Abstract

Undernutrition among adolescents is of public health importance in developing countries including India. However, there is little information on nutritional status of adolescents in urban West Bengal. In view of this present study was conducted to ascertain the level of undernutrition among Telaga adolescents in Kharagpur town. A total of 930 (472 boys and 458 girls) children were measured. The mean BMI of children had shown a consistently increasing trend in both sexes from age of 13 years onwards. Moreover, there is a gender bias in favour of girls in higher mean BMI at all ages except 10 and 13 years. The overall prevalence of undernutrition was 28.60%. The rates were significantly higher among boys (37.59 %) compared with girls (19.43%). In conclusion, nutritional status of the studied children is not impressive especially among early adolescent and boys, respectively. There is urgent need intervention strategy through community based nutrition awareness.

Introduction

Undernutrition among adolescents is of public health importance in developing countries including India. It is generally accepted worldwide that anthropometry is highly sensitive to undernutrition 1 . In fact, anthropometry has been used during adolescence in many contexts related to nutritional status 2,3 . The basic intention, according to World Health Organization (WHO), of nutritional assessment is to improve human health 4 . Body mass index (BMI) has been found the most appropriate, noninvasive and cost effective variable for determining nutritional status among adolescents 2,5 . In India, data are available on nutritional status of children and adolescents in rural 6,7,8,9,10,11 , urban areas 12 , slum 13 and tribal communities 14,15 . On the other hand, prevalence of undernutrition among adolescents varies 12 in different parts of India. But these studies have been mainly conducted in composite geographical populations which is heterogeneous in nature. There is little study on nutritional status among adolescents considering homogenous nature of population. To bridge the knowledge gap, the present study is an attempt to assess the status of undernutrition among the adolescents of endogamous population in Kharagpur, West Bengal, India.

Materials and Methods

This cross sectional study had been undertaken among the Telagas, an endogamous population of Kharagpur town, West Bengal, India, in a Telugu-speaking migrant population whose ancestors came to Kharagpur town from Srikakulum, Vishakhapatnam and East Godavari districts of Andhra Pradesh to lay the railway lines of Bengal Nagpur railways since late 1880s. From that time they have been working in the railways 16 . The bulk of these peoples have permanently settled here as a result of succession of employment through generation in course of expansion of the local railway workshop, which has become one of the largest of its kind in India. A few families have still retained their kinship links with their ancestral home especially due to railway facilities and reduction of employment opportunities at Kharagpur in recent times.

Extensive pedigrees had been collected from families having at least one growing child from the local endogamous population, Telaga 17 . Senior member of the household was employed as low grade skilled workers in the workshop at Kharagpur or in the open lines of the South Eastern Railways 18 . Thus, house hold socio-economic status was equal. The people lived in the same type of railway quarters. Their food consumption pattern was similar 19 . The children aged five to twenty years were measured in anthropometric and physiometric traits. But for this purpose, we have analysed only height and weight of adolescents of aged 9 - 20 years. Measurements were taken on the basis of consent of the subjects. The study protocol was approved by the institutional ethical committee.

Anthropometric measurements of weight and height were taken following the standard techniques 20 using weighing scale and anthropometer rod to the nearest 0.5kg and 1mm, respectively. The subjects were requested to remove their shoes and put on light clothes during taking measurements. Age estimation of all individuals had been aided by usual genealogical checks, horoscopes where available, birth or school certificates, and reference to the important events.

BMI was calculated as weight in kg divided by the square of height in meter. Nutritional status is estimated using the WHO 2 recommended age-sex specific cut-off points of BMI based on the National Health and Nutrition Examination Survey (NHANES) percentile values 21 . Undernutrition (thinness) was defined as BMI<5th percentile values as recommended by WHO 2 . This cutoff point has been utilized by several recent studies worldwide on undernutrition among adolescents.

Data entry and statistical analyses were performed using SPSS version-10.0 software. Differences in means of BMI were tested by students't-test (equal variances assumed) between sexes. Proportion tests were undertaken to test for sex differences in overall undernutrition in each age group and age combined, respectively. Statistical significance was considered at p < 0.05.

Results

A total of 930 children, out of 472 (50.75%) boys and 458 (49.25%) girls were included in the present analysis. Table I presents age-sex distribution of BMI (sd) of the studied population.

Table 1: Mean (SD) BMI (kg/m ² ) by age and sex.

The mean BMI of Telaga children had shown a consistently increasing trend in both sexes from the age of 13 years onwards. There is a gender bias in favour of girls in higher mean BMI at all ages except 10 and 13 years (Figure 1). Moreover, mean BMI of girls were significantly higher than boys at age 11, 12 and 14 to 19 years, respectively.

Figure: 1. Comparison of mean BMI by age and sex.

The overall (age-sex combined) rate of undernutrition was 28.60 % among studied population. Present study reveals that rate of undernutrition was significantly higher among boys (37.59 %) than girls (19.43%) counterpart (Table 2). They had 2.5 (OR=2.49; 95%CI: 1.83 - 3.39) times greater chance to be an underweight compared to girls. A trend of reduction in the rate of undernutrition can be observable in boys from age 11 to age 13 years and then sudden rise in age 14 and age 15 and thereafter, a consistent deceleration from age 15 onwards. On the other hand, prevalence of undernutrition among girls decreases with increasing age from 13 years onwards with a little exception in age 16.

Table 2: Prevalence of undernutrition (thinness) based on BMI.

Discussion

Adolescence is an important stage of growth and development that requires increased nutrition and adolescent anthropometry varies significantly worldwide 2,22 . But it has often failed to get increased attention as observed in childhood with regards to health related uses and interpretation of anthropometry 21 .

This study highlights the level of undernutrition among the adolescents in an endogamous population as opposed to earlier studies considering heterogeneous population. Present study reveals that mean BMI is consistently increasing in both sexes. There is a gender bias in favour of girls in higher mean BMI at all ages as reported earlier by Medhi et al 23 . The results of this study reveal that about 29 % of the adolescents are thin as against high percentage of thinner adolescents in rural areas 10,11,24,25 . On the other hand, percentage of undernourished adolescents is significantly less in late adolescence than early adolescence as observed in other studies 24,25,26 .

A significant sex differences in undernutrition can be observable in favour of boys as observed in other findings 23,24,27 . It is important to note that boys had 2.5 times higher risk being an undernourished compared to girls. Moreover, the level of undernutrition is drastically lowered from the age 15 onwards among the girls and from age 18 for boys. So, the variation in proportion and severity of undernutrition is of obvious importance for the formulation of health and development policies at the community level. In conclusion, nutritional status of the studied children is not impressive especially among early adolescent and boys, respectively. There is urgent need intervention strategy through community based nutrition awareness.

Correspondence to

Dr. Bidhan Kanti Das Lecturer in Anthropology Institute of Development Studies Kolkata Calcutta University Alipore Campus 1, Reformatory Street Kolkata – 700027. Email: bidhan_d@rediffmail.com bidhand@gmail.com

References