary indices (Hu 2002). Both factor analysis and cluster analysis are considered “a posteriori” because the eating patterns are derived through statistical modelling of dietary data at hand (Trichopoulos 2001). The dietary index approach, in contrast, is “a priori” because the indices are created on the basis of previous knowledge of an “healthy” diet.
Methods for studying dietary patterns, such as principal components factor analysis and cluster analysis, have become more widely used in epidemiology to summarize dietary data and investigate predictors and health outcomes associated with dietary patterns (kerver et al., 2003, Nettleton et al., 2006, Waijers et al., 2006, Schulze et al., 2006). Over the past few decades, the diet quality of adolescents has declined with increased energy intake from fast food, soft drinks, and salty snacks, and decreased fruit and vegetable intake (Nielsen et al., 2002, Larson et al., 2007).
Although dietary patterns analysis has emerged as a popular alternative to traditional methods used in nutritional epidemiology, most studies have focused on adult populations (Cutler et al., 2009). Some dietary patterns are consistently observed among adolescents, and put them at risk of unhealthy eating, the consequence of snacking, usually on energy-dense but otherwise nutrient-poor items, meal skipping, irregular eating patterns and a wide use of fast food for meals and snacks. Other eating behaviours generally recognized as common among adolescents are eating away from home, low intake of fruits and vegetables, and in some instances, of dairy products as well; and weight concerns leading to faulty dieting practices, particularly in girls (Forthing 1991, Perry-Hummicuft and Newman1993, Gutierrez and King 1993).
Adolescents may also try unconventional dietary practices, such as vegetarian diets, which may reflect their propensity to adopt social causes and explore different philosophies (Johnston and Haddad, 1996). Few studies examined behavioural correlates of dietary patterns, such as skipping breakfast (Song et al., 2005) or meal frequency. This study applied a dietary patterns approach to investigate the eating behaviours of adolescents.
1.1 Statement of the problem
Adolescents are considered as a nutritionally vulnerable subgroup because of a rapid growth rate combined with marginal nutrient intakes (Kabir et al., 2010) and also due to their eating behaviours (Forthing 1991; Perry-Hunnicuft and Newman, 1993).Failure to consume adequate diet during adolescence results in delayed sexual maturation and arrests or slow linear growth (Story 1992).
Poor nutritional status compounds the risk of adolescent pregnancy. Delayed growth and maturation in girls as a result of malnutrition further increases the risks associated with adolescent pregnancy, as biological age lags behind chronological age. This exposes both mother and child to adverse health and socioeconomic consequences (WHO 2005)
Malnutrition reduces adolescents’ working capacity and productivity (WHO 2005). Early malnutrition would affect physical work capacity through an adverse effect on height, body mass and more specifically muscle mass. Height in particular has most often been shown to be associated with work output, productivity or income.
Adolescents are exposed to under nutrition, micronutrient malnutrition as well as obesity. Their lifestyle and eating behaviours, along with underlying psychosocial factors, are particularly important threats to adequate nutrition.(WHO 2005).
Development of health information systems to support adolescent health gains both through prevention and early intervention has been weak and so far lagged behind those for early childhood and adulthood. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes (lancet 2012).Little is known indeed on nutrition-related perceptions, attitudes and behaviours in developing-country adolescents, apart from ICRW research findings (WHO 2005).
1.2 Justification for the study
Studying dietary pattern could have important public health implications because the overall pattern of dietary intake might be easy for the public to interpret or translate into diets (krauss et al., 2000).
Information on dietary pattern of adolescents can be used by policy makers in the development of health information systems to support adolescent health gains both through prevention and early intervention (WHO 2005).
Establishing an healthy dietary pattern of adolescents is an investment in adult health, because adolescents are in the process of establishing responsibility for their own health-related behaviours, including diet (WHO 2005).
A knowledge of an healthy and optimal dietary pattern in adolescence will improve and sustain the health of adolescents who are the future adults. population. The future economic development of poorer countries rests in large part on the prospect of having increasing proportions of the future adults who are educated, healthy and economically productive. There is an important interaction between economic opportunity and attitudes of the youth as pertinently noted by Burt (1996).
1.3 Objectives of the study
1.3.1 General objective
The general objective of this study is to Characterize the dietary pattern and assess the nutritional status of in-school adolescents in Abeokuta south and Abeokuta north Local Government Areas of Ogun state, Nigeria.
1.3.2 Specific Objectives
1. To perform a factor analysis on the dietary information obtained from the food frequency questionnaire administered by the respondents.
2. To determine the habitual dietary intakes and dietary habits of the respondents.
3. To assess the dietary intakes of the subjects by a 24hour dietary recall and analyse the energy and nutrient intakes by a TDA software.
4. To take Anthropometry measurements (Height and Weight) of the respondents and calculate the anthropometric indices (BMI for age, height for age, weight for age z scores).
5. To determine the prevalence of stunting, underweight, overweight and obesity among the respondents.
6. To determine the associations between the dietary pattern and socio-demographic characteristics, eating habits and nutritional status of the respondents.
1.4 Research Questions
1. What are the Characteristics of the dietary Pattern of in-school Adolescents in Abeokuta South and Abeokuta North Local Government Area?
2. What is the Nutritional Status of the in-school Adolescents?
3. What are the Factors Influencing the Dietary Pattern and Nutritional Status of in-school Adolescents?
4. Is the Nutritional Status of the in-School Adolescents affected by their Dietary Pattern?