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Diet and Eating Practices Among Adolescent Girls in Low- and Middle-Income Countries a Systematic Review

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Diet and Eating Practices Among Adolescent Girls in Low- and Middle-Income Countries a Systematic Review Diet and Eating Practices among Adolescent Girls in Low- and Middle-Income Countries A Systematic Review FEBRUARY 2018 EMILY C. KEATS, AVIVA RAPPAPORT, REENA JAIN, CHRISTINA OH, SHAILJA SHAH, ZULFIQAR A. BHUTTA ABOUT SPRING The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project is a seven-year USAID-funded cooperative agreement to strengthen global and country efforts to scale up high-impact nutrition practices and policies and improve maternal and child nutrition outcomes. The project is managed by JSI Research & Training Institute, Inc., with partners Helen Keller International, The Manoff Group, Save the Children, and the International Food Policy Research Institute. RECOMMENDED CITATION Keats, Emily C., Aviva I. Rappaport, Reena Jain, Christina Oh, Shailja Shah, Zulfiqar A. Bhutta. 2018. Diet and Eating Practices among Adolescent Girls in Low- and Middle-Income Countries: A Systemic Review. Arlington, VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project. DISCLAIMER This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-11-00031, SPRING, managed by JSI Research & Training Institute, Inc. (JSI). The contents are the responsibility of JSI, and do not necessarily reflect the views of USAID or the U.S. Government. SPRING JSI Research & Training Institute, Inc. 1616 Fort Myer Drive, 16th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: [email protected] Internet: 35Twww.spring-nutrition.org35T COVER ILLUSTRATIONS: Victor Nolasco for SPRING 46TDiet and Eating Practices among Adolescent Girls in Low- and Middle-Income Countries A Systematic Review Emily C. Keats, Aviva I. Rappaport, Reena Jain, Christina Oh, Shailja Shah, Zulfiqar A. Bhutta ABSTRACT Adolescent girls in low-and middle-income countries (LMIC) have poor nutrition profiles, including high risks for undernutrition, overweight/obesity, and micronutrient deficiencies. To better understand the current dietary intake and practices of adolescents in LMIC, we undertook a large-scale systematic review. We identified 288 studies which passed the inclusion and exclusion criteria. Foods were grouped according to an adapted version of the Food and Nutrition Technical Assistance (FANTA III) Minimum Dietary Diversity Guide for Women. We found that the diet quality of adolescent girls in LMIC is generally poor. Fruit and vegetable intake is vastly inadequate, and girls are consuming high-fat and calorie-rich foods that are likely to be contributing to the rise in overweight and obesity, especially among younger adolescents (10–14 years). In South Asia and Africa, protein intake is inadequate and fat intake is low—factors which may contribute to the prevalence of underweight in these regions. Overall, breakfast skipping and snacking are highly prevalent among adolescent girls of all ages. Along with obesity prevention initiatives, school-based policies should be mandated to limit the availability of unhealthy foods throughout the day. School meal programs should be considered for vulnerable or low-income populations. KEY MESSAGES* • A slightly higher proportion of younger adolescents (10–14 years) are overweight or obese compared to older adolescents (15–19 years). • For most regions, with the exception of South Asia and Europe and Central Asia, overweight and obesity prevalence surpasses that of underweight. • Energy-dense foods, including sweet and salty items, sugar sweetened beverages, and fast foods, are widely consumed • Significant differences exist among adolescent girls in different regions. For example: o 90 percent of adolescent girls in South Asia do not consume an adequate diet of fruits or vegetables o 40 percent of adolescent girls in Latin America and the Caribbean consume fast/convenient foods daily. • Protein intake is inadequate among older adolescents in Africa • Energy intake is lowest for urban poor populations. • 50 percent of adolescent girls in LMIC do not eat 3 meals per day; most skip breakfast. • Snacking (eating/drinking between meals) is common, and takes place during school hours. • Lunch is consumed away from the home; compared to younger adolescents, older adolescents are more likely to eat away from home on a daily basis. *Note: All findings pertain to adolescent girls. Boys were not included in this review. Diet & Eating Practices of Adolescents in LMIC TABLE OF CONTENTS ACRONYMS ............................................................................................................. vii STUDY OVERVIEW ................................................................................................... 1 OBJECTIVES ............................................................................................................. 2 CONCEPTUAL FRAMEWORK .................................................................................. 2 OUTCOMES OF INTEREST ...................................................................................... 4 METHODS .................................................................................................................. 4 Search Strategy .......................................................................................................... 4 Study Selection ........................................................................................................... 4 Data Synthesis and Analysis ...................................................................................... 5 BMI Status ................................................................................................................... 6 Energy and Macronutrient Intake ................................................................................ 7 Dietary Intake .............................................................................................................. 7 Meal Patterns .............................................................................................................. 8 Underlying Determinants ............................................................................................ 8 Quality Assessment .................................................................................................... 9 BMI Status ................................................................................................................. 15 Macronutrient Status ................................................................................................. 18 Energy Intake ............................................................................................................ 22 Dietary Intake of All Food Groups ............................................................................. 25 Place of Meal Consumption ...................................................................................... 57 Meal Patterns ............................................................................................................ 60 Macronutrient Status and Urban/Rural Residence, Socioeconomic Status, and Gender Inequality ...................................................................................................... 66 DISCUSSION ............................................................................................................ 66 Study Limitations ....................................................................................................... 66 Study Implications ..................................................................................................... 68 RECOMMENDATIONS ............................................................................................ 74 CONCLUSIONS ....................................................................................................... 76 ACKNOWLEDGEMENTS ........................................................................................ 76 REFERENCES ......................................................................................................... 77 APPENDIX I .............................................................................................................. 99 APPENDIX II ........................................................................................................... 154 Figures Figure 1. Conceptual Framework for Adolescent Girls’ Nutrition ................................ 3 Figure 2. PRISMA Flow Diagram for Study Selection .............................................. 10 Figure 3. Countries Represented by Our Included Studies (N=number of studies) . 12 Figure 4. Mean BMI for Adolescents (10–19), by Region ......................................... 16 Figure 5a. BMI Status for Adolescents (10–19) ........................................................ 16 Figure 5b. BMI Status among Adolescents (10–19), by Region ............................... 17 v Diet & Eating Practices of Adolescents in LMIC Figure 6. Prevalence of Inadequate Fruit and Vegetable Consumption among Adolescent Girls (10–19) .......................................................................................... 42 Figure 7. Common Foods Consumed by Brazilian Adolescent Girls (Ages 12-17 Years) ................................................................................................... 55 Figure 8. Proportion of Adolescents (10–19) Consuming Various Foods and Daily Consumption (of Those Who Reported Consuming the Food) ................ 56 Figure 9. Frequency
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