Anemia and hemoglobin concentrations and their association with minimum dietary diversity among adolescents aged 15-19 in India
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Abstract
Background: Adolescence, from age 10 to 19 years, is a critical period for peak physical growth and development, but also a vulnerable time for nutritional deficiencies, including anemia. Preventing and treating anemia during adolescence is crucial for optimal health outcomes. The objective of this study was to: (1) determine the prevalence and correlates of anemia, and (2) examine whether minimum dietary diversity (MDD) is associated with anemia among adolescents aged 15-19 years in India. Methods: This cross-sectional study used data from the Comprehensive National Nutrition Survey (CNNS) 2016-2018, which included sociodemographic, anthropometric, and dietary information from a nationally representative sample of Indian adolescents aged 15-19 years (n=6780). Logistic and linear regressions were used to identify correlates and also examine the associations of anemia and hemoglobin (Hb) concentrations with MDD, respectively. Sex-stratified analyses were also performed. Results: Anemia was widely prevalent (33%), with significantly higher rates in females (47.5%) compared to males (18.0%). Being a member of the scheduled tribes was associated with higher odds of anemia and lower Hb concentrations both in total population and sex-stratified analyses. In the total population only, iron folic acid (IFA) supplementation and starchy staples consumption were associated with higher odds of anemia and lower Hb concentrations, while consumption of meat, poultry, fish, and aerated drinks were associated with lower odds of anemia and higher Hb concentrations. In males, anthropometric status <-2SD for body mass index-for-age z-score (BMIZ), mid-upper arm circumference-for-age z-score (MUACZ), and waist circumference z-score (WCZ) were associated with higher odds of anemia and lower Hb concentrations, while highest wealth index was associated with lower odds of anemia and higher Hb concentrations. In females, consumption of dairy was associated with higher odds of anemia and lower Hb concentrations. Meeting MDD was significantly associated with lower odds of anemia in males (unadjusted analysis), and higher Hb concentrations in females (adjusted analysis). Conclusion: Our findings suggest that there are sex-specific risk factors for anemia, which may require tailored interventions. Promoting a diverse diet may help improve Hb concentrations among some adolescents. These findings underscore the need for comprehensive, tailored interventions to address the complex, multifaceted factors associated with anemia and lower Hb concentrations among adolescents in India.