This study explored and described the factors contributing to the dietary diversity and nutritional status of adolescents among girls (56.7%) and boys (43.3%) in the urban slums of Bangladesh. Regarding nutritional status according to the BMI-for-age Z score, we found that most (66.2%) of the participants were of normal weight, 11.1% were thin, and 22.7% were overweight and obese. Among the normal weight participants, 71.2% were girls and 59.6% were boys. A previous study in which a normal body weight was measured was conducted in Bangladesh (73%) (15). There is growing evidence that the pattern of dietary intake and the incidence of obesity in the developing world have been accelerating over the last few years (16). In Nigeria, the incidence of thin individuals was 20.1%, while obesity was prevalent in 3.2% of adolescents (16), which was dissimilar to our findings. Differences in sociodemographic characteristics might influence the variation (15). In addition, the BMI-for-Z scores of adolescent girls and boys in urban slums were associated with sex, age, education, education, education, education, occupation, and nonsmoking behaviors. Previous research revealed that the educational and occupational status of parents was associated with the nutritional status of adolescents (15). Similarly, in previous research, sex was shown to be positively correlated with BMI Z scores (17).
This research showed that 38.4% of adolescent girls had a low dietary diversity score, which is lower than that reported in a study performed in southern Ethiopia, in which 46.8% of adolescent girls had a low dietary diversity score. However, our findings were greater than those of research performed in Gondar (25.5%) (18). Most of the adolescents reported eating large quantities of grains, other vegetables and fruits or consuming moderate amounts of vitamins and micronutrients (vitamin A-rich vegetables and fruits, milk and milk products). Rice intake was almost universal in our sample, which is consistent with prior research in rural Bangladesh (19). This study revealed that the prevalence of milk and milk product intake was 12.4%, whereas it was less than 37.25% in India, 79.2% in Iran, and 26.5% in the Tigray region. The socioeconomic differences between the research participants and study locations might account for this difference (9). A higher DDS is not inherently linked to greater weight gain since it may be caused by a rise in the intake of low-calorie foods such as vegetables, whole grains, and fruit (20). Although just one tableful of food was necessary to obtain a point, measuring intake in this manner is problematic in a situation where family members shared meals from a single bowl (19). However, further studies are needed to focus on the dietary patterns of adolescents in urban slums, and additional steps should be taken.
These findings showed that sociodemographic factors, such as adolescents' education, fathers' education and occupation, mothers' education, families' monthly income, and nonsmoking family history, may influence adolescent dietary diversity.
This report showed that more than half of the adolescent girls and boys (59.07%) consumed a variety of foods. These results were greater than those reported by developing countries, such as Iran (26.55%), Zimbabwe (11.2%), and Adama city (41. 2%), the Gurage Zone (26.8%), the Amhara region (21. 8%) (5). The nature of the study could also explain why people in this study area eat a wide variety of foods. In our research, the prevalence of insufficient DD was lower (44.3%) among adolescent boys than among adolescent girls. Our study showed that boys were less likely to have inadequate DD, which is in contrast to the findings of previous studies conducted in Bangladesh (21). Moreover, a longitudinal, multicountry study demonstrated that DDs were slightly lower among teenage boys than among girls in India; however, this difference was not statistically significant (22). In the present study, there was a greater likelihood of having insufficient DD among girls than among boys due to the culture of gender discrimination in lower socioeconomic families in our country. An awareness campaign on gender discrimination and adequate food habits should be promoted to reduce insufficient dietary practices among adolescent girls.
The current study revealed that DD was considerably greater among adolescent boys and girls with no schooling or who did not finish primary school than among those with at least secondary education. In the majority of prior studies on adolescents' nutritional consumption, education level was not studied as a determinant of adolescents’ DD (21). The possible reasons for the association between not schooling and adequate dietary diversity are that adolescents who never went to school or had less education may have enough time to remain at home and receive proper care from their parents.
A lower education level, which included both maternal and paternal education (paternal education was strongly correlated with maternal education), was a major predictor of insufficient DD for both boys and girls according to a previous study conducted in Bangladesh (23). Prior research revealed that maternal education is a greater predictor of adolescent nutritional quality than paternal education is (21). Educated parents are more likely to have greater nutritional knowledge and awareness and to be financially well off, which may be evident in the quality of their children's diets (22). However, further research on the association between parental education and healthy eating patterns in adolescents is needed.
A high socioeconomic level is essential for enhancing household and individual dietary diversity. Due to the greater accessibility of media sources (20), adolescents living in wealthier families may have increased access to nutrition knowledge. The adequate dietary diversity of adolescents with a middle or higher economic status was 2.33 times greater than that of adolescents with a lower economic status. There was a considerable correlation between SES and the possibility of adequate DD. Usually, poor individuals lack access to a variety of foods. Access is essential, but understanding food-based dietary standards will likely have a greater impact. Moreover, it is apparent that dietary diversification requires higher costs (20). Our findings indicated that adolescent girls and boys from lower-income families were more likely to have insufficient DD than girls and boys from higher-income families were. Many other studies in Bangladesh have shown similar results. Several researchers have found that having a low asset quintile, a low socioeconomic status, a low household expenditure (16), a low income, and a low wealth score increased the likelihood of having insufficient DD among adolescents (23). Compared to a similar study in a neighboring country, individual dietary diversity scores were found to be adequate (22). Further longitudinal and qualitative studies are recommended in both urban and rural slums to understand the dietary patterns of adolescents and the associated factors.
Limitations
As this was a cross-sectional urban slum study, longitudinal research is needed to assess the exact dietary diversity and health status of adolescents in urban slums. The fact that the third installment of the FAO standards for evaluating household and individual dietary variety was only used for the previous 24 hours may not be a true picture of adolescents’ habits. The data were acquired via self-reports and did not include qualitative information such as meal size and food cleanliness. The evaluation of a family’s economic condition was either straightforward or accurate since, in general, families do not represent their true economic situation owing to concerns about taxes and other social issues. Additionally, because of the COVID-19 situation, we could not collect data from all divisions, so generalization is not possible.