Measuring the Nutrition Transition among Adolescents in India Open Access

Shaikh, Nida Izhar (2016)

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Nutrition transition, shifts in dietary patterns accompanying globalization and urbanization, are contributing to the emergence of nutrition-related chronic diseases in low- and middle-income countries, including India. Nutrition transition-related changes are believed to comprise shifts towards diets high in fat, sugar, and salt; these are also risk factors for chronic diseases. Little is known about the nutrition transition among adolescents, partly due to lack of appropriate data and metrics. The aim of this dissertation was to measure the nutrition transition among adolescents in India, home to 13.5% of the world's adolescents. First, dietary patterns were assessed in a representative sample of 399 school-going adolescents ages 13-16 years in a globalizing region in South India. Next, a comprehensive Nutrition Transition-Food Frequency Questionnaire (NT-FFQ), including a 125-item semi-quantitative FFQ and 27-item eating behavior questionnaire, was developed and evaluated for its reproducibility and validity to measure nutrition transition against three 24-hour dietary recalls in a sub-sample of 198 adolescents. Lastly, a pre-defined Nutrition Transition-Diet Score was developed using nutrition transition literature and dietary guidelines to measure nutrition transition, and evaluated for its validity against empirical dietary patterns derived from responses to the NT-FFQ. Adolescents' dietary patterns reflect a combination of global/non-local and traditional foods and can be categorized into three patterns; global, animal-source, and traditional (factor loadings ≥0.4). Compared with recommended guidelines, adolescents consumed higher-than-recommended energy-dense foods and lower-than-recommended dairy, fruits, and vegetables. Gender and school type were the main predictors of dietary patterns. The NT-FFQ showed good reproducibility and validity for most foods and eating behaviors and can measure nutrition transition among adolescents. The Nutrition Transition-Diet Score (mean 5.6 ± 1.2, range 0-10) included 10 components (7 food groups and 3 nutrients) and had good construct validity against empirical Global Diet pattern (factor 1; 60% concordance, 5% discordance, and Pearson correlation=.59, pdolescents' dietary patterns in a globalizing Indian region reflect unhealthy and healthy nutrition transition features. Validated instruments, NT-FFQ and Nutrition Transition-Diet Score can effectively measure nutrition transition and can be utilized in programs and policies to improve adolescent health.

Table of Contents

Table of Contents
CHAPTER 1: Introduction 1
Research Aim 1 5
Research Aim 2 6
Research Aim 3 6
CHAPTER 2: Background 17
Global Nutrition Transition 17
Nutrition Transition in India 20
Adolescent Health and Nutrition Transition 27
Nutrition Transition among Adolescents in India 29
Eating Behaviors of Adolescents in India 31
Measuring Nutrition Transition 33
Summary 38
CHAPTER 3: Methods 56
CHAPTER 4: Going global: Indian adolescents' eating patterns 61
Abstract 62
Introduction 64
Methods 67
Results 71
Discussion 74
Conclusions 79
Acknowledgements 80
References 81
Tables 87
CHAPTER 5: Development and Evaluation of a Nutrition Transition-Food Frequency Questionnaire for Adolescents in South India 93
Abstract 94
Introduction 96
Methods 97
Results 105
Discussion 108
Conclusions 114
Acknowledgements 115
References 117
Tables and Figures 124
CHAPTER 6: Development and Validation of a Nutrition Transition-Diet Score for Adolescents in India 136
Abstract 137
Introduction 139
Methods 142
Results 150
Discussion 152
Conclusions 156
Acknowledgements 157
References 158
Tables and Figure 167
CHAPTER 7: Summary and Conclusions 173
Main findings 173
Limitations 175
Strengths and Innovations 177
Next steps in developing validated dietary instruments to measure nutrition transition 178
Public Health Implications 180
Future Directions 182
Summary 184
References 185
Appendix A: Nutrition Transition-Food Frequency Questionnaire (NT-FFQ) 190
Appendix B: 24-hour Dietary Recall template 205
Appendix C: Article Attachment 210

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