Plant Foods for Human Nutrition 47:201 209, 1995. © 1995 Kluwer Academic Publishers. Printed in the Netherlands.

A study on the nutritional status of adolescent girls

M A L K I T N A G I , 1 S A N G E E T A C H A W L A 1 & SAVITA S H A R M A 2 Departments of 1Foods & Nutrition and 2Food Science & Technology, Punjab Agricultural University, Ludhiana, India

Received 17 May 1993; accepted in revised form 29 August 1994

Key words: Adolescent girls, Food habits, Haemoglobin, Income, Nutrients

Abstract. One hundred and twenty school girls in the age group of 13-15 years from four Government schools of Ludhiana city were selected for the study. On the basis of their family income they were divided into three experimental groups i,e. income group I (IgI), income group II (IgII) and income group III (IgIII). The results showed that the intake was low for all the foods. However, the consumption of fruits, milk and milk-products, sugar and jaggery, fats and oils by the subjects of IgII and IgIII was significantly higher (iv < 0.05) than IgI. The mean daily intake of energy, protein, iron, calcium, vitamin A & vitamin C was inadequate while the intake of fibre was adequate by the subjects as compared to ICMR recommendations. There was no significant difference in energy, protein and iron intakes among the subjects of three groups. However, the fibre intake by the subjects of IgI was significantly higher (p < 0.05) than the subjects of IgIII, whereas the intake of calcium, vitamin A and ascorbic acid by the subjects of IgII & IgIII was significantly higher (iv < 0.05) than those of IgI. The average body weights and heights of the subjects were normal. The haemoglobin (Hb) level of the subjects ranged from 8.5-12.5 g/dl with a mean value of 10.73 + 0.07 and reported that only 23 percent of the subjects had acceptable level.

Introduction

Nut r i t i on and food in take are closely re la ted to nu t r i t iona l s tatus and heal th of an individual . Adequa te a m o u n t of nutr ients in the form of dai ly diet are essential for the ma in tenance of heal th and good nutr i t ion. Nu t r i t i on surveys conduc ted by N a t i o n a l Ins t i tu te of Nu t r i t i on [1] on young gifts revealed tha t their diets were based ma in ly on cereals and conta ined negligible amoun t s of green and fruits (Protec t ive foods). The low in take of protec t ive foods m a y result in nu t r i t iona l disorders. Fur ther , the school chi ldren are general ly occupied with academic work, games and are under emot iona l stress which coupled with unba lanced diets result in p o o r heal th and nutr i ture. Hence the impor t ance of good nut r i t ion is real ized in the main tenance of hea l th of h u m a n being especial ly of children. Adolescent girls m a y be at r isk for p o o r nu t r i t iona l s ta tus which is even more of concern when consider ing tha t they m a y ho ld the responsibi l i ty of m o t h e r h o o d in the near future. The present s tudy was, therefore, unde r t aken to assess the adequacy of diets, a n t h r o p o m e t r i c measure- ments and b iochemica l analysis of adolescent girls.

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Table 1. Distribution of subjects according to the income of their parents

S No. Income groups Income level (Rs.) Number of % of total subjects subjects

1 Ig-I < 1500/month 38 32 2 Ig-II 1501-3000/month 44 36 3 Ig-III 3001 & above/month 38 32

Materials and methods

A representative sample of one hundred and twenty school girls in the age group of 13-15 years were selected by simple random sampling technique. They were the students of four Government High Schools of Ludhiana city. Based on the income of their families, they were classified in three income groups i.e. income group I (IgI), income group II (IgII) and income group III (IgIII) consisting of 38, 44 and 38 subjects, respectively (Table 1).

The food consumption of the subjects was recorded by 24 hour recall method for three consecutive days. A pretested questionnaire was used to collect information and interview was conducted by the investigator for precision. The subjects were shown the standardized utensils for converting the volume of cooked dishes into their weights. This helped in converting the cooked foods consumed by the subjects into equivalents of raw foods to facilitate calculation of nutrients in the diets. From the actual foods consumed daily by the subjects, the energy, protein, iron, calcium, fibre, vitamin A and ascorbic acid contents were calculated, using the nutrient composition of Indian foods of ICMR [2]. The body weight and height of the subjects were recorded according to the procedure suggested by Jelliffe [3].

Blood samples of the subjects were analysed for haemoglobin (Hb) by cyanmethemoglobin method [4].

The results were statistically analysed using analysis of variance [5]. The critical difference (CD) were calculated to see the difference between groups.

Results and discussion

Meal pattern. The food was consumed mainly in four meals breakfast, lunch, evening tea and dinner. The breakfast of girls comprised of stuffed/plain parantha;/bread with jam/egg;/chapati with seasonal vegetable; tea/milk. Seventy six percent of the subjects reported to bring packed lunch regularly whereas only three percent brought sometimes. The packed lunch was gen- erally consisted of cereal customary preparations, i.e. plain or stuffed parantha/ chapati with cooked vegetable or pickle. The girls who did not bring lunch took snacks either from school canteen or from hawkers standing outside the school premises. The snacks generally consumed were Samosa, kulcha-channa, icecream, kulfi and toffees. In the evening, the subjects took tea/milk with

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biscuits/bread slices/mathi/samosa. It was interesting to record that fruits, kulfi and icecream were consumed along with the meals more often by IglI & IglII subjects than those of IgI which was conspicuous from their food intakes also. Their dinner consisted of chapati/rice with rajmah/channa; seasonal vege- table/meat; salad/fruit. Only 20 percent of the girls took milk before retiring to bed. It was also observed from the study that the majority of the subjects (80%) skipped one of their meals. Thirty four percent of the subjects reported to skip their meals once in a while whereas 27 percent missed once a week and only 19 percent missed at least one meal daily from all the three income groups. The commonly missed meals were breakfast and lunch. Bogio & Klepping [6] observed that breakfast skipping increased with age and that habit was most prevalent among female adolescents. According to Michand et al. [7] most of the teenage girls consumed more inadequate meals as compared to younger ones. Therefore it can be said that at this age they become conscious of their body weight and start controlling their food intake even by missing complete meals.

Food habits. On the basis of their food habits, the subjects were divided into three categories i.e. vegetarian, nonvegetarian and ovavegetarian. It was observed that 44 percent were vegetarian while 36 percent were non-vegetarian and only 20 percent were ova-vegetarian. The reasons are religious beliefs and preferences of the subjects.

Dietary intake of foods. The mean daily intake of individual food consumed by the subjects of all the income groups is given in Table 2. The average daily consumption of cereals ranged from 113 to 400 g, 100 to 305 g and 103 to 457 g among the subjects of Ig-I, Ig-II and Ig-III, respectively. The difference in cereal consumption between the three income groups was non-significant. The overall mean intake of cereals by the subjects of all the groups was 61 percent adequate when compared at least cost balanced diet suggested by ICMR [8]. The main cause of inadequate cereal consumption was because of irregularity in their meals. Besides at this stage, girls become figure conscious and they are quite moodi. The mean daily intake of pulses of all the subjects of three groups was inadequate as compared to RDI of ICMR. Inadequate consumption of pulses among adolescent girls have been reported by Scrupriya & Mathew [9]. However, the pulse consumption of the subjects in Ig-III was significantly higher (p < 0.05) than that of Ig-I.

The diets consumed by the girls contained negligible amount of green leafy vegetables. Similar results in school children have been reported by Scrupriyas & Mathews [9]. The intake of roots and tubers did not vary much in the three income groups. The overall mean daily intake of roots and tubers by the subjects of all the groups was 70 percent adequate as compared to recommen- dations of ICMR. The intake of other vegetables by the subjects of Ig-I and Ig-II was significantly more (p < 0.05) than Ig-III but there was no significant difference between Ig-I and Ig-II. However, the overall intake of

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Table 2. Average intake of various foods (g/day) by the subjects

Foods Food intake g/day, Mean ± SE

Ig-I Ig-II Ig-III Mean

Least cost balanced diet suggested by ICMR (1985)

% diet adequacy

Cereals 228a 215a 202" 214 350 61 ± 10.30 ± 10.66 -t- 10.36 __. 5,99

Pulses 19 ~ 23 a'b 25 b 22 70 32 ± 1.26 + 1.78 ± 2.27 _ 1.07

Green leafy 2 a 3 ~ 5 a 4 150 2 vegetables ± 2.05 + 1.37 + 2.12 ± 1.06 Roots and 48" 56 ~ 55 a 52 75 70 tubers + 4.03 ± 2.56 + 3.50 ± 1,95 Other 453 49" 34 b 43 75 57 vegetables ± 3,53 __+ 4.23 -+ 3,67 ± 2,31 Fruits 163 3t b 25 b 24 30 82

±2.68 ±3.73 _+3,74 ±2.08 Meat and egg 0 30 a 24 ~ 27 30 90

± 11.53 ± 2.99 + 4.95 Milk and milk 160 ~ 241 b 252 b 219 250 87 products ± 16.72 ± 16.61 _+ 19.80 ___ 10.85 Sugar and 14" 21 b 18 b 18 30 59 jaggery ±1.11 ±1.64 ±1.34 +0,86 Fats and oils 20 a 25 b 25 b 24 35 68

±0.73 ±0.80 __+0.95 ±0,52

Two different superscripts in two different income groups indicate significant differences.

o ther vegetables was inadequa te by girls. Szpona r et al. [10] also r epor ted the inadequa te in take of o ther vegetables by girls. O n the whole, the results revealed tha t the subjects consumed very litt le vegetables because they were not

very fond of these. The difference in the fruit c o n s u m p t i o n of the subjects of Ig- I I and Ig - I I I was

significantly higher (p < 0.05) than those of Ig-I. The mean dai ly in take of fruits by all the subjects of three income groups was 24 + 2.08 g which was 82 percent adequa te when c o m p a r e d to R D I [8].

The average dai ly consumpt ion of meat , fish and egg by the subjects of Ig - I I and Ig - I I I was adequa te by 90 percent as c o m p a r e d to recommenda t ions . The difference in an imal foods consumpt ion between two groups was non-signifi- cant. Sabo te et al. [11] s tudied the diet of school chi ldren and repor ted that 92 percent of school chi ldren consumed mea t daily. The milk was ei ther consumed as such or in the form of tea, curd, cheese, ice-cream, burfi etc. The difference in the mean mi lk and mi lk p roduc t s c o n s u m p t i o n of Ig- I I and Ig - I I I was significantly h igher (p < 0.01) than Ig-I. The mean da i ly in take of milk and mi lk p roduc t s a m o n g all the subjects of three groups was 219 _+ 10.85 g which was 87 percent adequa te as c o m p a r e d to RDI .

The mean dai ly in take of sugar and j aggery by the subjects of Ig- I I and Ig - I I I was significantly higher (p < 0.05) than those of Ig-I. The overal l mean dai ly

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intake of sugar and jaggery of all the subjects from three groups was only 59 percent adequate. The inadequate consumption of sugar and jaggery by the adolescent girls has also been reported [2].

The consumption of fats was mainly as refined oil, butter, desi-ghee and hydrogenated vegetable oils by the subjects of three income groups. The difference in mean consumption of fats and oils by the subjects of Ig-II and Ig-II I was significantly higher (p < 0.0t) than those of Ig-I. The mean daily intake of fats and oils among all the subjects of three income groups was 24 g which was 68 percent adequate.

In general, the diets consumed by girls were grossly inadequate. The main causes seem to be their irregularities with their meals, their craze for slim figure and moodiness. In low income families, the high prices of milk, fruit and pulses also restricted their intakes, especially in the subjects of Ig-I.

Dietary intake of nutrients. The average daily nutrient intake by the subjects of all the groups is presented in Table 3. The average daily energy intake by the subjects of all the groups ranged from 765 to 2341 Kcal. The difference in the mean energy intake among the subjects of three groups was non-significant. The overall mean energy intake (Table 3) by the subjects of all the groups was 62 percent adequate when compared to recommended dietary allowance (RDA) by I C M R [2]. The low energy intake was related to the inadequate intake of cereals, pulses, fats, sugar and jaggery. The findings of the present study are in line with those of Bajaj et al. [12] that the diets consumed in the Punjab State were deficient in energy. Inadequate intake of energy in the diets of adolescents has been reported by Ogunton et al. [13]. The difference in the

Table 3. Mean daily nutrient intake by the subjects

Nutrients Mean ± SE RDA % adequacy

Ig-I Ig-II Ig-III Mean values

Energy (Kcals) 1224" 1316 a 1250 a 1266 2050 62 +43.51 +40.27 -t-52.53 ±16.19

Protein (g) 38.9" 40.5 a 39.4 a 39.7 67 59 ± 1.60 ± 1.53 __+ 1.50 ± 0.90

Fibre (g) 5,7" 5.4 a'b 4.9 b 5,4 4 7 97 +0.25 +0.29 -t-0.24 +0.16

Iron (mg) 12.8 ~ 13.P 12.08 12.6 28 45 ±0.55 ±0.52 ±0.65 ±0.33

Calcium (rag) 431.3" 608.6 b 613.4 b 557.0 600 92 ± 14.03 ±20.82 ±21.93 +19.08

Vitamin A (#g) 292.2 a 399.0 b 424.0 b 369.1 600 62 (Retinol) ±9.46 +11.91 -t-12.22 _+11.51 Ascorbic 25.2 38.1 41.9 31.8 40 80 acid (mg) _+ 1.71 +2.82 +_0.24 ±. 1.40

RDA = Recommended Dietary Allowances (ICMR, 1989). Two different superscripts in two different income groups indicate significant difference.

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protein intake among the three income groups was non-significant. The overall intake of protein of all the subjects among the three groups was 39.7 g which was 59 percent adequate when compared to RDA of ICMR. Similar results have been reported by Badopadhyay [14].

The difference in fibre content of the diets consumed by the subjects in Ig-I was significantly higher (p < 0.05) than Ig-III which could be attributed to more intake of cereals and other vegetables by the subjects of Ig-I. However, the fibre intake by the subjects of the three groups was adequate. On the contrary Kochar [15] reported the higher intake of fibre in the diets of college going girls. According to available reports excess of fibre inhibits the digestion and absorption of essential nutrients. At the same time sufficient quantity (4 to 7 g) is required for the normal functioning of gastro intestinal tract.

The average daily intake of iron among the subjects of Ig-I, Ig-II and IgoIII ranged from 5 to 26 rag. The overall mean daily iron intake among the subjects of all the groups was 12.6 mg which was 45 percent adequate as compared to RDA. The low iron intake was attributed to insufficient consumption of cereal grains and leafy vegetables. The low intake of iron by the girls has also been reported by Pushphamma et al. [16] and Horwarth [173.

The overall mean calcium intake by the subjects of all the groups was 557 mg which was 92 percent adequate as compared to RDA. However, the mean calcium intake by the subjects of Ig-II and Ig-III was adequate and significant- ly (p < 0.01) higher than those from Ig-I. High intake of milk and milk products by the subjects of both the groups is responsible for this gap. Chandana & Bhat [18] observed low intake of calcium in the diets of adolescent girls of Haryana. Another study conducted by Haekett et al. [19] also revealed that the higher social class girls had a higher calcium intake than lower social class girls.

The mean daily intake of vitamin A by the subjects of all the three groups was 62 percent adequate. The mean vitamin A intake by the subjects of Ig-II and Ig-III was significantly higher (p < 0.05) than those from Ig-I which is attributed to more intake of milk and milk products, meat and egg, as well as fruits by the subjects of both Ig-II & Ig-III groups. Similar results have been reported in adolescent girls of Andhra Pradesh, India, by Pushpamma et al [16]. The diet of adolescents in respect of ascorbic acid was adequate by 80 percent as compared to RDA. The difference in the mean ascorbic acid intake by the subjects of Ig-II and Ig-III was significantly higher (p < 0.05) than the subjects of Ig-I which is attributed to more intake of fruits and vegetables by the subjects of both the groups. Bandopadhyay [14] also reported the low intake of vitamin C among school children.

Anthropometric measurements. The age of the subjects ranged from 13 to 15 years. The mean weight of the subjects is given in Table 4. The mean weight of the subjects from Ig-II and Ig-III was significantly (p < 0.05) higher than those from Ig-I. The average height of the subjects belonging to three income groups is given in Table 4. The difference in mean heights of the subjects of

Table 4. Anthropometric measurements of the subjects

S. No. Income groups Number of subjects Weight kg Height cm

t. Ig-I 38 38.6" 150.4" +0.72 _+0.79 (11.47) (3.25)

2. Ig-II 44 43.2 b 154.5 b ± 1.34 _+ 0.98 (20.53) (4.20)

3. Ig-III 38 41.6 b 153.7 b ± 1.10 +0.76 (16.29) (3.06)

Indian Council of Medical Research (ICMR) values 35.1 105.6 National Centre Health Statistic (NCHS) standards 44.5 154.2

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The values are mean _ SE, Figures in parentheses represent C.V. percent. Two different superscripts in two different income groups indicate significant difference.

Ig-II and Ig-III was significantly higher (p < 0.01) than those of the subjects from Ig-I. Rao et al. [20] reported that the mean weight and height of girls from poorer families was significantly lower than those from upper income families.

The average weight of the subjects when compared with ICMR values [21] and with National Centre Health Statistics (NCHS) USA Standards [22] (50th percentile value) the subjects were found to be 118 percent and 93 percent respectively. Similarly the mean height of girls was 105 percent and 99 percent of ICMR values and NCHS standards respectively. This shows that the weight and height of the subjects compared well with the National and International Standards. The subjects even from Ig-I were heavier and taller as compared to ICMR values, because of ethnic differences, the Punjabi children are better off than their counterparts in other states. Secondly, these values are very old and authenticity is questionable.

Blood haemoglobin level. Blood haemoglobin (Hb) level of the subjects was analysed to identify the prevalence of anaemia. The overall range of Hb level was 8.5-12.5 g/dl in the subjects of three income groups. The mean haemoglo- bin level of the subjects of Ig-I, Ig-II and Ig-III (Table 5) was below the

Table 5. Mean haemoglobin level (g/dl) of the subjects

Income groups Number of subjects Haemoglobin level (g/dl)

Ig-I 38 10.83 a + 0.13 (7.20) Ig-II 44 10.74" + 0.13 (7.91) Ig-III 38 10.58 __+ 0.i3 (7.84) Total 120 10,73 + 0.07 (7.73)

The values are mean :2 SE: Figures in parenthesis repre~nt C.V. percent. Two different superscripts in two different income groups indicate significant difference.

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standard value [23]. This can be attributed to the low consumption of green leafy vegetables, pulses, legumes and cereals too. However, the difference in the Hb values among the subjects of three income groups was non-significant. Only 23 percent of the subjects from all the income groups had acceptable level and rest 77 percent were anaemic. Similarly, Shrestha [24] reported that 78.4 percent of the school children were found anemic.

From the foregoing results it emerges that the diets consumed by adolescent girls were lacking in almost all the foods which led to nutrient inadequacy. However, with increase in income, the consumption of pulses, milk and fruits increased while that of cereals decreased. The energy and protein intake of girls was lower by 784 Kcal and 30.4 g than RDA while the iron intake was adequate only by 45 percent. However, the weights and heights of the subjects were within the normal range. The dietary inadequacy of energy and iron may lead to low haemoglobin (Hb) level of the subjects categorizing 77 percent of them as anaemic. Therefore, in order to meet the daily nutrient requirement of the subjects, the quantitative increase in foods already consumed especially cereals, pulses and green leafy vegetables has been suggested to improve their nutritional status.

References

1. NIN (1984) Nutrition News. Hyderabad, India: National Institute of Nutrition. 2. tCMR (1989) Nutrient consumption of Indian foods. New Delhi. Indian Council of Medical

Research. 3. Jelliffe DB (1966) The assessment of the nutritional status of the community. Geneva: WHO

Monograph, Series No. 53. 4. Dacie J, Lewis SM (1966) Practical haematology. London: English Language Book Society and

JA Churchill Ltd. 5. Steel RGD, Torrie JH (1980) Principles and procedures of Statistics. New York: McGraw-

Hill, Boom Comp. 6. Bogio V, Klepping J (1981) Results of dietary survey in 5, 10 and 15 year old children. Wld

Rev Nutr Dietet, 57: 24. 7. Michand C, Muse N, Nicolas JP, Mejean L. (1990) Nutrient intakes and food consumption in

the adolescents school day breakfast in Lorraire. Nutr Res 10/11: 1t95. 8. ICMR (1985) Nutritive values of Indian foods New Delhi: Indian Council of Medical Research. 9. Scrupriyas S, Mathews S (1988) Nutritional status of tribal adolescents of village, Gogunda,

Rajasthan. Indian J Nutr Dietet 25(9): 281. 10. Szponar LV, Kazalska AL, Wachnikz (1989). Dietary habits of girls and boys in health camps

for children of short status and underweight. Cited from Nutr Abs Rev 59(1): 344. 11. Sabote J, Lindsted KD, Harris RD, Sanzhez A. (1991) Attained height of laeto ovo vegetarian

children and adolescents cited haem. Nutr Abs Rev 64(4): 4879. 12. Bajaj S, Hira C, Sekhon B, Verma S (1977) Effect of income on food distribution in family.

Meeting Proceedings of International Society of Nutrition/held in Brazil. p 21. 13. Oguntone CRB, Oguntone TE, Williams LS, Bin AK (1987). The food and nutritient intake

of adolescent in Barno, Nigeria. Nutr Rep Inc 36(5): 981. 14. Bandhopadhyay DA (1988) Nutritional survey of school children, Navay Nagar, Bombay.

Med J Armed Forces Ind. 44(1): 31. 15. Kochar G (1985) Dietary fibre and its components in mixed Punjabi diet. Ind J Nutr Dietet

22: 641-645.

209

16. Pushpamma P, Geervani P, Manorama R. (1983) Food and nutrient intake and nutritional status of pre-school and school age children in three regions of A.P., India Nutr Rep Int 28(2): 427.

17. Horwath CC (1991) Dietary intake and nutritional status among university undergraduates. Nutr Res 11(5): 395.

18. Chandana U, Bhat CM (1984) Nutritive value of diets consumed by hostel girls at HAU, Hissar: HAU J of Res t4:L 415.

19. Haekete AF, Rogg-Gum AJ, Appleton DR, Easter JHE, Jenbis GN (1984) A two year longitudial nutritional survey of 405 north urban land children in initially aged 11.5 years. Br J Nutr 5t: 67.

20. Rao NP, Singh D, Krishna TP, Nayer S (1984) Health and nutritional status of rural primary school children. Ind Pediat 21(10): 777.

21. ICMR (1972) Growth and physical development of Indian infants and children. New Delhi: Indian Council of Medical Research. Tech. Ser. No. 18.

22. NCHS (t974) National Centre of Health Statistics. USA. Cited in Gopaldas T, Sheshadari S (1987) Nutrition monitoring and assessment Bombay: Oxford University Press, p 52.

23. Gopaldas T, Shashadri S (1987) In Nutrition monitoring and assessment. Bombay: Oxford University Press, p 52.

24. Shrestha PN (1986) Anaemia in children of rural Kathmandu. Ind J Pediat 53(5): 647.