Nutrition in Adolescence: Dietary Intake and Micronutrient Status from Diverse Geographical Settings and Food Environments Restricted; Files Only
Jenkins, Mica (Spring 2024)
Abstract
Adolescents are vulnerable to micronutrient deficiencies due to their heightened nutrient requirements. Nutrition profiling is needed to improve the health and maximize the potential of this vulnerable group. The purpose of this dissertation is to characterize adolescent nutrition using data from two diverse countries – the United States and Ghana – and create individual- and school-level metrics to inform on adolescent nutrition. Using data from the United States, I describe food group consumption patterns, quantify dietary diversity and mean probability of nutrient adequacy (MPA), and create a food group-based adolescent dietary diversity score (ADDS) and dichotomous indicator. For Ghana, I describe food-related behavior among in-school adolescents, quantify dietary diversity, create an ecologic school food environment score (FES), and explore associations between this score and adolescent-level nutrition outcomes.
Among United States adolescents, I found significant differences in food group consumption by sex, race/ethnicity, and income status. ADDS was 4.7 and MPA was at the 79th percentile. Food group intake was positively associated with MPA, age and body mass index were negatively associated with MPA, and energy intake was a significant confounder of this relationship. A dichotomous cutoff of 6 food groups in a given day was identified as a proxy for nutrient adequacy among adolescents in the United States.
In Ghana, ADDS was 4.3. Crude anemia prevalence among girls and boys was 22% and 11%, respectively. The number of food groups available on campus and the FES differed by school level (i.e., junior and senior high school). There were significant differences in ADDS and the proportions achieving dietary diversity cutoffs by school level and by wealth status. Higher FES was associated with greater ADDS and a larger proportion consuming > 5 food groups among senior high school students, and with lower anemia prevalence in both girls and boys.
While mean food group intake is similar in the United States and Ghana, the population burden of anemia is much higher in Ghana, illustrating the importance of integrated programming using a combination of nutrition-specific and nutrition-sensitive approaches to combat the multiple causes of malnutrition.
Table of Contents
Contents
Acknowledgments. vi
List of Figures. ix
List of Tables. x
Chapter 1: Introduction. 1
Chapter 2: Overview of Methods. 6
2.1 Data Sources and Populations. 6
2.2 Data Collection and Data Management 7
2.3 Statistical Methods and Data Analysis. 9
2.4 Alternate Study Designs and Analytic Strategies. 10
Chapter 3: What Do United States Adolescents Eat? Food Group Consumption Patterns and Dietary Diversity from a Decade of Nationally Representative Data. 19
3.1 Introduction. 21
3.2 Methods. 23
3.3 Results. 25
3.4 Discussion. 28
3.5 Conclusion. 32
3.6 Tables and Figures. 33
Chapter 4: Development of a Population-level Dichotomous Indicator of Minimum Dietary Diversity in U.S. Adolescents Aged 10–19 Years. 44
4.1 Introduction. 46
4.2 Methods. 48
4.3 Results. 52
4.4 Discussion. 54
4.5 Conclusion. 58
4.6 Tables and Figures. 60
Chapter 5: The School Food Environment in Ghana is Associated with Dietary Diversity and Anemia: Findings from the 2022 National Nutrition and Health Survey of In-school Adolescents. 77
5.1 Introduction. 79
5.2 Methods. 80
5.3 Results. 82
5.4 Discussion. 84
5.5 Conclusion. 87
5.6 Tables and Figures. 88
Chapter 6: Expanded Discussion. 107
6.1 Summary of findings. 107
6.2 Relevance of Findings to Nutrition Programs and Policies. 109
6.3 Strengths and Challenges. 112
6.4 Remaining Research Gaps. 113
6.5 Conclusions. 115
About this Dissertation
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File download under embargo until 22 May 2025 | 2024-04-04 15:10:49 -0400 | File download under embargo until 22 May 2025 |
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