|Keywords:||Nutrition; Public health; Epidemiology; nutrition transition; adolescents; India; food frequency questionnaire; dietary patterns; reproducibility and validity|
|Full text PDF:||http://pid.emory.edu/ark:/25593/rpfw2|
Nutrition transition, shifts in dietary patterns accompanying globalization and urbanization, are contributing to the emergence of nutrition-related chronic diseases in low- and middle-income countries, including India. Nutrition transition-related changes are believed to comprise shifts towards diets high in fat, sugar, and salt; these are also risk factors for chronic diseases. Little is known about the nutrition transition among adolescents, partly due to lack of appropriate data and metrics. The aim of this dissertation was to measure the nutrition transition among adolescents in India, home to 13.5% of the world's adolescents. First, dietary patterns were assessed in a representative sample of 399 school-going adolescents ages 13-16 years in a globalizing region in South India. Next, a comprehensive Nutrition Transition-Food Frequency Questionnaire (NT-FFQ), including a 125-item semi-quantitative FFQ and 27-item eating behavior questionnaire, was developed and evaluated for its reproducibility and validity to measure nutrition transition against three 24-hour dietary recalls in a sub-sample of 198 adolescents. Lastly, a pre-defined Nutrition Transition-Diet Score was developed using nutrition transition literature and dietary guidelines to measure nutrition transition, and evaluated for its validity against empirical dietary patterns derived from responses to the NT-FFQ. Adolescents' dietary patterns reflect a combination of global/non-local and traditional foods and can be categorized into three patterns; global, animal-source, and traditional (factor loadings ≥0.4). Compared with recommended guidelines, adolescents consumed higher-than-recommended energy-dense foods and lower-than-recommended dairy, fruits, and vegetables. Gender and school type were the main predictors of dietary patterns. The NT-FFQ showed good reproducibility and validity for most foods and eating behaviors and can measure nutrition transition among adolescents. The Nutrition Transition-Diet Score (mean 5.6 ± 1.2, range 0-10) included 10 components (7 food groups and 3 nutrients) and had good construct validity against empirical Global Diet pattern (factor 1; 60% concordance, 5% discordance, and Pearson correlation=.59, p<.0001). Based on the results, adolescents' dietary patterns in a globalizing Indian region reflect unhealthy and healthy nutrition transition features. Validated instruments, NT-FFQ and Nutrition Transition-Diet Score can effectively measure nutrition transition and can be utilized in programs and policies to improve adolescent health. Table of Contents – CHAPTER 1: Introduction 1 – Research Aim 1 5 – Research Aim 2 6 – Research Aim 3 6 – CHAPTER 2: Background 17 – Global Nutrition Transition 17 – Nutrition Transition in India 20 – Adolescent Health and Nutrition Transition 27 – Nutrition Transition among Adolescents in India 29 – Eating Behaviors of Adolescents in India 31 – Measuring Nutrition Transition 33 – Summary 38 – CHAPTER 3: Methods 56 – CHAPTER 4: Going global: Indian adolescents' eating… Advisors/Committee Members: Argeseanu, Solveig (Thesis Advisor), Martorell, Reynaldo (Committee Member), Ramakrishnan, Usha (Committee Member), Patil, Shailaja S. (Committee Member), Yount, Kathryn (Committee Member), Venkat Narayan, K.M. (Thesis Advisor).