Nutritionists fight adolescent malnutrition in developing countries

Malnutrition in adolescents in developing countries is a significant, but often overlooked issue that researchers at the Friedman School are working to address.

F. James Levinson, associate professor and director of the International Food and Nutrition Center at the Friedman School, and his colleagues are helping to assess efforts undertaken by Bangladesh and Tanzania to improve the health of their teen populations. While a great deal of research has been conducted on malnutrition in children and adults in developing countries, there are only a handful of studies on adolescent malnutrition.

What little research exists indicates that “stunting is highly prevalent among adolescents, and younger adolescents tend to be more undernourished than older adolescents,” the researchers wrote in a peer-reviewed publication of the United Nations System Standing Committee on Nutrition. “And contrary to expectations, boys are almost twice as undernourished as girls.”

Researchers face a number of challenges in determining the number of adolescents who are underweight. “Due to the wide range of variations in the onset of puberty and the resulting growth spurt, determining adolescent nutrient requirements should be based on physiological or maturation age, as opposed to chronological age,” the researchers wrote.

“Adolescents can gain 15 percent of their ultimate adult height and 50 percent of their adult weight in this time period,” Levinson said. “They simply need more nutrients to support that growth and to become healthy adults.”

The authors point to programs in Bangladesh that demonstrate the potential for government-driven solutions. The Bangladesh Integrated Nutrition Project developed the Adolescent Girls Forum, which focused on teaching young women about healthy diets, reproductive health, delaying pregnancy and women’s rights, while the Newly Married Couples initiative helped young women through their first pregnancy. It is preferable for adolescent girls to attain full growth prior to their first pregnancy because pregnancy places severe nutritional demands on the body, the Tufts authors wrote.

The Adolescent Girls Forum was successful in delaying the average age of marriage by five months and the average age of the first pregnancy by more than seven months, Levinson said. “Adolescent girls … were significantly more aware of the importance of adequate food intake, rest, as well as of the importance of initiation and optimal length of breastfeeding than adolescents in control areas,” the U.N. report says.

Based on the success of the program for adolescent girls, the Bangladesh Rural Advancement Committee, the nation’s largest NGO, is exploring new programs that will focus on male adolescent health as well as educating young men on women’s reproductive health, women’s rights and infant and child care.

In Tanzania, two issues are driving increased awareness of adolescent malnutrition. “Part of this is simple demographics because almost 23 percent of the population is teenagers,” Levinson said. The other driving force is AIDS, a leading cause of death in young people in Tanzania and in many other African nations.

“Recognizing that the country’s future—its leaders, labor pool, parents, caregivers and providers—will emerge from this group [adolescents]...there is a growing commitment in Tanzania to invest in adolescents with a view to attaining a healthier and more productive adult population,” the authors wrote.

Preliminary results of a Tufts study on adolescent health and nutrition in Tanzania indicate that about 19 percent of teens in a large rural area are undernourished. As with other studies on adolescent growth, “boys were found to be almost twice as malnourished as girls (64 percent vs. 36 percent),” the report says.

“We are examining relationships between adolescent nutritional status and household food security, periodic household food shortages, skipping meals, school attendance and orphan status,” Levinson said. “This data will guide future efforts in Tanzania and permit the development of counseling materials comparable to those used by the programs in Bangladesh.”