Nutrition status of nulliparous married Indian women 15-24 years: Decadal trends, predictors and program implications

Sethi, Vani; Dinachandra, Konsam; Murira, Zivai; Gausman, Jewel; Bhanot, Arti; Wagt, Arjan de; Unisa, Sayeed; Bhatia, Salima; Baswal, Dinesh; Subramanian, S. V.

doi:10.1371/journal.pone.0221125

Cited by 5 publications

(6 citation statements)

References 33 publications

(32 reference statements)

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“…19 For adolescent females (15–19 years) in the sample, BMI for age Z score (BAZ) < –1 standard deviation ( SD ) and <–2 SD were used to estimate the prevalence of thinness and severe thinness, as BAZ < –2 SD corresponded to BMI of 16.5 as per a recently published analysis of married adolescents under NFHS‐4. 20 Disaggregation of severe thinness prevalence estimates either by age or state was not possible due to the small sample size. However, we present the distribution of several cases by age and district.…”

Section: Methodsmentioning

confidence: 99%

“…Household characteristic included caste, access to drinking water, access to toilets, and wealth quintiles. 20 Additionally, for pregnant women or adolescents, variables related to diet such as consumption of milk/curd, pulses/beans, eggs/meat/fish, and dark green leafy vegetables daily, and weekly consumption of fried food and aerated drinks were added. For postpartum women, variables related to diet and access to antenatal care services were added.…”

Section: Methodsmentioning

confidence: 99%

“…Adult BMI cut‐offs for thinness (<18.5) and severe thinness (<16) as per WHO were used to estimate the prevalence of thinness among pregnant and postpartum women (20–49 years) 19 . For adolescent females (15–19 years) in the sample, BMI for age Z score (BAZ) < –1 standard deviation ( SD ) and <–2 SD were used to estimate the prevalence of thinness and severe thinness, as BAZ < –2 SD corresponded to BMI of 16.5 as per a recently published analysis of married adolescents under NFHS‐4 20 . Disaggregation of severe thinness prevalence estimates either by age or state was not possible due to the small sample size.…”

Section: Methodsmentioning

confidence: 99%

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Population estimates and determinants of severe maternal thinness in India

Choedon

Sethi

Chowdhury

et al. 2021

Intl J Gynecology & Obste

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Objective To examine prevalence, risk factors, and consequences of maternal severe thinness in India. Methods This mixed methods study analyzed data from the Indian National Family Health Survey (NFHS)‐4 (2015–2016) to estimate the prevalence of and risk factors for severe thinness, followed by a desk review of literature from India. Results Prevalence of severe thinness (defined by World Health Organization as body mass index [BMI] <16 in adult and BMI for age Z score < –2 SD in adolescents) was higher among pregnant adolescents (4.3%) compared with pregnant adult women (1.9%) and among postpartum adolescent women (6.3%) than postpartum adult women (2.4%) 2–6 months after delivery. Identified research studies showed prevalence of 4%–12% in pregnant women. Only 13/640 districts had at least three cases of severely thin pregnant women; others had lower numbers. Three or more postpartum women aged ≥20 years were severely thin in 32 districts. Among pregnant adolescents, earlier parity increased odds (OR 1.96; 95% CI, 1.18–3.27) of severe thinness. Access to household toilet facility reduced odds (OR 0.72; 95% CI, 0.52–0.99]. Among mothers aged ≥20 years, increasing education level was associated with decreasing odds of severe thinness (secondary: OR 0.74; 95% CI, 0.57–0.96 and Higher: OR 0.54; 95% CI, 0.32–0.91, compared with no education); household wealth and caste were also associated with severe thinness. Conclusion This paper reveals the geographic pockets that need priority focus for managing severe thinness among pregnant women and mothers in India to limit the immediate and intergenerational adverse consequences emanating from these deprivations.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Population estimates and determinants of severe maternal thinness in India

Choedon

Sethi

Chowdhury

et al. 2021

Intl J Gynecology & Obste

Self Cite

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show abstract

“…Due to cultural norms, in our study population, women typically eat last among all the household members [ 29 ]. Despite early marriage being linked with child undernutrition, however, very few studies have investigated its direct association with maternal nutritional status, and the results are heterogeneous across societies [ 25 , 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

Associations of age at marriage and first pregnancy with maternal nutritional status in Nepal

Wells

Marphatia

Manandhar

et al. 2022

Evolution, Medicine, and Public Health

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Background and objectives Women’s nutritional status is important for their health and reproductive fitness. In a population where early marriage is common, we investigated how women’s nutritional status is associated with their age at marriage (marking a geographical transfer between households), and at first pregnancy. Methodology We used data from a cluster randomised control trial from lowland Nepal (n = 4,071). Outcomes including body mass index (BMI) were measured in early pregnancy and trial endpoint, after delivery. We fitted mixed-effects linear and logistic regression models to estimate associations of age at marriage and age at pregnancy with outcomes, and with odds of chronic energy deficiency (CED, BMI <18.5 kg/m2), at both timepoints. Results BMI in early pregnancy averaged 20.9 kg/m2, with CED prevalence 12.5%. In 750 women measured twice, BMI declined 1.2 (95%CI 1.1, 1.3) kg/m2 between early pregnancy and endpoint, when CED prevalence was 35.5%. Early pregnancy was associated in dose-response manner with poorer nutritional status. Early marriage was independently associated with poorer nutritional status among those pregnant ≤15 years, but with better nutritional status among those pregnant ≥19 years. Conclusions and implications The primary determinant of nutritional status was age at pregnancy, but this association also varied by marriage age. Our results suggest that natal households may marry their daughters earlier if food insecure, but that their nutritional status can improve in the marital household if pregnancy is delayed. Marriage age therefore determines which household funds adolescent weight gain, with implications for Darwinian fitness of the members of both households. Lay Summary In lowland Nepal, the primary determinant of women’s nutritional status was age at pregnancy. However, among those pregnant early, those married earlier had poorer nutritional status, suggesting they were married to ameliorate food insecurity. Marriage age determines which household funds adolescent weight gain, with fitness implications for members of both households.

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“…Previous studies from India have reported trends in height and BMI in a specified age group at one point in time or over short periods. These trends have been predominantly studied by presenting categorical data on the prevalence of stunting, underweight, overweight or obesity (8,9,14) .…”

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confidence: 99%

Birth cohort differences in height, weight and BMI among Indian women aged 15–30 years: analyses based on three cross-sectional surveys

Deshpande

Kinnunen

Kulathinal

2021

Public Health Nutr.

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Objective: To explore long-term trends in height, weight and body mass index (BMI) across birth cohorts among Indian women aged 15-30. Design: Nationally representative cross-sectional surveys. Setting: Data from three National Family Health Surveys conducted in 1998-99, 2005-06 and 2015-16. Height and weight were modeled jointly, employing a multivariate regression model with age and birth cohorts as explanatory variables. The largest birth cohort (born 1988-92) was the reference cohort. Stratified analyses by place of residence and by marital status and dichotomized parity were also performed. Participants: 437,753 non-pregnant women aged 15-30 years. Results: The rate of increase in height, weight and BMI differed across birth cohorts. The rate of increase was much lower for height than weight, which was reflected in an increasing trend in BMI across all birth cohorts. In the stratified analyses, increase in height was found to be similar across urban and rural areas. Rural women born in the latest birth cohort (1998-2001) were lighter, whereas urban women were heavier compared to the reference cohort. A relatively larger increase in regression coefficients were observed among women born between 1978-82 compared to women born between 1973-77 when considering unmarried and nulliparous ever-married women and, one cohort later (1983-87 vs. 1978-82), among parous ever-married women. Conclusion: As the rate of increase was much larger for weight than for height, increasing trends in BMI were observed across the birth cohorts. Thus, cohort effects show an important contributory role in explaining increasing trends in BMI among young Indian women.

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Nutrition status of nulliparous married Indian women 15-24 years: Decadal trends, predictors and program implications

Cited by 5 publications

References 33 publications

Population estimates and determinants of severe maternal thinness in India

Population estimates and determinants of severe maternal thinness in India

Associations of age at marriage and first pregnancy with maternal nutritional status in Nepal

Birth cohort differences in height, weight and BMI among Indian women aged 15–30 years: analyses based on three cross-sectional surveys

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