Dietary Diversity, Haemoglobin and Anaemia in Nepali Adolescent Girls: A Longitudinal Study

Adolescent girls and young women in Nepal are vulnerable to poor diets and anaemia, yet the extent of these risks remains overlooked. We assessed changes in dietary diversity, haemoglobin, and anaemia, and identified associated factors among adolescent girls and young women in Nepal. We analysed data from a longitudinal panel study including never-married and not-pregnant participants, enroled at 10-19 years in 2017 (n = 770) and followed up in 2018 (n = 682) and 2019 (n = 618). We used descriptive statistics and mixed-effects regression analyses. The dietary diversity score was on average four out of 10 food groups, haemoglobin remained between 12.7 and 12.8 g/dL throughout the study period, and anaemia prevalence increased from 20.6% (2017) to 24.8% (2019). In adjusted models, we found positive associations between more schooling and dietary diversity and between access to improved toilet and haemoglobin. Living in the terai and hills, and disadvantaged caste/ethnicity were negatively associated with dietary diversity, and haemoglobin, while living in the terai and disadvantaged caste/ethnicity were negatively associated with anaemia. Food insecurity was negatively associated with dietary diversity only. Post-menarche status was associated with lower haemoglobin and higher odds of anaemia. Adolescent nutrition should be prioritised within national health, education, and social protection frameworks. Multi-sectoral interventions particularly in terai and hills, should focus on scaling up micronutrient supplementation, enhancing government-led school meal programme to provide balanced, culturally appropriate meals (including vegetarian protein sources for lacto-vegetarians), improving educational uptake, ensuring access to sanitation facilities, and delivering targeted, sustained interventions around menarche throughout adolescence.