DIETARY DIVERSIFICATION AND ANTHROPOMETRIC STATUS OF ADOLESCENTS (10-19 YEARS) IN SECONDARY SCHOOLS

4.2 Socio-economic characteristics of the adolescents

4.6a  Food consumption  pattern of adolescents using 24-hour dietary recall

4.7 Dietary diversity score of the adolescents

4.8aheight-for-age and BMI-for-age by sex of adolescents

Adolescence is an important stage of physical growth and development (Thomas, 1991). Growth occurs in skeleton, in the muscle, and in almost every system and organ of the body in adolescence except the brain and the head (Spear, 1996). Biological, psychosocial and cognitive changes that occur throughout adolescence directly affect nutritional status and nutrient needs (Barbara, 2001). Adolescents experience dramatic physical growth and development during puberty, which in turn appreciably increases their requirements for energy, protein, and many vitamins and minerals (Christian and West, 1998). During adolescence, more than 20% of total growth in stature and up to 45% of adult bone mass are achieved, and weight gained during the period contributes about 50% to adult weight (Spear, 2002). The increased need for energy and nutrients among adolescents, combined with increasing financial independence, increasing need for autonomy when making food choices, and immature cognitive abilities, place adolescents at nutritional risk (WHO, 2000). Dietary habit has profound influence on the nutritional health of individual and communities. Protein deficiency has been shown to reduce growth during adolescence (Scholl et al., 1994). Iron has also been suggested to be essential for skeletal growth. It has been shown to be a limiting factor for growth if intake is deficient (Dallman, 1989). Vitamin A has also been indicated to be important for growth and development, and maturation. Increase in skeletal size and its mineral content enhances need for calcium, which is therefore greater during adolescence than in either childhood or young adulthood. The nutritional value of the food a person consumes becomes very crucial to his or her biological and intellectual developments (Lifshiz et al., 1993). Optimum nutrition is crucial, if the body is to achieve its maximum growth potential in order to retain the process of nutritional related problems. 

All people need a variety of foods to meet requirement for essential nutrients and the value of a diverse diet has long been recognized. Lack of diversity is a particular severe problem among poor populations in the developing world (Hooshmand, 2013). For vulnerable growing adolescents, the problem is particularly crucial because they need energy and nutrient densed foods to grow and develop both physically and mentally and to live a health life (Martin Prevely et al., 2012). Because of the perceived importance of dietary diversity for health and nutrition, indicators of dietary diversity have become increasingly popular in recent years (Arimond and Ruel, 2004). Dietary variety instruments often called dietary diversity scores have recently become the preferred method for studying dietary adequacy in developing countries. (Ruel, 2003; Seo, 2011) have stated that dietary diversity is associated with child nutritional status. Increased dietary diversity helps ensure adequate intake of essential foods. It is a key element of high quality diet. Dietary diversity is intended as a proxy of access to food, intake of energy and other macronutrients and as well as intake of micronutrients (Tarini, 1991). At individual level it refers to consumption of a particular nutrient inside and outside home. Healthy diets are said to be those that are the most varied in nature. Food diversity is emphasized by the Food Guide Pyramid and the USDA (The United States Department of Agriculture). Food variety is expressed as the number of biologically distinct foods eaten over a designated period of time. In other words, variety means that we chose to eat a mixture of foods across the range of food types (eg cereal, fruits, dairy products) and a mixture from within food types (eg rice, barley, wheat). There is need and scope for testing applicability of newer approaches for assessing dietary diversity. Food Frequency Method has the potential of providing insight into dietary habit on qualitative considerations.

Dietary diversity refers to an increase in the variety of foods across and within food groups (WHO/FAO, 1996) capable of ensuring adequate intake of essential nutrients that can promote good health (Ruel, 2002). Since no single food can contain all nutrients, Labadarios et al. (2011) noted that the more food groups included in daily diet the greater the likelihood of meeting nutrient requirements. Dietary diversity can also be defined by the number of individual food items or food groups consumed in the 24 hours (Hiddinot and Yohannes, 2002). Kennedy et al. (2009) argued that, a diet which is sufficiently diverse may reflect nutrient adequacy. Thus far, dietary diversity can be viewed as a proxy measure of food security (Hoddinott, 2002).  Food security on the other hand entails three important aspects (availability, access and utilization) in the relationship between man and food, critical to ensure that nutrition plays its optimum role in human health (Ajani, 2010). Interestingly, dietary diversity has been positively linked with these three pillars of food security ie availiability, accessibility, and utilization (Bernal et al., 2003; Styen et al., 2006; Hillbruner and Egan, 2008). Eating a large variety of foods, across and within major food groups has therefore been recommended in most dietary guidelines (Jeanene et al., 2006), since it is associated with a number of improved outcomes such as nutrient adequacy, anthropometric indices and improved haemoglobin concentrations (Swindale and Bilinsky, 2005).  Understanding household dietary diversity may therefore be an alternative easy pathway to estimate household food security (Thorne-Lyman et al., 2009; Vakili et al., 2013). Also, the dietary diversity pathway may be more related to food security (Hoddinott, 2002; Styen et al., 2006; Hillbruner and Egan, 2008; Ajani, 2010), than the current focus on dietary quantity - dietary energy (Rashid et al., 2006).Macro and micro nutrients deficiencies are public health concerns in most developing countries partly due to monotonous cereal based diet that lacks diversity (Mimiran, 2004). Further more diverse diet reflects the nutrient adequacy of the diet (Kantak, 1995) and this can be assessed a dietary diversity score which is based on simple count of food groups (Savy et al., 2006). To better reflect a quality diet, the number of different food groups consumed is calculated, rather than the numbers of different foods consumed (Haddinot and Yohannes, 2002). The indicator can be modified and used as an individual dietary diversity score (IDDS) which is used as a proxy measure of the nutritional quality of an individual’s diet (Mirmiran, 2004). A Dietary diversity score (DDS) could give a fairly good assessment of the nutritional adequacy of the diet. They are useful because they are correlated with nutrient intakes as well as various anthropometric measures in adolescents, measurements are simple to collect and easily adapt to diet in various settings (Hooshmand and Udipi, 2013). However, some complexities have been encountered during its measurement in rural areas of developing countries because the population often receives little education and generally shares food from communal bowl (Dercon et al., 2000)

There are few studies in Nigeria about dietary diversity and its associated factors on adolescents. It is only recently that efforts, although small, has been made to include adolescents as beneficiaries in some of the health and nutrition intervention programmes. Therefore this study aims to investigate dietary diversity and associated factors among adolescents in Nigeria.

According To Ruel. (2002), lack of dietary diversity is a challenge for rural and urban communities in developing countries. Rural adolescent diet can be a default defined on starchy staples with inadequate animal products, fresh fruits and vegetables while the urban adolescent diet is default defined on sweets, junks and empty calorie snacks (Ruel et al., 2004). For adolescents the problem is particularly crucial because they need energy and nutrient dense foods to grow and develop both physically and mentally and to live a healthy life (Hooshmand and Udipi, 2013) while also considering the fact that their nutritional status have an all pervasive impact on the physical wellbeing and socio- economic condition of a nation (Berger et al., 2007). Due to unhealthy eating behaviours adolescents become vulnerable to malnutrition and micro nutrient deficiencies and nutrition related diseases could occur (Oldewage et al., 2010, Olumakaiye and Ajayi, 2007; Delisle et al., 2000) which could persist during adulthood. Consumption of a variety of diets is therefore crucial if adolescents are to adopt healthy eating pattern throughout the life cycle.

Nigeria has an adolescent population of about 22.3% and malnutrition, micronutrient deficiencies and nutrition related chronic diseases are particularly important threats to productivity and mobility risks in their adulthood if not prevented (WHO, 2006). Several studies conducted among adolescents in Nigeria have focused more on food consumption, meal patterns and food choices of adolescents (Eneobong and Akosa, 1993; Olumakaiye et al., 2010; Henry Uneze, 2011; Ogunkunle and Oludele, 2013) but there is death of information on the dietary diversity of diets of adolescents in Nigeria. Several authors therefore argue that, the quality of diets is directly correlated to dietary diversity and inversely related to malnutrition (Azadbakht et al., 2005, Styen et al., 2006). As rightly suggested by Rashid et al. (2006) a large number of studies seem to be focusing on determinants of dietary energy consumption (or dietary quantity) given the fact that diverse diet normally rare among adolescents from developing countries is critically important for adolescents in terms of supply of micronutrients and energy for physical and mental growth (Pan American Health Organisation, 2001;Tourless et al., 2003; WHO, 2003., Ruel et al., 2004).Traditionally, adolescents are targeted more for reproductive health interventions and less often for nutritional intervention (Delisle et al., 2000; Olumakaiye and Ajayi, 2007) Given their nutritional vulnerability as a result of unhealthy eating habits, there is need to assess their dietary diversity, because it would give a glimpse of their diet. Consequently, the non-diverse diet of adolescents in secondary schools in Abia State pose a nutritional risk, hence the need for the assessment of anthropometric status of the population.

The general objective of this study to assess dietary diversification and its effect on the anthropometric status of adolescents (10-19yrs) in secondary schools in Abia State.

The specific objectives are to:

This research will help to motivate educators, as well as other nutritionist educating families and secondary school students on the benefits of dietary diversity in their house hold meals. The success of this study will create awareness and provide appropriate and adequate knowledge on proper dietary practices. It will further provide convincing information to the government for use in planning programmes and policies that will improve the nutritional status as well as overall health of adolescents in secondary schools.