Dietary diversity and social determinants of nutrition among late adolescent girls in rural Pakistan

Authors

Jo-Anna B. Baxter, Hospital for Sick Children, Toronto, Ontario, Canada
Yaqub Wasan, Aga Khan UniversityFollow
Muhammad Islam, Hospital for Sick Children, Toronto, Ontario, Canada
Simon Cousens, London School of Hygiene and Tropical Medicine, London, UK.
Sajid Bashir Soofi, Aga Khan UniversityFollow
Imran Ahmed, Aga Khan UniversityFollow
Daniel W. Sellen, Hospital for Sick Children, Toronto, Ontario, Canada
Zulfiqar Ahmed Bhutta, Aga Khan UniversityFollow

Document Type

Article

Department

Centre of Excellence in Women and Child Health

Abstract

The conditions in which adolescent girls mature shape their health, development and nutrition. Nutrient requirements increase to support growth during adolescence, but gaps between consumption and requirements exist in low- and middle-income countries. We aimed to identify and quantify the relationship between dietary intake and diverse social determinants of nutrition (SDN) among a subset of adolescent girls 15-18.9 years (n = 390) enrolled within the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The primary outcome, dietary diversity score (DDS), was derived by applying the Minimum Dietary Diversity for Women 10-item scale to 24-h dietary recall data collected three times per participant. To examine the associations between the SDN-related explanatory variables and DDS, we generated a hierarchical, causal model using mixed effects linear regression to account for the cluster-randomized trial design. Using all data, diets lacked diversity (DDS mean ± SD: 3.35 ± 1.03 [range: 1-7; n = 1170]), and the minimum cut-off for dietary diversity was infrequently achieved (13.5%; 95% CI: 11.6-15.6%). Consumption of starches was reported in all recalls, but micronutrient-rich food consumption was less common. Of the SDN considered, wealth quintile had the strongest association with DDS (P < 0.0001). The diets of the sampled Pakistani adolescent girls were insufficient to meet micronutrient requirements. Poverty was the most important predictor of a diet lacking in diversity, indicating limited purchasing power or access to nutritious foods. Dietary diversification and nutrition education strategies alone are unlikely to lead to improved diets without steps to tackle this barrier, for example, through fortification of staple foods and provision of supplements.

Comments

Volume, issue, and pagination are not provided by the author/publisher

Publication (Name of Journal)

Maternal & Child Nutrition

Recommended Citation

Baxter, J. B., Wasan, Y., Islam, M., Cousens, S., Soofi, S., Ahmed, I., Sellen, D. W., Bhutta, Z. A. (2021). Dietary diversity and social determinants of nutrition among late adolescent girls in rural Pakistan. Maternal & Child Nutrition, e13265.
Available at: https://ecommons.aku.edu/coe-wch/31

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.