ABSTRACT
Poor dietary pattern is amongst the major causes of morbidity and mortality among adolescents especially in the developing countries like Nigeria. This study examines the the dietary pattern and malnutrition among in-school adolescents in Etim Ekpo Local Government Area, Akwa Ibom State. The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 300 adolescents aged 10-19 years. Data on socio-demographic/economic characteristics, feeding habits and anthropometric status of the respondents were collected using structured and validated questionnaire. The IBM SPSS version 23.0 computer programme was used to analyze the data. Significant relationship was judged at p ≤ 0.05. Data obtained were described using frequency, percentage, mean and standard deviation. WHO anthro plus was used to obtain the anthropometric status of the adolescents. Pearson correlation was used to analyze relationship between the relationship between dietary habits and anthropometric status of the adolescents. Result from this study revealed that (42.0%) of the adolescents studied were between 17-18 years old. Almost half (41.3%) of the adolescents skip meals and the meal mostly skipped is lunch (46.0%). Majority (89.3%) of them consume snacks. Family likes/preferences are one of the major factors (54.0%) that influence the choice of food of the respondents. The anthropometric status of the adolescents showed that majority (98.3%) of the adolescents were not stunted while few (3.7%) of the adolescents were stunted. Some (17.3%) of the adolescents were overweight, 4.3% of them were obese while very few (1.0%) were thin. There was a significant positive relationship between educational qualification of mother and meal skipping habits of the adolescents There was also a significant negative relationship between occupation of mothers, educational qualification of mothers and BMI-for –age of the adolescents. Adequate nutrition education is needed at both primary and secondary level; this will enable the adolescents to make good food choices and positively influence their eating habits thereby ensuring better nutritional status.
TABLE OF CONTENTS
Title page i
Declaration ii
Certification iii
Dedication iv
Acknowledgment v
Table of contents vi
List of tables viii
Abstract ix
CHAPTER 1
INTRODUCTION
1.1 Statement of Problem 4
1.2 Objectives of the Study 5
1.2.1 General objective
of the study 5
1.3.2. Specific objective
of the study 5
1.3 Significance of the study 6
CHAPTER 2
LITERATURE REVIEW
2.1 Adolescents and nutrition 7
2.1.1 Characteristics of adolescence 8
2.1.2 Growth during the period of adolescence
8
2.2 Nutritional needs during adolescence 9
2.2.1 Macronutrient requirement of adolescents 9
2.2.2
Micronutrient requirements of adolescent
11
2.2.2.1 Iron 11
2.2.2.2 Calcium 12
2.2.2.3 Folate 12
2.2.2.4 Riboflavin 13
2.2.2.5 Vitamin D 13
2.3 Eating habits of
adolescent girls 14
2.3.1 Meal skipping habits of adolescents
15
2.3.2 Snacking habits of adolescents 15
2.4 Factors contributing to nutritional problem of adolescents 16
2.4.1 Disease and Infection 16
2.4.2 Socio-economic status 17
2.4.3 Lack of nutrition education
at school level 18
2.4.4 Peer Pressure 18
2.4.5 Eating disorders 18
2.5 Arithropometry of adolescents
19
2.5.1 Weight 19
2.5.2 Height 20
2.5.3 Weight-for-age 20
2.5.4 Weight-for-length/height 21
2.5.5 Length/height-for-age 21
CHAPTER 3
MATERIALS AND
METHODS
3.1 Study design 22
3.2 Area
of study 22
3.3 Population of the Study 22
3.4 Sampling and sampling techniques 23
3.4.1 Sample size 23
3.4.2 Sampling
Procedure 23
3.5 Preliminary activities 24
3.5.1 Preliminary visits 24
3.5.2 Training of research assistants 24
3.5.3 Informed consent 25
3.5.4 Ethical approval 25
3.6 Data collection 25
3.5.6 Questionnaire design 25
3.6.1 Questionnaire administration 25
3.6.2 Interview 26
3.6.3 Anthropometric measurement 26
3.6.3.1 Weight measurement 26
3.6.3.2 Height measurement 26
3.6.3.3 Mid Upper Arm Circumference (MUAC) measurement 27
3.6.5 Dietary
assessment 27
3.6 Data analysis 27
3.7 Statistical
Analysis 28
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Socio-demographic characteristics of adolescents 29
4.2 Socio- economic
characteristics of parents 31
4.3
Food consumption pattern
of the respondents 34
4.4 Anthropometric status of the adolescents 44
4.5 Relationship between socio economic characteristics of the parents,
dietary habit and anthropometric status of the adolescents 47
CHAPTER 5
CONCLUSION AND RECOMMENDATIONS
5.1
Conclusion 50
5.2 Recommendation 50
REFERENCES
CHAPTER
1
INTRODUCTION
The World Health Organization
(WHO) has defined adolescence as the age group of 10-19 years (WHO, 2017). Adolescence
is the most critical period of life with intense growth and development,
physiological, psychological, emotional and social transformation (Goldberg et al., 2009). Evidence shows that
dietary quality declines from childhood to adolescence. The intake of fruit,
vegetables, milk, and fruit juices decreases, whereas poor dietary lifestyle
such as skipping breakfast, a low intake of milk, fruits, and vegetables; and a
high intake of carbonated beverages, sweets, and fast food increases during
this time (Lytle et al., 2010).
Adolescence is considered as a
nutritionally vulnerable stage and distinguished from other stages of the life
cycle with features of rapid growth and development (Sawyer and Susan, 2012).
This period has also been identified as a period of potential interest in
correcting nutritional imbalance and insufficient growth from childhood. During
this stage, 25% of adult height and up to 50% of adult weight is attained. The
combined stresses of puberty and social expectation place great nutritional
demands. Dietary habits and attitudes towards health that are cemented during
adolescence also affect their future nutritional health status (Voelke et al., 2015). It has been indicated
that adolescents are particularly vulnerable to nutrient inadequacies as their
bodies undergo various physiological changes, and as they become more socially
independent, which often impacts negatively on their dietary intakes (Bhutta et al., 2017). The nutrient needs of
adolescents are higher than those of prepubescent children and adults. Given
the increasing autonomy in diet and eating habits that adolescents experience
as parental control lessens, adolescence can be a key entry point for
interventions that will underlie healthy practices in adulthood (Bhutta et al., 2017).
Dietary
habits are the ways in which individuals or group of people respond to social,
cultural and economic pressure, choose, consume and make foods available (WHO,
2013). Proper dietary
behavior and adequate physical activities reduce the risks of some
cardiovascular diseases. Many recent studies have underlined the risks of
excessive energy intake and sedentary lifestyle in adolescents, which can be
associated with the increased prevalence of dyslipidemia, obesity, and
cardiovascular diseases (CVD) (Chapman et
al., 2014). Particularly, sedentary lifestyle (e.g., playing computer
games) is associated with unhealthy snacking patterns, including low intake of
fruits and vegetables and overconsumption of energy and fat (Ganesh et al., 2014).
Malnutrition
is a major problem that contributes to decreased growth (Pinhas-Hamiel et al., 2017). Manifestations of
malnutrition can be observed in the nutritional status of adolescents.
Nutritional status is the level of nutrients related to normal metabolism in
the body (Elmadfa and Meyer, 2014). The high and low intake of nutrients and
their use in the body have an impact on nutritional status (Gibson, 2015). The
nutritional requirements in adolescents increase rapidly due to the rapid
increase in biological or psychological growth, either in boys or girls (Mramba
et al., 2017). The second period of a
growth spurt after infancy occurs in adolescence (Spear, 2012). Besides that,
the highest bone mass reserve is also found in adolescence (Matkovic et al., 2014). Adolescent nutrition will
affect the health of adolescents in the present and future, future labor
productivity, and improvement in the generation that will be born (Clark et al., 2014). Several studies
throughout the world indicated a high prevalence of malnutrition in this stage,
either as a form of overweight or underweight (Adesina, 2012; Bibiloni et al., 2013; Jamalikandazi, 2016;
Delvarianzadeh et al., 2016). It is
now well documented that being overweight and obese during childhood and
adolescence is a risk factor in long-term health problems such as diabetes,
cardiovascular disease and premature death whereas, inadequate diet during
adolescent years can result in many nutrition related disorders, delayed sexual
maturation and can arrest or slow linear growth (Voelker et al., 2015). However, recent studies have shown that these
nutritional problems in adolescence are attributed to their lifestyle and
eating habits (Majeed, 2015).
Anthropometric
measurements are a series of quantitative measurements of the muscle, bone, and
adipose tissue used to assess the composition of the body. The core elements of
anthropometry are height, weight, body mass index (BMI), body circumferences
(waist, hip, and limbs), and skinfold thickness (Kyle and John, 2021). In
adolescents, nutritional status can be determined by using anthropometric
indicators, such as body mass index for age (BMI-for-age) and height-for-age
(De Onis et al., 2017). Body mass
index-for-age and height-for-age less than or equal to -2 standard deviations
(SD) are categorized as thin and short, respectively. Meanwhile,
weight-for-height less than -2 standard deviations (SD) are categorized as
wasted while weight-for age less than -2 standard deviations (SD) are categorized as underweight (De Onis et al., 2017).The potential for
increased risk of malnutrition in adolescents is affected by the state of food
insecurity (Mramba et al., 2017). The
previous review in the adolescent group showed that half of the studies showed
a positive association between food insecurity and low nutritional status,
especially stunting (Maitra, 2018).
The high prevalence of chronic energy and micronutrient
deficiencies of today's adolescent is directly linked to the quality of the
next generation. Without addressing these deficiencies, the vicious cycle of
inter-generational under nutrition, chronic diseases, and poverty perpetuates
(Alam et al.,
2015). Undernourished adolescents are likely to grow into undernourished
young adults who are more likely to give birth to undernourished babies (Smith
and Haddad, 2015). Thus, the aim of this study is to assess
the dietary pattern and malnutrition among in-school adolescents in Etim Ekpo
Local Government Area, Akwa Ibom State.
1.1 STATEMENT OF PROBLEM
Poor
dietary pattern is amongst the major causes of morbidity and mortality among
adolescents especially in the developing countries like Nigeria. Poor eating
habits are often observed in adolescents, whose diets are characterized by a
high intake of sugar, soft drinks, sodium- and energy-dense food items, both in
developed and developing countries (Prochnik et al., 2009). This eating pattern is of major concern because it
can lead to overweight and a higher probability of chronic non-communicable
diseases (NCDs), such as obesity, diabetes, high blood pressure, dyslipidaemia,
cardiovascular diseases and cancer later in life (Anector et al., 2012)
Kurz
and Johnson-Welch (2014) reported that one of the nutritional problems
affecting adolescent populations worldwide, and Nigeria in particular, is a
micronutrient deficiency in iron, calcium and vitamin A. Certain nutritional
problems, such as deficiencies in certain micronutrients, like zinc, calcium,
iron and vitamin A, are frequently observed in adolescents in developed and
developing countries, including Nigeria (Thacher et al., 2006). In-school adolescents have a trend of skipping
breakfast, thereby increasing the level of snacking during the day (Mullie et al., 2016). Lack of time to prepare
food, lack of parental guidance on what to eat and laziness are all reported as
reasons for skipping breakfast, thus resulting in malnutrition. The main
nutritional problems affecting adolescent populations worldwide include under
nutrition (in terms of stunting and wasting), overweight and obesity which are
emerging public health problems during this time (Anyika et al., 2009). Worldwide, 10% of adolescents are overweight with
obesity prevalence varying between 2-3%. In a Nigerian study conducted by
Omobuwa et al. (2014), 7.6% of the
adolescents were obese while the prevalence of underweight among the adolescent
girls in the study was 23.4%. The Food
Consumption and Nutrition Survey in Nigeria (FCSN) (2012) revealed that 42% of
Nigerian children and adolescents were stunted, 25% were underweight and 9%
were wasted. Prevalence of thinness among adolescents in Nigeria is 23%
(National Population Commission (NPC), 2013). Hence, this study was conducted
to assess the dietary pattern and malnutrition among in-school adolescents in
Etim Ekpo Local Government Area, Akwa Ibom State.
1.3 OBJECTIVES OF THE STUDY
1.3.1
General
Objective of the Study
The
general objective of the study is to assess the dietary pattern and
malnutrition among in-school adolescents in Etim Ekpo Local Government Area,
Akwa Ibom State.
1.3.2. Specific Objective of the Study
The specific
objectives of this study are to:
i.
determine the personal
information of the adolescents and socio-economic status of their parents.
ii.
assess their dietary
habits of the adolescents.
iii.
assess the anthropometric
status of the adolescents
iv.
determine the
relationship between the relationship between dietary habits and anthropometric
status of the adolescents.
1.3 SIGNIFICANCE OF THE STUDY
Findings from the study will generate
information that can be used by Organizations like FAO, WHO, UNICEF. The information will
help them in forming food policy which will improve the nutritional status of
adolescents. The information will also indicate health and nutritional related
problems that are associated with poor feeding among adolescents.
It will also be of interest and useful to health practitioners, nurses, doctors
and educationist by providing them with information on the extent to which
malnutrition has spread among adolescents. Information gotten from this study
will also provide an insight to policy makers/programmers thereby serving as a
baseline data for further studies that are related to lifestyle pattern and
nutritional status of adolescents.
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