ADOLESCENT NUTRITIONAL STATUS AMONG FIRST YEAR EDUCATION

STUDENT IN XAVIER UNIVERSITY- ATENEO DE CAGAYAN, SY 09-10

Artango, Daniel
Bagongon, Christian
Dagatan, Luvilla
Edpalina, Connie Ryan
Fernandez, Janette

Health 2 EDA
Miss Edralin Manla
 CHAPTER 1

THE PROBLEM

Introduction
Conceptual Framework
Schematic Diagram

. Independent Variable Dependent Variable

Food Consumption

Meal Pattern and Planning

Physical Activity or Exercise

Personal and Environmental Adolescent Nutritional Status

Sanitation

Statement of the Problem

The study would like to find out the nutritional status of the first year education

students. This also aims to answer the following questions:

1. What is the status of the respondents with respect to:

a. Food Consumption

b. Meal Pattern and Planning

c. Physical Activity or Exercise

d. Personal and Environmental Sanitation

2. What is the over all adolescent nutritional status?

Significance of the study

The study provides reliable information about the current adolescent

nutritional status among first year education students. The result of this study may

also be useful to the following persons:

Administrators. The school administrators maybe given sufficient data on the

nutritional status of their adolescent students. Furthermore, the school administrators

may be able to create programs that would address the result of this study. They

may establish health programs such as feeding programs, seminars, workshops, and

school activities that promotes nutritional awareness. They may also implement

Health 2 subjects in all courses of the university. School administrators may also

implement Adolescent and Youth Health Program and Development (DOH), Nutrition

education, the Medium Term Youth Development Plan (MTYDP) as the national

framework for youth development (National Youth Commission), and may foster

nutrition-friendly schools canteens and cafeterias to provide a variety of options of

nutritious but affordable meals and snacks as well as promote the sale of safe and

nutritious foods among vendors in the vicinity of the school.

Teachers. Teachers may be able to plan lessons that integrate proper nutrition

among students. Faculty teachers may also see each other and agree to employ

thematic teaching for a couple of weeks or months in order to response to the call for

adolescent nutrition. The teachers, upon knowing the result of this study, may be

able to encourage their students to be conscious of their nutritional status. Teachers

may also teach adolescents of negative consequences of fad diets to their health.
Students. Students will be aware of their nutritional status and through this study

they will be more observant on the foods they take and the kind of life style they

have. Hence, they may also inform their peers as well as that significant others in

their lives about nutrition. Aside from awareness, the students may be able to initiate

making proper meal preparation and may be able to consciously check the nutritional

content of the foods they take. This study will encourage adolescents to make time

for a good meal.

Parents. Parents may be aware of their son’s and daughter’s nutritional status and

thus they may be able to plan new ideas on supervising the foods that their

seedlings are taking up. The parents may be aware that they play an important role

in encouraging, supporting, and enabling of their sons and daughters to be involved

in more healthful behaviours.

Future Researchers. This research may be replicated by the future researchers. The

results of this research may provide information to other researchers which will be

studying on adolescent nutritional status.

Scope and Limitation

The array of this study was limited only to first year education students who are in

the in the age of adolescence and those who are currently enrolled in the first

semester of the school year 2009-2010. Those freshmen education students who
are not anymore included in the range of adolescence are not allowed to participate

in the research. Respondent’s honesty is the limitation of this research since the

researchers are not absolutely sure if those who took the questionnaire really tell

what they suppose to tell.

Definition of Terms

The following are defined as used in the study.

Adolescence- the transition between childhood and adulthood , ages 10-19 , of the

first year education students that is best viewed as a time of evaluation, decision

making, and commitment rather than as a time of rebellion, crisis, and pathology.

Adolescence is a unique intervention point in the life cycle. It offers a chance to

acquire knowledge about optimal nutrition during young adulthood that could prevent

or delay adult-onset diet-related illnesses later on. It is a stage of receptivity to new

ideas and a point at which lifestyle choices may determine an individual's life course.

Adolescence is the second most critical period of physical growth in the life cycle.

Food Consumption- this refers to the foods and nutrients intake of the first year

education students. The study looks on the variety of foods and the nutritional

content of these foods that the first year educations are consuming.

The food consumption is composed of foods that contains energy (Kcal), protein (g),

vitamin A, vitamin C & D, Thiamin, Riboflavin, Niacin, Folate, Calcium, Iron,

Iodine, Magnesium, Phosphorus, Zinc, Selenium, Flouride, Manganese,

Meal Pattern and Planning- This refers to the foods that are present in every meal

they take and the schedule of eating time.

Physical Activity or Exercise- This refers to the muscular movements ranging from

moderate to vigorous body activity the first year education students .This is also a

way of relieving stress, relaxation, distraction from worries, and mental break

according Duffy, Karen G. (2004).

Personal and Environmental Sanitation- This refers to the

Nutrition- This is the act or process of nourishing by which the first year education

students take in and utilizes food material.

Nutritional Status- Growth during adolescence is faster than at any other time in an

individual’s life except the first year. Good nutrition during adolescence is critical to

over the deficits suffered during childhood and should include nutrients required to

meet the demands of physical and cognitive growth and development.

 CHAPTER 2

REVIEW OF RELATED LITERATURE

The content of this chapter will show some related literature and studies

conducted by the previous researchers with the same topic. This collected literatures

and studies helped the researchers in achieving the goal of this study.

Adolescent nutritional status in developing countries.

By Kurz KM.

International Center for Research on Women, Washington, DC 20036,

USA.

PIP: In the last 10 years, interest in adolescence has increased worldwide.

Much of the attention has been on adolescent health, in particular

adolescent pregnancy and sexually transmitted diseases, including HIV

infection, but adolescent nutrition has aroused little interest. 11 studies

on nutritional status of boys and girls have recently been conducted in

Benin, Cameroon, Ecuador, India, Jamaica, Mexico, Nepal, Guatemala,

and the Philippines. The studies differed in protocol, sample size, and data

collection methods. Anemia was the most important nutritional problem.

Anemia prevalence was high in 4 studies (55% in India, 42% in Nepal,

32% in Cameroon, 48% in Guatemala) and significant in 2 others (17% in

Ecuador and 16% in Jamaica). Slow growth was common in 9 studies

(27-65%). Height in girls as well as in boys did not improve during the

entire 8 years of adolescence. It approached the fifth percentile at age 10

and at age 18. Low body mass index (BMI) was high (23-53%) in only 3

studies. It was surprising that boys had a BMI 2 times lower than that of

girls relative to sex-specific data. With the difference in growth in height,

BMI increased substantially throughout the 8 years of adolescence among

all girls for both low BMI or satisfactory BMI at age 10 but only for low

BMI among boys age 10. At age 18, the median BMI for girls and boys

was well below the fifth percentile. However, in 3 countries where the

median BMI at age 10 was low, the boys did not reach the 50th percentile

and were still growing, while girls had reached the 50th percentile and

stopped growing. These results suggest that the iron status of adolescents

needs to be improved, but it is necessary to be cautious when improving

height when the BMI is adequate for age 18.

Diet and nutritional status of rural adolescents in India.

Venkaiah K, Damayanti K, Nayak MU, Vijayaraghavan K.

National Institute of Nutrition, Indian Council of Medical Research,

Hyderabad - 500 007, India. kodalivenkaiah@yahoo.com

OBJECTIVE: To study the current diet and nutritional status of rural

adolescents in India. DESIGN: Cross-sectional study with household as

the unit of randomization. SETTING: National Nutrition Monitoring Bureau

collected information in the rural areas of the nine States. METHODS: In

each State, 120 villages were selected from eight districts. From each of

the selected villages, 20 households (HHs) were selected from five

clusters. The information on socio-demographic profile was collected in all

the 20 HHs, while anthropometric data such as weight, height and clinical

signs of nutritional deficiency was collected on all the available

adolescents in the selected households. In every fourth sampled

household, ie five HHs, dietary information on all the members was

collected using 24 h dietary recall. The outcome measures for nutritional

status were proportion of underweight (<median -2 s.d. of NCHS

standards of weight for age), stunted (<median -2 s.d. of NCHS

standards of height for age) and body mass index. The nutrient intakes

were compared with recommended dietary allowances (RDA). RESULTS:

Anthropometric and socio-economic information on 12 124 adolescent

boys and girls and dietary information on 2579 individuals in 1996-1997

was available for the analysis. The major occupation of the heads of the

households surveyed was agriculture. More than a third (37.3%) of the

families with adolescents did not possess any land. The per capita income

per month was about Rs 250/- at 1996-1997 prices. About 23% of the

adolescent girls were married before the age of 18 y. About a quarter of

the married adolescent girls had short stature and 18.6% were

underweight. They considered as 'at risk'. About 39% of the adolescents

were stunted (<Median -2 s.d. of NCHS height for age) irrespective of

sex. The prevalence of undernutrition (<median -2 s.d. of NCHS weight

for age) is higher (53.1%) in boys than in girls (39.5%). The extent of

stunting was higher (42.7%) among adolescents belonging to the

scheduled caste community. In the case of girls, the extent of

underweight was considerably less in each age group than their male

counterparts. About 70% of adolescents consumed more than 70% of

RDA for energy. The intakes of micronutrients such as vitamin A and

riboflavin were woefully inadequate. CONCLUSIONS: The extent of

undernutrition was high among adolescents and was higher among boys

than girls. Adolescent girls in the rural areas could be at greater risk of

nutritional stress because of early marriage and early conception before

completion of their physical growth.

Public Health Nutrition 1998 Jun;1(2):83-92.

Dietary pattern, nutrient intake and growth of adolescent school girls in

urban Bangladesh.

Ahmed F, Zareen M, Khan MR, Banu CP, Haq MN, Jackson AA.

OBJECTIVE: To investigate the dietary pattern and nutritional status of

adolescent girls attending schools in Dhaka city and to examine the
association with various social factors. DESIGN: Cross-sectional study.
SETTING: Girls high schools in Dhaka city. SUBJECTS: A total of 384 girls,
aged from 10 to 16 years, who were students of classes VI to IX of 12
girls high schools in Dhaka city were selected by systematic random
sampling. Nutrient intake was assessed using the 24-h recall method and
the usual pattern of food intake was examined using a 7-day food
frequency questionnaire. RESULTS: The prevalence of undernutrition
among the participants assessed as stunting was 10% overall with
younger girls being less stunted (2%) than older girls (16%), whereas
16% were thin with relatively more of the younger girls (21%) being thin
than of the older girls (12%). Based on the usual pattern of food intake, a
substantial proportion of the girls did not consume eggs (26%), milk
(35%) or dark green leafy vegetables (20%). By comparison, larger
proportions consumed meat (50%) and fish (65%) at least four times a
week. For the intake of energy and protein, only 9 and 17% of the girls,
respectively, met the recommended daily allowance (RDA). For nearly
77% of the girls, the intake of fat was less than the recommendation.
Intakes less than the RDA were found for iron (77% of the girls), calcium
(79%), vitamin A (62%), vitamin C (67%), and riboflavin (96%). Based
on the food consumption data, cereals were the major source of energy
(57%), thiamin (67%), niacin (63%) and iron (37%). Animal sources
supplied 50% of dietary protein. Cooking fats were the principal source of
fat (67%) in t(d diet. Malk was 4he major contributor for riboflavin and
prefobmed vitamin A (retinol). Leafy vegetables and fruits were the main
snurces of provipamin A (cabotenes). The girls from families with ,ess
educated parents were more likely to be thin and short for their age.
Those girls from families with lower incomes and less educated parents
had a dietary pattern which ten$ed to be poor with regard to egg, milk,
meat and fruit, with lower intakes of protein, fat and riboflavin.
CONCLUSION: The findings indicate that the diets of these girls tended to
be inadequate both for macronutrients and micronutrients, with
significant health implications. There was also a relationship between the
family income and the education of the parents with the nutritional status
of the girls.

Physical status, nutrient intake and dietary pattern of adolescent

female factory workers in urban Bangladesh.

Khan MR, Ahmed F.

This cross-sectional study examined the physical status, nutrient intake

and dietary pattern of adolescent female factory workers in urban

Bangladesh. A total of 1211 postmenarchial girls aged 14-19 y from

seventeen readymade garment industries spread over the Dhaka City

participated in the study. Body weight, height and skin fold thickness

were measured for all subjects. The nutrient intake was assessed by 24-h

recall method and 7-day food frequency questionnaire was used to

investigate their dietary pattern on a sub-sample of 509 girls. Sixty five

percent of the girls were short (height-for-age, <3rd percentile of NCHS

reference values). Pre-valence of short stature was higher in the older

girls. Mean body weight was 38k g for the 14 year old girls, which

gradually increased across the age groups to about 42 kg for the 18 and
19 year olds. About 17% of the girls were thin (BMI-for-age <5th

percentile of NCHS reference values). Over all, about 23% were lean

(TSFT-for-age <5th percentile of NCHS reference values). Food intake

data revealed a deficit of 1.62 MJ/day in energy. Mean intake of protein,

calcium, iron, vitamin A, thiamin, riboflavin, niacin and vitamin C were

below the recommended dietary allowance. Most of the energy and

nutrients came from cereal grains. Habitual pattern of food intake

revealed poor intake of eggs, milk, meat, and green leafy vegetables. In

conclusion, the data show a poor physical status of the adolescent female

factory workers in Bangladesh. Simultaneous substantial deficits in energy

and several nutrients in their diet stress the need for an appropriate

intervention to improve their overall nutritional and physical status of

these young females.

Adolescent nutritional status in developing countries.

In the last 10 years, interest in adolescence has increased worldwide.

Much of the attention has been on adolescent health, in particular

adolescent pregnancy and sexually transmitted diseases, including HIV

infection, but adolescent nutrition has aroused little interest. 11 studies

on nutritional status of boys and girls have recently been conducted in

Benin, Cameroon, Ecuador, India, Jamaica, Mexico, Nepal, Guatemala,

and the Philippines. The studies differed in protocol, sample size, and data

collection methods. Anemia was the most important nutritional problem.

Anemia prevalence was high in 4 studies (55% in India, 42% in Nepal,

32% in Cameroon, 48% in Guatemala) and significant in 2 others (17% in

Ecuador and 16% in Jamaica). Slow growth was common in 9 studies

(27-65%). Height in girls as well as in boys did not improve during the

entire 8 years of adolescence. It approached the fifth percentile at age 10

and at age 18. Low body mass index (BMI) was high (23-53%) in only 3

studies. It was surprising that boys had a BMI 2 times lower than that of

girls relative to sex-specific data. With the difference in growth in height,

BMI increased substantially throughout the 8 years of adolescence among

all girls for both low BMI or satisfactory BMI at age 10 but only for low

BMI among boys age 10. At age 18, the median BMI for girls and boys

was well below the fifth percentile. However, in 3 countries where the

median BMI at age 10 was low, the boys did not reach the 50th percentile

and were still growing, while girls had reached the 50th percentile and

stopped growing. These results suggest that the iron status of adolescents

needs to be improved, but it is necessary to be cautious when improving

height when the BMI is adequate for age 18.

Adolescent Nutrition

June 2003

There are 1.2 billion adolescents ages 10-19 in developing nations,

making up one fifth to one quarter of their country's populations.

Adolescents have typically been considered a low risk group for poor

health, and often receive few healthcare resources and scant attention.

However, this approach ignores the fact that many health problems later
in life can be improved or avoided by adopting healthy lifestyle habits in

adolescence.

Adolescence is a unique intervention point in the life cycle. It offers a

chance to acquire knowledge about optimal nutrition during young

adulthood that could prevent or delay adult-onset diet-related illnesses

later on. It is a stage of receptivity to new ideas and a point at which

lifestyle choices may determine an individual's life course.

There is evidence from research in countries as diverse as Peru and India

that this population can be highly amenable to public health information

as it relates to their own well-being. Adolescent boys and girls can be

motivated to adopt nutrition behaviors that improve their looks, school

achievement and athletic performance. Potentially, behavior change

messages embraced by adolescents will contribute to more sustained

health and nutrition impacts within a population as the cohort of

adolescents moves through its adult years. Although good nutrition for

boys is an important goal on its own, an unanswered research question is

the extent to which inclusion of adolescent boys in nutrition and healthy

lifestyle programs will contribute to the improved nutrition and health of

women during childbearing and for infants and young children in the

critical early years of life.

Undernutrition (being too thin or too short, frequently caused by chronic

energy deficiency) in adolescents frequently goes unrecognized by young

people or their families. We now know that it:

Affects their ability to learn and work at maximum productivity

Increases the risk of poor obstetric outcomes for teen mothers

Jeopardizes the healthy development of future children

Children born to short, thin women are more likely themselves to be

stunted and underweight (low weight for age). In addition, the heightened

obstetric risk caused by stunting in childhood and adolescence persists

throughout a woman's reproductive life. If adolescents are HIV+, some

research suggests that undernutrition may increase the speed with which

they develop full-blown AIDS, and heighten the chance that infected girls

will transmit the virus to their babies. Lack of adequate nutrition

diminishes the already poor quality of life of persons living with HIV/AIDS.

We have little information about the nutritional status of adolescents and

nutrition. Resources have traditionally been directed at young children

and pregnant women. These conditions: lack of data; low policymaker

interest in the nutritional problems of adolescents; little program

experience; and the dearth of resources-contribute to a critical lost

opportunity to bolster the health, development, and economic progress of

nations.
top

What are the main nutritional issues for adolescents?

Adolescence is the second most critical period of physical growth in the

life cycle after the first year. Twenty five percent of adult height is

attained during adolescence. For many adolescents, inadequate quality

and quantity of food are the prime determinants of nutrition problems.

These conditions may be due to household food insecurity, intrahousehold

allocation of food that does not meet their full range of dietary needs,

livelihoods insecurity, and lack of nutrition knowledge. Micronutrient

malnutrition and chronic energy deficiency resulting in thinness (low Body

Mass Index or BMI [1. Body Mass Index (BMI) is a measure of thinness in

adolescents and adults; it is equal to a person's weight in kilograms

divided by height in meters2 or (kg)/(m2)]) and stunting stem primarily

from poor diet. Excessive physical activity patterns (e.g., heavy workloads

and walking long distances) and infection may also contribute to

undernutrition.

Stunting (short stature) in both adolescent boys and girls was prevalent

in 9 of 11 studies conducted by the International Center for Research on

Women in the early 90's, ranging from 27 to 65 percent. Data on

underweight (thinness indicated by low BMI for adolescents and adults)

are largely unavailable for adolescents. ICRW reported low BMI ranging
from 3 to 53 percent. Adolescents in India, Nepal, and Benin were the

most severely affected among the 11 study sites.

Overweight/obesity data are not widely reported for adolescents, but

there is growing concern about these problems. WHO estimates that 60

percent of deaths globally are due to noncommunicable diseases

associated with unhealthy diets and physical inactivity, with 79 percent of

these deaths occurring in developing countries. The same changes in diet

and physical activity contribute to the increased prevalence of obesity in

youth, often seen side by side in communities with undernutrition. There

is also some evidence that low birth weight may predispose individuals to

obesity and associated chronic diseases later in life. In Chile, 12 percent

of schoolchildren are obese; 17 percent of older adolescent girls in South

Africa are obese; and in China, one study found that the prevalence of

overweight and obesity (BMI >25), in young adults has moved up from

10 to 15 percent for urban areas, and from 6 to 8 percent in rural areas,

over a ten year period (1982-1992).

Iron deficiency is the most prevalent micronutrient deficiency among

adolescents. Iron deficiency and anemia are associated with impaired

cognitive functioning, lower school achievement and most likely lower

physical work capacity. WHO estimates that 27 percent of adolescents in

developing countries are anemic; the ICRW studies documented high

rates in India (55 percent), Nepal (42 percent), Cameroon (32 percent)
and Guatemala (48 percent). Adolescents (both boys and girls) are at risk

of developing iron deficiency and iron deficiency anemia because of the

increased iron requirements for growth. Infectious diseases such as

malaria, schistosomiasis, and hookworm affect both boys and girls,

contributing to anemia by affecting the absorption of or increasing the

loss of iron. Following the end of their growth spurt, boys rapidly regain

adequate iron status, whereas girls may continue to be or become more

deficient because of the increased requirements for iron due to

menstruation, pregnancy, and lactation.

Folate deficiency, if not addressed during the pre or periconceptual

period, may cause irreversible fetal damage. Addressing folate deficiency

beyond the middle of the first trimester of pregnancy will not correct

neural tube defects that occur in the early weeks of pregnancy. The

unplanned nature of many adolescent pregnancies underscores the need

to take a preventive approach to this specific nutritional issue for youth.

In settings of endemic iodine deficiency, girls are affected

disproportionately relative to `oys, although all individuals are affected.

Datrimdftal cognitiv% effects inclqde neural imp`irment and poor school

performance. The fetus of an iodine-deficiejt mother i3 at risk of

spontaneous abortion as well as a range of neurological and intellectuad

impairments.
Other micronutrients that may be deficient in adolescents include vitamin

A, zinc, and calcium. The latter two are particularly important for

achieving maximum growtH potential. Calcium intake in adolescence is

also important for preventing osteoporosis (brittle bones) later in life.

Vitamin A deficiency appears to negatively affect growth and possibly

sexual maturation. It is critical for healthy immune system functioning

and optimal vision.

A related health issue is adolescent pregnancy. It is often associated with

nutritional, obstetric, and perinatal health risks for teen mothers and their

babies. Incomplete maternal growth heightens the risk of obstructed

labor. There is evidence that competition for nutrients will favor the still-

growing mother, placing offspring at risk for low micronutrient stores and

low birth weight. Concurrent pregnancy and growth worsen maternal

micronutrient deficiencies—iron and calcium for example. Children of

adolescent mothers are also often at greater risk of poor nutritional care

and feeding practices.

Adults and adolescents: assessment of nutritional status in

emergency-affected populations

New publications1, 2

In July last year the ACC/Sub-committee on nutrition published two

reports on the assessment of nutritional status in emergencies. One

report deals with adults and the other with adolescents3.

Adults

This report describes simple techniques suitable for the assessment of the

nutritional status of adults aged 20-60 years in emergency-affected

populations. The report makes preliminary recommendations stressing

that there is no consensus on a definitive method to assess adult

undernutrition and that more research is required.

Main findings

Surveys and population level assessments of chronic undernutrition

The BMI may be used to estimate the prevalence of chronic undernutrition

in a population survey using the classification system below

Classification of chronic underweight categories (Kg/m2) BMI

Normal >= 18.5

Grade 1 17.0-18.4

Grade 2 16.0-16.9

Grade 3 <= 15.9

In order to account for changes in body shape the Cormic Index (sitting

height/standing height) must be taken into account and standardised for,

when comparing the BMI of different populations.

MUAC may also be used to assess the prevalence of chronic

undernutrition at the population level

Screening severely undernourished adults

BMI is inappropriate for this purpose as it is affected by oedema and body

shape and difficult to measure in any particular situation. MUAC in

combination with clinical signs should therefore be used to screen adult

entrance into feeding centres using the following classifications.

For admission to therapeutic feeding centres

MUAC < 160 mm irrespective of clinical signs

MUAC 161-185 mm plus one of the following: . bilateral pitting oedema .

inability to stand . apparent dehydration

Famine oedema ( i.e. oedema demonstrable up to the knee) alone as

assessed by a clinician to exclude other causes.

Additional social factors can be included in the model. The relative

weighting of these must be determined locally; for example whether you

need one, two or three additional social factors to tip the balance in

favour of therapeutic rather than supplementary care.

For admission to supplementary feeding centres

MUAC 161-185 mm and no relevant clinical signs or few relevant social

criteria

These suggested standards should only be used as a starting point and

adapted according to the situation specific context.

Adolescents

The current WHO recommendations to compare the BMI of individual

adolescents with a reference population made up of adolescents in the US

using the 5th centile of this reference as a cut off point to define

undernutrition may not be appropriate. Surveys using these

recommendations have found unrealistically high levels of adolescent

undernutrition.

There are several difficulties with anthropometry in adolescents; for

example:

body proportions, including indices using weight and height

measurements change with age, making it necessary to compare an

individual to adolescents in a reference population who are of the same

age. As a result, age must be collected on persons screened for admission

to feeding programmes or measured as survey subjects. Adolescents in

many emergency affected populations do not accurately know their ages

body proportions change with sexual development. The age at which

sexual development occurs differs in different populations and

complicates the comparison of subjects from one population to

adolescents in a reference population

Possible solutions

These problems affect all anthropometric indices. The following

adjustments may allow better estimates:

better methods of assessing the age of attainment of key pubertal

landmarks may allow adjustment for difference in maturation age

between survey and reference populations.

Cormic Index may to some extent be used to adjust for ethnic differences

in body proportions - however this technique has not been studied in

adolescents.

a new international reference consisting of adolescents from 6 countries

and a new method of determining cut-off points may alleviate some of the

biases from using a reference population for a single country.

Preliminary recommendations

Until better methods can be developed and validated, screening for

severe undernutrition in order to determine the need for therapeutic

feeding should use clinical criteria.

In surveys, some correction for different ages of sexual maturation should

be carried out if the age of sexual maturation differs substantially

between the survey and reference population.

For pre-pubertal adolescents, weight for height could be used as the

anthropometric index and compared to revised weight for height tables

currently in use.

For post-pubertal adolescents, BMI could be used as the anthropometric

index and compared to a new international reference population.

Appropriate cut-off points could be used to identify malnourished

individuals.

Regardless of which index is used, cut-off points are age-specific; as a

result age should be collected as accurately as possible on all adolescents

measured during screening or survey activities.

The reference population of American adolescents, currently

recommended by WHO for use with BMI should not be used.

Adolescents should not undergo nutritional assessment in isolation. A

large discrepancy between the estimated level of undernutrition in

adolescents and other population subgroups should stimulate

investigation of the validity of the methods and results of the adolescent

assessment.

In order to assess the methods and comparability of surveys, all survey

reports should describe in detail the anthropometric index used, how

measurements were taken, which reference population was used, how

individuals were compared to this reference, and the cut-off points used

to define various degrees of undernutrition.

Approximately 20% of the population of the WHO South-East-Asia

(SEAR),
consists of adolescents. The foundation of adequate growth and

development is laid before birth, during childhood, and is followed during

adolescence. Adolescents are the future generation of any country and

their nutritional needs are critical for the well being of society. In SEAR, a

large number of adolescents suffer from chronic malnutrition and

anaemia,

which adversely impacts their health and development. The high rate of

malnutrition in girls not only contributes to increased morbidity and

mortality associated with pregnancy and delivery, but also to increased

risk of delivering low birth-weight babies. This contributes to the

intergenerational cycle of malnutrition.

In most developing countries, nutrition initiatives have been focusing

on children and women, thus neglecting adolescents. Addressing the

nutrition needs of adolescents could be an important step towards

breaking

the vicious cycle of intergenerational malnutrition, chronic diseases and

poverty. Epidemiological evidence from both the developed and

developing

countries indicates that there is a link between foetal under-nutrition and

increased risk of various chronic diseases during adulthood.

A review of the nutritional status of adolescents in Member Countries

of WHO’s South-East Asia Region has been undertaken to identify the

nutritional problems and to suggest relevant strategic interventions for

policy
makers. This review can be used to identify research gaps and serve as a

guide to researchers for undertaking research in priority areas to generate

evidence for strategic interventions.

Very few studies that provided data on nutritional status of adolescents

in the Region were available. Available literature on adolescent population

Executive Summary

vi

Adolescent Nutrition: A Review of the Situation in Selected South-East

Asian Countries

(sex-wise) covering literacy rate; average age at marriage; median age at

first pregnancy; pregnancy outcomes; nutrients and micronutrients

consumption and deficiency and anthropometric data among numerous

other parameters were studied. These were obtained from demographic

survey reports, national health surveys, conference proceedings, technical

reports and other published and unpublished scientific papers.

Demographic profile: Adolescents constitute about 20% of the total

population in countries of the Region with the exception of Sri Lanka and

Thailand where they comprise about 17% of the population. In all

countries,

male adolescents outnumber female adolescents. The illiteracy rate is

high

among adolescents in Bangladesh, Bhutan, India and Nepal, especially in

girls. A majority of older adolescents are not in school. Rural adolescents

are more likely to work and less likely to study than their urban

counterparts.

A large percentage of adolescents in the Region suffer from nutritional

deficiencies. Dietary intake with respect to adequate availability of food in

terms of quantity and quality (particularly, the mean caloric intake),

ability

to digest, absorb and utilize food and the social discriminations against

girls

can greatly affect the adequate nutrition of adolescents. Studies in India

and

Bangladesh have shown deficiencies in the intake of all nutrients,

particularly

iron, calcium, vitamin A and vitamin C. The reported reasons are mainly

the

low educational level of parents and low family income.

Studies conducted in different countries in the Region, reveal that

nutritional deprivation affects almost all growth parameters and final adult

body size resulting in thinness and stunting. However, nutritional status of

both boys and girls improved with age, showing that the effect of

malnutrition is more pronounced at the time of peak growth.

Obesity amongst adolescents is responsible for carrying weight-related

risks like cardiovascular diseases into adulthood. An Indian study has

shown
vii

Adolescent Nutrition: A Review of the Situation in Selected South-East

Asian Countries

that obese adolescents are more likely to develop hypertension later in

life as compared to their leaner counterparts. According to a Thai study,

over-consumption of calories, especially fast food, snacks and soft drinks

were contributing factors resulting in obesity and female adolescents were

more prone to this as compared to males.

Profile of nutritional status of children

and adolescents

The Australian Institute of Health and Welfare is Australia’s national

health and welfare statistics and

information agency. The Institute’s mission is better information and

statistics for better health and

wellbeing.

In this section, available data relevant to the dietary guidelines for

children and adolescents in Australia (NHMRC 2003) are presented in

relation to the recently published nutrient reference values (NRVs)

(NHMRC 2006) and the Australian guide to healthy eating (AGHE) (Smith

et al. 1998). From the NRVs, estimated average requirements (EARs) and

adequate intakes (AIs) are used, where applicable, to assess nutrient

intakes. EARs can be used at a population level to estimate the

prevalence of inadequate intakes within a group. The usage of AIs is

slightly different, with usual intakes at or above this level implying a low

prevalence of inadequate intakes (NHMRC 2006:3). It should be noted

that the age groups presented here vary slightly due to differences in the

age groups used for recommendations in the AGHE compared with the

NRVs.

Encourage and support breastfeeding

Breastfeeding has nutritional, health, social and economic benefits.

Evidence is mounting of the protective role breastfeeding may have in

several chronic diseases including Type 1 diabetes, inflammatory bowel

disease and allergic diseases (NHMRC 2003:6). Breastfeeding has also

been seen to play an important role in the prevention of obesity in

children, attributed to physiological factors in human milk as well as

feeding and patterns (extent and duration) associated with breastfeeding

(Krebs et al. 2003). Based on a conservative estimate, a minimum of

$11.5 million could be saved each year in Australia if the prevalence of

breastfeeding at 3 months was increased from the (then) current level of

less than 60% to 80% (Drane 1997 in NHPAC 2005:17). The dietary

guidelines suggest that an achievable goal is an initiation rate in excess of

90%, with 80% of mothers still breastfeeding at 6 months (NHMRC

2003:2) In 2004–05, 88% of infants aged 3 years and under had ever

been breastfed. This is similar to the proportions reported in 2001 and

1995 (Table 1). From the 2001 NHS, the proportion of infants breastfed at

6 months was 48%, and at 12 months was 23%. Fifty-four per cent of

infants aged 3 months or less were fully breastfed, and 32% at age 6

months or less (ABS 2003). These data are similar to those reported in

1995. ‘Fully breastfed’ refers to infants who receive only breastmilk on a

regular basis, which the World Health Organization recommends for

infants up to 6 months of age (WHO 2002).

Children and adolescents need sufficient nutritious

foods to grow and develop normally

Growth and development are an important part of childhood and

adolescence, and weight gain and increasing body size are normal

components of this process. Children need sufficient nutritious food, and

in particular sufficient energy, to enable this growth (NHMRC 2003:22).

However, it is also important to avoid over-nutrition. The median reported

energy intakes for children and adolescents from the 1995 NNS were

largely within the estimated energy requirement (EER) ranges (Table 2).

However, there was a significant proportion of children and youth who

reported consuming less than the EER range (particularly females aged 13

years and over). This may be due to the under-reporting of intake. It has

been suggested that up to one-third of the population under-report their

energy intake by up to 25% (Schoeller 2002)

Eat plenty of vegetables, legumes and fruits

People who consume diets high in vegetables, fruit and legumes (also

called ‘pulses’) have a substantially lower risk of coronary heart disease,

stroke, some cancers, hypertension, Type 2 diabetes mellitus, cataracts

and macular degeneration of the eye (NHMRC 2003:68). In 1996 it was

estimated that inadequate fruit and vegetable consumption (less than five

serves per day) was responsible for 3% of the total burden of disease and

11% of the total cancer burden in Australia (AIHW: Mathers et al. 1999).

It is likely that the protective effect of these foods against disease in later

life begins at an early age (NHMRC 2003:73). Data from the 2004–05

NHS shows that only around one-quarter to one-third of young people

report usually consuming adequate serves of fruit and vegetables (Table

3). The AGHE recommendations for children and adolescents are outlined

in Table 4. From the 1995 NNS, average fruit and vegetable consumption

among children and adolescents, measured by the 24-hour recall method,

appears to be below the recommended number of serves for almost all

age groups. However, it should be noted that this analysis excludes fruit

juice, and that the allocation of mixed foods to different food groups

based on weight (for example, only if the fruit part of a mixed food

constituted the major ingredient of the food was it classified under fruit

products) may affect these findings (McLennan & Podger 1998:48).

Consumption of fruit among Australian children and adolescents declined

with age among both males and females, while vegetable consumption

increased (Table 4). In addition, one quarter of children and adolescents

did not consume fruit on the day prior to the survey, and one-fifth did not

consume vegetables (Magarey et al. 2001).

Include lean meat, fish, poultry and/or alternatives

Lean meat, fish, poultry and alternatives are important sources of protein,

iron, zinc and

vitamin B12 for children and adolescents (NHMRC 2003:100).

‘Alternatives’ highlighted by

the dietary guidelines include eggs, liver, kidney, shellfish, legumes and

nuts. The

recommended number of serves is ½–1 for children aged 4–8 years, 1–

1½ for those aged

9–13 years and 1–2 for those aged 14–18 years. A serve equates to 65–

100 g of cooked meat or

chicken, half a cup (cooked) of dried beans, lentils, chick peas, split peas

or canned beans,

80–120 g of cooked fish fillet, two small eggs, one-third of a cup of

almonds or peanuts, or a

quarter of a cup of sunflower or sesame seeds.

Average intakes of meat, fish, poultry and alternatives increase with age

(see Table A2 for

details on consumption by age), as do median intakes of protein, iron and

zinc (Tables 6, 7,
9). Protein is important for growth and development, and from the 1995

NNS it can be seen

that Australian children were generally consuming much more protein

than the estimated

average requirement (EAR). Iron is essential in brain development in

infancy and very early

childhood. It continues to be important for brain function in later life, and

iron deficiency is

associated with fatigue. The most recent data for the prevalence of iron

deficiency among

children and adolescents in Australia (the 1985 National Dietary Survey of

Schoolchildren)

found that iron status was generally satisfactory in boys aged 9, 12 and

15 years and in girls

aged 9 and 12, but that 9.2% of 15-year-old girls were iron deficient

(English & Bennett 1990).

Zinc is also essential for growth and development and plays a role in

many metabolic

processes, as well as in immune function and cell growth and repair

(NHMRC 2003:107).

In 1995, the main sources of iron were cereals and cereal products, and

meat, poultry and

game products and dishes (Table 8). The main sources of zinc were meat,

poultry and game

products and dishes, and milk products and dishes (Table 10).

Among all children and adolescents surveyed in the 1995 NNS, very few

did not meet the

EAR for protein on the day prior to the 24-hour recall—10% of males and

females aged 14–18

years (Table 6). However, in relation to iron, 10% of 2–3 year olds,

around 14% of females

aged 9–13, and over 30% of females and 13% of males aged 14–18

years reported that they

did not consume enough to meet the EAR (Table 7). Thirteen per cent of

females aged 9–13,

44% of males and 25% of females aged 14–16, and 28% of males and

21% of females aged 17–

18 did not meet the EAR for zinc.

Include milks, yoghurts, cheese and/or alternatives

Milk and milk products or alternatives are good sources of nutrients—

particularly calcium,

but also protein, riboflavin, zinc, vitamin A and vitamin B12. The scientific

basis for this

guideline centres on the role of milk foods as a key source of calcium,

which is important in

attaining peak bone mass (thus preventing osteoporosis). It should be

noted that many types

of milk and milk products are fortified with calcium. However, milk foods

also provide

about one-third of the saturated fat in the diet of children and adolescents

(NHMRC

2003:124–7).

The AGHE (Smith et al. 1998) recommends 2 serves for children aged 4–

13 years and 2–2½

for those aged 14–18 years. A serve is equivalent to a cup of milk, half a

cup of evaporated

milk, 40 g of cheese, or 200 g of yoghurt. For ‘alternatives’, a serve

equals a cup of calciumand

vitamin B12-fortified soy beverage, a cup of almonds, five sardines or half

a cup of pink

salmon (with bones) or a cup of calcium-fortified breakfast cereal (NHMRC

2003:123).

Intakes of milk decreased with age, with a corresponding increase in

consumption of cheese,

frozen milk products and flavoured milks (see Table A3 for details on

consumption of milk

and milk products by age). In 1995, median intakes of calcium were

within or above the EAR

for all age groups except females aged 14–18 (Table 11), and most of the

calcium consumed
was from milk and milk products (Table 12). Of the children and

adolescents surveyed in the

1995 NNS, the older age groups had high proportions of both boys and

girls who did not

meet the EAR for calcium on the day prior to the 24-hour recall (AIHW

analysis). Most

notably, 50% of males and nearly 80% of females aged 14–18 years did

not meet the EAR.

Consume only moderate amounts of sugars and

foods containing added sugars

Sugar intake among children has been linked to dental caries, which

remains a significant

public health problem in Australia (NHMRC 2003:205–208). The dietary

guidelines report

that there is no evidence that consumption of up to 15–20% of energy as

sugars is

incompatible with a healthy diet. However, consumption of greater

amounts than this may

decrease nutrient density of the diet (NHMRC 2003:210).

From the 1995 NNS, it is evident that Australian children consumed more

than 15–20% of

their energy intake as sugar (Table 19). Proportionately more added

sugar than natural sugar

was consumed by children as their age increased. Males and females

consumed similar

proportions of their energy intake as sugar, although males consumed a

higher absolute

amount of sugar (Table 20).

By compiling existing data, this report provides a baseline regarding

children’s nutrition, in

preparation for the planned Kids Eat, Kids Play (KEKP) survey. The KEKP

(the national

children’s nutrition and physical activity survey) commenced in February

2007. This report

can also be used to inform the analysis and presentation of data from the

KEKP by

illustrating the data requirements for reporting against the dietary

guidelines. For example,

the benefit (and current lack) of data analysis relating to the number of

serves consumed for

the cereal, meat and dairy food groups, which would allow data to be

compared with

recommendations.

The data presented highlight some positive nutrition-related behaviours—

for example, the

proportion of mothers initiating breastfeeding is edging closer to 90%. In

addition, the

median intakes of many nutrients are close to the estimated average

requirements (EAR).

However, there are some concerning dietary behaviours that are apparent

when the data are

presented alongside the dietary guidelines and aligned to the new nutrient

reference values

(NHMRC 2006). In 1995, Australia’s children and adolescents reported

consuming a high

proportion of energy as fat and sugar, and not enough fruit and

vegetables. This is of

concern, as consumption patterns similar to this have been linked to a

high risk of chronic

disease (Jacobs & Steffen 2003; Hu et al. 2000). In addition, there was a

high proportion of

adolescents who did not meet the EAR for iron, zinc and calcium.

This report can inform the preparation for analysis and reporting of the

data from the KEKP

in a couple of ways. First, it suggests that data available from the 1995

NNS cannot be easily

compared with the current NRVs and dietary guidelines without re-

analysis. The new

analysis undertaken for this report relate to the new NRVs; calculating

median intakes for

different age groups to those reported previously and the proportion not

meeting the

estimated average requirement (EAR). However, in relation to the dietary

guidelines,

extensive analysis would be required for assessing 1995 NNS intakes

against the serves

recommended in the AGHE for cereal, meat and dairy food groups, which

was outside the

scope for this report. Second, in the data published by the ABS (ABS &

DHAC 1999), foods

are grouped according to the primary component of each food (for

example, if the cereal

component of a food comprised more than 50% then it was classified

under cereal-based

products and dishes). However, a food might contribute to more than one

food group (for

example, both cereals and fruits) and in order to determine the number of

serves consumed

from each food group (for example, in order to compare against

recommendations)

additional analysis would be required. Future work—for example, analysis

of the upcoming
KEKP—should ensure that assessment against food group

recommendations can be made.

While this report highlights the lack of recent data relating to children’s

nutrition, this

should be largely remedied by the planned KEKP. This survey will collect

information

relating to food and supplement intake, and data on macro- and

micronutrient intakes will

be reported. However, there is also a lack of data relating to food safety

among children, and

ways to fill this data gap should be investigated.

It should also be noted that in order to make appropriate comparisons,

there may be a need

to adjust 1995–2007 data to compensate for differences in data collection

periods (for

example, months of the year, days of the week), and possibly also to

ascertain the extent to

which changes in intake are due to differences in the food databases used

(which may not

reflect ‘real’ changes in food composition).

National Nutrition Survey (NNS), 1995

The NNS, conducted by the ABS and the Commonwealth Department of

Health, was the

first nationally representative Australian survey of food and nutrient

intake, dietary habits

and body measurements. The survey collected information from a

subsample of respondents

from the 1995 NHS, approximately 13,800 people from urban and rural

areas of Australia.

The NNS was conducted over a 13-month period from February 1995 to

March 1996

(McLennan & Podger 1998).

The NNS included a detailed 24-hour dietary recall (which provided a valid

estimate of

mean and median population food and nutrient intakes), questions on

food habits and

attitudes, and a food frequency questionnaire. In addition, blood pressure

(of those aged

16 years and over), height, weight, and waist and hip circumferences

were measured by

trained interviewers.
 Chapter 3

RESEARCH METHODOLOGY

This chapter presents the methodology that was used in the conduct of the

study and was included in the discussion of research design, samplings,

respondents, data gathering and statistical instrument used.

The Research Design

The study used a non random purposive survey design in its attempt to

determine the nutritional status of first year education students in Xavier University.

Samplings and Respondents

The respondents were the Freshmen Education Students who were enrolled

during the first semester of the school year 2009-2010 at Xavier University. The

sample population was 62 students regardless of their specialization and gender

since the research design was a non-random purposive survey.

Research Setting

The place for the research was in the Xavier University campus, specifically in

or at the area where the target respondents and were available for answering the

survey sheet. Possible places within the school were classrooms, canteen, library,

etc.

Data Gathering Procedure

Non-random purposive sampling was used to get the respondents. The

researchers gave questionnaires to anyone who was qualified as a respondent.

Then the researchers gave the nutritional status survey questionnaire to the selected

respondents in which they answer the question with honesty.

E. Instruments Used

The main tool was a set of research made questionnaire composed of 35 item

questions used to measure the nutritional status of the first year education Freshmen

Students. There were 15

item questions for food consumption, 10 items for meal pattern and planning, 5 items

for physical activity and exercise, and 5 items for personal and environmental

sanitation. This tool was used in gathering data and necessary in formations on the

Adolescent nutritional status. Through the used of this questionnaire, information

was being gathered regarding the profile of the respondents like food consumption,

meal pattern and planning, physical activity or exercise, and personal and

environmental sanitation.
Scoring Procedure

For food consumption, there will be 15 items and all shall be answered by only “Yes”

or “NO” and is coded 1 and 0 respectively. For Meal pattern and planning, there will

be 10 items to be answered shall be answered by “Yes” or “No” and is also being

coded as 1 and 0 respectively. For physical activity or exercise, there are 5 items to

be answered by “Yes” or “ No” and is to be coded as 1 and 0 respectively. The

same procedure shall be applied for personal and environmental sanitation.

CHAPTER 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter provides a presentation, analyses, and interpretation of data

gathered from the first year education students of Xavier University. The data

involves the respondents’ nutritional status based on the answered questionnaire.

Problem 1. What is the status of the respondents with respect to:

a. Food Consumption

b. Meal Pattern and Planning

c. Physical Activity or Exercise

d. Personal and Environmental Sanitation

Problem 2. What is the over all adolescent nutritional status?

Problem 1: What is the status of the respondents with respect to:

a. Food Consumption

FoodConsumption
number of respondents

62

52
42
42

32

20
22

12

2
1 2
good poor

Series1

b. Meal Pattern and Planning

 Meal PatternandPlanning
number of respondents
62

52

42
34
32 28 Series1

22

12

2
1 2
good poor

c. Physical Activity or Exercise

Physical Activity or Exercises

Number of respondents

62

52

42
33
29
32 Series1

22

12

2
1 2
good poor

d. Personal and Environmental Sanitation

 Personal and Environmental Sanitation
number of respondents

70 62
60
50
40
Series1
30
20
10
0
0
1 2
good poor

General Average

62
number of respondents

52
44
42

32 Series1

22 18

12

2
1 2
good poor