Approximately 20% of the population of India consists of adolescents. Adolescents are the future generation of any country and their nutritional needs are critical for the well being of society. The phenomenal growth that occurs in adolescence, second only to that in the first year of life, creates increased demands for energy and nutrients. Almost 40% adolescents suffer from chronic undernutrition, which adversely impacts their health and development. The high rate of malnutrition in girls not only contributes to increase 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.
Addressing the nutrition needs of adolescents could be an important step towards breaking the vicious cycle of intergenerational malnutrition, chronic diseases and poverty. Good nutrition during adolescence is critical to cover the deficits suffered during childhood and should include nutrients required to meet the demands of physical and cognitive growth and development, provide adequate stores of energy for illnesses and pregnancy, and prevent adult onset of nutrition-related diseases.
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, ability to digest, absorb and utilize food and the social discriminations against girls can greatly affect the adequate nutrition of adolescents. Studies in India 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.
Obesity is a growing problem in India. 7-9% all of cases of obesity worldwide found among Indian urban families. An Indian study has shown that obese adolescents are more likely to develop hypertension later in life as compared to their leaner counterparts. Obesity amongst adolescents is responsible for carrying weight-related risks like cardiovascular diseases into adulthood. Over-consumption of calories, especially fast food, snacks and soft drinks were contributing factors resulting in obesity.
Anaemia has a serious negative impact on growth and development during adolescence. A high rate of iron deficiency anaemia is reported among adolescents in our country. Adolescent mothers bear a double burden: one involving their own growth and development, and another involving the intra-uterine growth and development of their offspring. The limited studies carried out in India showed a high prevalence of malnutrition among pregnant adolescents. Programmes addressing adolescent nutrition in our country are very few and are undertaken on a small and experimental basis. They are mainly aimed at the prevention and control of anaemia among adolescents.
The main strategies suggested for improving adolescent nutrition include: food-based strategies like dietary diversification and food fortification, for ensuring adequate nutrition at household level; addressing behaviour modification to bring about dietary change in adolescents. This can be achieved through school-based nutrition interventions, using a social marketing approach, behaviour change through communication and mobilizing families and communities; control of micronutrient deficiencies; regular nutrition assessment and counselling of adolescents; care of adolescents during pregnancy and postnatal period; intersectoral linkages at community level. Public private partnership model would be a good choice for providing adolescent friendly health services by involving NGOs like IAAH working for the betterment of adolescents. They would help in policy making and also in providing services to the adolescents.
Adolescent nutrition can be addressed as part of existing maternal and child nutrition programmes. The health sector should play the major role in integrating adolescent nutrition in other programmes and also mainstream it in other sectors e.g., education, social welfare, food and agriculture, mass media, and the legal sector. The major actions required from the health sector are: developing database regarding health and nutrition of adolescents; designing advocacy material; formulating policy guidelines and strategies to improve adolescent nutrition; developing an integrated and intersectoral approach to address nutritional problems of adolescents; development of adolescent-friendly health centres catering to the holistic needs of adolescents; mainstreaming adolescent nutrition in the health systems and reaching the unreached out-of-school adolescents with nutrition interventions. It is also necessary to equip the service providers with knowledge, skills, particularly counselling and communication skills, and developing appropriate training methodologies and tools for training.
The UN and other international and national agencies and NGOs working at the regional level should increase commitment and advocacy for improving adolescent nutrition, share knowledge and information with the countries in the Region, build capacity of providers, support and encourage research and provide support to Member Countries for developing locally defined anthropometric cut-offs.
Closing the gaps, both in research and in action, would benefit society as a whole, resulting in improved health and nutrition of adolescents and help in harnessing their full physical and mental potential for overall improvement of the population.
Dr Tulika Singh
Senior Resident Community Medicine