Dietary diversity, undernutrition and anemia among rural adolescents in Sindh, Pakistan

BACKGROUND: Adolescence is the second window of opportunity to catch-up growth, and children can attain their full physical growth potential. However, optimum dietary intake is essential for this. In this study, we aimed to estimate dietary diversity, stunting, thinness, and anemia among unmarried adolescent boys and girls in selected communities of rural Sindh, Pakistan. METHODS: A cross-sectional survey of 788 unmarried 10-19-year-old adolescents in rural Sindh was conducted. Adolescents were interviewed using a food frequency questionnaire. Daily intake of at least 5 out of 10 food groups was labelled as having minimum dietary diversity following the Minimum Dietary Diversity for Women (MDDS-W) guide. Less than 2 standard deviations for z-scores of height for age and BMI for age were labelled as stunting and thinness, respectively. Anemia was defined as Hb less than 12 gm/dl for girls and for boys between the ages of 10–15 years. Cut-off of < 13 gm/dl was used for anemia in boys more than 15 years of age. The Cox-proportional algorithm was used to analyze the associated factors of stunting, thinness, and anemia and prevalence ratios with 95% confidence interval were estimated. RESULTS: Our study found that < 1% of adolescents achieved minimum dietary diversity (MDD). There was a higher daily intake of sugar-sweetened beverages (SSB) and bread, and daily intake of meat, eggs, and nuts was among < 1% of the participants. The sub-optimum dietary intake was reflected as high rates of stunting 31.9%, thinness 18.0%, and anemia 68.2% in our sample. Stunting and anemia were significantly higher among girls compared to boys (35.8% vs. 28.0%; 82.1% vs. 54.7% respectively). In sex-stratified analysis, the age of the adolescent and wealth quintiles were associated with stunting among girls. No other variables were associated with stunting, thinness, or anemia among girls and boys. CONCLUSION: The prevalence of low dietary diversity and anemia was alarmingly high in adolescents and calls for immediate attention. The high burden of stunting shows chronic undernutrition and missing the second window of opportunity during adolescence to gain potential adult height.