Seeds of prevention: the impact on health behaviors of young adolescent girls in Uttar Pradesh, India, a cluster randomized control trial.

Of the world's 1.2 billion adolescents (10-19 years), India is home to the largest number globally, about 243 million. However not much is known about the health of young adolescent girls (11-14 years) in India who enter puberty with substantial nutritional and health deficits. Identifying early adolescence as a "gateway" moment, the Saloni pilot study is arandomized control trial (RCT) to improve nutrition, hygiene and reproductive health behaviors in 30 schools in rural Uttar Pradesh (UP), India. A prevention model that includes Sadharanikaran, an ancient Indian theory of communication, guided the development of the intervention. The Saloni strategy includes a 10 session in-school intervention based on compassion, self efficacy, emotional well being, peer and parental support, packaged in the form of short, easy-to-use instructional modules. A diary designed to engage adolescent girls is provided to each girl. The cluster RCT was conducted from January 2010 to October 2011 with adolescent girls (11-14 years of age) in Hardoi district. The trial is a two-level, nested RCT with the unit of randomization being the block with 15 schools in the intervention arm and 15 schools in the control arm. A sample of 1200 girls was randomly selected. The intervention had a significant impact on more than 13 preventive health behaviors. About 65 percent girls in the intervention group had adopted 13 or more health behaviors at end line compared 4.5 percent in the control group at end line and 5 percent at baseline. Behavioral impact was demonstrated in all three areas of nutrition, hygiene and reproductive health. The study provides evidence that early adolescence is indeed a "gateway moment" to build nutritional and health reserves.

Development of a diet quality index with special reference to micronutrient adequacy for adolescent girls consuming a lacto-vegetarian diet.

Recent dietary guidelines emphasize micronutrient sufficiency by giving importance to consumption of whole grains and a variety of fruits and vegetables. The objective of this study was to identify a measure of micronutrient quality of diets in adolescent girls consuming a lacto-vegetarian diet. Data were collected on the nutritional status of 630 schoolgirls (ages 10 to 16 years) from Pune city, India, in a cross-sectional survey during 2006-2007. Dietary intakes were assessed by 24-hour recall on 3 nonconsecutive days. Nutrient intakes were calculated from the Indian nutritive value databases. Micronutrient adequacy was expressed as a ratio of observed intake to reference intake. An Adolescent Micronutrient Quality Index (AMQI) was formulated using the Indian and the recent US dietary guidelines. Fasting blood samples were analyzed for plasma levels of vitamin C, beta carotene, and zinc. The average energy intake of the majority of the girls was below the Indian recommended dietary intakes, whereas micronutrient intakes were 50% to 70% lower than recommended dietary intakes. The mean AMQI score was 41.5+/-9.4. The age of subjects as well as mother's education and occupation were significantly associated with the AMQI. The AMQI was correlated with nutrient intakes and the ratio of observed intake to reference intake (P<0.01) after controlling for energy intake and sociodemographic factors. Higher AMQI scores were associated with higher concentrations of plasma vitamin C (r=0.26), beta carotene (r=0.34), and zinc (r=0.12). The AMQI is a useful measure of the dietary adequacy and micronutrient quality of the diets of adolescent girls consuming lacto-vegetarian diets.

Diet patterns of lactovegetarian adolescent girls: need for devising recipes with high zinc bioavailability.

OBJECTIVE: Populations subsisting on plant foods are believed to be at a high risk of mineral deficiencies. The aim of the present study was to examine the diet patterns of vegetarian adolescent girls for zinc adequacy and devise recipes to improve bioavailable zinc intakes. METHODS: A cross-sectional survey was carried out in 630 schoolgirls (10-16 y old) from Pune, India, from 2006 to 2007. Diet was assessed by a 24-h recall method on 3 random days. Diet patterns were identified by principal component analysis. Nutrient intakes were estimated using the cooked-foods database of our laboratory. Twenty recipes representing the diet patterns were formulated using foods that have a high zinc content and using methods such as sprouting/fermentation. In vitro zinc dialyzability of the recipes was determined by simulating gastrointestinal conditions and atomic absorption spectrometry. RESULTS: Five diet patterns were identified reflecting intakes of different cereals. Girls in the five diet patterns had inadequate intakes of energy, protein, and micronutrients including zinc compared with the recommended dietary intakes of India. In the new cereal-based recipes, the average contents of energy, protein, iron, calcium, zinc, beta-carotene, and vitamin C per 100g of cooked weight were 205 kcal, 6.2g, 2.5mg, 105 mg, 1.5mg, 716 microg, and 4.4 mg, respectively. Therefore, a supplement of 200 g of the recipe would fulfil 75% of the daily zinc requirement of adolescents and increase other micronutrient intake manifolds. CONCLUSION: Diets of Indian schoolgirls were deficient in zinc. Zinc-rich recipes with high bioavailability have the potential to alleviate zinc deficiency in adolescents.

Influence of dietary and socio-demographic factors on the iron status of married adolescent girls from Indian urban slums.

To explore the influence of dietary factors of iron bioavailability and socio-demographic conditions on blood iron status of married adolescent girls (MAG), a cross-sectional study was conducted in 173 MAG (15-19 years old) from urban slums near Pune city, India. Diet was assessed by two random 24-h recalls. The age, weight, height, education, family size, income, physical work, and number of days of menstrual loss were recorded. Fasting blood was analyzed for hemoglobin and serum ferritin. Mean intakes of micronutrients were 40-75% less than the recommended dietary intakes for Indian adolescent girls. High intake of phytates (171+/-6 mg/day) and low intakes of vitamin C (25+/-1 mg/day) resulted in low bioavailable iron intakes. The mean bioavailable iron intake was 0.76+/-0.3 mg/day, which is one-half of the basal iron requirement of adolescent girls. The prevalence of iron deficiency (serum ferritin<12 microg/l) was 25.1%, and anemia (hemoglobin <12 g/l) was seen in 46.4% of MAG. A multiple regression model adjusted for energy intake indicated that intakes of beta-carotene and riboflavin were associated with hemoglobin (P<0.001) and those of zinc, riboflavin and thiamin associated with serum ferritin (P<0.01). Multiple regressions including socio-demographic factors revealed that the family size, number of menstrual days lost and total bioavailable iron intake were the influencing factors for low iron status. In conclusion, there is a need to increase intakes of vitamin C and other micronutrients of the MAGs and to improve iron bioavailability through diet modifications.

Zinc supplementation improved cognitive performance and taste acuity in Indian adolescent girls.

OBJECTIVE: To test the efficacy of zinc supplementation through diet or ayurvedic zinc tablet on cognitive function and taste acuity in adolescent girls. METHODS: Using zinc-rich food items, snacks were prepared by adopting food-processing methods that enhance zinc bioavailability. Ayurvedic zinc tablet (jasad bhasma) was chosen as a natural elemental zinc supplement. Efficacy of snacks and the tablet was assessed in 180 schoolgirls (12.5 +/- 0.85 years) from Pune City, India, who were randomly allocated to any of the 3 groups: (1) ayurvedic zinc tablet-J, (2) zinc-rich snacks-D, or (3) Control-C. Supplementation was given on every school day (6 days/wk) for 10 weeks. All measurements were recorded at baseline and at the end of the study period. Food intake was recorded by 24-hour diet recall on 3 random days. Hemoglobin, serum ferritin, and plasma zinc were estimated on a fasting blood sample. Cognitive assessment was done on each participant using tests for simple reaction time (SRT), recognition reaction time (RRT), visual memory, and Raven's Progressive Matrices (RPM). Taste acuity was determined by recognition thresholds for salt (RTS) over a range of 10 different salt concentrations. RESULTS: A higher increase in plasma zinc (61.3%) was observed in the J group than in the D group (9.9%) (p < 0.01), whereas plasma zinc declined in the control group (-2.2%) over baseline (p > 0.1). Hemoglobin showed no change in all 3 groups (p > 0.1). Percent increment in scores for memory and RPM was significantly more in the D and J groups (24.5%-29.6%) than in the C group (6.5%) (p < 0.05). Mean SRT and RRT were reduced more in the D and J groups (5%-16%) than in the C group (1.6%) (p < 0.05). A significant fall in median RTS from 5 to 2.5 mmol/L was noted after both diet and zinc supplementation (p < 0.01); however, it remained the same at 5 mmol/L in the Control group after 10 weeks. CONCLUSION: Supplementation of ayurvedic zinc and zinc-rich foods are effective in improving cognitive performance and the recognition threshold for salt of adolescent girls.